GMO’s and Glyphosate, a Disastrous Marriage

Glyphosate was discovered by John E. Franz, an organic chemist who synthesized the herbicide while working at Monsanto’s Company in 1970. This chemical became, and now remains, the active ingredient in Roundup, a broad-spectrum herbicide used and sold by Monsanto. Today, it is still used extensively in agriculture, and by millions of homeowners to control weeds in their landscapes.

Roundup is applied directly to the leaves of weeds, and works systemically. This means that once it is absorbed by the leaf, it spreads throughout the entire plant system. It kills the plant by interfering with the “shikimate pathway”. This seven step pathway is a metabolic route which is vital to the lifecycle of bacteria, fungi, algae, and every living plant. When disrupted, the biosynthesis of necessary folates and aromatic acids such as phenylalanine, tyrosine, and tryptophan are halted. As production of these proteins fail, plant death is inevitable.

Initially, Roundup effectively controlled weed growth, however, contact with the crop plant was detrimental. Glyphosate is a broad-spectrum killer, which means it cannot distinguish between crop plants and unwanted weed species. In 1996, Monsanto set out to remedy this problem, by introducing Roundup Ready soybean. This was the first genetically engineered crop that was developed by Monsanto. It was created by introducing a bacterial gene resistant to glyphosate into the DNA of the soybean. This gene was derived from a type of bacteria called Agrobacteria, and now allowed farmers to spray Roundup not only the weeds, but the entire crop without damage.

In consequent years, a variety of other Roundup Ready crops were developed, including cotton, corn, sugarbeets and other crops. Roundup was effective until all susceptible weeds were killed, however, soon resistant weeds began to dominate farmlands. These “superweeds” did not respond to the same dosages that killed their susceptible predecessors, therefore, growers simply increased application rates, to eradicate these superweeds.

The US Department of Agriculture has estimated that Roundup Ready crops have resulted in an additional application of 383 million pounds of herbicides. This increase in the use of glyphosate greatly increases the likelihood of the chemical running off into nearby ecosystems. At these elevated concentrations, glyphosate potentially causes environmental damage, as well as damage to human health.

Monsanto claims that glyphosates are not toxic to humans because human cells do not function by the shikimate pathway. This is true, however, the bacteria in our gut do use this pathway! This means that the glyphosphate residue that we ingest kills the beneficial bacteria in our digestive systems. Pathogenic bacteria are not affected, and as a result they dominate the gut, deplete micronutrients and produce ammonia and formadelhyde by-products, that toxify the system causing inflammation.

In addition, the absence of the production of folates and aromatic compounds cause cell shrinkage, resulting in the leakage of these produced toxins into the blood stream. This results in the development of many diseases including encephalitis, Alzheimer’s, diabetes, obesity, cancer and autism to name a few.

The damages and affects of humans ingesting glyphosate (Roundup) require further investigation. At present, there are no regulations that require the labeling of products that contain glyphosate or the incorporation of GMO’s. We are the ONLY country that does not require this! Therefore, many people continue to suffer unknowingly, completely unaware of the havoc this herbicide is causing within their bodies.

Why Vitamin D or Lack of It May Be Contributing to or Causing Your Health Issues

I’m sure by now everybody has heard of Vitamin D and how important it is for our overall health! If you haven’t, please crawl out from under that rock for a moment so I can bring you up to speed! Most people, I’m hoping, are even supplementing with it daily (or they should be). Vitamin D is actually a not a vitamin at all but is a pro-hormone, as it can be manufactured in our body when we are exposed to light. Herein is where our problems arise. We get very little sunshine into our tissues on a regular basis nowadays. Many of us live at a latitude which predisposes us to sub-par sun exposure on our skin (where all the Vitamin D magic starts), or we are slathering on sunscreen for protection against the damaging effects of the sun, (like producing Vitamin D to keep us healthy) which halts our vitamin D conversion!

It turns out that about 40% of the global population is deficient in Vitamin D and over 70% of Americans are either deficient or insufficient in their vitamin D levels. The sunlight we are exposed to daily is our primary source of vitamin D and since we get very little from our diets, if we are not receiving that exposure on our skin, you can imagine how important supplementation now becomes. A deficiency of Vitamin D (a serum vitamin D 25-OH level less than 20 ng/dl) is linked to many chronic diseases, cancers, poor bone health, autoimmune diseases, neurocognitive issues like depression, mood stability and Alzheimer’s disease. You can begin to see the importance of having adequate levels for our bodies to operate efficiently and without disease. We have a vitamin D receptor in nearly every single cell in our body and it is responsible for regulating over 3000 of our genes. So, you can understand the gravity of the situation. Unless you plan on sunbathing in the summer and taking vacations to sunbathe in the winter, your Vitamin D requirements might need some attention. I always tell my patients that they should know their vitamin D level. Vitamin D is a fat soluble vitamin (OK, pro-hormone) that needs to be monitored. As with any fat soluble vitamin, toxicity can be an issue (although Vitamin D has a very broad range level of safety).

Where do we start? With a simple blood draw, inexpensive, not routinely done with the normal CBC or CMP, but can easily be added by asking your doctor. The test is serum Vitamin D 25-OH, and is one of the more important numbers you should know.

I had a patient who was suffering from crippling agoraphobia (she felt it unsafe to leave her home). What stood out the most from her blood work results was that her vitamin D 25-OH level was in the single digits at 7ng/dl. Very shortly after supplementing with Vitamin D3 (cholecalciferol) she had no anxiety, depression or mood instabilities, and her words were, “she felt like herself again”!

Vitamin D is one of the supplements I tell every one of my patients they should be taking regularly for their health. How much you may ask? Dosage depends on your serum blood levels. If you are deficient or insufficient in your Vitamin D levels, work with a practitioner to help monitor it and set your dosing appropriately. That being said, a very safe dosage that you may immediately start supplementing with (until you can have your blood levels checked) is a summertime dose of 5,000 I.U.s and wintertime dose of 7-10,000 I.U.s of vitamin D3. Everyone should be supplementing with some amount of Vitamin D for better health. If you need your levels checked or dosage customized, give us a call and we’ll accommodate your needs.

7 Main Reasons to Drink More Water

“Water is the driving force of all nature” – Leonardo Da Vinci

Water, the liquid life. It makes up 60% of your body, 75% of your muscles and 85% of your brain. It’s the lubricant that is involved in nearly every chemical process that takes place inside your cells.

Water is clearly the most important nutrient for the human body, but we often take it for granted. Opting for soda, fruit juice, alcohol, coffee, or tea over boring old water. That’s likely the reason why 75% of Americans are suffering from chronic dehydration. There’s just so many other options!

Interestingly enough, even though water is so important for the body, there’s not much scientific research dedicated to learning more about water and how it affects human health. That’s because water is very cheap for most developed countries. Water’s health benefits don’t increase the bottom line of the giant pharmaceutical companies that usually fund health research. The few research articles that I did find were actually done by bottled water companies such as Evian, meaning that even this research may be slightly biased.

Nonetheless, water is a necessary and fundamental part of being healthy and it’s importance should not be underestimated. Making sure to drink the right type of water and plenty of it is crucial to achieving your health goals. Here are the 7 Main Reasons to Drink more water. Let’s dive in.

The 7 Main Reasons to Drink More Water

#1 – Water Helps You Lose Weight
Everyone wants to look good and be in shape. The EASIEST way to do that is to drink more water. Here are the two main ways that water can help you lose weight or maintain optimal weight.

Water Reduces Cravings
In the center of your brain, there is an area called the hypothalamus. The hypothalamus is responsible for regulating hormones in the body, controlling body temperature, and the sensations of hunger and thirst. Since your feelings of hunger and thirst are supplied from the same area of your brain, you may sometimes mistake your thirstiness for your desire to munch on something.That’s why if you get a craving for food, you should try drinking a glass of water and waiting 15 minutes. Most of the time the craving should go away and you reduce your calorie intake, which helps you lose weight.

Water Stimulates Your Metabolism (Burning of Calories)
Did you know that drinking water stimulates your metabolism and increases your calorie burn? Especially if you drink cold water. Drinking cold water forces your body to burn calories to warm up the water to body temperature. Really any water that you drink needs to be processed and transported to the rest of your body.

Research showed that in 14 healthy and in-shape individuals, drinking 500ml of water increased their metabolism by 30% in just 10 minutes. Another study showed that drinking 2 liters of water a day could increase calorie burn by up to 400 calories. A short-term study of overweight women showed that the women who drank more than 1 liter of water a day over 12 months, lost an extra 4lbs of weight without any other lifestyle changes.

Water needs to be processed and transported to be used by the body, which requires energy. More energy demand causes an increase in metabolic rate. Just by drinking more water you’ll burn more fat and get leaner. It’s like the best natural fat-loss product. A Zero-Calorie food!

#2 – Water Increases Your Mental and Physical Performance
Fatigue is one of the first signs of dehydration. Even if you lose just 1-2% of your body weight in water, it can impair physical and mental performance. That’s because everything that goes on in your body and brain requires water.

Physical Performance
If you exercise regularly, you need to hydrate even more than the normal sedentary human being. You lose water rapidly through your sweat and your breath when you exercise. It has been shown that athletes often lose 6-10% of their body weight in water during competition and intense training. Dehydration during training results in reduced endurance, increased fatigue, reduced motivation, and increased perceived effort. All of which negatively impacts performance.

The good news is that proper rehydration reverses all of these negative effects and even reduces oxidative stress caused by exercise and dehydration. Make sure to hydrate before, during, and after exercise to aid in recovery and maximize your performance. A solid workout with maximum effort also means more calories burned, resulting in a leaner and better you.

Mental Performance
Even just mild dehydration curbs cognitive functions such as concentration, alertness and short term memory in everyone including children (10-12 years), young adults (18-25 years) and (50-82 years). The brain is 85% water, so staying adequately hydrated is important to ensure proper functioning of your brain. In the morning, instead of going straight for coffee, try drinking 500ml of water as soon as you wake up. It will help kickstart your day and get you going faster. When that afternoon snooze starts creeping, try drowning it with water. Water, not coffee, is the key to sustained energy throughout the day.

#3 – Water Improves Your Skin Health
The skin is the largest organ of your body and contains 30% water, which contributes to the plumpness and elasticity of skin. Drinking more water can improve skin thickness and density, helping your skin look more youthful, smooth, and firm. Choosing water instead of inflammatory drinks such as sugary sodas, processed fruit juice, caramel macchiatos, and even milk will help you achieve clearer skin. These inflammatory drinks cause spikes in blood sugar which messes up your hormones and leads to unwanted breakouts. Be conscious of what you drink, especially for the sake of your skin.

#4 – Water Helps Detoxify your Body
There are so many toxins that you come into contact with everyday from processed food, household chemicals, environmental pollutants, etc. It’s your kidney’s job to filter out your blood and remove toxic waste. The kidneys depend on plenty of fluid available in your body so that even if you lose fluid through your urine, your body can function optimally. Give your kidneys adequate water, they can efficiently work and remove all the toxins from your blood. The more dehydrated you are, the harder your kidneys have to work to fit all the toxins into a small amount of urine. Leading to the darker and darker shades of yellow in your urine. The easiest way to make sure you’re getting enough water is to drink enough water until your urine is crystal clear. This will help your kidneys remove toxins from your body efficiently, and you will feel great!

#5 – Water Helps Minimize Joint Pain and Muscle Pain
Your joints are the hinges where two bones come together. Between your bones is a coating of cartilage which provides a cushion between the your bones to prevent friction.

Joints are like sponges. Wet sponges move easily against each other while hard sponges can rub and break off. Drinking plenty of water ensures that your sponges (cartilage) are hydrated and soft, minimizing joint discomfort. That’s what glucosamine and other joint supplements are designed to do, retain more moisture in your cartilage. You can do this naturally by drinking more water.

Muscle pain is a slightly different issue. If you work out or lift weights, there’s a build-up of lactic acid and microtears in your muscle fibers that cause pain. Drinking plenty of water flushes out the lactic acid, and transports nutrients to your muscles (assuming that you’re eating nutritious diet) that will help repair muscles quicker and reduce muscle pain. Drinking more water means faster and more efficient recovery.

#6 – Water Makes You Happier
The more water your drink, the better your mood will be. If your body is running efficiently on plenty of water, you’ll have more energy and be in a better mood. A study on 120 healthy female college students showed that the girls who drank more water on average had less tension, depression, and confusion.

Another study on 30 people who drank five cups of water a day showed that when the same people were asked to increase water intake to ten cups a day their mood, energy, and satisfaction all improved. DRINK MORE WATER, it will make you happier.

#7 – Water Helps You Digest and Poop
Your digestive tract is where everything goes to gain entrance into your body, including water. Keeping this area nice and moist is good for your digestion.

Water Aids Digestion
Everything that you eat lands in your stomach first and waits there to be broken down by stomach acid and digestive enzymes. The rate at which digested food then moves into your intestines from your stomach is mostly determined by the volume of food & fluid that is in the stomach at the time. After your stomach breaks down the food, it empties into the small intestine, where most of the nutrients and water are absorbed. The more water that is available, the better the absorption.

However, there’s a constant debate among health professionals on whether or not drinking water with meals positively or negatively affects digestion. On one hand, it’s theorized that drinking water during meals dilutes your stomach acid and enzymes leading to poor breakdown of nutrients and causes limited absorption. On the other hand, drinking water is said to aid in moving food through your digestive tract quickly and smoothly.

So in order to cover both sides of the argument, here’s the best way to drink water for proper digestion.

  • Drink plenty of water throughout the day so you don’t have to gulp down water right before you eat.
  • Take small sips of water (preferably room temperature or warm) during meals.
  • Make sure to beginning hydrating again 30 minutes after your meal to give time for your body to digest the food you ate.

Is Cord Blood Banking Worth It?

A lot of debate is going on about the cord blood banking. Nowadays this field is being pursued nearly in all the developed countries that are doing a lot for the advancement of technology. Basically, cord blood is simply the blood obtained from the umbilical cord of the newly born baby. As far as the banking of that blood is concerned, it is stored in the blood bank for use in future. The cells that are worth to obtain are those resembling stem cells. The function for which they are obtained is also nearly the same but not that exact which makes them more efficient than stem cells of bone marrow. Here, the term, ‘functions’ should be used rather than just ‘function’ because of the “endless” uses these cells have. “Endless” in the sense that this blood was found to be immensely useful after a number of abortive attempts and the uses are still being explored.

A number of experiments were and are carried out in which scientists and researchers explored and are exploring more and more uses along with a couple of limitations too. The baby who is newly born, his/her blood is collected for his/her own treatments in the future and for the siblings too. So far, a few of such experiments are carried out which can prove the reliability of this blood for the recipient who is not a relative. In fact, it can be proved successful but not that much as in those cases involving the donating and receiving between the relatives. The one advantage of cord blood banking that is noticeable is that over the stem cells. With the cord blood banking, your child can be saved from the diseases that are to come in future with no any pain or much trouble. As painfully as the stem cells are collected from bone marrow one may not bear it for one’s child. Apart from this trouble, since the birth of a child, you can have it collected and stored in the blood bank and be care free for the future.

Simply the cells are injected into the blood for annihilating the disorder. It is the blood stream which makes them move across the whole body of a diseased person. Cord blood banking enables one to get rid of a tremendously huge number of diseases which include a number of thalassemias, anemia, sex-linked disorders, blood and bone marrow diseases, blood cancers, immune system disorders and a lot more. Along with a lot of uses, some researchers argue that it may not save one from every sort of disease. This cannot be called a disadvantage as it is not possible to use it as one remedy for all the disorders. Continuous research can prove to lessen these reservations too. A lot is yet to be explored which is a plus point. From the late 20th century on, the non-stop research is indicating to open new ways and means of using and may be manipulating it.

Incorporating Fitness With Fun – Today’s Playground Equipment

When movement is concerned in children, it is absolutely vital that parents consider assimilating sports and complex exercise in playtime. The benefits of physically demanding exercise in children are near endless and they help to not only produce short term advantages (quicker bedtimes) but long term as well. Children also tend to learn by experiences and the best way for that is through trial and error in the playgrounds.

For a long while it was a rarity when a trip to the park or playgrounds would render your children exhausted and content for the entirety of the day, but these days the trend is on the way out. Just last week I heard the two incredibly desired words from my four-year old, “I’m tired”. Now this is incredibly uncommon coming from my sugar-rushed son whose idea of a pre-bedtime meal is a massive bowl of Froot Loops. So hearing that he was exhausted from his afternoon on the local church’s playground equipment had a welcome reception from the missus and I. This is perhaps largely due to the new play structures our local church had recently installed. The artificially elevated hills where the slides were placed helped tire him during his runs and the new modular climbing frames really pushed his little body to the limits. So as his prematurely early bedtime approached, I began thinking about the shift in the core design of playground equipment.

Manufacturers of playground structures have long toiled with different ideas to incorporate into their products and recently, it seems the focus has turned towards improving the fitness of children without compromising on the fun one bit. Take the Ant Hill for instance. Our church has a slightly modified version of this structure and once I’ve seen this in one play-space already, it’s difficult not to see other variations of this in other playgrounds around the area too. But the Ant Hill is a brilliant example of the way manufacturers are now incorporating exercise into play time. The simple structure features a series of toughened walls which support “rock-climbing” characteristics. So now, not only can children experience the thrill associated with this play structure, but exhaust themselves during playtime in ways that were reserved for ball or contact sports only. This helps drill the essential cognitive and physical characteristics children require while growing from a remarkably early age.

One might argue that church playground equipment of this kind does bring a new level of dangers that children may be exposed to, and these are all valid concerns. This is something I wondered as well and hesitated when my son wanted a go, and one fall later I figured that the foam padding used for the playground was a suitable enough surface for children to withstand impacts on.

So the next time you’re out and about with your child, looking for the best playground to spend your afternoon in, consider one that incorporates movement and exercise with its play structures and utilizes foam padding for playgrounds as a surfacing material.

Novel Stem-Cell Procedure Saves A Boy’s Leg

Stem cells have opened so many gateways to personalized medicine that no one could ever imagine a few years back. Not only the traditional transplants, with stem cells, medical practitioners are now able to treat many rare conditions. Thanks to the researchers and their novel techniques, involving stem cells.

This is a story of Javier Tan, a 9 year old boy, who was suffering from a rare genetic illness, Fanconi anaemia, which led his blood count drop to a significantly low levels. He required a stem-cell transplant; so that his body would be able create new blood cells

He received his first stem cell transplant when he was 7. The surgery was meant to save his life but call it irony of fate that it turned his life into a nightmare. Instead of healing, he contracted a bone infection. His condition was so severe that his doctors anticipated he would lose the limb.

In that scenario, the optimum option was to wait for another donor, which might have taken several months. Instead his doctors administrated another transplant and that too within weeks. When his doctors realized that they would require the donor to be only a 50% and not 100%, his father became the donor, who was earlier rejected.

Human leukocyte antigen (HLA) matching is important in both cord blood and bone marrow transplant. It’s a protein, which is found in cells, used to match a donor’s stem cells with that of the patient’s. However, this time Javier’s doctors went for a different method, called haploidentical transplant. In this process, the T-cells, the immune cells that are responsible for attacking foreign elements in the body were removed. So in Javier’s case, the T-cells could not attack the newly transplanted cells.

After seeing the immense improvement, Javier’s mother is very happy. Mrs Vivian Tan recalled the day when doctors told her that they might need to amputate his son’s leg. And now look at him. He is a healthy student of Primary 3, excelling in English and Chinese. His surgery was done in January and Javier was back in school in May. She said, “I am definitely relieved and thankful that he has his health back.”

Dr Rajat Bhattacharyya, the consultant at the department of paediatric sub-specialities at KK Women’s and Children’s Hospital (KKH) confirmed that the new transplant method is versatile enough to find anyone the suitable donor. However, the technique has been in existence since 2010. The National University Hospital (NUH) successfully conducted the procedure successfully on 38 children. The National University Cancer Institute, Singapore (NCIS) has administrated 8 transplants on adults. KKH doctors have treated 4 kids with this technique since October 2014. 10 adult leukaemia patients have been treated with this method by Singapore General Hospital (SGH) since 2004.

The number of patients undergoing haploidentical transplant is gradually increasing. And why not! Without the procedure, the chances of finding the most suitable donor might take several months or year. The haploidentical transplant offers hope for patients, who suffer from rare conditions and are left with minimum hope to live a healthy life ahead.

A Single Protein Can Boost Stem Cell Regeneration

Would you believe if we told you that stem cell regeneration can be boosted with a single protein? Wondering about the implications? It means you can recover from injuries faster. CIRM-funded scientists from the UCLA Broad Stem Cell Research Center confirmed that hematopoietic stem cells (HSCs), which are responsible for generating cells in the blood and immune system, enact faster when the bone progenitor cells are injected, which are available in bone marrow.

The bone progenitor cells are able to improve the survival and recovery of HSCs when a protein called dickkopf-1 (Dkk1) is applied. This process helps in fast recovery from injuries. The study was administered on a Petri dish and in mice.

The main aim of the surgery was to understand how different cell types, available in the bone marrow interact with HSCs in order to increase their ability to recover from any injury and at the same time to enhance the immune system. Senior author on the study, UCLA Professor Dr. John Chute and his team discovered that bone progenitor cells in the bone marrow secrete Dkk1 protein when an injury occurs. They conducted the study on mice by exposing them to irradiation, which causes the injuries.

Dr. Chute stated that the earlier study showed that the endothelial cells were needed for blood stem or cord cell regeneration when the mice were exposed to irradiation. However the latest surgery demonstrated that bone progenitor cells are also needed for blood stem or cord cell regeneration if exposed to irradiation. The study showed that Dkk1 not only improves HSC regeneration, but it also enhances the regeneration of HSCs. On the contrary, when Dkk1 protein was deleted from HSCs, the stem cells did not recover or regenerate.

He said, “The precise functions of bone cells, stromal cells and endothelial cells in regulating blood stem cell fate are not completely understood,” he added. “Our prior studies demonstrated that endothelial cells are necessary for blood stem cell regeneration after irradiation. The current study suggests that bone progenitor cells are also necessary for normal blood stem cell regeneration after irradiation, and that this activity is mediated by secretion of Dkk1 by the bone progenitor cells.”

Dr. Chute went on saying how his latest research on secreting a single protein on HSCs is related to his previous study on deleting a gene from HSC stem cells to boost blood cell regeneration. He said, “In this paper we discovered the role of a niche cell-derived protein, Dkk1, and how it promotes blood stem cell regeneration after myelosuppression in mice.”

He also explained, “In the Cell Reports paper, we described our discovery of an adaptor protein, Grb10, which is expressed by blood stem or cord cells and the inhibition of which also promotes blood stem cell regeneration after myelosuppression. So, these are two novel molecular mechanisms that regulate blood stem or cord cell regeneration that could be therapeutically targeted.”

We can safely conclude that both the researches have contributed a lot in treatments of patients in need of a boost in their blood and immune systems followed by radiation or bone marrow transplants.

A Look At The Benefits Of Chiropractic Care

The benefits of chiropractic care are well established today and people suffering from back and neck pain are increasingly seeking out this alternative treatment technique. Take a look at some of the more powerful benefits of chiropractic care:

Provides Effective Pain Relief

Several studies that have been done have established that chiropractic care can be more effective than medications when it comes to relieving lower or upper back pain or neck pain. It also works to treat the pain of sciatica, bulging disc and slipped disc.

Pain Management Without Drugs

As research throws up more and more evidence of the dangers of taking medication and prescription pills, we are becoming more conscientious about reducing our dependence of medication. Chiropractic provides the perfect alternative as it promotes a drug-free approach. Chiropractic focuses on treating the whole system holistically.

Low Risk Treatment

Conventional medicine uses prescription medication for mild back pain and surgery for more severe back pain. Both of these are high risk as medications can cause complicated adverse effects and surgery is invasive. With chiropractic adjustments the only side effect you can expect is a bit of soreness and in some cases fatigues. Very rarely are there any serious side effects.

Treats The Cause Of The Pain

Most medications merely help to manage the symptoms of pain but the cause of the pain still remains in the body. Painkillers may mask the pain in your upper or lower back but it does not cure the bulging disc. Chiropractic care on the other hand addresses the cause of the pain, which is more effective for long-term relief.

Treatments Can Be Customized Depending On Your Condition

Chiropractors make use of a wide range of tools and techniques to treat pain and other mobility issues. All of these techniques can be customized for your body shape and size and the location of your pain. If you let your chiropractor know the exact spot that is painful and the kind of pain, you will receive customized Chiropractic treatment.

Prevents Joint Dysfunction & Several Other Conditions

One of the greatest benefits of chiropractic care is that it reduces joint dysfunction, which could otherwise lead to symptoms in other parts of the body. Routine treatment can also prevent and treat several other health conditions, from headaches and migraines to menstrual disorders, fertility issues, gastrointestinal disorders and ear infection. Your chiropractor can help develop a customized treatment plan for you depending on your symptoms.