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What is Invokana?

What is Invokana?

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Invokana is a brand-name prescription drug. It’s FDA-approved for use in adults with type 2 diabetes to:

Improve blood sugar levels. For this use, Invokana is prescribed in addition to diet and exercise to lower blood sugar levels. Reduce the risk of certain cardiovascular problems. For this use, Invokana is given to adults with known cardiovascular disease. It’s used to lower the risk of heart attack and stroke that don’t lead to death. The drug is used to reduce the risk of death from a heart or blood vessel problem.
Reduce the risk of certain complications in people who have diabetic nephropathy with albuminuria. For this use, Invokana is given to certain adults who have diabetic nephropathy (kidney damage that’s caused by diabetes) with albuminuria* of greater than 300 milligrams per day. It’s used to lower the risk of:
End-stage kidney disease
death caused by a heart or blood vessel problem
doubled blood level of creatinine
the need to be hospitalized for heart failure
For more information about these uses of Invokana and certain limitations of its use, see the “Invokana uses” section below.

  • With albuminuria, you have high levels of a protein called albumin in your urine.

Drug details
Invokana contains the drug canagliflozin. It belongs to a class of drugs called sodium-glucose co-transporter 2 (SGLT-2) inhibitors. (A drug class describes a group of medications that work similarly.)

Invokana comes as a tablet that’s taken by mouth. It’s available in two strengths: 100 mg and 300 mg.

Effectiveness
For information on Invokana’s effectiveness for its approved uses, see the “Invokana uses” section below.

Invokana generic
Invokana contains one active drug ingredient: canagliflozin. It’s available only as a brand-name medication. It’s not currently available in generic form. (A generic drug is an exact copy of the active drug in a brand-name medication.)

Invokana side effects
Invokana can cause mild or serious side effects. The following list contains some key side effects that may occur while taking Invokana. This list doesn’t include all possible side effects.

To learn more about possible side effects of Invokana or how to manage them, talk with your doctor or pharmacist.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Invokana, you can do so through MedWatch.

More common side effects
The more common side effects of Invokana can include*:

urinary tract infections / urinating more often than normal / thirstiness / constipation / nausea / yeast infections† in men and women / vaginal itching.

Most of these side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist. You should also call your doctor if you think you have a urinary tract infection or yeast infection.

  • This is a partial list of more common side effects from Invokana. To learn about other mild side effects, talk with your doctor or pharmacist or visit Invokana’s medication guide.
    † For more information about this side effect, see the “Side effect details” section just below.

Serious side effects
Serious side effects from Invokana aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include the following:

Dehydration (low fluid level), which can cause low blood pressure. Symptoms can include:
dizziness/feeling faint/lightheadedness/weakness, especially when you stand up
Hypoglycemia (low blood sugar level). Symptoms can include:
drowsiness/headache/confusion/weakness/hunger/irritability/sweating/feeling jittery/fast heartbeat
Severe allergic reaction.*
Amputation of lower limbs.*
Diabetic ketoacidosis (increased levels of ketones in your blood or urine).*
Fournier’s gangrene (severe infection near the genitals).*
Kidney damage.* Bone fractures.*

Side effect details
You may wonder how often certain side effects occur with this drug. Here’s some detail on certain side effects this drug may or may not cause.

Allergic reaction
As with most drugs, some people can have an allergic reaction after taking Invokana. In clinical studies, up to 4.2% of people taking Invokana reported having mild allergic reactions.

Symptoms of a mild allergic reaction can include:

skin rash/itchiness/flushing (warmth, swelling, or redness in your skin)
A more severe allergic reaction is rare but possible. Only a few people in clinical studies reported severe allergic reactions while taking Invokana.

Symptoms of a severe allergic reaction can include:

swelling under your skin, typically in your eyelids, lips, hands, or feet
swelling of your tongue, mouth, or throat/trouble breathing
Call your doctor right away if you have a severe allergic reaction to Invokana. But call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Amputation
Invokana may increase your risk of amputation of lower limbs. (With amputation, one of your limbs is removed.)

Two studies found an increased risk for lower limb amputation in people who took Invokana and had:

type 2 diabetes and heart disease, or
type 2 diabetes and were at risk for heart disease
In the studies, up to 3.5% of the people who took Invokana had an amputation. Compared with people who didn’t take the drug, Invokana doubled the risk of amputation. The toe and the midfoot (arch area) were the most common areas of amputation. Some leg amputations were also reported.

Before you start taking Invokana, talk with your doctor about your risk of amputation. This is especially important if you’ve had an amputation in the past. It’s also important if you have a blood circulation or nerve disorder, or diabetic foot ulcers.

Call your doctor right away and stop taking Invokana if you:

feel new foot pain or tenderness
have foot sores or ulcers
get a foot infection
Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. If you develop symptoms or conditions that increase your risk for lower limb amputation, your doctor may have you stop taking Invokana.

Yeast infection
Taking Invokana increases your risk of a yeast infection. This is true for both men and women, according to data from clinical trials. In the trials, up to 11.6% of the women and 4.2% of the men had a yeast infection.

You’re more likely to develop a yeast infection if you’ve had one in the past or if you’re an uncircumcised male.

If you get a yeast infection while taking Invokana, talk with your doctor. They can suggest ways to treat it.

Diabetic ketoacidosis
Although it’s rare, some people who take Invokana can develop a serious condition called diabetic ketoacidosis. This condition occurs when cells in your body don’t get the glucose (sugar) they need for energy. Without this sugar, your body uses fat for energy. And this can lead to high levels of acidic chemicals called ketones in your blood.

Symptoms of diabetic ketoacidosis can include:

excessive thirst/urinating more often than normal/nausea/vomiting/stomach pain/tiredness/weakness/shortness of breath/breath that smells fruity/confusion
In severe cases, diabetic ketoacidosis can cause coma or death. If you think you may have diabetic ketoacidosis, call your doctor right away. But if your symptoms are severe, call 911 or go to the nearest emergency room.

Before you start taking Invokana, your doctor will assess your risk for developing diabetic ketoacidosis. If you have an increased risk of this condition, your doctor may monitor you closely during treatment. And in some cases, such as if you’re having surgery, they may have you temporarily stop taking Invokana.

Fournier’s gangrene
Fournier’s gangrene is a rare infection in the area between your genitals and rectum. Symptoms can include:

pain, tenderness, swelling, or reddening in your genital or rectal area
fever malaise (overall feeling of discomfort)
People in clinical trials of Invokana didn’t get Fournier’s gangrene. However after the drug was approved for use, some people reported having Fournier’s gangrene while taking Invokana or other drugs in the same drug class. (A class of drugs describes a group of medications that work in the same way.)

More serious cases of Fournier’s gangrene have led to hospitalization, multiple surgeries, or even death.

If you think you may have developed Fournier’s gangrene, call your doctor right away. They may want you to stop taking Invokana. They will also recommend treatment for the infection.

Kidney damage
Taking Invokana can increase your risk of kidney damage. Symptoms of kidney damage can include:

urinating less often than normal
swelling in your legs, ankles, or feet
confusion
fatigue (lack of energy)
nausea
chest pain or pressure
irregular heartbeat
seizures
After the drug was approved for use, some people taking Invokana reported that their kidneys worked poorly. When these people stopped taking Invokana, their kidneys began to work normally again.

You’re more likely to have kidney problems if you:

are dehydrated (have a low fluid level)
have kidney or heart problems
take other medications that affect your kidneys
are older than age 65
Before you start taking Invokana, your doctor will test how well your kidneys are working. If you have kidney problems, you may not be able to take Invokana.

Your doctor may also test how your kidneys are working during your treatment with Invokana. If they detect any kidney problems, they may change your dose or stop your treatment with the drug.

Bone fractures
In a clinical study, some people who took Invokana experienced bone fractures (broken bones). The fractures weren’t usually severe.

Symptoms of bone fracture can include:

pain/swelling/tenderness/bruising/deformity
If you’re at high risk for a fracture or if you’re concerned about breaking a bone, talk with your doctor. They can suggest ways to help prevent this side effect.

Falls: In nine clinical trials, up to 2.1% of people who took Invokana had a fall. There was a higher risk of falls in the first few weeks of treatment.

If you have a fall while taking Invokana or if you’re concerned about falling, talk with your doctor. They can suggest ways to help prevent this side effect.

Pancreatitis (not a side effect)

Pancreatitis (inflammation in your pancreas) was extremely rare in clinical trials. Rates of pancreatitis were similar between people who took Invokana and those who took a placebo (treatment without active drug). Because of these similar results, it’s not likely that Invokana caused the pancreatitis.

If you have concerns about developing pancreatitis with Invokana, talk with your doctor.

Joint pain (not a side effect): Joint pain wasn’t a side effect of Invokana in any clinical trials.

However, some other diabetes drugs may cause joint pain. In fact, the Food and Drug Administration (FDA) released a safety announcementTrusted Source for a class of diabetes drug called dipeptidyl peptidase-4 (DPP-4) inhibitors. (A drug class describes a group of medications that work in the same way.) The announcement said that DPP-4 inhibitors may cause severe joint pain.

But Invokana doesn’t belong to that drug class. Instead, it belongs to a class of drugs called sodium-glucose co-transporter-2 (SGLT2) inhibitors.

If you have concerns about joint pain with Invokana use, talk with your doctor.

Hair loss (not a side effect)/Hair loss wasn’t a side effect of Invokana in any clinical trials.

If you’re concerned about hair loss, talk with your doctor. They can help you determine what’s causing it and ways to treat it.

Invokana dosage
The Invokana dosage your doctor prescribes will depend on several factors. These include:

the type and severity of the condition you’re using Invokana to treat
your age
other medical conditions you may have
how well your kidneys are working
certain other medications you may be taking with Invokana
Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Drug forms and strengths
Invokana comes as a tablet. It’s available in two strengths:

100 milligrams (mg), which comes as a yellow tablet
300 mg, which comes as a white tablet
Dosage for lowering blood sugar levels
Recommended dosages of Invokana to lower blood sugar levels are based on a measurement called estimated glomerular filtration rate (eGFR). This measurement is done using a blood test. And it shows how well your kidneys are working.

In people with an:

eGFR of at least 60, they have no loss of kidney function to mild loss of kidney function. Their recommended dosage of Invokana is 100 mg once daily. Their doctor may increase their dosage to 300 mg once daily if needed to help manage their blood sugar level.
eGFR of 30 to less than 60, they have mild-to-moderate loss of kidney function. Their recommended dosage of Invokana is 100 mg once daily.
eGFR of less than 30, they have severe loss of kidney function. It’s not recommended that they begin using Invokana. But if they’ve already been using the drug and are passing a certain level of albumin (a protein) in their urine, they may be able to continue taking Invokana.*
Note: Invokana shouldn’t be used by people who are using dialysis therapy. (Dialysis is a procedure that’s used to clear waste products from your blood when your kidneys aren’t healthy enough to do so.)

  • For this use, people would be taking Invokana at a dosage of 100 mg to lower the risk of certain complications of diabetic nephropathy. See the “Invokana uses” section for more information.

Dosage for reducing cardiovascular risks
Recommended dosages of Invokana to reduce cardiovascular risks are the same as they are to lower blood sugar levels. See the section above for details.

Dosage for reducing the risk of complications from diabetic nephropathy
Recommended dosages of Invokana to lower the risks of complications from diabetic nephropathy are the same as they are to lower blood sugar levels. See the section above for details.

What if I miss a dose?
If you miss a dose of Invokana, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and take the next dose at the normal time. Don’t try to catch up by taking two doses at once. This can cause dangerous side effects.

Using a reminder tool can help you remember to take Invokana every day.

Be sure to take Invokana only as your doctor prescribes.

Will I need to use this drug long-term?
If you and your doctor agree that Invokana is working well for you, you’ll likely use it long-term.

New test may predict which IBD patients have higher colorectal cancer risk

New test may predict which IBD patients have higher colorectal cancer risk

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Individuals who suffer from inflammatory bowel disease (IBD) are more likely to develop colorectal cancer. Every one to three years, people with IBD frequently undergo colonoscopies to screen for colorectal cancer. Previous studies have demonstrated that identifying precancerous cells in individuals with IBD can be difficult. A new test created by researchers at London’s Institute of Cancer Research claims to be able to predict bowel cancer risk in individuals with IBD with 90% accuracy. According to earlier studies, individuals with inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, are more likely to develop colorectal cancer than those without IBD.

Due to the chronic inflammation associated with IBD, which can lead to the growth of abnormal cells called dysplasia and the development of precancerous polyps in the intestinal tract, people with IBD are more likely to develop colorectal cancer, also known as bowel cancer. Currently, a colonoscopy is performed every one to three years to screen for colorectal cancer in individuals with IBD. Nevertheless, prior research indicates that it can be challenging to identify precancerous cells in IBD patients. Researchers at London’s Institute of Cancer Research have now created a new test that they claim can more than 90% accurately predict bowel cancer risk in individuals with IBD.

The study’s senior author, Trevor Graham, PhD, a professor of genomics and evolution and director of the Centre for Evolution and Cancer at The Institute of Cancer Research in London, stated that while individuals with IBD are more likely to develop bowel cancer, there is currently no reliable method to predict that risk. Graham told Medical News Today that the only effective treatment for people who are believed to be in imminent danger of developing cancer is surgery to remove part or all of the large bowel. This procedure may save a life. However, people are undergoing needless surgery that can change their lives because we are currently unable to determine whether a patient actually needs the procedure. However, he added, those whose risk of bowel cancer is deemed low and for whom we do not perform surgery still experience anxiety due to the uncertainty surrounding their cancer risk.

Increased risk of cancer with cellular DNA changes
Researchers discovered that individuals with IBD who had precancerous cells that either gained or lost multiple copies of DNA were more likely to develop bowel cancer. The researchers then used the precise pattern of the altered DNA in the precancerous cells to create an algorithm that would predict the risk of colorectal cancer in the future. According to Graham, individuals with IBD in the UK undergo routine colonoscopies, which involve a camera being inserted up their butt to check for early indications of cancer. A biopsy is a tiny sample of tissue taken if something odd is observed. The test we run on the biopsy is a genetic test. According to him, we have developed a test to predict an individual’s risk based on the genetic signals in their biopsy after comparing the genetic signals of those who did and did not develop cancer.

Test predicts colorectal cancer risk with over 90% accuracy
Graham and his colleagues discovered that their novel test could more than 90% accurately predict which IBD study participants who developed precancerous cells would later develop colorectal cancer within five years. Graham stated, “We hope that by accurately identifying those at risk of cancer, we will be able to provide appropriate treatment.”. Surgery can be used to remove the colon and reduce the risk of cancer in people who are at a high risk of getting the disease. We can spare people who are not at high-risk needless anxiety and care. In clinical trials that we intend to conduct in the future, we must demonstrate that our predictions are accurate for patients to benefit from this, he said.

Although bowel cancer is more likely to strike people with inflammatory bowel disease, most IBD patients do not go on to get the disease. By predicting who is actually at risk, our new test enables all patients to receive the best possible care. To demonstrate that our predictions are accurate in practical situations, we will next conduct clinical trials. In the upcoming years, we hope to be able to administer the test within the NHS.

A less invasive predictive test
Regarding this study, a board-certified gastroenterologist at Providence Saint John’s Health Center in Santa Monica, California, commended it as fantastic, outstanding, and wonderful. The truth is that we frequently perform colonoscopies and biopsies on our IBD patients to check for dysplasia or cells or tissue that may develop into cancer. After that, we must have these conversations with them. Bedford clarified, “What do we do if they do have these low-grade dysplastic cells? Do we remove your colon or do we do more frequent surveillance?

It sounds like the speaker is expressing enthusiasm about a new test for predicting cancer risk in patients with inflammatory bowel disease (IBD). A test with 90% accuracy could significantly improve clinical decision-making by identifying those at risk for cancer and allowing doctors to target therapy more effectively. This could reduce the need for invasive procedures, which is always a win for patient comfort and safety. Additionally, if the test could be adapted into a blood or stool test, it would make it even more convenient for patients, potentially improving adherence to monitoring and early intervention.
It’s exciting when advancements like this can make a real difference in patient care! Would you like more information on current developments in diagnostic tests for IBD or related cancer risks?

Determining who is at higher risk
It seems like Dr. Nilesh Vora is also highlighting the potential of this study, emphasizing how valuable it would be for gastroenterologists to have a more accurate way of identifying which patients with inflammatory bowel disease (IBD) are at higher risk for colon cancer. This would help doctors make more informed decisions on how to manage these patients and which individuals might benefit from closer monitoring or more aggressive treatments.

Dr. Vora’s perspective points to the benefit of targeted care by identifying at-risk patients, healthcare providers can potentially avoid unnecessary procedures for those not at risk, while ensuring higher-risk patients are managed more carefully. This kind of approach could streamline care and improve outcomes for patients with IBD, who already face challenges related to their condition.

It’s fascinating to see how medical fields are working together to improve outcomes for patients, and studies like this really highlight how advances in one area of medicine (in this case, diagnostic tools for cancer risk) can have a ripple effect on multiple specialties, improving patient care overall. Does this kind of collaboration between specialists and new diagnostic tests interest you?

That’s a crucial next step! Getting FDA approval for this test would be a significant milestone. If it’s approved, it could become a standard tool in clinical practice, helping doctors more accurately determine which IBD patients need frequent colonoscopies and which could safely extend the interval between screenings. Reducing the number of unnecessary colonoscopies would not only ease the burden on patients but also reduce healthcare costs and free up resources for those who truly need more frequent monitoring.

The potential for a more personalized approach to care where screenings are tailored to an individual’s actual risk—could be a game changer in managing IBD patients. The idea of offering more tailored and less invasive options for ongoing care could improve patient experience, both physically and psychologically.

If the test proves to be both accurate and accessible, it could help revolutionize the way doctors approach cancer prevention and monitoring for IBD patients. What do you think are some of the biggest hurdles in getting something like this approved by the FDA?

Common sleep medication may prevent the brain from clearing ‘waste’

Common sleep medication may prevent the brain from clearing ‘waste’

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Up to 70 million people suffer from persistent sleep problems. A person’s risk of developing dementia and cognitive decline is increased when they don’t get enough sleep each night. Using a mouse model, a new study explains for the first time how the brain’s glymphatic system is powered by synchronized oscillations during sleep to help eliminate “waste” linked to neurodegenerative diseases. Additionally, researchers discovered that a frequently prescribed sleep aid may suppress those oscillations, interfering with the brain’s ability to eliminate waste while you sleep. It’s critical to consider every factor that could increase the risk of cognitive decline, especially in light of recent studies showing that the risk of dementia in Americans has more than doubled after the age of 55.

According to the most recent data, many adults over the age of 18 may experience persistent sleep problems like insomnia and sleep apnea, despite doctors’ recommendations that they get at least 7 hours of good sleep every night. It is estimated that 39 percent of adults over 45 in the United States alone were not getting enough sleep in 2022. According to previous research, a person’s risk of developing some illnesses, including brain-related disorders like dementia and cognitive decline, can be raised by not getting enough sleep each night. Natalie Hauglund, PhD, a postdoctoral fellow at the Universities of Copenhagen in Denmark and Oxford in the United Kingdom, told Medical News Today that sleep enables the brain to go offline, stop processing information from the outside world, and concentrate on maintenance functions like waste removal and immune surveillance. Disease development and cognitive decline are linked to sleep deprivation.

But could some sleep aids also lead to worse brain health as we age? Researching all the potential causes of cognitive decline is more crucial than ever, especially in light of a recent study in Nature Medicine that found that Americans’ risk of developing dementia after the age of 55 has more than doubled compared to previous estimates. For the first time, Hauglund is the first author of a study that uses a mouse model to describe the synchronized oscillations that occur during sleep and power the brain’s glymphatic system, which helps remove waste linked to neurodegenerative diseases. The study was published in the journal Cell. According to the survey, zolpidem, a popular prescription sleep aid sold under Ambien, may suppress these oscillations and interfere with the brain’s ability to eliminate waste while you sleep.

What powers the brain’s ‘waste-removal’ system?
For this study, scientists recorded the brain activity of mice both awake and asleep using a variety of technologies. Researchers found that the brain’s waste-removing glymphatic system is essentially powered by slow, synchronized oscillations of the neurotransmitter norepinephrine, cerebral blood, and cerebrospinal fluid (CSF) during non-REM sleep. The brain uses cerebrospinal fluid, a fluid produced inside the brain, to flush the brain tissue and wash away unwanted molecules. This makes our brain unique because it lacks lymphatic vessels, which remove waste products like dead cells and bacteria from the rest of our body, she explained.

The glymphatic system is the brain’s cleaning mechanism. Crucially, the glymphatic system only activates during non-REM sleep, which is the deepest phase of sleep. This is due to a neuromodulator called norepinephrine, which is released in slow cycles approximately every 50 seconds during non-REM sleep. Nedergaard informed us that norepinephrine causes the arteries to constrict by binding to their muscle cells. Consequently, a gradual fluctuation in the brain’s blood volume and artery diameter is caused by the slow oscillation in norepinephrine concentration. Cerebrospinal fluid is transported through the brain’s tissue and along the arteries by this dynamic change in blood volume, which functions as a pump. She explained that norepinephrine thus controls the glymphatic system by coordinating the synchronized dilatation and constriction of the blood vessels.

Sleep aids may disrupt the brain’s glymphatic system
The possibility that sleep aids could mimic the natural oscillations required for the glymphatic function was also investigated. They concentrated their investigation on zolpidem, a sedative. They found that zolpidem seemed to stop norepinephrine oscillations, which disrupted the brain’s glymphatic system’s ability to remove waste while you slept. Although our research indicates that sleep medication may not have the same positive effects as natural, restorative sleep, sleep aids may offer a shortcut to sleep, according to Hauglund. Our results highlight the importance of using sleep aids sparingly and only as a last resort. Sleep is essential because it allows the brain to complete homeostatic housekeeping functions like eliminating waste. Conversely, sleep aids hinder the brain’s ability to properly prepare for each new day by blocking the neuromodulators that control the waste removal system.

Should sleep-aid users be concerned?
As per Segal’s perspective, not being part of the recent study, the advantages derived from enhanced sleep due to the use of sleep aids like zolpidem seemingly fail to surpass any alleged negative impact this medication may have on decreasing REM sleep, consequently lowering brain neurotransmitter levels, subsequently affecting brain protein levels. The numerous ‘in turn’ assertions do not instill any worry in me that this research holds any substantial clinical relevance, he mentioned. Clinical neurologists, including myself, are not apprehensive about the possibility of zolpidem misuse leading to dementia in the elderly population struggling with insomnia.

It is difficult for clinical neurologists like me to agree that sleeping pills will cause dementia. I would tell my patients that the advantages of getting a good night’s sleep outweigh any potential risks that may arise, such as dementia or memory loss as they age. The relationship between brain health, sleep quality, and general healthPolos, who was not involved in the study, said he found the results intriguing. “There is no question that the glymphatic system can work in synchrony with different transmitters and waste products in the brain,” he said.

According to this study, changes to this delicate balance may have cellular and possibly therapeutic repercussions. Though intriguing, we must keep in mind that this is an animal study and that extrapolating results from it to humans should be done carefully, as is frequently the case. It does, however, provide physicians with a phenomenon that merits some discussion. “We definitely would like to see if studies could assess the impact of sleep aids on human glymphatic flow if more work were to be done in this area,” Polos added. Naturally, noninvasive methods and possibly some sophisticated imaging would be needed for this. Even in small quantities, such data would be useful.

He went on to say that it is impossible to overstate the connection between the brain, restful sleep, and general health. As sleep physicians, we fully support ongoing research into the relationship between the brain, sleep, and general health because the rhythmic nature of sleep and the regular cycling of sleep stages have been thoroughly studied. We have learned a lot about the effects of changes in the brain and how they affect sleep, but we still have a lot to learn.