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Do you feel like your diet has gotten away from you? Have you spent the first part of winter eating yummy, warm and kilojoule dense foods? Are your clothes starting to fit a little more snugly than you’d like? Now may be a good time to review your eating habits to make sure you’re eating as well as you can to improve your health, energy levels and mood.
Here are some handy hints to help you get started.
Ref: ** Pharmaceutical Benefits Scheme (PBS) | Closing the Gap (CTG) PBS Co-payment Program **
Expansion of the Closing the Gap Pharmaceutical Benefits Scheme Co-payment Program – Information for First Nations People
The CTG PBS Co-payment Program improves access to affordable PBS medicines for First Nations people living with, or at risk of, chronic disease.
Under this program, eligible First Nations people who are registered on the CTG PBS Co-payment Register and who would normally pay the full general PBS co-payment amount, pay the concessional rate when obtaining PBS medicines from their local community pharmacy, approved medical practitioner, or private hospital. Eligible patients who would normally pay the concessional rate receive their PBS medicines for free, without having to pay a co-payment.
From 1 July 2024 the CTG PBS Co-payment Program has been expanded to apply to all PBS medicines dispensed by community pharmacies, approved medical practitioners, and private hospitals.
Answers to Frequently Asked Questions and further information for First Nations people, community pharmacies, hospital pharmacies, prescribers and Aboriginal and Torres Strait Islander Health Practitioners are provided at the links below:
** Ref: Pharmaceutical Benefits Scheme (PBS) | Closing the Gap (CTG) PBS Co-payment Program **
If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our nurses. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.
Clinical trials are an important part in improving healthcare outcomes. If you are not familiar with what a clinical trial is, you’re not alone! Clinical trials are research studies involving people like you and me, to evaluate if a treatment is safe and helpful. The new treatment under testing may be a medicine, procedure, technique, vaccine, device, or lifestyle/behaviour. Clinical trials are carefully designed and must undergo a thorough review to ensure the procedures have merit, are safe and ethical. Ultimately, clinical trials are essential to help us improve the management of health conditions!
People participate in clinical trials for various reasons. Some people who are aware of clinical trials understand their participation helps inform how to manage health conditions. However, many may not be aware of the other benefits. These benefits include playing an active role in your healthcare, receiving treatment from leading medical practitioners, and accessing treatments for your condition which may not be possible otherwise. One clinical trial is the MeTeOR2 trial, which compares meniscal allograft transplant surgery to a type of physiotherapy for people who experience post-meniscectomy pain.
The meniscus is a c-shaped cartilage that distributes loads at the knee joint. A torn meniscus is common, especially among young people engaged in sport activities. Conservative treatments are available including activity modification, medication (e.g., non-steroidal anti-inflammatories, paracetamol), and physiotherapy. Some tears may be surgically repaired depending on the location of the tear. Other tears cannot be repaired, so the torn parts are removed with a keyhole surgery called arthroscopic partial meniscectomy. Although this procedure can improve pain and locking symptoms in most people, some patients may still experience pain and functional limitations after the surgery. This scenario can be very disabling and emotionally distressing, particularly at a young age when people are expected to be active, healthy, and free of disability. When this is the case, only a few treatment options are available.
Treating pain and functional limitation after a meniscectomy
For people with considerable pain or functional limitations after meniscectomy, surgical and non-surgical treatment options are available. One surgical option is the meniscal allograft transplant (MAT), which involves inserting a donated meniscus into the injured knee. The MAT surgery is thought to improve symptoms by restoring normal load distribution within the knee, along with the rehabilitation after surgery. Non-surgical management, such as personalised rehabilitation – which consists of many different types of treatment, including exercise, weight management, and lifestyle and activity advice – is also a viable option. Although the mechanisms of how personalised rehabilitation reduces symptoms are unknown, improvements have been observed in people with post-meniscectomy pain. However, it is still unknown which treatment option is better, in terms of safety and cost-effectiveness, to improve health-related outcomes.
MeTeOR2 is a clinical trial designed for people suffering from pain and/or functional limitations after partial meniscectomy. This study aims to compare two knee treatments – meniscal allograft transplant (MAT) surgery and personalised knee therapy (rehabilitation) – and evaluate if one treatment is superior to another in improving knee pain and function.
If you are interested in the study and consent to participate, you will have a 50% chance of being put into one of the two groups. The first group will receive the meniscal allograft transplant (MAT) surgery, while the second group will receive personalised knee therapy (rehabilitation). Participants in both groups will be asked to complete a series of questionnaires at baseline and 3, 6, 12, 18, and 24 months following randomisation.
You may be eligible to participate in this study if you have:
Inclusion Criteria:
Exclusion Criteria:
If you are interested in being part of this important and exciting clinical trial, please contact the study facilitator: meteor2.study@sydney.edu.au
Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.
It’s 2am and you’ve been tossing and turning for hours. You’re so tired, but you just can’t sleep. You lay on your left side, but your neck hurts too much in that position. So you roll on to your back, but your lower back aches. You turn on to your right side, and success (!) that feels ok. But now your knees hurt, your brain’s counting down the hours until you have to get up for work, and you need to go to the toilet. Sigh.
Sound familiar? We’ve all experienced the dreaded ‘painsomnia’ – or insomnia caused by persistent pain.
Without the distractions of our daily activities, the dark of night can become a long, painful expanse of time. Even when we’re exhausted, sleep can be elusive. It might take longer to fall asleep, we can’t get comfortable, we wake frequently, or we just don’t get enough sleep. Or all of the above.
When you add anxiety about sleep into the mix, it becomes a vicious cycle. Poor sleep lowers your pain threshold which affects the quality of your sleep. Pain can affect your ability to be active – which affects your sleep quality and your pain levels. This can make you anxious or stressed – which again will affect how well you sleep and the amount of pain you experience.
And when you’re stuck in this cycle, exhausted and in pain, it affects your mood, your ability to concentrate and it’s very easy to become depressed. So it’s important that you act quickly as soon as you start having issues sleeping.
The good news is there are many things you can do to break the cycle. The not-so-good news is they may not work immediately. And they’ll require some effort on your part. But they’re all tried and true ways to develop good sleep habits and get the good night’s sleep you crave.
If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our nurses. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.
From time-to-time many of us experience a flare, when symptoms like pain, inflammation and fatigue are worse, or more intense. This is a flare.
Flares are temporary, but can be frustrating and painful while they last. We don’t always know why they happen – and sometimes they seem to come out of the blue.
So it’s important that you have a plan for how you manage a flare when it happens.
Your flare plan
Some of the suggestions listed here are easy, however others involve a bit of thought, as well as input from others. But taking the time to work out a plan that works for you will help you manage your flares better, and with less disruption to your life.
Get advice from your doctor, and others in your healthcare team. Or, contact our free helpline on 1800 263 265 and speak with a nurse or email us at helpline@muscha.org
MORE INFORMATION
NPS MedicineWise: Managing Your Flare
In this edition of Connected tISSUES we are shining a spotlight on the complex and often serious musculoskeletal condition, psoriatic arthritis (PsA). PsA is a condition that presents differently in different people. In simple terms, PsA causes pain and inflammation in the joints and is usually associated with the skin condition psoriasis (but it can occur without someone experiencing this…we told you it was complex!)
Psoriatic arthritis can be challenging to recognise because of the varied ways it can present and because of overlapping symptoms with other conditions. This difficulty can sometimes lead to a delay in diagnosis and treatment. Our on-demand webinar Psoriatic Arthritis – Diagnosis and Management by Dr Adam Rischin is a great resource for anyone seeking information on PsA, its symptoms, tests that can assist with diagnosis and effective treatment options.
PsA can affect anyone. Our nurse recalls a 30-year-old male contacting the free Musculoskeletal Health Australia B.A.M. Helpline because he was struggling with the effects of his psoriatic arthritis. The impact this condition was having on his life was heartbreaking. He was living with quite severe plaque psoriasis (plaques appear as raised, inflamed, and scaly patches of dry skin that may be itchy and painful). This young mans mental health, financial security, social, personal and professional life had also been negatively impacted by his condition. It was sad to learn that he had left his job due to the embarrassment he felt, embarrassment that was caused by a symptom of his condition (he was extremely conscious of the silvery flakes of skin he ‘was leaving’ on the chair at work and he didn’t want other people to have to sit on that after him). He was living with chronic pain due to the inflammation in his joints. His quality of life had been severely impacted and he was desperately looking for understanding, help and connection.
Whilst there are a number of treatment options available to people living with PsA most recently a medication called Apremiast (OTEZLA) was added to the PBS. Apremiast is showing some positive results for plaque psoriasis which is good news as up to 30% of people with psoriasis will develop psoriatic arthritis.
For more information on Psoriatic arthritis (PsA) go to the Musculoskeletal Health Australia website and download the PsA Information Sheet. For those living with PsA, make sure you access our self-care plan to help you understand, manage and live well with your condition, or call our helpline and speak to our nurse (Monday to Thursday 9am to 5pm) on 1800 263 265 or email helpline@muscha.org
Other sources of information on PsA:
The 80’s song ‘catch me I’m falling’ could have been my family anthem. We’re clumsy, uncoordinated, and with two left feet, always slipping, tripping, and falling. 😁
It‘s just the way we are. I’ve even gotten to the point of doing a ‘ta-da’ after a trip, extending my arms over my head like a gymnast at the end of a routine.😀
But now, as I’m getting older, it’s not so amusing. I’m conscious of the more serious repercussions of falling. In fact, just last week, I tripped over my cat, whacked the side of my head on the kitchen counter and broke my glasses. Fortunately, I wasn’t seriously injured. But it made me take stock, stop thinking about falls as something I have to put up with and start being more proactive in preventing them.
Because the good news is that falls aren’t inevitable. They can often be prevented, or at the least, any injuries that occur can be minimised.
Data from the Australian Institute of Health and Welfare shows that falls are Australia’s largest contributor to injuries that require a stay in hospital and are a leading cause of injury deaths.(1) More than half of the hospitalisations were due to broken bones – often hips, vertebrae and wrists.
Falls can happen anywhere and to anyone, but a fall that lands you in hospital is more common in older people and most likely to occur in the home.
The stats are alarming, and like me, you may think these were falls from a height or down stairs. But the truth is, ‘over half of all falls leading to hospitalisation occurred on a single-level surface (for example, by slipping), and only 7% of falls leading to hospitalisation involved stairs or steps.’(1) 😱
And if you have osteoporosis and your bones are already fragile, the risk of breaking a bone due to a fall is much greater.
So to avoid becoming one of these stats, we can’t see falls as an inevitable part of life and getting older. They’re a serious problem, and we all need to take steps to prevent them.
We know that falls can result in broken bones, but they can also cause:
Falls are usually caused by a combination of factors. Changing some of these factors can lower your chances of falling. Or, if you do fall, reduce your risk of serious injury.
Australian physical activity and exercise guidelines recommend that all adults be active most days, preferably every day, for 30 minutes or more. Exercise is vital for good health, maintaining independence, and lowering your risk of falls and fall-related injuries. Physical activity helps to maintain and improve your mobility, strength, posture, coordination, balance and flexibility.
People with better posture, better balance and stronger muscles are less likely to fall or be injured. On the other hand, people who aren’t very active are more likely to fall and be injured than those who are more active.
Talk with your doctor, physiotherapist or exercise physiologist for information and advice about how you can safely become more active.
And read Exercise for preventing falls by The Royal Australian College of General Practitioners for more info.
Sometimes, no matter how careful you are, you can still have a fall.
So if you have a fall, it’s important that you try not to panic (easier said than done 😑). And although your first reaction may be to get up quickly, especially if you’re in public, because you’re embarrassed (been there, done that), take a moment.
If you’ve done all you can to prevent falls and are still concerned about your risk, there are services available to help you.
Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.
(1) Falls, Australian Institute of Health and Welfare, 2022.
(2) Falls and the elderly, healthdirect, 2020.
Originally written and published by Lisa Bywaters 2022.
Sadly winter is more than just lazy Sundays when you can stay at home, warm on the couch with a loved one. Reality means we need to eventually (and reluctantly) head out of our cosy homes and face the cold, wet winter. And when we’re at home, because of crazy energy prices and rising living costs, we have to make hard decisions about how to spend the household budget. Heating is one of the more significant costs in winter, so many people are forced to reduce it to save money.
For those of us with conditions like fibromyalgia, lupus, osteoarthritis, rheumatoid arthritis, back pain, scleroderma, and Raynauds’ phenomenon, this can be a painful problem. We often feel the cold more keenly with increased joint and muscle pain or lack of blood circulation to the extremities.
So, how can you stay warm and keep the costs down this winter? We’ve got some suggestions for you to try.
Let’s start with the basics. You need to dress for the temperature and wear layers. It can sometimes feel cumbersome and bulky, but it’s one of our best defenses against the cold. So put on the warm pants and jumper, embrace your inner Wiggle and wear a skivvy, pull on your thick socks and/or tights and appropriate footwear. If you’re still cold, consider adding thermals to your layers.
When you head outdoors, add more layers – including a coat, hat, gloves, and scarf. You can also buy a fantastic range of heated vests, socks, scarves, and gloves. They can be a little pricey, but they may be worth that initial outlay if you’re outdoors a lot. Check online or in-store at outdoor suppliers.
If you’re at home and still feeling the cold, grab a blanket for your legs as you sit at your desk or on the couch. You can use any warm blanket, doona or heated throw. Whatever you choose, just be careful you don’t trip on it when you get up.
Don’t assume you’re on the best energy plans for your gas and electricity. Take some time to see if there’s a better deal. If you live in Victoria, visit Victorian Energy Compare. For all other parts of Australia, visit Energy Made Easy.
When the wind’s howling outside, you know it’s trying to find a way indoors 💨. So cover the bottom of your door with a door snake or an old towel, or add some door seals. Pull your curtains and blinds over the windows at night and during miserable days to keep the warmth inside. If you have floorboards, consider putting down rugs (just be careful they don’t become a trip hazard).
If you can safely do so, close or cover air-conditioning vents, exhaust fans, and unused chimneys. However, it’s important to be aware that some gas appliances require a certain amount of ventilation or fresh air, or they can be unsafe. They should also be serviced every two years or sooner if you notice anything unusual. If in doubt, speak with a licensed gas fitter. Energy Safe Victoria has lots of useful info about heating your home with gas and what to look for when searching for a licensed gas fitter.
Sustainability Victoria also has helpful information on draught-proofing your home. You can also watch these handy DIY draught-proofing videos from the City of Port Phillip (Melbourne).
While it’s tempting to crank the heat up, the most efficient temperature to set your heater to (if you can select the temp) is 18-20 degrees. While that may not sound particularly warm, we’re often outside during the warmer months wearing short sleeves when it’s 18-20 degrees. It’s just a matter of perspective.
And only heat the areas you’re using. If you can turn the heating off in unused parts of your home, do it. Shut the doors and use a draught stopper to prevent the warm air from the rest of the house from escaping into these areas. And turn the heating off when you go to bed or leave home.
Thick curtains made from heavyweight, tightly woven fabrics can prevent heat from escaping your home. For the best results, curtains should be fitted as close to the window frame as possible, extend below the sill and well over the sides of the window frame, and a pelmet fitted over the top. This acts to seal the window from the rest of the room and prevent heat loss. Curtains will also keep the hot air outside in summer.
Open your curtains and blinds on sunny days to let the sun shine on your windows. Even with a chilly wind, the sun will bring wonderful warmth into your home.
And remember to close them when the sun starts to go down. As someone who goes for walks when it’s dark in the early morning and evening, I’m always amazed by how many people have their windows uncovered. You can practically see the heat escaping through the glass. So close them to keep the warmth in and the gaze of the sticky-noses (like me) out 😉.
You sleep better when your body can cool down, so turn the heater off at night. It’s also safer to sleep with the heater off. You can remove the chill from your bed using a hot water bottle or an electric blanket. Just remember to turn your electric blanket off before sleeping.
There’s nothing like slipping into a deliciously warm bed on a cold night, especially if there’s soft flannelette involved! So swap out your lighter, everyday bedding for heavier winter ones. And add layers – a top sheet (if you don’t already use one) and extra blankets. Finally, if you have floorboards in your bedroom, adding a rug under your bed can prevent draughts from making their way to your bed.
When the weather allows, go for a brisk walk outdoors, wearing appropriate clothing, and you’ll warm up in no time. Save on pricey petrol and walk to the shop/school/post office instead of driving.
When you’re at home, exercise indoors using an online program, a DVD or an app. Play with the kids. Clean the house. Do anything that gets you moving, and you’ll feel warmer than if you sit in one place for hours.
However, if you’re having a flare or experiencing a lot of pain, be as active as you can within your limits. And use your heat packs to help relieve muscular pain.
Many of us use our shower to warm up sore joints and muscles so we can get moving. However, hot water uses a lot of energy; even a few extra minutes will add to your bill. If you can, shorten the time you spend in the shower. Aim for four minutes or less. You can use a timer or sing your favourite song. Hunter Water has a great playlist of four-minute(ish) songs to get you inspired.
Anything that blocks a heater will prevent the warm air from flowing around the room uninterrupted. So move clotheshorses and other obstructions away from the heat source.
Hot air rises, so if you have ceiling fans, flick the reverse or winter mode switch and turn the fan on low. This will pull the cooler air towards the ceiling and push the warmer air down to you.
And to stay safe, fire authorities say you should keep clothing and other fabrics at least one metre from your heater. Never place them on heaters.
Get comfy on the couch with your partner, kids, and pets. Grab a warm blanket or doona, share your body heat, and enjoy being together.
If you’re feeling stiff and sore, heat packs or hot water bottles can provide temporary pain relief and help you get moving. But you need to be careful when using them.
If you’re using a heat pack or wheat bag, let it cool completely before you reheat it. Don’t sleep with your wheat bag or smother it behind you in your chair or bed. This can cause it to overheat and catch fire. Always carefully follow the manufacturer’s instructions and never overheat them in the microwave.
If you’re using a hot water bottle, use hot water from the tap, not boiling water. Wrap it in a cloth or use a cover so it doesn’t come into contact with your skin.
Always examine your hot water bottles and heat packs before use, and toss them out if you notice signs of wear or damage. And always check their temperature before use to ensure they’re not too hot.
Many delicious winter recipes bring comfort and warmth on the most miserable days. So crack open the cookbooks and get cooking! Or go online for inspiration for yummy, warming curries, soups and stews. We’ve got some great recipes to get you started! Can’t be bothered cooking? Simple. Grab a cup of hot chocolate, tea or coffee. It’ll warm your insides and your hands. Perfect! ☕🍵
If you’re in the market for a new heater or hot water system, make sure you’re buying one that’s energy-efficient and best suits your needs. Read Canstar’s guide to energy-efficient heaters and Choice’s article on buying the best hot water system for more info.
Insulation keeps your home warm in winter and cool in summer by preventing heat from escaping or entering your home. This keeps your home at a more consistent temperature and reduces the need to crank up your heating or cooling.
If your home isn’t properly insulated, this is something you can do that’ll have long-term benefits. There’s a substantial upfront cost, but it may be an option for some households. Find out more about insulation, including the different types available and how to install it, from the Australian Government’s website, Your home.
If you’re struggling to pay your energy bills, Energy.gov.au also has some information about support for Australian households, including info on potential rebates that may be available.
We’ve also put together lots of info to help you if you’re struggling with financial stress.
Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available Monday to Thursda between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.
When we say the word “Australian” it conjures up images of sun, sand, fun and the laid back, lovable (NOT gullible) Aussie. But a recent study commissioned by MYFitnessPal and conducted by the Dublin City University Business School found that Australians are the most gullible when it comes to health advice on TikTok. https://www.thenewdaily.com.au/life/2024/04/11/aussies-love-dodgy-tiktok-advice
The study found that “9 out of 10 Australians have taken nutrition advice from the social media platform more than once”. Overall, two in five Australians (42%) are “trusting the social media platforms for nutrition and wellness advice”.
This is a worrying trend and one that highlights the critical importance of knowing where you can go for reliable, evidence-based health information and advice.
When ‘asking’ the internet for health information there are some trusted and reliable sources that are kept up to date with the latest information and advice – for example Musculoskeletal Health Australia’s (MHA) website (www.muscha.org.au). There are unfortunately, many websites, social media groups and platforms that contain information that does not have the research and evidence to ‘back up’ their claims. This is why being ‘health info savvy’ is so important!
A few MHA tips on where to go and how to find good health information online:
Another good reference is the Australian Commission on Safety and Quality in Health Care How to find good health information online (safetyandquality.gov.au) See some of their tips include:
Some other things to consider when you do a ‘search’ and to assist you to navigate (is) the CRAAP – the Currency, Relevance, Authority, Accuracy and Purpose Test.
Currency – Is this information up to date? When was it published or posted online? How old is the information? Has the information been recently revised or updated and do the links work?
Relevance – Is the information relevant to you?
Authority – Is the information from an authoritative, reliable source?
Accuracy – Where does the information come from and is it accurate?
Purpose – Why was the information created and shared?
Your health is important! Taking the time to research and evaluate information will increase your knowledge and health literacy and ensure you are in a better position to make informed health decisions.
Another important way you can help Musculoskeletal Health Australia build understanding and awareness and support others to access quality information and support is… if you’re not sure a social media post, website or discussion forum is evidence based and trustworthy, don’t share it with other people.
For quality, evidence based and reliable information and support on back pain, arthritis and other musculoskeletal conditions head to any of the following sites AND make sure you bookmark them and come back regularly to see what new information has been added:
Please call our free, national Help Line* on 1800 263 265, or email helpline@msk.org.au for more information and support about musculoskeletal conditions, musculoskeletal health and living well.
(*Monday to Thursday 9am to 5pm, excluding public holidays)
https://medlineplus.gov/evaluatinghealthinformation.htm
fhttps://www.library.qut.edu.au/transcripts/craaptest.jsp
https://hslmcmaster.libguides.com/c.php?g=306752&p=5238186
It’s that time of year again and early indications are we are in for another ‘bumper’ flu season. Let’s also not forget the seemingly ever present and lingering COVID-19. So, it is important everyone has the most up to date information on what they should and should not do to safely get through the 2024 flu season!
Influenza (also called flu) is an infection of the airways that is easily spread. It affects people of all ages and can be very serious for babies, young children, pregnant women, and people with underlying medical conditions.
Vaccination is a safe and very effective way to protect yourself and those around you from serious illness caused by influenza.
Yearly influenza vaccinations are given to protect against the most common strains of the virus. It is recommended for all people aged 6 months and over. It is important that you talk to your health professional about getting vaccinated.
You should get your annual influenza vaccine anytime from April onward to be protected for the peak flu season, which is usually June to September. Influenza vaccination can be given at the same time as a COVID-19 vaccination.
And don’t forget – COVID-19 vaccination
Yes, COVID-19 is still around (even though we may be tired of hearing about it), and it is important to be up to date with your vaccinations especially as we head into winter. Make sure you talk to your health care professional about your vaccination options.
(Read more: ATAGI statement on the administration of COVID-19 vaccines in 2024 (health.gov.au) )
For those who live with autoimmune and inflammatory diseases, the Australian Rheumatology Association has produced an information sheet about COVID-19 vaccination.
Also, if you have symptoms of COVID-19 make sure you talk to your doctor who may prescribe antivirals if you are eligible. Please note research has confirmed that antivirals should be given as early as possible and only to those who are at a high risk of developing severe disease.
Speak to your health care professional about getting your flu and Covid-19 vaccinations. Vaccinations are available through your GP, and pharmacies across the country.
Please call our free, national Help Line* on 1800 263 265, or email helpline@msk.org.au for more information and support about musculoskeletal conditions, musculoskeletal health and living well.
(*Monday to Thursday 9am to 5pm, excluding public holidays)
https://www.betterhealth.vic.gov.au/stay-well-this-winter
November 25, 2024
November 25, 2024
November 12, 2024
