ThirdAge Services

ThirdAge Services

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Can I ask you questions about care-giving right on your page like this? Things that others might like the answer to as well?

Things like: Mom is now deep into transition between urinary continence and incontinence. Is there a product between pads and diapers? Is there some way we can ease the embarrassment for her having to take these measures?

Thanks for having this page, let me know if this is the kind of thing you thought would happen when you created it.
This is some good stuff. Much of this is available at the dollar stores and would certainly work as well at home as in a community. Way better than dozing in front of the TV all day and up all night! 😉https://www.facebook.com/CCYoung1922/?hc_ref=ARQK55aUFp6VtusZl0bgaFRDYPh9GANHDfej7WtvSsEayCa4dCAnAKTODXcWzJDgdb8&pnref=story#
Gosh, Why am I not surprised? They run their business like a car manufacturing corporation. Assembly line thought process...

ust found the most useful website to compare skills/ratings of Surgeons for the most common surgeries. Wow! what important information for anyone contemplating a surgery. I only wish that I had know of this site earlier. I could have helped guide so many of my clients to the very best available in their area.
The Agency for Healthcare Research and Quality (AHRQ) found no high-level evidence that any interventions could delay or prevent clinical Alzheimer’s-type dementia, but they did identify some intervention combinations that showed promise. Listen to Dr. Campos-Outcalt’s summary of AHRQ’s findings here. The full report can be found at: https://effectivehealthcare.ahrq.gov/ehc/products/634/2417/cognitive-decline-report-170324.pdf.

Certified Dementia Consultant for families She consults face to face with families in North Texas and via telephone with families nationwide..

Carole Larkin MAG, CMC, CAEd, QDCS, EICS is a Certified personal consultant to families who have a family member who has Alzheimer’s or a related dementia. Her company is called ThirdAge Services LLC, She can be reached at 214-649-1392 or at [email protected].

Operating as usual

12/06/2020

Retired!!!! Will be shutting down this facebook account soon. If you want to get in touch with me, you'll need to go to Carole Larkin.

11/20/2020

Retired as of 11/2020
If you need referrals to others that do what I did- just contact me!

Maskomania: Masks and COVID-19 05/25/2020

Maskomania: Masks and COVID-19

The headline is very misleading. The article is clear. Any mask is more protective of you than no mask. Surgical masks are pretty damn good. Cloth masks are effective too. Reusing a mask is better than not using one at all.You can clean masks and tells you how. My comment: You see pictures of kids with cancer in the hospital during cancer treatment. They are wearing masks. Is this because they don't want to pass on Cancer to the rest of the world? Oops, snarky question-sorry! Just trying to get the attention of all those who don't care about anybody but themselves.
Maskomania: Masks and COVID-19
THE-HOSPITALIST.ORG
Maskomania: Masks and COVID-19
Masks alone are not enough to control COVID-19 and must be coupled with other nonpharmacologic interventions.

Maskomania: Masks and COVID-19 Masks alone are not enough to control COVID-19 and must be coupled with other nonpharmacologic interventions.

03/27/2019

CarolMarak.com

I'm on Facebook with Carol Marak talking about legal issues like Medical Powers of Attorney for older adults, especially for those who are alone. Take a look!

03/26/2019

CarolMarak.com

I'm on Facebook with Carol Marak talking about legal issues like Medical Powers of Attorney for older adults, especially for those who are alone. Take a look!

medpagetoday.com 10/15/2018

Dementia and Guns

Superlative article on the doctors ( on the whole) not addressing guns in the home of a person with a dementia. A tragedy just waiting to happen? I think so.

medpagetoday.com When should doctors broach the topic?

texmed.org 09/18/2018

Stop Proposed Medicare Changes, TMA Tells Lawmakers

You think Medicare isn't being changed- think again. Proposed changes make the Texas Medical Association think that Doctors will quit taking Medicare patients in DROVES. Even more than they do now. The Texas Medical Association is begging politicians to STOP the changes. Lookie Here!

https://www.texmed.org/TexasMedicineDetail.aspx?id=48561

texmed.org Federal lawmakers must hold hearing immediately to stop proposed changes to Medicare that would cause lasting and serious damage to the program and to health care in the United States, Texas Medical Association President Douglas Curran, MD, told two key Texas congressmen today.

09/10/2018

ZDoggMD

To my patients: I wasn't planning on getting so angry, but here's why we've been forced to go from connecting...to clicking.

Please send this to patients, colleagues, administrators, and representatives and join the movement to rehumanize medicine: zdoggmd.com/list

08/29/2018

Reliant Rehab To Pay $6.1M After Settling Allegations It Paid Kickbacks « D CEO Healthcare

Man, this really bugs me...

healthcare.dmagazine.com Reliant Rehab To Pay $6.1M After Settling Allegations It Paid Kickbacks 08/24/2018| by Shawn Shinneman|  Share Post Plano-based Reliant Rehabilitation Holdings Inc. will pay the federal government $6.1 million to settle claims the company paid kickbacks to skilled nursing facilities and doctors. Th...

aginglifecare.org 08/28/2018

Event Display - 2018 ALCA South Central Chapter Conference

I am a member of the ALCA (Aging Life Care Association) South Central Chapter Conference Committee putting on this Conference. I think that it's gonna be AWESOME!!! Who knew that I'd be this much work? I didn't, until now! Anyways, it's November 9 & 10, 2018.(just before Veteran's day) All are welcome. A bunch of CEU's! Cheap!!!

http://tinyurl.com/y7jd74j6

aginglifecare.org Aging Life Care™/ geriatric care management is a holistic, clientcentered approach to caring for older adults or others facing ongoing health challenges. Working with families, the expertise of Aging Life Care™ Professionals provides the answers at a time of uncertainty. Their guidance leads fam...

sciencedaily.com 07/12/2018

Amyloid beta protein protects brain from herpes infection by entrapping viral particles: Chronic viral infection could induce overproduction of Alzheimer's-disease-associated protein and cause damaging inflammation

Interesting. Alzheimers as protection against herpes virus. Protection run amuck. Hmmm...

sciencedaily.com A new study has found the mechanism by which amyloid beta -- the protein deposited into plaques in the brains of patients with Alzheimer's disease -- protects from the effects of herpes viruses commonly found in the brain.

medpagetoday.com 05/18/2018

Intense Exercise Fails to Boost Cognition in Dementia Patients

Now this is an interesting study. I goes against established thinking. Hmmm, what's up with this?

medpagetoday.com U.K. study shows better fitness, but not cognition

medpagetoday.com 04/26/2018

Trina Changed His Life, Then It Bankrupted Him

Sad, sad, sad. I see it with people promoting all kinds of craziness that they claim "cures" Alzheimers.

medpagetoday.com Ron Briggs felt he'd experienced a medical miracle, and just wanted to share it

tinyurl.com 04/12/2018

TinyURL.com - shorten that long URL into a tiny URL

These doctor's comments on the different definition of Alzheimer's for researchers are all over the place. Very interesting reading!

http://tinyurl.com/yak4auxp

tinyurl.com

mdedge.com 04/10/2018

Alzheimer’s: Biomarkers, not cognition, will now define disorder

A NEW WAY TO DEFINE ALZHEIMER'S!! This could start to ACTUALLY begin to take the stigma out of it! All we have to do is make the biological tests available to everyone. That means PET scans or Spinal Taps. Ok, can anyone make those tests affordable, or at least get them covered by Medicare???

https://www.mdedge.com/familypracticenews/article/163073/alzheimers-cognition/alzheimers-biomarkers-not-cognition-will-now?channel=180&utm_source=News_FPN_br_041018_F&utm_medium=email&utm_content=Breaking%20News:%20Biomarkers,%20not%20cognition,%20will%20now%20define%20Alzheimer%27s

mdedge.com This new way of classifying AD may change the way doctors and patients talk about the disease – and, one day, could change treatment.

medpagetoday.com 04/09/2018

PTAC OKs New Nursing Facility Payment Model

Now all they have to do is find enough Geriatricians, nurses, social workers and pharmacists in the United States to staff it!

medpagetoday.com Proposal provides 24/7 access to care team, mentors nursing home staff

mdedge.com 04/03/2018

‘Aggressive’ new advance directive would let dementia patients refuse food

I say that it is person centered, person driven care. Also, there is no doubt at all that it will be fought out in the courtroom, possibly up to and through the supreme court. And so folks, it ain't happenin' any time soon. That, you can take to the bank!

mdedge.com Critics say it’s a disturbing effort to allow withdrawal of basic sustenance from the most vulnerable in society.

sciencedaily.com 03/08/2018

One-month worth of memory training results in 30 minutes

As I suspected, computer brain training programs really train people in tasks similar to the exercise they learn to do, rather than really increase working memory. Better to learn a whole new language or take up a new hobby to really improve working memory.

sciencedaily.com A significant part of working memory training effects is a result of a fast development of task-specific strategies during training, rather than an increase in working memory capacity.

medpagetoday.com 02/27/2018

Shoddy Data; Surgeon Scam; Medicaid Millionaires

And you wonder why I've turned into a cynic? Look at the bad behavior from so many sources within health care. Makes me sick and sad.

medpagetoday.com The week in investigative reporting on health

01/02/2018

Fresh Air with Terry Gross

"Ten years should be enough time for us to develop, if not a cure, certainly a much better treatment than what we have at the moment," says neuroscientist Joseph Jebelli.

medpagetoday.com 12/27/2017

Interventions Unproven for Preventing Late-Life Dementia

Sadly, nothing seems to stop Dementia from progressing, or prevent it from starting, new research shows. (a Meta Analysis no less). DAMN!!! Not good news!!!

www.medpagetoday.com/neurology/dementia/69970

medpagetoday.com Little benefit seen in meta-analyses for exercise, 'brain training,' nutrition supplements

mdedge.com 12/11/2017

Intranasal insulin, ketogenic diet may benefit Alzheimer’s patients

You know, usually I read this stuff and go, "it's just more bla, bla, bla. But in this case, I think that there may be something to this. Why? Because over the years I've noticed an extraordinary proportion of my Alzheimer's clients have an addiction to sweets (read Sugar), whether they are diabetic or not. I've theorized that their addiction to sugar may just be the only way their brains instinctively know how to force insulin to the portions of the brain that need it to keep functioning at the level it used to. Do I have any proof of this? NO! But the theory falls in line with this research perfectly. But then, maybe I'm just looking for self confirmation here! ; < )

mdedge.com Growing evidence from basic science and preclinical studies demonstrates that insulin plays a key role in brain synaptic function viability, vascular function, amyloid/tau regulation, and cerebral glucose metabolism.

12/03/2017

My most memorable Client.

I have had so many clients over the 12 years that I have been a personal consultant to families that have a family member with one of the dementias, but one stands out as my most difficult but also most rewarding case. She was 92 years old, and recently passed away from both breast cancer and from her dementia. I was with her for her last 7 years. I would like to tell you of my time with her.
I’ll call her Debby (not her real name, of course). I was called in to the case by the administrator of the family trust, on recommendation from the neurologist that diagnosed her with mid-stage dementia, probably of the Alzheimer’s type. She was rich. I mean stinkin’ filthy rich. She had a Picasso hanging in her living room. It didn’t even have an honored place on the wall. It was just one of her paintings. That’s how rich she was.
Her last husband had died a few years before. Her son lived across the country and visited her every year or two. That was a good thing because even though he claimed that he loved her, the two together were like oil and water. No, worse than that. When they were together, it took no time at all for arguments and agitation to ensue. We’d have to calm her down afterward. UGH!!!
She lived in a condo in the best condo building (at the time) in the most expensive part of Dallas. Attending to her was her husband’s butler, who had stayed on after her husband died. He knew nothing about Alzheimer’s and how to deal with it. I did a lot of teaching/coaching to him over the years, and I think that it took a long time for him to wrap his head around the fact that she really did have a dementia. It wasn’t until her last year of life that he fully came to believe it. His job was as house man, meaning cooking, cleaning, shopping and running errands for her.
Debby had grown up poor in Oklahoma, but over the years had acquired great wealth through her marriages. It didn’t hurt that she was a beauty. I mean a Hollywood Starlet beauty. And in fact, she was a Hollywood Starlet. In the house were pictures of her with Hollywood directors, producers and actors of the era. She was friends with people like Howard Hughes, Frank Sinatra, and many other familiar Hollywood stars of that era.
Over the years, she had learned to be what I call “entitled”. Apparently, everyone kowtowed to her every wish. Now with mid stage Alzheimer’s, the filter was off. She could and did regularly verbally slice you up like so much meat waiting for the butcher’s knife. I mean, she could push every one of your buttons when she wanted to, and she wanted to a lot.
She had the usual mid-stage paranoia, heightened by the fact she had so many possessions to misplace and then accuse others of stealing from her. When I arrived, the local police and fire department departments were so tired of her constant 911 calls that they asked the trust to “so something to stop the calls”.
Ironically, she was really was being scammed and robbed of some of her jewelry by some “new” friends who claimed that they were jewelry appraisers who would take her jewelry to be appraised. She’d forget that it was gone, and it was never seen again. OH BOY! I had to discreetly (as one could never let this information out due to her position in society) stop this from happening again. What did we do? We prevented the scammers from seeing her, calling her or communicating with her in any fashion. They were persistent, but we were vigilant. It took a few months but they finally stopped trying to contact her. On to greener fields I presume.
I knew that I would have to find the world’s best caregiver to contend with this mess. And find her I did. Actually, I transferred her from another one of my clients, who presented no challenge, and was underutilizing her skills. I’ll call the professional caregiver Mary. (Again, not her real name.) Over the years Mary not only endured the verbal slicing and dicing, bur also physical abuse, including kicking, biting, scratching, slapping and punching from Debby. It came at bath time, but at other times as well. Mary took to wearing protective gear and gloves at bath time especially. Through all of this, plus the houseman’s nose being out of joint having to share power with another person in the household, she persisted. She stayed with Debby to the end, and was there when Debby took her last breath. Mary is my hero forever, period.
Probably, the most amazing thing in this saga is, in the last year and a half of Debby’s life, her personality changed completely. It happens to some people with Alzheimer’s or another dementia. Debby became sweet, relatively quiet, thoughtful, in other words, nice. On her deathbed, she used to tell Mary and me that she was so glad that she was friends with us. She said that she had put us in her will (she hadn’t) and that she would split her estate between Mary, me, and her son, (again, not true.). She would tell both Mary and I that we were pretty and that she loved us over and over again. Yes, she kept her verbal abilities, all the way up to the end. I used to get tickled when on her deathbed, she would correct my grammar and pronunciation. And she was mostly right!
I miss her a lot. And Mary was so devastated at her death that she got out of the caregiving field entirely, going back to her previous profession. Mary and I still are friends, and will be going out to lunch together now and then.
No, I will never forget Debby. All the bad and all the good. May she rest in peace.

11/15/2017

Fisher Center for Alzheimer's Research Foundation

Carole Larkin of ThirdAge Services offers these tips to help caregivers overcome the ordeals of bathing 's patients.

10/28/2017

And now the article on lack of caregivers right now. And folks its going to get worse in the future unless we change some things.

The Common Cause of the Abuse of Neudexta and the lack of Real “Person Centered Care in America.

I’m trying to kill 2 birds with one stone here. This article will be 98% fact and 2% my opinion.

FACT:

Marie Marley asked in a comments section of my last article “The True Meaning of Person-Centered Care”, so which of the national chains of Residential Care for seniors are good?”

Marie, I’d love to give you a simple answer, but there really isn’t one. There are way too many other influences on any given Assisted Living/Memory Care/Skilled Nursing Care Facility than just the corporate policy dictating how things should run at the community/facility. Granted, Corporate policy is the foundation and the framework that sets the outside parameters of how the community is run. There is no disputing that.

Large corporations of all types depend on “standardization” to ensure consistency of their product going to the consumer, for maximum efficiency of production of the product at the lowest cost possible. It’s the same “assembly line” model that America has used for well over a century, since the era of industrialization emerged from the pre-industrial era. (Yes, I was a history major in college.) It works the same whether its cars or residents in a community/facility. In order for this model to work, people must be viewed as objects on the assembly line, hence the lack of real person-centered care.

But other things also impact how each community/facility runs daily and how they treat their residents. Consider the importance of the community’s/facilities management (the Executive Director or Administrator, the Assistant Executive Director or Administrator, the Director of Nursing and Assistant Director of Nursing) in your assessment of the community/facility strengths and weaknesses. The management’s personalities, their compassion, their love and dedication to their job, and finally how willing they are to “buck” the corporation edicts at any given time on any given issue. Still another factor is how full the community/facility is and how big their profits are (yes, even in “non-profit” communities) at any given time.

But of all the other factors, the biggest factor is clearly if they have enough trained, knowledgeable, caring staff (meaning aides, caregivers or whatever they are called in that community/facility).

Now I live in Dallas TX, a BIG city and we have a shortage of aides available to help care for disabled or demented older adults. Here the demand is too high for the pool of people available to satisfy the need. And I am talking for any caregivers, be they good, bad or otherwise. The demand for “good” aides is even higher, as you can well imagine. I don’t even want to think about smaller cities and “rural” America, where there is way less people in the pool.

Here’s who is competing for the same pool of people: hospitals and rehabs, nursing homes, assisted livings and memory care communities, home health companies, home care and personal assistant companies and private employers (think families). Not to mention non-health care related companies like fast food and other restaurants, retail stores, etc. And, except for private employers, the non-health care related companies pay more per hour and sometimes offer health insurance benefits. Now which would you rather do, clean up a spill in aisle 3 or clean up a mess in somebody’s incontinence wear?

Any wonder why there’s a shortage now and a crisis looming in the near future as the baby boomers “mature” into consumers of care?

So how can assisted livings, memory care communities and nursing homes cope with a lack of staff to service their needs?
One way is to make the consumers/residents less “needy”, in this instance, users of less time to need the aide’s attention, so that the aide can help more people per shift. How can you accomplish that? Restrain the residents that are “acting out” and causing a ”ruckus”, which usually demands more than one aide to quieten/calm them down. In the old days, they were physically tied down to their bed or wheelchair. Well, that was outlawed so the industry had to look for another way to solve the problem of “needy/disruptive” residents.

The answer? Chemical restraints to put the residents to sleep so that they are less of a problem. Conveniently, the use of antipsychotic drugs (drugs originally meant to calm people with a mental illness called Psychosis), worked just fine on people with dementia. This use was/is off label, meaning the drug wasn’t developed for them anyway. Never mind the side effects of some of these drugs can harm people with dementia and others, they worked. Well, eventually the Federal Government (FDA, CMS, Medicare) figured this out and have started penalizing communities/facilities for using these drugs in that way. The penalty is taking away money from their reimbursements for the care of the residents. That got the communities/facilities attention. Buy the way, this penalization has just started happening within the last year or two.

Now the communities/facilities backs are against the wall again. What to do? TA DA!!! Neudexta (a drug that is NOT technically classified as an Antipsychotic) is invented and comes on the market. Neudexta is really a combination of Quinine (tonic water) and Dextromethorphan (an ingredient in some cough medicines to help quiet coughing). It was approved by the FDA for a specific condition called Pseudobulbar Affect (PBA). Danny Glover of the Lethal Weapon movies advertises it. Maybe you’ve seen some of the ads. Apparently, it has the same effect as the now penalized antipsychotics on some dementia patients.
Anyways, the federal government hasn’t gotten wind of it yet, and hasn’t addressed it’s use off label yet, hence, no penalties for its use, and fair game for chemically restraining users of aides’ time and energy. Therefore, communities/facilities being able to get by with less staff.

See the connection?

OPINION:

To me, all this dodging the law is just putting Band-Aids on a cut that needs sutures. How about trying to really fix it by making the aides jobs more attractive so that people want to do the job rather than run away from it? Yes, doing that involves money. Lots of it. To raise salaries, to give health care and other benefits and to give significant training to aides.

And there’s the rub.

The general public doesn’t want to do that. Why? Because the prevailing view is that old people are not “worth” it. In academia it’s called “ageism”. Whatever it’s called, it’s basically saying old people (and disabled people including those with dementia) have no value because they are not contributing to the USA’s economy. So, until that attitude changes the real “fix” won’t happen. We’re going to just keep putting on Band-Aids and complaining about lousy care for our elderly family members.

What was it that Pogo (the cartoon character) said?
“We have met the enemy, and he is us”

californiahealthline.org 10/27/2017

Largest Assisted Living Chain In U.S. Sued For Poor Care Of Elderly

Just wrote an article about precisely the issue that the suit on Brookdale is about. Will publish that article shortly, but first read this.
https://californiahealthline.org/news/largest-assisted-living-chain-in-u-s-sued-for-poor-care-of-elderly/.

californiahealthline.org A class-action complaint filed in a federal court in Northern California alleges that insufficient staffing and poor worker training has had “devastating” consequences for residents in the assisted…

mdedge.com 10/25/2017

Driving ability of Parkinson’s patients can decline quickly

Carepartners of people with Parkinson's disease, this is for you.
http://tinyurl.com/ycnhppy8

mdedge.com Findings suggest that health care providers should routinely ask about driving status and make referrals for testing if necessary.

10/09/2017

Question:

Can I ask you questions about care-giving right on your page like this? Things that others might like the answer to as well?
Things like: Mom is now deep into transition between urinary continence and incontinence. Is there a product between pads and diapers? Is there some way we can ease the embarrassment for her having to take these measures?

Thanks for having this page, let me know if this is the kind of thing you thought would happen when you created it.

Answer:

ThirdAge Services

The best way, and the most effortful way, unfortunately, for this time between continence and incontinence is instituting the toileting schedule. the toileting schedule is done this way: Track the times during the day ( and night if that can be accomplished) that she urinates and defecates. Most humans need to urinate once every 90 minutes to 2 hours after drinking liquids, if well hydrated. If not well hydrated, it generally is more often than that. (amazingly, being dehydrated can cause urinary infections, which of course means more urination. Go figure!)

You can usually detect a persons patterns of urination/defecation by charting it for a week. sometimes less. Once the pattern is detected, you simply take them (or cue them) to go to the bathroom a few minutes before that time. This method helps reduce accidents, helps reduce embarrassment on the person with dementias part, and helps them feel more "normal" if you will. A win-win all around.

Most care partners set an alarm on one or more of their electronic devices to do this. Even if the person with dementia says, "I don't need to go" the care partner takes them. Using a reward after going to the bathroom is a respectful way to get them to go. Example:"Let's stop at the bathroom and then we can go have lunch, have a cookie, some ice cream, do something they like to do like take a ride in the car," You see what I mean.

Most people don't make this effort, So the short answer to your question is no- there is nothing between pads and "adult incontinence wear'" as we call it in the business. If you go this route, try several brands, some are more comfortable than others, some are more "attractive" than others, some can cause rashes, other's don't. Once you identify the best type for mom, order in bulk on line. Much cheaper in the long run.

I didn't know what would happen when I created this page, honestly. But I'm happy to educate anybody, anywhere, anytime,So this is fine.

09/26/2017

NCI-funded TMIST study compares 2-D and 3-D mammography for finding breast cancers

I want to let women under the age of 74 know about this NIH Study getting ready to start. If a location where it will be done it'd be crazy not to try and participate. /www.nih.gov/news-events/news-releases/nci-funded-tmist-study-compares-2-d-3-d-mammography-finding-breast-cancers

nih.gov Study will help women make informed decisions about screening tests in the future.

09/26/2017

The Purple Angel Project in Dallas Texas is slated specifically towards hospitals and other acute care institutions. It is a way for hospitals and other acute care facilities to identify patients who have dementia, delirium, Traumatic Brain Injuries and other forms of "altered mental status" quickly. A sticker of the "Purple Angel" is placed on the wrist band of the patient, and the Purple Angel sign is placed on the white board in the patients hospital room, or on the patients hospital room door, just like a fall risk sticker and sign are currently used. This immediately notifies the hospital staff that the patient must be handled differently than one with no cognitive issues. A 5 section, 15-20 minute per section training program accompanies the provided logo JPEG. This program is free of charge. To know more about the Program contact me. [email protected]

jamanetwork.com 09/21/2017

New Toolkits Help Physicians Detect, Diagnose, and Manage Dementia

Great! But will primary care physicians use them? Well, there is a better chance now that there is a billing code to charge Medicare for the work, especially since they could be part of the annual medicare checkup.

jamanetwork.com This Medical News story discusses 2 new toolkits aimed at helping primary care physicians detect, diagnose, and manage dementia in patients.

alzheimersreadingroom.com 09/19/2017

The True Meaning of “Person Centered Care”

Sometimes I can't help myself. I just have to write an article. Thanks Bob DeMarco for publishing it!
http://tinyurl.com/ybvu5e4g

alzheimersreadingroom.com Is person centered care really being used in Alzheimer's and dementia care facilities?

Videos (show all)

Early Onset Alzheimer's person from Australia
an early onset man with Alzheimer's. Incredible! So positive! Inspirational!

Location

Telephone

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13601 Preston Road
Dallas, TX
75240

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