Blog | Dinizulu Law Group, Ltd

Report Shows Nursing Home Abuse Increased But Extremely Underreported

July 29, 2019/in Blog, Uncategorized/by Yao Dinizulu

CHICAGO, IL – A study recently conducted by the U.S. Government Accountability Office (GAO) shows an increase in nursing home abuse between 2013 and 2017, stating abuse deficiencies more than doubled. In 2017, abuse deficiencies were categorized at the highest levels of severity causing actual harm to residents or putting them in immediate jeopardy.

GAO identified the most common types of abuse and perpetrators including physical abuse (46 percent) and mental/verbal abuse (44 percent) were the leading forms of abuse, followed by sexual abuse (18 percent). Nursing home staff, which includes staff working in any part of the nursing home, are most often the perpetrators (58 percent), followed by resident perpetrators (30 percent), and other types of perpetrators (2 percent).

The federal law requires nursing homes to report allegations of abuse of reasonable suspicion of crimes committed against residents; however, Centers for Medicare & Medicaid Services (CMS) has not properly instructed nursing homes on what information should be included in incident reports. Furthermore, there is a lack of information given to state survey agencies which delays the determination of if an investigation should occur.

There are undeniable gaps in the CMS process for referring incidents of abuse to law enforcement, which can limit CMS’s ability to ensure nursing homes meet federal requirements to ensure residents are free of abuse. GAO noted issues relating to referring abuse to law enforcement in a timely manner, tracking abuse referrals, defining what it means to substantiate an allegation of abuse, and sharing information with law enforcement. GAO made recommendations for the respective issues addressed in gaps in the referral process.

Although physical, mental, and verbal abuse is less common than neglect, the review shows a substantial increase in abuse deficiencies cited in nursing homes. The study specifically highlights the largest increase in severe cases. The report notes imperative changes CMS must make to have information complete and readily available, in addition to reporting incidents to law enforcement upon reasonable suspicion a resident is in danger.

General Evidence of Abuse

A loved one may be experiencing abuse if there is a sudden change in their behavior and personality, and/or tension between an elder and their caregiver. The Nursing Home Abuse Center mentions signs and symptoms to look for if you suspect a loved one is being abused.

Physical Abuse

Unexplained broken bones, dislocations, or sprains
Bruising, scars or welts
Failing to take medication properly
Signs of restraint
Broken eyeglasses
Caregiver refusing to let you be alone with the elderly individual

Emotional

Unusual behavior that can resemble symptoms of dementia, including mumbling, sucking one’s thumbs, or rocking behavior
Witnessing the caregiver belittle, control, or use threatening behavior towards elderly person

Sexual Abuse

Unexplained STDs of other genital infections
Bruising on body
Stained, bloody, or torn underwear

Nursing home and elderly abuse is not limited to just abuse – neglect, health care fraud, and financial exploitation are all forms of abuse to consider. If you or a loved one has experienced or suspect elderly abuse is occurring, please contact Dinizulu Law Group, Ltd right away at (312) 384-1920 or by visiting our website. Due to the statue of limitations, we must begin working on your case right away.

Report Shows Pharmaceutical Companies Contributing to U.S. Opioid Epidemic

July 19, 2019/in Blog, Uncategorized/by Yao Dinizulu

CHICAGO, IL – Recently released federal data shows how drug makers and distributors contributed to the nation’s opioid epidemic by increasing shipments of opioid painkillers between 2006 to 2012.

The Drug Enforcement Administration (DEA) records show that over 76 billion oxycodone and hydrocodone pills were distributed to U.S. pharmacies during the 6 year time period. According to the U.S. Centers for Disease Control and Prevention (CDC), opioids contributed to more than 100,000 deaths in the United States between 2006 and 2012.

The Associated Press reported Purdue Pharma was fined $635 million for falsely marketing OxyContin as being less addictive than other generic and brand opioids; however, Purdue accounted for 3 percent of pills sold during that time compared to generic drug distributors accounting for nearly 90 percent of sales.

According to the CDC, other prescription and illegal opioids such as heroin and fentanyl have resulted in more than 430,000 deaths in the U.S. since 2000. Between 2006 and 2012, the annual amount of opioid-related deaths rose from 18,000 to more than 23,000.

Synthetic opioids, such as fentanyl, are among the most common drugs involved in drug overdose deaths in the U.S. According to the National Institute of Drug Abuse, there were 59 percent of opioid-related deaths involving fentanyl in 2017 compared to 14.3 percent in 2010.

Local and state governments have requested these records not be released to the public; however, U.S. District Judge Dan Polster, who is overseeing most of the cases, ruled that it could be made public. Records from 2013 to 2014 have not been released yet and have asked to be sealed and protected.

An article released in 2016 by PBS calls the opioid epidemic “the worst drug crisis in American history,” destroying lives nationwide regardless of age, race, wealth, or location. The CDC stated whites and Native Americans have experienced the largest rise in death rates; moreover, by 2014, whites and Native Americans were dying at double or triple the rates of African-Americans and Latinos.

Drug expert Dr. Andrew Kolodny told the New York Times “racial stereotypes” may be an explanation for the gap, saying studies have found doctors are more reluctant to prescribe painkillers to minorities, worrying they may sell them or become addicted.

More than 2,000 state, local, and tribal governments are seeking to hold drug companies accountable for the national crisis. According to the Associated Press, West Virginia, Kentucky, Tennessee, and Nevada all received more than 50 pills for every man, woman, and child each year.

Opioid addiction is a chronic disease that can cause major health, social, and economic problems. Opioids are a class of drugs that act in the nervous system to produce feelings of pleasure and pain relief (U.S. National Library of Medicine). Opioids change the chemistry in the brain and lead to a drug tolerance, resulting in needing increased dosages over time to experience the same effect. Opioids are potent, meaning they have a high potential for causing addiction in some people, even when administered and taken properly.

Medical professionals can make costly mistakes that lead to serious harm or death of a patient. Responsible parties can include:

The physician who prescribed the medication for prescribing too much, the wrong dosage, or failure to monitor the patient after medication has been prescribed
The hospital if medication was given during hospitalization or emergency room visit
The pharmacy and/or pharmacist if the wrong drug or dosage was given to a patient

If you or a loved one has suffered from a prescription drug overdose or medical error, you may seek justice from a negligent medical professional by filing a medical malpractice lawsuit. It’s important to report and hold the responsible party accountable to prevent others from suffering in the same way. The attorney’s at Dinizulu Law Group, Ltd. work diligently to recover compensation for monetary, emotional, and mental losses you or a loved one may have suffered.

Please call (312) 384-1920 or visit www.dinizululawgroup.com to seek legal representation.

Boeing Offers $100M to Those Affected by Crashes, Families Have Not Heard Directly from Boeing

July 16, 2019/in Blog, Uncategorized/by Yao Dinizulu

CHICAGO, IL – Boeing Co. has offered $100 million to help families and communities affected by the deadly crashes of its 737 MAX planes in Ethiopia and Indonesia. Families are still mourning after the tragic accident that occurred on March 10, 2019.

Ethiopian Airlines Flight 302 was scheduled to fly internationally from Addis Ababa Bole International Airport in Ethiopia to Jomo Kenyatta International Airport in Nairobi, Kenya. Six minutes after takeoff, the aircraft crashed near the town of Bishoftu killing all 157 people aboard.

Flight 302 is the deadliest accident involving an Ethiopian Airline craft to date that affected farmers in Ethiopia, victims’ families and relatives, and Kenyan and Ethiopian governments have still not heard about the funds.

Farmers lands were destroyed after crashing into fields and has been fenced off since; however, the site is filled with debris still and farmers can’t afford to rent plots elsewhere.

According to Reuters, Boeing said in a statement last week, “These funds will support education hardship and living expenses for impacted families, community programs, and economic development in impacted communities.”

Another crash in Ethiopia in October 2018 on a Lion Air aircraft killed 346 people. After the investigation concluded, it was said both pilots, flying Boeing’s new 737 MAX 8 model, struggled to override an automated system that pointed plane’s nose down.

Boeing has yet to reach out to families, farmers, or authorities directly. The 737 MAX was grounded worldwide after the second crash. Regulators must approve a fix and implement new pilot training before jets can fly again.

Some families are asking the money to be put towards a memorial at the crash site to honor their loved ones; on the other hand, some have requested Boeing fund professional counseling.

There were people from 35 countries abroad the Ethiopian Airlines flight that crashed. The Dinizulu Law Group, Ltd. offers our deepest condolences to those affected by the Boeing crashes. The Dinizulu Law Group, Ltd. is located in Chicago, IL where Boeing is currently faces litigation from some of the families affected.

Contact: www.dinizululawgroup.com or call 1(800)-693-1LAW(1529)

Army Veteran Dying of Cancer Delivers Emotional Statement to Congress on Medical Malpractice

July 10, 2019/in Blog, Uncategorized/by Yao Dinizulu

CHICAGO, IL – U.S. Army Sergeant First Class Richard Stayskal testified before Congress an emotional statement regarding medical malpractice in the military. Lawmakers on Capitol Hill heard testimony about allegations of medical malpractice by Defense Department medical professionals as Congress considers overturning the Feres Doctrine, a legal doctrine prohibiting people who are injured as a result of military services from suing the federal government under the Federal Tort Claims Act for injuries and negligence (Cornell Law).

Stayskal delivered an emotional opening statement to lawmakers explaining a misdiagnosis and inadequate medical care involving a tumor in his lungs that he suffered with for months. Medical professionals brushed off symptoms of walking pneumonia, even though he was on the verge of death throwing up pools of blood.

According to Newsweek, Staksyal was diagnosed with stage four lung cancer in January 2018 – something U.S. Army doctors overlooked or ignored. Over time, his cancer spread to his lymph nodes in his neck, spleen, liver, and ilium crest, which forms a hipbone, along with his spine and right hip.

Lung cancer is the leading form of cancer in both men and women and account for nearly 25 percent of cancer deaths. A five-year survival rate for those diagnosed with stage-four lung cancer is less than ten percent (American Lung Association).

“I want to say that this does affect me obviously, but my children are the true victims,” Stayskal, 37, said. “They will now grow up without a father. Someone that will teach them how to drive, walk them down the aisle when they get married. They seek counseling and special treatment at school. One of the biggest things they try and understand is how this happened.

As Skayskal’s case shows, a failure to diagnose frequently involves medical professionals mistaking symptoms of one disease for another. A misdiagnosis can lead to unresolved treatment needed to prevent symptoms from worsening or becoming terminal.

If you have experienced a misdiagnoses by a doctor for your medical condition, under the breach of standard care, you may potentially seek damages through civil litigation. The Feres Doctrine is a unique consideration that applies only to members of the military.

If your doctor has failed to accurately diagnose a medical condition that has led to serious problems, the attorneys at Dinizulu Law Group, Ltd. are ready to assist you with a malpractice claim. Our attorney’s have experience, resources, and a network of medical professional to build a strong case on your behalf. Please call (312) 384-1920 or go online to schedule a consultation.

Tips for a Memorable Fourth of July

July 1, 2019/in Blog, Uncategorized/by Yao Dinizulu

The Fourth of July is a day that you get to enjoy quality time with family and friends, enjoy delicious food, and celebrate the independence of our nation. With the Fourth of July quickly approaching, it’s important to keep in mind a few safety tips so your day is memorable for the right reasons.

Alcohol Safety
Operating a Motor Vehicle

Over 34 million Americans are expected to travel over the course of Fourth of July weekend. The Fourth of July is one of the deadliest days for drunk driving. July 4 has the second highest percent of car crash deaths linked to alcohol where deaths involved blood alcohol content of 0.08 g/dL or more (Fatality Analysis Reporting System).

Even if you’ve had one drink, do not drive. As you know, law enforcement agencies are highly populated across the country on this holiday. By drinking and driving, you put not only yourself, but other innocent people at risk too. DUI checkpoints are enforced across the country along popular routes. Order an Uber or assign a designated driver for the night.

Weather
If you’re planning to drink outside, especially during the day during peak hours of high temperatures, remember to stay hydrated. Heat exhaustion or a stroke can happen quickly and suddenly, so be aware of how you feel and be on the lookout of your friends that show signs of nausea, fatigue, faintness and dizziness.

Firework Safety
Nearly 280 people go to the emergency room every day with firework-related injuries around the weekend of July 4. Please ensure that fireworks are legal in your area before purchasing or using them.

There should always be an adult supervising the use of fireworks. Place fireworks on dry, flat surface and never stand directly over a firework while lighting the fuse. Immediately back up a safe distance after lighting the firework. Never point or throw fireworks at a person and keep a bucket of water nearby in case of an emergency.

Children ages 10-14 have the highest rate of firework-related injuries.

Pool Safety
An adult should supervisor any child that is going to be around a pool or any body of water. It can be easy for risks to go unnoticed while mingling with a large crowd that’s preoccupied enjoying their time.

Children should be supervised at all times. Keep floatation devices nearby for quick response if someone needs help in the water. Young and inexperienced swimmers should wear U.S. Coast Guard approved life jackets.

Pet Safety

One in five pets go missing from fear of loud noises of fireworks, thunderstorms, and other loud-related noises during the July 4^th weekend according to the American Society for the Prevention of Cruelty to Animals. July 5^th is one of the busiest days of the year at animal shelters because of pets running away on July 4^th.

Make sure your animal’s identification tags have your up-to-date contact information. If your pets are microchipped, make sure this information is also up-to-date. If your animal is not microchipped, consult with your veterinarian about this process which greatly improves the chances of finding your animal if they were to ever become lost. Take a current photo of your animal just to be on the safe side.

If you know you are likely to pay attention to your pet because you’re busy entertaining or mingling, make sure they are in a safe, gated area. When setting off fireworks, keep your pet inside and away from anything flammable. Please note just as you get hot from the sun, hot temperatures can be dangerous for your animal, too.

Grill Safety
It’s the best day of the year to grill out and BBQ, but there are a few things to keep in mind. When using your grill, make sure it is away from your home and out from under any branches or overhangs. Remove any grease of buildup in trays to avoid being ignited. Do not let children or pets near the grill and avoid wearing any loose clothing that can catch fire while grilling.

Above all, have a safe and memorable Fourth of July holiday from the Dinizulu Law Group.

11th American Dies Following Trip to Dominican Republic

June 25, 2019/in Blog, Uncategorized/by Yao Dinizulu

CHICAGO, IL – According to the US State Department, 11 American citizens have died in the Dominican Republic over the course of the last year. FBI investigators are comparing blood samples from the deceased tourists to alcohol samples at Dominican resorts.

Many deceased tourists were reported to have pulmonary edema, a fluid in the lungs at the time of death; however, Dominican Republic officials insist the deaths are unrelated and stating it’s still safe to visit (Rolling Stones).

The most widely reported theory on how American tourist death toll continues to rise has been linked to counterfeit alcohol. Counterfeit alcohol is unregulated, or bootlegged, and has caused deaths in India, Iran, Indonesia, and several other countries in recent years (Business Insider). Bootlegged alcohol is sold outside of governmental regulation – this leads to low quality health regulations which can be toxic or deadly. Hotels where the deceased tourists have stayed include Grand Bahia Principe Bouganville Hotel, Hard Rock Hotel and Casino in Punta Cana, and Bahia Principe in Punta Cana.

A Canadian couple recently stated they had visited Grand Bahia Principe Punta Cana in 2016 and became hospitalized after sleeping in their hotel room being woken up to a powerful chemical smell (ABC7 Chicago). The couple initially changed rooms until the situation became critical. The woman’s muscles, hands, and legs began to spasm before she lost consciousness; she was hospitalized for four days with effects still lingering.

The International Alliance for Responsible Drinking (IARD) said bootlegged alcohol is driven by the economic benefit of being extremely cheap to produce compared to legal, branded products. Counterfeit alcohol can be laced or made with substances such as battery acid, methanol, or embalming fluid.

There have been 150 deaths attributed to alcohol poisoning in Assam, a state of India, from bootleg alcohol. According to the 2018 IARD report, 29 percent of total alcohol sales in the Dominican Republic are from illegal alcohol sales.

To ensure you are not drinking counterfeit alcohol, always drink at licensed bars and restaurants, and drink brands you recognize. It’s important to check the spelling on the label of bottles and that label is firmly secured. The seal of liquor should always be secure and never tampered with. You can also hold a bottle upside down to inspect for any unidentified particles or sediments.

Liquor in foreign countries can be much cheaper to purchase; however, it may not always be the best choice. Always inspect products before purchasing and be cautious of consumption.

Semi-Truck Explodes on I-94 Killing 2 in Racine County

June 21, 2019/in Blog, Uncategorized/by Yao Dinizulu

CHICAGO, IL – Just before 11 am on Wednesday morning, two semi-truck drivers were killed in a multi-vehicle car crash on I-94 in Racine County, Wisconsin.

Northbound and southbound lanes were closed throughout the day and into Thursday afternoon, though southbound lanes reopened around 8:30 p.m.

According to ABC 7 Chicago, a semi-truck driver was driving southbound attempting to switch lanes when it over-corrected and lost control before hitting the median wall of the interstate, bursting into flames. As a result of the collision, three other vehicles collided into each other and the median wall.

Another semi-truck traveling northbound attempted to avoid the crash by turning into a ditch lane, in which he drove off the road, and burst into flames. The truck plunged nearly 30 feet off the right side of the highway, onto another road. The semi-trailer caught fire before exploding.

Two semi-truck drivers died at the scene, and at least two others were taken to a local hospital and sustained minor injuries.

Semi-truck accidents or collisions can be rare, but when they occur, they can be catastrophic. The average weight of a commercial vehicle is roughly 80,000-230,000 pounds. Semi-trucks also require a longer distance to stop. If a semi is driving 55 miles per hour, it will take about 400 feet to come to a complete stop (Safer America, 2019). Please keep these thoughts in mind when passing in a semi-drivers blind spot or driving past any commercial truck.

A New Way to Get Around Town

June 20, 2019/in Blog, Uncategorized/by Yao Dinizulu

CHICAGO, IL – Over the weekend, the city of Chicago launched a pilot program of electronic scooters to see if they serve as a viable means of transportation for Chicago residents. More than 2,500 scooters through 10 different companies – including Bird, Bolt, Lyft, and Spin – are part of the program. The four month pilot program launched on Saturday the south west side.

Electric scooters push scooters with electric motors, allowing riders to stand upright while controlling the speed using a throttle and brakes. Rather than paying for an Uber or Lyft, the electric scooter could provide a new way for commuters to get to and from work, among various different locations.

Overseeing the program is the Department of Business Affairs and Consumer Protection and the Chicago Department of Transportation. They hope to keep e-scooters out of the Loop and away from traffic. Just as the city has biking lines, scooter rides are suppose to ride in these lanes, as well.

On the first day of the pilot program, 10 companies reported surpassing 1,200 rides.

Areas the e-scooter perimeter is between Irving Park Road on the north, city limits and Harlem on the west, the Chicago River and Halsted Street on the east, and the river on the south.

If a rider tries to bring the scooter downtown, it will actually slow down and eventually shut down according to co-founder of VeoRide, Candice Xie.

The rider is required to provide a photo of the scooter properly parked before ending their fare.

The trial run continues now through October 15. The city of Chicago will then asses feedback before making a decision whether this option would be good for residents of Chicago.

Illinois Nursing Homes Ranked 3rd Worst in Country

June 17, 2019/in Blog, Uncategorized/by Yao Dinizulu

Each nursing home is different than the next in terms of how patients are treated and being taken care of. Some nursing homes provide clients with excellent care following guidelines and procedures while another may be suffering a staff shortage, and employees may have to overcompensate by caring for more patients than they are able to handle resulting below quality care. A recent report from a non-profit advocacy group ranked Illinois as the 3^rd worst state in the country for nursing home quality.

Families for Better Care gave Illinois an “F” for the quality of its nursing homes (Chicago Tribune). Ratings include Washington D.C. in which Illinois was ranked 49^th in the country, only above North Carolina and Texas.

Nursing home residents in Illinois receive an average of only 1.6 hours of professional nursing care a day. Residents also receive roughly 2.2 hours of direct care that relates to daily needs such as going to the bathroom, help getting dressed, getting out of bed, and being turned to avoid bedsores. Nearly 97 percent of nursing homes in Illinois have had federal deficiencies or citations; moreover, 28 percent have severe federal deficiencies.

Although Medicaid is a state and federally funded insurance program, many Illinois nursing homes are challenged by low payments by it. Nationwide, Medicaid covers upwards of 60 percent of nursing home residents according to the Kaiser Family Foundation report (2017). The report states the typical cost of nursing home care is $82,000 annually. The state’s Medicaid reimbursement pay is about $35 less per resident than what the actual cost of caring for the resident is.

Illinois recently adopted a new-found budget that includes $240 million for Medicaid funding for nursing homes, $70 million which specifically is for staffing. Nursing homes that fail to meet staffing requirements will now face a financial penalty. Nursing homes that violate the requirement will have to post notices explaining themselves which is to be posted in each publicly used doorway into the facility, in the main lobby, next to the registration desk, and on their website.

Illinois law requires nursing homes to provide 3.8 hours of nursing and personal care per day for residents that need skilled care, and 2.5 hours for residents needing intermediate level care.

The top states for nursing homes are Hawaii, Delaware, and Alaska according to the Families for Better Care report. You can check out how the federal government rates individual nursing homes here. If you or a loved one has been a victim of nursing home abuse or neglect, please call Dinizulu Law Group, Ltd. at (312) 384-1920. Due to the statue of limitations, we will have to begin working on your case right away.

3 Little-Known VA Pensions: Do You Qualify?

June 14, 2019/in Blog, Uncategorized/by Yao Dinizulu

CHICAGO, IL – Are you or a loved one a veteran or a surviving spouse? The VA offers many benefits; however, there are hundreds of thousands of veterans and/or surviving spouses that are eligible for these little-known VA benefits. These funds are used for assisted living at many facilities and for at-home care. Please consult an adviser to see if you or a loved one qualifies for the following VA benefits.

There are three levels of VA benefits called Pensions:

Basic Pension/Improved Income – healthy veterans with low incomes over the age of 65
Aid & Attendance – veterans over the age of 65 that require assistance with daily living activities
Housebound – veterans with a disabling rate of 100% that prevents them from leaving their home, but doesn’t have to be related to their military service

Aid & Attendance and Housebound pension benefits provide an additional monthly income over and above the Basic Monthly pension. To be eligible for either pension, the individual must meet the requirements for Basic Pension. The Aid & Attendance Pension benefits eligible veterans and their surviving spouses, or just the spouse in the event of a veteran’s death, to pay for the assistance they need in an everyday function. This includes eating, bathing, dressing, and medication management.

It’s important to note that potential eligibility conflicts between pensions and other assistance may arise. There are complex financial considerations for Aid & Attendance eligibility; however, the general requirements listed below must be met by the veteran or the surviving spouse:

Age – Veterans or surviving spouses must be 65 years old, or officially disabled if younger
Period of Military Service – Veterans must be considered “war time” veterans, meaning they served at least 90 days and served at least 1 day during the wartime dates listed below; this does not necessarily mean in combat:
- World War II: Dec. 7, 1941 – Dec. 31, 1946
- Korean War: June 27, 1950 – Jan. 31 – 1955
- Vietnam War: Aug. 5, 1964 – May 7, 1975 (or Feb. 28, 1961 – May 7, 1975 for Veterans who served in Vietnam)
- Gulf War: Aug. 2, 1990 – Undetermined
Discharge Status – Veterans cannot have been dishonorably discharged.
Disability Status – Veterans are eligible without a disability; however, a higher benefit is available to those who are disabled.
- Aid & Assistance Eligibility – veteran must require help with daily activities at home, in nursing homes, or assisted living. The need for that help does not have to be related to service in the military.
- Housebound Eligibility – veteran needs to have the disability rating of 100% that prevents them from leaving their home. The disability does not have to be related to their military service.
- Basic Pension/Improved Income Eligibility – no disability requirement.
Marriage Rules – a surviving spouse must have been living with the veteran at the time of their death and must be single at the time of a claim.

Medical-related expenses include skilled nursing, assisted living, adult day centers, and at-home care. Medicare and other insurance premiums, as well as prescriptions that may not be covered by insurance, should be included as medical-related expenses. Please check out how the VA calculates income here.

When calculating assets, the VA allows a veteran to deduct the value of their homes and vehicles; in addition, the VA looks at the applicant’s overall net worth in addition to their income. Net worth accounted for includes assets in bank accounts, stocks, bonds, mutual funds, and property, plus furnishings and personal effects, such as clothing.

VA Pensions can be used to pay family members who are the caregiver of a veteran or survivor (with the exception of spouses). Care expenses can be deducted from their income. Veterans’ spouses are not considered since joint income is calculated as household income.

The downside to these VA Pensions is it can be a lengthy process. Applicants can expect to wait 9-12 months before receiving their benefits; however, there are loans available to help pay for care while claims are being processed. Please consult an adviser to learn more about VA Pensions and Benefits.