Feb 14

Sunshine Advantage: Providing High-Quality ABA Therapy Services for Children with Autism

Applied Behavior Analysis (ABA) therapy is a scientifically proven method that helps individuals with Autism Spectrum Disorder (ASD) develop skills, reduce challenging behaviors, and improve their overall quality of life. While ABA therapy has been around for decades, its popularity has increased significantly in recent years as more and more families seek effective treatments for their loved ones with ASD.

Sunshine Advantage, a Medicaid health plan, offers ABA therapy services for children with ASD in select states. Their goal is to provide high-quality, evidence-based therapy that meets the unique needs of each child and helps them achieve their full potential.

What is ABA Therapy?

ABA therapy is a form of therapy that focuses on changing behavior by reinforcing positive actions and reducing negative ones. It is based on the principles of behaviorism, which states that behavior is learned and can be modified through the environment.

ABA therapy can help individuals with ASD learn new skills, such as communication, socialization, and self-care, while also reducing challenging behaviors, such as self-injury, aggression, and tantrums. It typically involves one-on-one therapy sessions with a trained therapist, who uses positive reinforcement and other behavior techniques to teach and reinforce new behaviors.

How does Sunshine Advantage provide ABA therapy services?

Sunshine Advantage works with qualified and licensed ABA providers to offer ABA therapy services to eligible children with ASD. They provide a comprehensive range of services, including assessments, individualized treatment plans, one-on-one therapy sessions, family training and support, and progress monitoring.

When a child is referred to Sunshine Advantage for ABA therapy services, they conduct a thorough evaluation to determine their specific needs and develop an individualized treatment plan. The plan is based on the child’s strengths, weaknesses, and developmental level, and may include a variety of techniques, such as discrete trial training, natural environment training, and positive behavior support.

The therapy sessions are typically conducted in the child’s home, school, or community, depending on their specific needs and goals. The therapists work closely with the child’s family to ensure that they are involved in the therapy process and have the support they need to reinforce positive behaviors and manage challenging ones.

Sunshine Advantage also provides ongoing monitoring and support to ensure that the child is making progress toward their goals and that the therapy plan is adjusted as needed to meet their changing needs.

Why choose Sunshine Advantage for ABA therapy services?

Choosing the right ABA therapy provider is essential to ensure that your child receives the best possible care and support. Here are some reasons why Sunshine Advantage may be a good choice for families seeking ABA therapy services:

  • Evidence-based therapy: Sunshine Advantage’s ABA therapy services are based on the latest research and best practices in the field, ensuring that your child receives the most effective treatment possible.
  • Qualified providers: Sunshine Advantage works with qualified and licensed ABA providers who have experience working with children with ASD.
  • Comprehensive services: Sunshine Advantage provides a comprehensive range of ABA therapy services, including assessments, individualized treatment plans, one-on-one therapy sessions, family training and support, and progress monitoring.
  • Family-centered approach: Sunshine Advantage’s ABA therapy services are designed to involve the child’s family in the therapy process and provide them with the support they need to reinforce positive behaviors and manage challenging ones.
  • Medicaid coverage: Sunshine Advantage is a Medicaid health plan, which means that eligible children can receive ABA therapy services at little or no cost to their families.

Conclusion

ABA therapy can be a life-changing treatment for children with ASD, helping them develop skills, reduce challenging behaviors, and improve their overall quality of life. Sunshine Advantage’s ABA therapy services are designed to provide high-quality, evidence-based care to eligible children with ASD, helping them achieve their full potential. By working with qualified and licensed ABA providers, providing comprehensive services, and taking a family-centered approach, Sunshine Advantage is committed to ensuring that each child receives the individualized care and support they need to thrive.

If you have a child with ASD and are interested in ABA therapy services, it’s important to explore your options and choose a provider that meets your child’s specific needs. Sunshine Advantage may be a good choice for families who are eligible for their Medicaid health plan and seeking high-quality ABA therapy services.

Ultimately, ABA therapy can be a powerful tool for children with ASD and their families, providing hope, support, and the opportunity for growth and development. With the right provider and the right approach, children with ASD can achieve their full potential and lead happy, fulfilling lives.

Feb 14

The Role of Medication in Treatment-Resistant Depression: An Overview

Depression is a debilitating mental illness that affects millions of people worldwide. While many individuals can find relief through therapy and medication, some patients experience treatment-resistant depression. This type of depression is challenging to treat, and traditional antidepressants may not be effective. As a result, researchers and medical professionals have been exploring alternative medications and therapies to help those with treatment-resistant depression. 

In this article, we’ll take a closer look at the role of medication in treating this complex form of depression. We’ll examine the types of medications commonly used, their effectiveness, and potential side effects. By understanding the role of medication in treating treatment-resistant depression, we can gain a better understanding of how to help those who are struggling with this challenging condition.

What is treatment-resistant depression?

Treatment-resistant depression is a type of depression that does not respond to traditional antidepressants or therapy. This form of depression is challenging to treat, and patients may experience symptoms for extended periods. Treatment-resistant depression is also known as refractory depression. According to studies, about one-third of people with depression do not respond to traditional antidepressants or therapy. This can have a severe impact on their quality of life, leading to social isolation and even suicidal thoughts.

The traditional approach to treating depression

The traditional approach to treating depression involves a combination of therapy and medication. Therapy can help individuals address the root causes of their depression and develop coping mechanisms. Antidepressants are commonly used to alleviate symptoms of depression, such as sadness, lack of energy, and difficulty sleeping. Antidepressants work by increasing the levels of neurotransmitters in the brain, such as serotonin, dopamine, and norepinephrine. These neurotransmitters are responsible for regulating mood, and imbalances can lead to depression.

Limitations of traditional antidepressants for treatment-resistant depression

While traditional antidepressants can be effective for many individuals, they may not work for everyone. Patients with treatment-resistant depression may not respond to traditional antidepressants or may experience side effects that outweigh the benefits. Additionally, traditional antidepressants can take several weeks or even months to take effect. This delay can be challenging for patients who are struggling with severe depression and need relief quickly.

Alternative medications for treatment-resistant depression

Due to the limitations of traditional antidepressants, researchers and medical professionals have been exploring alternative medications that may be more effective for treatment-resistant depression. Some of the alternative medications that have shown promise include ketamine, esketamine, and lithium.

How alternative medications work

Ketamine is a dissociative anesthetic that has been used for decades in surgery. However, in recent years, it has been found to have antidepressant properties. Ketamine works by blocking NMDA receptors in the brain, which can lead to an increase in the levels of neurotransmitters, such as glutamate. This increase can help alleviate symptoms of depression.

Esketamine is a nasal spray that was approved by the FDA in 2019 for the treatment of treatment-resistant depression. Esketamine works similarly to ketamine and can help alleviate symptoms of depression in a matter of hours.

Lithium is a mood stabilizer that has been used for decades to treat bipolar disorder. However, recent studies have found that it may also be effective for the treatment of depression. Lithium works by increasing the levels of certain neurotransmitters in the brain, such as serotonin and norepinephrine.

The effectiveness of alternative medications

Studies have shown that alternative medications, such as ketamine, esketamine, and lithium, can be effective in the treatment of treatment-resistant depression. According to a study published in the American Journal of Psychiatry, ketamine was found to be effective in over 70% of patients with treatment-resistant depression. Esketamine has also shown promising results, with studies showing that it can alleviate symptoms of depression in a matter of hours. Lithium has been shown to be effective for the treatment of depression in patients who have not responded to traditional antidepressants.

Potential side effects of alternative medications

While alternative medications may be effective for the treatment of treatment-resistant depression, they can also come with potential side effects. Ketamine can cause dissociation, hallucinations, and other psychological side effects. Esketamine can cause dizziness, nausea, and vomiting. Lithium can cause tremors, weight gain, and thyroid problems. It’s essential to weigh the potential benefits and risks of alternative medications before starting treatment.

Other therapies for treatment-resistant depression

In addition to alternative medications, other therapies have shown promise for the treatment of treatment-resistant depression. Transcranial magnetic stimulation (TMS) is a non-invasive therapy that uses magnetic fields to stimulate nerve cells in the brain. TMS has been shown to be effective in the treatment of treatment-resistant depression. Electroconvulsive therapy (ECT) is another therapy that has been used for decades to treat severe depression. ECT involves sending small electrical currents through the brain, which can help alleviate symptoms of depression.

The importance of personalized treatment plans

While alternative medications and therapies can be effective for the treatment of treatment-resistant depression, it’s essential to remember that everyone’s experience with depression is unique. It’s crucial to work with a medical professional to develop a personalized treatment plan that takes into account your individual needs and circumstances. This may involve a combination of medication, therapy, and other therapies, depending on your symptoms and the severity of your depression.

Conclusion and resources for further information

In conclusion, treatment-resistant depression is a challenging condition that requires a personalized treatment plan. While traditional antidepressants may not be effective for everyone, alternative medications and therapies have shown promise for the treatment of this complex form of depression. It’s essential to work with a medical professional to develop a treatment plan that takes into account your individual needs and circumstances. If you or someone you know is struggling with treatment-resistant depression, there are resources available to help. The National Institute of Mental Health (NIMH) and the Depression and Bipolar Support Alliance (DBSA) are excellent resources for further information and support.

Jan 18

Facial Plastic Surgery: Understanding Rhinoplasty and Choosing the Right Surgeon

Facial plastic surgery is a rapidly growing field, with more and more people seeking to enhance their physical appearance through various surgical procedures. One of the most popular types of plastic surgery is rhinoplasty, which is also known as a “nose job.” Rhinoplasty is a cosmetic surgical procedure that involves altering the nose’s size, shape, and structure to enhance its appearance. In this article, we will discuss open rhinoplasty surgery and what to look for when choosing a rhinoplasty surgeon.

Understanding Open Rhinoplasty Surgery

Open rhinoplasty surgery is a type of surgical procedure that involves making a small incision on the outside of the nose, along the columella (the tissue that separates the nostrils). This allows the surgeon to lift the skin and soft tissue of the nose to access the underlying structures. With open rhinoplasty surgery, the surgeon has a better view of the nasal structures, which allows for greater precision and control during the procedure. This type of rhinoplasty is typically recommended for more complex cases where significant changes to the nose’s structure are required.

Choosing the Right Rhinoplasty Surgeon in Dallas

Choosing the right rhinoplasty surgeon in Dallas is crucial to achieving the desired results and minimizing the risks and potential complications associated with the procedure. Here are some factors to consider when looking for a rhinoplasty surgeon:

  • Credentials and Board Certification: Look for a surgeon who is board-certified in facial plastic surgery and otolaryngology (ENT). Board certification indicates that the surgeon has undergone rigorous training and testing in their specialty.
  • Experience: Choose a surgeon who has experience performing rhinoplasty procedures, particularly the type of procedure you are considering.
  • Before and After Photos: Review the surgeon’s before and after photos to get an idea of their previous work and the results they have achieved.
  • Patient Reviews and Testimonials: Look for patient reviews and testimonials to get an idea of the surgeon’s bedside manner, professionalism, and overall patient experience.
  • Communication: Schedule a consultation with the surgeon to discuss your goals, concerns, and expectations. This will give you a chance to get to know the surgeon and determine if you feel comfortable with them.

Rhinoplasty at Dallas: What to Expect

If you are considering rhinoplasty at Dallas, here’s what you can expect during the procedure:

  1. Anesthesia: Rhinoplasty is typically performed under general anesthesia or local anesthesia with sedation.
  2. Incisions: Depending on the type of rhinoplasty procedure, the surgeon will make incisions either inside the nostrils (closed rhinoplasty) or outside the nose (open rhinoplasty).
  3. Reshaping the Nose: The surgeon will then reshape the nose by removing or rearranging the cartilage and bone. They may also add cartilage grafts or implants to achieve the desired shape.
  4. Closing the Incisions: Once the surgeon has completed the reshaping, they will close the incisions with sutures and apply a splint to the nose to help it maintain its new shape.
  5. Recovery: Recovery time varies from patient to patient but typically involves swelling, bruising, and discomfort for the first week or two. It is essential to follow all post-operative instructions provided by the surgeon to ensure proper healing and minimize the risk of complications.

Conclusion

Facial plastic surgery can be a life-changing decision for many individuals seeking to enhance their appearance and improve their self-confidence. Rhinoplasty, in particular, is a popular procedure that can address both functional and aesthetic concerns with the nose. If you are considering rhinoplasty or any other facial plastic surgery procedure, it is important to research and choose a qualified, experienced surgeon who can help you achieve your desired outcome.

At the same time, it is crucial to have a clear understanding of what to expect from the procedure, including the potential risks and complications. Open rhinoplasty surgery is a popular option for many patients, and it can be a great choice for those who are looking for a more dramatic transformation.

If you are looking for a skilled and experienced rhinoplasty surgeon in Dallas or any other city, be sure to do your research, ask plenty of questions, and make an informed decision that is right for you. With the right surgeon and the right approach, facial plastic surgery can be a safe, effective way to achieve the look you’ve always wanted and boost your confidence for years to come.

Dec 28

Services Offered By An ENT Doctors

Are you wondering whether or not you need the services of an ear, nose, and throat doctor or an ENT doctor? Well, here is what you need to know about an ENT practice and what the doctor can offer you.

What Does ENT Mean?

ENT doctors practice under otolaryngology which is a specialty handling disorders affecting the ears, nose, and throat. ENT specialists or doctors have specialized skills to identify and offer treatment plans for conditions affecting the ears, nose, and throat. They offer services to both adults and children. Some of the conditions treated by an ENT specialist include the following.

  • Ears – The specialist will identify, evaluate, and treat various clinical problems affecting the ears. The ENT specialist will rely on various devices and surgery to treat conditions such as ear infections, hearing loss, malformations, nerve damage, balance disorders, and anything else affecting the inner and outer ear. Moreover, ENT doctors can even recommend a hearing aid style for your needs
  • Nose – ENT doctors also treat conditions affecting the nose such as malformation, deviated septum, chronic sinusitis, nerve disorders, and sensory and smell issues. ENT specialists are also qualified to handle allergies and breathing problems or any disorder resulting from the nasal cavity.
  • Throat – ENT specialists have the best skills to handle any throat problems such as cancer, vocal issues, speech problems, speaking limitations, and eating disabilities. If you suffer from infections of the throat, whether chronic or acute, you should visit an ENT specialist.

What Services Are Offered By An ENT Specialist?

ENT specialists rely on various techniques, devices, and tools to detect problems within the ear, nose, and throat. With these diagnostic measures, the specialist should be able to identify the root of the problem and identify the best treatment option. The specialists rely on medical devices or corrective surgery to treat various health conditions of the ear, nose, and throat.

What To Expect From An Appointment From An Ent Specialist?

Some of the signs that you need to visit an ENT specialist include the following.

  • A growth in your mouth
  • Changes in your voices
  • A lump in the neck
  • Spitting up blood
  • Changes on your skin
  • Persistent ear infections or earache

Whether it’s you or your child making an appointment with the ENT doctor, you should discuss any current health issues with the specialist. Next, the specialist will perform various tests to identify the cause of the problem. These include hearing tests, visual exams, laryngoscopes, and many more. Once the underlying condition has been identified, the specialist will set up a proper treatment plan.

Dec 24

Considering Plastic Surgery or Rhinoplasty in Plano, TX?

Getting a rhinoplasty isn’t for everyone. A lot of us need to love ourselves a lot more; however, those who have very strong noses may be happier about their appearance if they have a Rhinoplasty done. We all have things we don’t like about our bodies, some issues can be too much to bear. Women and men use chemicals to treat a bad case of acne. Getting a rhinoplasty is very similar to this if the nose is too large and stands out.

Can A Plano Rhinoplasty Surgeon Improve Your Appearance?

A lot of people look better after plastic surgery when they have realistic expectations and a well-thought-out reason for doing it. You may want to look better if something is out of the ordinary. The truth is people, judge things about our appearance that stands out as not being normal. A very large nose is one of those things. While it is important to love who you are, that doesn’t mean you shouldn’t do something if you are very unhappy about your appearance.

How Much Does A Plano Rhinoplasty Cost?

It depends on several factors. The doctors’ experience, the hospital chosen to get it done, and the area you live in. Typically, the cost of rhinoplasty is a few thousand dollars. This doesn’t mean anything when it comes to the end cost. This is only the average for the procedure alone. It does not include factors like hospital charges. It is merely the fee of a typical surgeon.

In Short, How Is It Done?

The typical Rhinoplasty is done by breaking the nose and reshaping it. This is done in cases where there needs to be a larger adjustment. Noses that do not require as much attention are often fixed by shaving down the bone. This leads to a less painful healing process. Pain medications are often prescribed during the recovery process.

A Plastic Surgeon Will Tell You If The Procedure Is Right For You

A facial plastic surgeon in Plano is fairly honest when it comes to cosmetic surgery. They may tell you your nose is fine and the procedure would be a waste. If they feel that the procedure would greatly help your physical appearance, they will want to do the procedure if you are healthy enough for surgery. Most surgeons will not do the procedure on someone who is younger than sixteen. Do this for yourself. No one should be pressuring you to get plastic surgery.

Dec 23

How To Get Help From A Good Neck & Spine Doctor

It’s smart to find a good neck and spine doctor so you know you’ll get your neck issue cared for quickly. There are a number of doctors out there that can help you out. Before you pick one from the options you have, you’re going to want to read through these tips.

A good doctor is going to be one that has a solid reputation. To find out more about someone before you work with them, you can check reviews on the internet. You want to know that they have done good work for many people in the past. You also want to make sure that they have been doing their work for a while now so you know they have a good amount of training. Do your best to find someone that is well-regarded and when you work with them you’ll get cared for in the right manner.

Know if your insurance is going to cover you seeing a new doctor. You can just call the doctor’s office to ask them whether they take your insurance or not. Don’t wait to get this information until you’ve seen the doctor because if they don’t accept your insurance, then you’re going to have to pay full price for your visit. Also, learn if you have coverage for different procedures they may need to do on you. If you don’t have insurance of any kind, then find a doctor that will let you pay on a payment plan so you’re not paying a bunch of money right off the bat.

Go to a neck and spine doctor on a regular basis even if you don’t have any further problems. That way, if something is going on that you need to know about, they will make that obvious. If you wait to go to a doctor until you’re in a lot of pain, you may find out that you waited too long and now the problem won’t be easy to deal with. When you’re put on medication, keep an eye out for side effects and contact your doctor right away if you have anything going on that makes you uncomfortable.

Once you’re able to find a neck doctor to work with, you’ll want to get help from them right away. Don’t wait for your issue to get worse and more painful. All you have to do is use what you learned above and the end result will be you being in better health.

Dec 21

Reasons To Visit The Coates Hearing Clinic

The Coates Hearing Clinic hearing test is something that you should consider doing if you are currently having problems with your hearing. You would want to go to this clinic if you have noticed that you cannot hear sounds clearly, or if you are having trouble understanding the people around you. They may also have treatments that can assist you if you are suffering from tinnitus. This is a condition where ringing in your ears is going to be constant from hearing aids to balance testing. They can always offer you excellent strategies that can assist you in your attempt to hear and listen to things better.

What Type Of Testing Do They Do?

The type of testing that they offer is very similar to other hearing tests that are performed by audiologists across the country. They are also experts at creating the best hearing aids, addressing hearing loss that you may be experiencing, and they will also remove earwax which can be at the root of your problem. Those that do suffer from tinnitus can benefit from the types of testing that they offer. This will ensure that you are doing everything that you can to hear things much better.

How Do You Schedule An Appointment?

Scheduling an appointment will only take a few minutes of your time. You will be able to contact and speak with one of the representatives. They will schedule a time for you to come in and speak with you about the hearing loss that you are experiencing. If you do have tinnitus, they can also recommend certain treatments. Once you have gone through their program, you will start to hear better, which is what many of their patients actually experience very quickly. If you are tired of not being able to hear people, or if there is ringing in your ears that will not go away, you certainly want to set an appointment with this company.

To schedule an appointment and go through the Coates Hearing Clinic hearing test, contact this company today. They will be more than happy to work with you, helping you to understand what the problem is that you are facing, and offer you many options that can help you. It is one thing to live with hearing loss, the completely another to avoid the potential help that may be right around the corner. Contact this business and schedule your appointment to find out what is wrong, and eventually locate a solution to your problem.

Dec 20

About Maryland Lactation Consultant/Specialist

Women that want to have families in Maryland, need to make sure that they are healthy and well. They will want to be seen by a doctor when they become pregnant and clear through the pregnancy. Since they will also want to be seen afterward, they will want to stay in contact with their doctor all the time.

Sometimes Women Have Problems With Lactation In Maryland

For those women that may have a problem with lactation in Maryland, they will need to see a specialist. One of the lactation consultant jobs will assist mothers, especially new parents with any problems that they might be having. A woman needs to set up an appointment with the lactation consultant so that she will receive a consultation.

After the consultation, she will have a better idea of what is going on and what she needs to do about it. This helps a woman to remain calm as she may have been upset at the problems that she was having. The specialist is there to help her so that she is not scared and so that she can deal with the issues that she is having during a certain time. It will make a huge difference for her.

How Much Will A Maryland Lactation Specialist Cost?

A Maryland lactation specialist will vary in price. It will depend on what the woman needs to have completed as well as any other issues that might be present. The costs will be discussed before a woman agrees to the help that she will get from the specialist. She will always know exactly how much is needed when it comes to the price that she will need to pay.

The best that a woman can do is to stay in touch with their doctor on a regular basis and touch base with a consultant when she is having trouble. This will alleviate her fears and allow her to talk about the issues that are plaguing her. With all that she has to think about when she is having a family, the consultant can assist her through the problems that she might be having. It will be very comforting for a woman that is going to be having a family and is not sure of all that she is up against.

Having the consultant is a way that she can be sure that she is doing the right things for herself and her family.

Dec 18

How To Hire The Best Plumbing Services

Hiring a plumber is an important household decision. You have some work that needs to be done, whether it be a repair, a new installation, or some other matter to attend to at the present moment. You’re looking at whom to hire, and you’re thinking about the costs. What can you expect to pay when you hire a plumber?

There are all sorts of jobs that plumbers are responsible for of course. You know your situation and at least a little of what might be expected. There can always be those unexpected tweaks that you run into with any plumbing job, but you will get a solid quote from the reputable plumbing professional that you hire. Let’s take a look at average plumbing job costs for 2022 though.

On average, you can expect to pay between $175 and %500. That median range of figures is based on an average of what people pay to hire a plumber in general, all jobs considered. If you need something that seems rather minor, you might not pay anywhere close to the high average figure. Yet if you need major work done, you likely know that the costs are going to fall at the $500 figure or above.

The best thing you can do right now is to reach out to a reputable plumber. He or she will set up an appointment with you and provide you with a quote. They are going to have to come to take a look. There can be a service fee just for doing that, but sometimes there isn’t one. They want your business, so they are willing to take a look. Regardless, you need to be sure that you’ve chosen the best plumbing services in the area before you make any hiring decision.

You also need to be comfortable with the quote provided to you. The average plumbing cost figures have been explained to you, and now it’s your decision concerning what to do next. You want to be sure that you don’t get gouged on the price. Plumbing repairs and installations can be expensive enough, but they are important.

You want to get this job as soon as possible. Therefore, your next step is to make sure that you’ve done your due diligence and have selected the absolute best plumber in your area. You can make that phone call, and then it’s time to see what quote is provided. It helps as well if you do choose a plumber that can handle emergencies in case anything arises in the future that requires immediate attention.

Dec 10

Discovering The Right Medical Marketing Consulting Company For Your Practice

It’s not too difficult to find the proper medical marketing consulting company. What you have to do is take your time with it and you should be able to find what works. Below you’ll get a few tips so you can find the right kind of service to work with.

Medical digital marketing for doctors is something that should only be done by people that have a lot of experience, in short experts. You don’t want an amateur to help you with your medical marketing because if they were to make mistakes then you’ll end up having to pay to fix them in the future. Also, don’t try to do SEO marketing for doctors‘ work without consulting with a professional in this field, also something doesn’t go wrong in the end for you. There are too many people out there that think marketing is easy only for them to later find out that they made things worse because they didn’t know what they were doing.

When you want to know more about a consulting company that does medical marketing work, try to find reviews on their services. You want to know for sure that they are able to do a good job for you so you’re not wasting your money. When looking for reviews, take note of when they were posted online. Try to find the most up-to-date reviews there are online for that company so you know what to expect. Sometimes companies change hands and in the end, you don’t get the best service because they are no longer that good.

A marketing service needs to be able to work with you on a regular basis, not just one time and that’s it. If you want to keep marketing, then your business will keep growing. You don’t just want to launch one marketing campaign and call it good because that will only get you so many new patients. Try to find a company that you can work with every few months that can help you keep reaching out to the public so you are able to get as much business as possible when all is said and done.

Now you know what to do when you want to find a medical marketing consulting company. There are a few out there that do great work so look for them when doing your research. There are also companies that don’t do the best work so you’ll want to avoid them.