What Parents Should Expect When Their Child Is Getting an Appendectomy

When a child experiences abdominal pain, it can be a cause of concern for parents. One of the most common causes of severe stomach pain in children is appendicitis. Appendicitis occurs when the appendix becomes inflamed or infected. If it is left untreated, it can rupture, leading to serious complications.

Signs and symptoms of appendicitis in children include:

  • Sudden pain in the lower right side of the abdomen
  • Nausea or vomiting
  • Fever
  • Loss of appetite
  • Swelling or bloating in the abdomen

Symptoms of appendicitis may vary, and younger children may have difficulty articulating their pain.

The best treatment for appendicitis is a surgical procedure called an appendectomy. An appendectomy is often an emergency surgery.

Your child may not have a lot of time to get ready for the appendectomy. The healthcare team will want to know when your child last ate because having food in the stomach can cause problems when your child is under anesthesia. If the surgery is planned ahead of time, ask the healthcare provider when your child should stop eating and drinking beforehand.

After the appendectomy, your child will need to rest as it may take a few weeks for them to feel back to normal.

Some tips to help your child have a smooth recovery after the appendectomy include:

  • Follow the surgeon’s post-operative care instructions closely
  • Limit strenuous activities to avoid putting strain on the surgical area
  • Keep your child hydrated and encourage them to eat a light, nutritious diet to aid in their recovery

It is important to call your healthcare provider if your child:

  • Has fever higher than 101.5°F (38.6°C) or higher
  • Has abdominal swelling
  • Has green or yellow drainage from any incision
  • Has pain that gets worse as hours or days pass
  • Has redness or swelling around the incision
  • Shows signs of sluggishness
  • Is vomiting
  • Will not drink
  • Doesn’t start to eat one or two days after surgery
  • Hasn’t had a bowel movement for two days after the surgery
  • Has diarrhea

The pediatric surgeons at Jamaica Hospital Medical Center provide many different surgical services to younger patients. For more information about our Queens, NYC pediatric surgical services or to make an appointment, please call (718) 206-7001.

 

 

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Measles

Measles is a highly contagious disease caused by the measles virus. It can affect anyone, but it is most common in children.

Some risk factors for measles include:

  • Being unvaccinated
  • Traveling internationally
  • Having a Vitamin A deficiency

Measles infects the respiratory tract and then spreads throughout the body. Signs and symptoms of measles appear around 10 to 14 days after exposure to the virus, including:

  • Fever
  • Dry cough
  • Runny nose
  • Sore throat
  • Inflamed eyes
  • Koplik’s spots (tiny white spots with bluish-white centers on a red background, which form on the inner lining of the cheek)
  • A skin rash made up of large, flat blotches that often flow into one another

The infection occurs in stages that span over two to three weeks. These stages include:

  • Infection and incubation- the measles virus spreads in the body for 10 to 14 days after infection. During that time, there are no signs or symptoms.
  • Nonspecific signs and symptoms- measles typically begins with a mild to moderate fever, a persistent cough, a runny nose, inflamed eyes, and a sore throat. This mild illness can last two to three days.
  • Acute illness and rash- a rash that can consist of small red spots, with some that may be slightly raised. Spots and bumps in tight clusters give the skin a splotchy red appearance. The face is usually the first place it appears. The rash spreads down the arms, chest, and back, then over the thighs, lower legs, and feet over the next few days. At the same time, the fever rises to temperatures as high as 104 to 105.8.
  • Recovery- the measles rash can last for about seven days. The rash fades gradually from the face and lastly the thighs and feet. As other symptoms go away, coughing and the darkening or peeling of the skin where the rash was, last about 10 days.

A person with measles can spread the virus to others for about eight days. Starting four days before the rash appears and ending when the rash has been present for four days.

When an infected person coughs, sneezes, or talks, infectious droplets spray into the air where others can breathe them in. Infectious droplets can stay in the air for about an hour and on a surface for several hours.

Many complications can arise from measles, including:

  • Diarrhea and vomiting
  • Ear infection
  • Bronchitis, laryngitis, or croup
  • Pneumonia
  • Encephalitis
  • Pregnancy problems

The U.S. Centers for Disease Control and Prevention (CDC) recommends that children and adults receive the measles vaccine to prevent infection.

Your healthcare provider can usually diagnose measles based on the disease’s characteristic rash and the Koplik’s spot on the inner lining of the cheek. Your healthcare provider may ask whether you or your child received measles vaccines, whether you traveled outside of the U.S. recently, and if you had contact with anyone who has a rash or fever.

The rash can be confused with many other illnesses. However, a blood test can be done to confirm whether the rash is measles. A test using a throat swab or urine sample can also be used.

There is no specific treatment for a measles infection once it occurs. Treatment can include providing comfort measures to relieve symptoms, such as rest and treating or preventing complications.

Some measures can be taken to protect individuals who don’t have immunity to measles after they have been exposed to the virus, including:

  • Post-exposure vaccination
  • Immune serum globulin
  • Medications
    • Fever reducers
    • Antibiotics
    • Vitamin A

If you become sick with severe symptoms, particularly after potential exposure to the measles virus, you must receive treatment from a doctor as soon as possible. You can schedule an appointment with a doctor at Jamaica Hospital Medical Center’s Ambulatory Care Center. Please call (718) 206-7001.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Back to School Health Tips

As children prepare for the school year, it is important for them to return to school healthy.

Here are some tips to make sure your child is healthy before they go back to school:

  • Make sure they are up to date on their vaccinations. Vaccinations are essential for protecting children and others against various diseases.
  • Make sure they get their flu and COVID-19 shots. Every child six months or older should get their yearly flu shots, as flu season typically starts in the fall and peaks between December and February.
  • Make sure they get vision and hearing tests done. Children should have their hearing and vision tested with their doctor from infancy through high school. Watch for signs of hearing or vision loss and talk to your child’s healthcare provider if you notice any changes.
  • Help your child make healthy food choices, even at school. Encourage them to eat plenty of fruits and vegetables. When eating bread or pasta, choose 100% whole-grain products. Encourage them to choose water, not juice or soda.
  • Make sure to take care of their mental health. Managing school stress, relationships, and friendships can be overwhelming. Encourage them to talk about their emotional health.
  • Make sure to limit their screen time. Children under the age of two years old should have no screen time. Limit screen time to one to two hours a day for children two years old and over. Parents are encouraged to delay access to smartphones until at least 14 years old.
  • Be sure to monitor their social media use. Social media use starting during childhood can play a significant role in the relationships and experiences that impact children’s and teens’ growth, development, and mental health. Parents are encouraged to set aside time to discuss social media use, including setting privacy limits on who can see and interact with them.
  • Make sure your child gets a good night’s sleep. Adequate sleep helps kids focus each day at school and is important for their health. Children between the ages of three and five should sleep 10 to 13 hours (including naps). Children six to 12 years of age should sleep nine to 12 hours a night. Teenagers 13 to 18 years of age should sleep eight to 10 hours a night.

These back-to-school health tips will help you and your family return to the classroom safely and be confident in your health.

 

 

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

National Breastfeeding Month

August is National Breastfeeding Month. It is a time when communities and health organizations work in tandem to share the many health benefits of breastfeeding for the nursing mother and baby and to celebrate the natural and healthful bond between a new mother and her infant.  

There are five great health benefits of breastfeeding, including: 

  • Breast milk is the best source of nutrition for most babies. As the baby grows, the mother’s breast milk will change to meet the baby’s nutritional needs. 
  • Breastfeeding can help protect babies against some short- and long-term illnesses and diseases. Breastfed babies have a lower risk of asthma, obesity, Type 1 diabetes, and sudden infant death syndrome (SIDS). Breastfed babies are also less likely to have ear infections and stomach bugs.  
  • Breast milk shares antibodies from a mother to her baby. These antibodies help babies develop a strong immune system and protect them from illnesses.  
  • Mothers can breastfeed anytime and anywhere. Mothers can feed their babies on the go without worrying about having to mix formula or prepare bottles. Breastfeeding can also provide a source of comfort for babies whose normal routine is disrupted while traveling. 
  • Breastfeeding has health benefits for the mother as well. Breastfeeding can reduce the mother’s risk of breast and ovarian cancer, Type 2 diabetes, and high blood pressure.  

Ways you can celebrate National Breastfeeding Month include: 

  • Learn more and educate others about breastfeeding 
  • Support breastfeeding mothers 
  • Advocate for better breastfeeding policies 
  • Donate to relevant breastfeeding advocacy organizations 
  • Share stories and experiences about breastfeeding 
  • Volunteer during National Breastfeeding Month 
  • Participate in breastfeeding events 
  • Express gratitude for those who are breastfeeding 

At Jamaica Hospital’s Baby Friendly USA-designated Department of Women’s Health Services, we are passionate about meeting the various needs of women in our community. We proudly treat women from all walks of life, and we provide a warm and welcoming environment. To learn more about our OB/GYN services, such as breastfeeding, please contact us at 718-291-3276 for more information. 

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Children’s Eye Health and Safety Month

August is Children’s Eye Health and Safety Month. As many parents prepare their children for the new school year, it is essential to have their eyes checked.  

Vision is a vital part of a child’s development. It is how they learn, play, and interact with the world around them. Uncorrected vision problems can impair child development, interfere with learning, and even lead to permanent vision loss.  

Unfortunately, many eye problems in children go undetected, which can lead to long-term issues. Regular eye exams are crucial in identifying problems early, ensuring your child has the best chance for healthy vision. Good vision is essential for their performance in school, in sports, and for their overall well-being. 

Vision issues in children are common in the United States. They are vulnerable to many eye problems, including: 

  • Injuries 
  • Infections 
  • Nearsightedness 

There are many things to be aware of that may indicate a problem with your child’s eyes, including: 

  • Their eyes do not line up or appear crossed 
  • Their eyelids are red-rimmed, crusted, or swollen 
  • Their eyes are watery or inflamed 
  • They rub their eyes a lot 
  • They close or cover one eye 
  • They tilt their head forward 
  • They have trouble reading or doing other close-up work  
  • They hold objects close to their eyes to see 
  • They blink more than usual or seem cranky when doing close-up work 
  • Things are blurry or hard to see for them 

There are many ways to protect your child’s eye health, including: 

  • Getting regular eye exams 
  • Wearing protective eyewear during sports and other activities 
  • Limiting screen time 
  • Practicing healthy nutrition 

If you would like to schedule an eye exam for your child, you can visit an ophthalmologist at Jamaica Hospital Medical Center. To schedule an appointment, please call (718) 206-5900. 

 

 

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Cystic Fibrosis Awareness Month

May is Cystic Fibrosis Awareness Month. It is observed as a month that encourages education about the battle against the disease, which affects more than 30,000 people in the United States.

Cystic Fibrosis is a genetic disorder that affects the lungs, causing constant lung infections. It also impacts other organs in the body where mucus builds up, such as the pancreas.

There are two types of cystic fibrosis, classic cystic fibrosis and atypical cystic fibrosis.

Classic cystic fibrosis often affects multiple organs. It is usually diagnosed in the first few years of life.

Symptoms of classic cystic fibrosis include:

  • Frequent lung infections
  • Loose or oily poop
  • Trouble breathing
  • Frequent wheezing
  • Frequent sinus infections
  • A nagging cough
  • Slow growth
  • Failure to thrive (inability to gain weight despite having a good appetite and taking in enough calories)

Atypical cystic fibrosis is a milder form of the disease. It may only affect one organ, or symptoms may come and go. It is usually diagnosed in older children or adults.

People with atypical cystic fibrosis may have some of the same symptoms as those with classic cystic fibrosis. Over time, they might experience symptoms that can include:

  • Chronic sinusitis
  • Nasal polyps
  • Dehydration or heatstroke from abnormal electrolyte levels
  • Diarrhea
  • Pancreatitis
  • Unintended weight loss

Changes to the cystic fibrosis transmembrane conductance regulator (CFTR) gene cause cystic fibrosis. It affects the cells that make mucus, sweat, and digestive juices. When the CFTR protein doesn’t work as it should, it results in a thick, sticky mucus in the respiratory, digestive, and reproductive systems, as well as extra salt in sweat.

Changes in the CFTR gene that cause cystic fibrosis are divided into several different groups based on the problems they cause. Different groups of gene changes affect how much CFTR protein is made and how well it works.

To have cystic fibrosis, children must get one copy of the changed CFTR gene from each parent. If children get only one copy, they won’t develop cystic fibrosis. But they will be carriers and could pass the changed gene to their children. People who are carriers may have no symptoms of cystic fibrosis or a few mild symptoms.

Because cystic fibrosis is a genetic condition, family history is a risk factor. Cystic fibrosis occurs in all races. However, it is most common in white people of North European ancestry. Because it is less common in people who are Black, Hispanic, Middle Eastern, Native American, or Asian, this may lead to a much later diagnosis.

A late diagnosis may cause worse health issues. Early and effective treatment can improve your quality of life, prevent complications, and help you live longer. If you are a person of color and have symptoms that could be cystic fibrosis, talk to your healthcare provider so you can get tested for it.

To diagnose cystic fibrosis, healthcare providers usually perform a physical exam, review your symptoms, and perform tests.

Every state in the U.S. now routinely screens newborns for cystic fibrosis. Early diagnosis means treatment can begin right away. Testing can include:

  • Newborn screening
  • A sweat test
  • Genetic testing

Cystic fibrosis tests may be recommended for older children and adults who weren’t screened at birth. A healthcare provider may suggest genetic and sweat tests if you have repeated bouts of symptoms of cystic fibrosis.

Unfortunately, there is no cure for cystic fibrosis, however, treatment can ease symptoms, lessen complications, and improve quality of life. Close monitoring and early, aggressive intervention are recommended to slow the worsening of cystic fibrosis over time, which can lead to a longer life.

The goals of treatment include:

  • Preventing and controlling infections that occur in the lungs
  • Removing and loosening mucus from the lungs
  • Treating and preventing intestinal blockages
  • Getting enough nutrition

To learn more about cystic fibrosis or to make an appointment with a pulmonologist at Jamaica Hospital Medical Center, please call (718) 206-7126.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Lazy Eye in Children

Lazy eye or amblyopia is reduced vision in one eye caused by abnormal visual development early in life. The weaker or lazy eye often wanders inward or outward. Amblyopia generally develops from birth up to seven years old, and rarely affects both eyes.

Signs and symptoms of lazy eye include:

  • A wandering or crossed eye
  • Eyes that appear not to work together
  • Poor depth perception
  • Squinting or shutting an eye
  • Head tilting
  • Abnormal results of vision screening tests

It is important to note that some children display no symptoms of amblyopia. The child’s strong eye and brain can compensate for the weaker eye, making it appear that the child has good vision. Over time, the brain gets used to working with only one eye. The eye that’s being ignored by the brain doesn’t develop normal vision.

There are three main causes of amblyopia, including:

  • Strabismus- which occurs when a child’s eyes aren’t aligned. The eyes don’t work together, leading the brain to ignore one eye
  • Refractive error or need for glasses- children are especially at risk if one eye has a larger need for glasses compared to the other eye
  • Conditions that cause poor vision in one eye, like cataracts or droopy eyelid, prompt the brain to ignore the blurry pictures seen by that eye

Additional factors that can place a child at a higher risk for amblyopia, include:

  • A family history of amblyopia
  • Prematurity
  • Developmental delay
  • Craniofacial disorders
  • Certain genetic conditions, such as:
    • Down syndrome (trisomy 21)
    • 22q deletion syndrome
    • Williams syndrome
    • Noonan syndrome

Vision screening is the best way to diagnose amblyopia and its risk factors. Photoscreening, a type of vision screening that uses a special camera to determine how well a child can see, is often performed in conjunction with vision testing.

Treatment options depend on the cause of lazy eye and how much the condition affects your child’s vision. Treatment your doctor may recommend include:

  • Corrective eyewear
  • Eye patches
  • Bangerter filter
  • Eye drops
  • Surgery

Treatment while your child is young and the eyes are still developing, gives them a better chance of overcoming amblyopia. The goal is to make your child’s brain use both eyes. Getting the eyes to work as a team becomes harder as your child grows. Therefore, early treatment is best. Treatment may not work if started after seven to ten years of age.

If your child is experiencing symptoms of lazy eye, schedule an appointment at Jamaica Hospital Medical Center’s Ophthalmology Center now by calling (718) 206-5900.

 

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

National Bullying Prevention Month

October is National Bullying Prevention Month. It is a time to acknowledge that bullying has devastating effects on children and families.

There are many forms of bullying. It can be verbal, physical, through social exclusion, or digital sources like email, texts, or social media. Unlike mutual teasing or fighting, bullying occurs when one person or group of people is perceived as being more powerful than another and takes advantage of that power through repeated physical assaults, threats of harm, intimidation, or by purposely excluding a person from a valued social group.

Being bullied can severely affect a person’s self-image, social interactions, and school performance, leading to mental health problems such as depression, anxiety, and substance abuse. It can lead to suicidal thoughts and behaviors as well.

There are many steps you can take to prevent bullying, including:

  • Addressing bullying at school- educators and teachers can create a safe and supportive learning environment and a classroom culture of positivity, inclusivity, and respect.
  • Talking about bullying at home- parents and caregivers can talk with their children about their school and digital life, and the many roles children can play in bullying.
  • Supporting your community- mentors can model kindness, inclusivity, and respect.
  • Raising awareness- share information about bullying prevention, its impact, and resources for support on social media to educate your community.
  • Support anti-bullying organizations- contribute to or volunteer with organizations dedicated to bullying prevention and support for victims.
  • Organize anti-bullying events- plan or participate in events, workshops, and seminars in your community that focus on bullying prevention and promote empathy.
  • Engage in school programs- encourage schools to implement anti-bullying programs and provide resources for students, teachers, and parents.
  • Be an upstander- teach children and teenagers the importance of standing up for others and reporting bullying incidents when they occur.

Participating in bullying prevention allows you to join the fight against bullying and create a more inclusive and empathetic society.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Hand Hygiene for Children

Hand hygiene is essential for overall health. Parents and caretakers play an important role in teaching children how to wash their hands. Good hand washing is the first line of defense against the spread of many illnesses as it is the best way to keep children from getting sick.

Here are some tips you can use to turn handwashing into a healthy habit for life:

  • Explain the benefits of handwashing
  • Demonstrate the correct steps of handwashing
    • Step 1: Wet hands with running water
    • Step 2: Apply enough soap to cover wet hands
    • Step 3: Scrub all surfaces of the hands, including the back of the hands, between the fingers, and under the nails
    • Step 4: Rinse hands thoroughly with running water
    • Step 5: Dry hands with a clean cloth or a single-use towel
  • Hands should be washed with soap for at least 20-30 seconds. An easy way to determine the time is by singing the entire “Happy Birthday” song twice.
  • Set the times when they should be washing their hands
    • When they are visibly dirty
    • Before and after eating
    • After using the toilet
    • After touching animals and pets
    • After blowing their nose or when they cough or sneeze
    • Before and after visiting friends and relatives
  • Turn it into a fun family activity

There might be moments when children can’t get to a bathroom to wash their hands with soap and water. Teach them how to use hand sanitizer, especially one that contains at least 60% alcohol.

Handwashing can become a lifelong habit if you start teaching it to children at an early age. The time you spend at the sink could save you trips to the doctor’s office.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Updated Vaccine for Returning Students

The new school year is right around the corner. That means parents will be taking their children shopping for new school supplies and clothes. In addition to updating their child’s wardrobe and supplies, parents should remember to schedule vaccinations before the school year begins.

Vaccines are the best way to prevent your child from getting many illnesses and spreading them to others. Each age group has recommended vaccines they need to receive before starting their new grade:

Vaccines for children aged four to six before they start kindergarten:

  • Flu – needed every year
  • COVID-19
  • Measles, mumps, and rubella (MMR)
  • Diphtheria, tetanus, and pertussis (DTaP)
  • Chickenpox
  • Polio

Vaccines for children aged seven to 10 before they start elementary school:

  • Flu
  • COVID-19

Vaccines for children aged 11 to 12 before they begin middle school:

  • Flu
  • COVID-19
  • Tetanus, diphtheria, and pertussis (Tdap)
  • Meningococcal conjugate (MenACWY)
  • HPV

Vaccines for children aged 13-18 before they enter junior and high school:

  • Flu
  • COVID-19
  • Meningococcal conjugate (MenACWY)
  • HPV

Vaccines for college-aged teenagers:

  • Flu
  • COVID-19
  • Meningococcal conjugate (MenACWY)
  • HPV

You can find the complete schedule of recommended vaccines for your child by age on the Centers for Disease Control and Prevention’s website. To schedule an appointment for your child to receive the vaccines needed, you can call Jamaica Hospital Medical Center’s Ambulatory Care Center at 718-206-7001.

 

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.