About Healthwise

Healthwise is a nonprofit organization founded in 1975 with the mission to help people make better health decisions. More than 100 million times a year people like you use Healthwise^® information to take an active role in their health.

The best formula for making health decisions is to combine the most reliable medical facts with your personal feelings. Put more simply: Medical Information + Your Information = Better Health Decisions.

Your decisions influence your overall well-being as well as the quality and cost of your care. By taking an active role in your health, you are likely to be happier with the care you receive and the results you achieve.

Read these Healthwise stories to see how Healthwise helps people make better health decisions.

	Patricia used the Healthwise Knowledgebase to save her own life. Patricia had just finished her Saturday-morning chores when her lungs began burning. She was sweating and had some numbness in her arms. She drew a bath thinking, "I must be having a panic attack-I'll be all right if I can just relax." A few hours later, the 42-year-old still felt like she had "an elephant sitting on my chest." Patricia canceled her usual horse-riding lesson and took a nap instead. When she awoke, she felt even worse. "Then I thought: Check the [Healthwise® Knowledgebase on] the Internet," says Patricia. "I had almost every heart attack symptom described in the Healthwise® Knowledgebase. I knew I had to get to the hospital right away!" Hospital tests confirmed that Patricia had indeed had a heart attack, and the following Tuesday she had triple-bypass heart surgery. Today, Patricia is back in the saddle, riding horses and enjoying life.
	You can count on Susan Van Houten-Healthwise medical writer, grandmother, and former ER nurse. "Helping people like Patricia make important medical decisions is our sole focus," says Susan Van Houten. "We know our work makes a difference in people's lives, every day." The people at Healthwise are very much like the people who use our information. We're health care consumers too. We care for our own health and for the health of our kids and parents. And, we all share a commitment to the Healthwise mission. Susan is a mother of 6, grandmother of 10, and daughter of her 78-year-old mother. Several people in her family deal with chronic diseases like hypertension and diabetes. Just like you, she wants health information to be easy to use for herself and her family. Unlike many of our readers, Susan is an expert in developing health information and has been doing so at Healthwise for 14 years. She is also a nurse who practiced in hospitals for 25 years, 15 of which were as the director of an emergency room. "I've seen firsthand how valuable it is for people to have good information," Susan says. "Helping you make better health decisions is important to me-and to all of us at Healthwise."
	World-class heart doctor Robert Kloner, MD, PhD, is in your corner. Robert Kloner is one of 295 experts who review Healthwise information for accuracy and currency. He helps us help you make better health decisions on heart-related issues. Dr. Kloner is known as one of America's leading heart experts. For the past 30 years Dr. Kloner has taught at medical schools, participated in major research projects, and contributed to medical journal articles. He is professor of medicine at the Keck School of Medicine of University of Southern California. He is also director of research at the Heart Institute of Good Samaritan Hospital in Los Angeles and an attending cardiologist at Los Angeles County/University of Southern California Medical School. Dr. Kloner previously directed the Cardiac Research Laboratory at Harvard Medical School. He has also edited 18 authoritative medical texts. "Good information is critical to good health and good health care," says Dr. Kloner. "With easy-to-understand, reliable information, people can make good decisions. When I hear stories like Patricia's, I'm especially gratified to be part of the Healthwise review team."

Comments

Healthwise benefits from readers' input to keep our content helpful. Send us your comments by contacting your sponsoring organization or by emailing Healthwise at comments@healthwise.org. If you contact Healthwise, you can expect a reply within about two weeks. For answers to your specific health issues, contact your health professional. Or if you think you need care right away, call 911 or other emergency services.

Last updated: March 2011

Healthwise Medical Review Board

The Healthwise Medical Review Board is directed by our chief medical officer, Dr. Martin J. Gabica, and our medical directors, Dr. Adam C. Husney and Dr. Kathleen Romito, all board-certified family medicine physicians. Dr. Catherine Serio provides leadership on behavioral health issues for all Healthwise products. There is also a panel of board-certified associate medical directors who are involved in the planning and the regular and routine review of content written by Healthwise.

Chief Medical Officer:Martin J. Gabica, MD, Family Medicine, Boise, Idaho

Medical Director:Adam C. Husney, MD, Family Medicine, Boise, Idaho

Medical Director:Kathleen Romito, MD, Family Medicine, Boise, Idaho

Behavioral Health Specialist:Catherine Serio, PhD, Psychology, Boise, Idaho

Associate Medical Directors:

• William H. Blahd, Jr, MD, FACEP, Boise, Idaho
• Susan C. Kim, MD, Pediatrics, Boise, Idaho
• Sarah Marshall, MD, Family Medicine, Sacramento, California
• Rakesh K. Pai, MD, FACC, Cardiology, Electrophysiology, Boise, Idaho
• Anne C. Poinier, MD, Internal Medicine, Boise, Idaho
• John Pope, MD, Pediatrics, Phoenix, Arizona
• Steven L. Schneider, MD, Family Medicine, Boise, Idaho
• E. Gregory Thompson, MD, Internal Medicine, Boise, Idaho

The Healthwise Medical Review Board also includes more than 200 health professionals and medical specialists who review Healthwise content from a specialist's point of view. Their credentials include board certification, licensure/registration and/or certification, academic appointments at leading medical schools, involvement in research, and publication in peer-reviewed journals and medical textbooks. Most important, they share the Healthwise commitment to empowering patients with reliable health information and building strong patient-provider relationships. This encourages partnerships in the decision-making process. With input from these specialists, and with oversight by one of the Medical Directors or Associate Medical Directors, Healthwise medical writers develop health information based on scientific evidence and current clinical practice.

Before approving reviewers, Healthwise verifies that they have current licenses, registrations, and certifications with state or national agencies. We also verify with bodies that certify in specialty areas, if appropriate. The reviewers must be in good standing with these organizations during the time they review Healthwise content. We check this standing at least every 3 years. In addition, reviewers agree to notify Healthwise immediately if the status of their licenses, registrations, or certifications changes. The following physicians and health professionals are members of the Healthwise Medical Review Board:

Addiction Medicine

John R. Hughes, MD, Addiction Psychiatry, Burlington, Vermont

James R. McKay, PhD, Addiction, Philadelphia, Pennsylvania

Peter Monti, PhD, Alcohol and Addiction, Providence, Rhode Island

Allergy and Immunology

Thomas B. Casale, MD, Omaha, Nebraska

Rohit K Katial, MD, Denver, Colorado

Lora J. Stewart, MD, Pediatric Allergy and Immunology, Denver, Colorado

Anesthesiology

John M. Freedman, MD, Anesthesiology, Santa Rosa, California

Cardiology

Stephen Fort, MD, MRCP, FRCPC, Interventional Cardiology, Kelowna, British Columbia, Canada

Robert A. Kloner, MD, PhD, Los Angeles, California

Larry A. Latson, MD, Pediatric Cardiology and Critical Care, Cleveland, Ohio

John A. McPherson, MD, FACC, FSCAI, Interventional Cardiology, Nashville, Tennessee

John M. Miller, MD, Electrophysiology, Indianapolis, Indiana

Carl E. Orringer, MD, Clinical Lipidology, Cleveland, Ohio

Rakesh K. Pai, MD, FACC, Electrophysiology, Boise, Idaho

George J. Philippides, MD, FACC, Boston, Massachusetts

Chiropractic

Christine Goertz, DC, PhD, Davenport, Iowa

Complementary and Alternative Medicine

Marc S. Micozzi, MD, PhD, Rockport, Massachusetts

Dentistry

Arden G. Christen, DDS, MSD, MA, FACD, Indianapolis, Indiana

William F. Hohlt, DDS, Orthodontics, Indianapolis, Indiana

Steven K. Patterson, BSc, DDS, MPH, Edmonton, Alberta, Canada

Bryan D. Tompson, DDS, FRCDC, Orthodontics, Toronto, Ontario, Canada

Dermatology

Randall D. Burr, MD, Boise, Idaho

Amy McMichael, MD, Winston-Salem, North Carolina

Alexander H. Murray, MD, FRCPC, Halifax, Nova Scotia, Canada

Diet and Nutrition

Colleen Gobert, PhD, RD, Registered Dietitian, London, Ontario, Canada

Rhonda O'Brien, MS, RD, CDE, Dietitian and Certified Diabetes Educator, Boise, Idaho

Ruth Schneider, RD, MPH, Dietitian, Boise Idaho

Emergency Medicine

William H. Blahd, Jr, MD, FACEP, Boise, Idaho

Sean P. Bush, MD, FACEP, Envenomation Specialist, Loma Linda, California

William M. Green, MD, FACEP, Sexual Abuse, Sacramento, California

David Messenger, BSc, MD, FRCPC, FCCP, Critical Care Medicine, Kingston, Ontario, Canada

H. Michael O' Connor, MD, MMEd, FRCPC, Kingston, Ontario, Canada

Endocrinology, Diabetes, and Metabolism

Alan C. Dalkin, MD, Charlottesville, Virginia

Jennifer Hone, MD, Santa Barbara, California

Lois Jovanovic, MD, Gestational Diabetes, Santa Barbara, California

Matthew I. Kim, MD, Boston, Massachusetts

David C.W. Lau, MD, PhD, FRCPC, Calgary, Alberta, Canada

Ergonomics

William S. Marras, PhD, CPE, Bioengineering and Ergonomics, Columbus, Ohio

Exercise Physiology

Heather O. Chambliss, PhD, FACSM, Exercise Science, Memphis, Tennessee

Richard B. Kreider, PhD, FACSM, FASEP, Exercise Physiology, Waco, Texas

Family Medicine

Thomas M. Bailey, MD, CCFP, Victoria, British Columbia, Canada

Patrice Burgess, MD, FAAFP, Boise, Idaho

Christine H. Fordyce, MD, Geriatrics, Seattle, Washington

Michael W. Foutz, MD, Kuna, Idaho

Martin J. Gabica, MD, Boise, Idaho

Adam C. Husney, MD, Boise, Idaho

Sarah Marshall, MD, Sacramento, California

Joy Melnikow, MD, MPH, Sacramento, California

Rosalia Richardson, MD, Boise, Idaho

Kathleen Romito, MD, Boise, Idaho

Steven L. Schneider, MD, Boise, Idaho

David S. Smith, MD, West Bend, Wisconsin

Donald Sproule, MD, CM, CCFP, FCFP, Montreal, Quebec, Canada

Andrew Swan, MD, CCFP, FCFP, Victoria, British Columbia, Canada

Gastroenterology

Peter J. Kahrilas, MD, Chicago, Illinois

Jerome B. Simon, MD, FRCPC, FACP, Kingston, Ontario, Canada

Jerry S. Trier, MD, Boston, Massachusetts

Arvydas D. Vanagunas, MD, FACP, FACG, Chicago, Illinois

Genetics

Siobhan M. Dolan, MD, MPH, Medical Genetics, Bronx, New York

Geriatric Medicine

Carla J. Herman, MD, MPH, Albuquerque, New Mexico

Elizabeth A. Phelan, MD, MS, Seattle, Washington

Hematology/Oncology

Jeffrey S. Ginsberg, MD, FRCPC, Hematology, Hamilton, Ontario, Canada

Brian Leber, MDCM, FRCPC, Hematology, Hamilton, Ontario, Canada

Joseph F. O'Donnell, MD, Hanover, New Hampshire

Michael S. Rabin, MD, Medical Oncology, Boston, Massachusetts

Martin H. Steinberg, MD, Hematology, Boston, Massachusetts

Douglas A. Stewart, MD, FRCPC, Medical Oncology, Calgary, Alberta, Canada

Hepatology

Gregory T. Everson, MD, Transplant Hepatology, Englewood, Colorado

Steven L. Flamm, MD, Gastroenterology, Chicago, Illinois

W. Thomas London, MD, Philadelphia, Pennsylvania

Hospice and Palliative Medicine

Robin L. Fainsinger, MB, ChB, LMCC, CCFP, Palliative Medicine, Edmonton, Alberta, Canada

Shelly R. Garone, MD, Roseville, California

Infectious Diseases

William L. Atkinson, MD, MPH, Medical Epidemiology, Atlanta, Georgia

W. David Colby, IV, MSc, MD, FRCPC, Travel Medicine and Tropical Diseases, London, Ontario, Canada

Christine Hahn, MD, Medical Epidemiology, Boise, Idaho

Jeanne Marrazzo, MD, MPH, Prevention Epidemiology, Seattle, Washington

Peter Shalit, MD, PhD, Internal Medicine, Seattle, Washington

Stanford T. Shulman, MD, Pediatric Infectious Diseases, Chicago, Illinois

Devika Singh, MD, MPH, Seattle, Washington

Dennis L. Stevens, MD, PhD, Boise, Idaho

Raymond A. Strikas, MD, MPH, FACS, Atlanta, Georgia

Internal Medicine

Tina E. Bronner, MD, San Diego, California

Claudia A. Finkelstein, MD, Seattle, Washington

Carmen Lewis, MD, MPH, Preventive Medicine, Epidemiology, Chapel Hill, North Carolina

Brigid McCaw, MD, MPH, MS, FACP, Family Violence, Oakland, California

Brian O'Brien, MD, FRCPC, Halifax, Nova Scotia, Canada

Anne C. Poinier, MD, Boise, Idaho

E. Gregory Thompson, MD, Boise, Idaho

Maternal-Fetal Medicine

William M. Gilbert, MD, Sacramento, California

Neonatal-Perinatal Medicine

Kim E. Dow, MD, FRCPC, Kingston, Ontario, Canada

Jennifer Merchant, MD, Boise, Idaho

Nephrology

Michael Mallea, MD, Boise, Idaho

Mitchell H. Rosner, MD, Charlottesville, Virginia

Tushar J. Vachharajani, MD, FASN, FACP, Clemmons, North Carolina

Neurology

David N. Alexander, MD, Los Angeles, California

Colin H. Chalk, MD, CM, FRCPC, Montreal, Quebec, Canada

Barrie J. Hurwitz, MB, MRCP, FCP(SA), Durham, North Carolina

Karin M. Lindholm, DO, Boise, Idaho

Benjamin Natelson, MD, East Orange, New Jersey

Steven C. Schachter, MD, Boston, Massachusetts

Peter J. Whitehouse, MD, PhD, Cleveland, Ohio

G. Frederick Wooten Jr., MD, Charlottesville, Virginia

Nursing

Kathryn Earhart, RN, CWOCN, Wound Ostomy Continence, Boise, Idaho

Mary Moe Robbins, RNC, IBCLC, Lactation Consultant, Newcastle, California

Obstetrics/Gynecology

Rebecca H. Allen, MD, MPH, Providence, Rhode Island

Ross S. Berkowitz, MD, Gynecologic Oncology, Boston, Massachusetts

Philip D. Darney, MD, Reproductive Sciences, San Francisco, California

Divya Gupta, MD, Gynecologic Oncology New York, New York

Kevin Holcomb, MD, Gynecologic Oncology, New York, New York

Kirtly Jones, MD, Reproductive Endocrinology, Salt Lake City, Utah

Femi Olatunbosun, MB, FRCSC, FACOG, Reproductive Endocrinology, Saskatoon, Saskatchewan, Canada

Deborah A. Penava, MD, FRCSC, MPH, London, Ontario, Canada

George F. Sawaya, MD, San Francisco, California

Occupational Medicine

Peter M. Rabinowitz, MD, MPH, Occupational and Environmental Medicine, New Haven, Connecticut

Ophthalmology

Steven T. Charles, MD, Vitreoretinal Surgery, Memphis, Tennessee

Carol L. Karp, MD, Miami, Florida

Christopher Joseph Rudnisky, MD, BMs, MPH, FRCSC, Edmonton, Alberta, Canada

Jill Ann Smith, MD, Newton, Massachusetts

Orthopaedics

Davide Bardana, MD, FRCSC, Sports Medicine, Kingston, Ontario, Canada

Michael R. Baumgaertner, MD, Northford, Connecticut

Timothy Bhattacharyya, MD, Orthopaedic Trauma, Bethesda, Maryland

Freddie H. Fu, MD, Pittsburgh, Pennsylvania

Robert B. Keller, MD, Biddeford, Maine

Kenneth J. Koval, MD, Orthopaedic Trauma, Lebanon, New Hampshire

Steven C. Ludwig, MD, Spine Surgery, Baltimore, Maryland

Patrick J. McMahon, MD, Sports Medicine, Pittsburgh, Pennsylvania

David Pichora, MD, FRCSC, Trauma, Hand and Microsurgery, Kingston, Ontario, Canada

Herbert von Schroeder, MD, MSc, FRCSC, Hand and Microsurgery, Toronto, Ontario, Canada

Otolaryngology

Steven T. Kmucha, MD, JD, FACS, Otolaryngic Allergy, Daly City, California

Donald R. Mintz, MD, FRCSC, Vancouver, British Columbia, Canada

Charles M. Myer III, MD, Pediatric Otolaryngology, Cincinnati, Ohio

Martin Tubach, MD, Boise, Idaho

Pathology

Corinne L. Fligner, MD, Anatomic, Clinical and Forensic Pathology, Seattle, Washington

Pediatrics

Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC, Montreal, Quebec, Canada

Susan Kim, MD, Boise, Idaho

Georgeanna J. Klingensmith, MD, Pediatric Endocrinology, Aurora, Colorado

Stephen H. LaFranchi, MD, Pediatric Endocrinology, Portland, Oregon

Chuck Norlin, MD, Salt Lake City, Utah

Louis Pellegrino, MD, Neurodevelopmental Disabilities, Developmental and Behavioral Pediatrics, Syracuse, New York

John Pope, MD, Pediatric Hospitalist, Phoenix, Arizona

Frederick P. Rivara, MD, MPH, Seattle, Washington

Michael J. Sexton, MD, Boise, Idaho

Pharmacy

Margaret Hetherington, PharmD, Kingston, Ontario, Canada

Theresa O'Young, PharmD, Clinical Pharmacist, Seattle, Washington

Physical Medicine and Rehabilitation

Margaret M. Doucette, DO, Wound Care and Hyperbaric Medicine, Boise, Idaho

Nancy E. Greenwald, MD, Boise, Idaho

Richard D. Zorowitz , MD, Baltimore, Maryland

Physical Therapy

David A. Fleckenstein, MPT, Boise, Idaho

Mary McVicars Heckel, PT, MAPT, CLT-LANA, CWS, Boise, Idaho

Mary Virginia Keely, MS, PT, OCS, FAAOMPT, Orthopaedic Physical Therapy, Aptos, California

Joan Rigg, PT, OCS, Orthopaedic Physical Therapy, Boise, Idaho

Plastic and Reconstructive Surgery

Keith A. Denkler, MD, Larkspur, California

Adam D. Schaffner, MD, FACS, Otolaryngology, New York, New York

Podiatry and Podiatric Surgery

Gavin W.G. Chalmers, DPM, FACFAS, Vancouver, British Columbia, Canada

Barry L. Scurran, DPM, Fremont, California

Psychiatry

W. Stewart Agras, MD, FRCP©), Palo Alto, California

David A. Axelson, MD, Child and Adolescent Psychiatry, Pittsburgh, Pennsylvania

David A. Brent, MD, Child and Adolescent Psychiatry, Pittsburgh, Pennsylvania

Evan Eyler, MD, MPH, Adolescent and Psychosomatic Medicine, Burlington, Vermont

Peter Hauser, MD, Portland, Oregon

Yifrah Kaminer, MD, MBA, Child and Adolescent Psychiatry, Farmington, Connecticut

Alfred J. Lewy, MD, PhD, Portland, Oregon

Steven Locke, MD, Psychosomatic Medicine and Behavioral Health, Wayland, Massachusetts

Miklos F. Losonczy, MD, PhD, East Orange, New Jersey

Fred R. Volkmar, MD, Pediatric Psychiatry, New Haven, Connecticut

Myron F. Weiner, MD, Geriatric Psychiatry, Dallas, Texas

Lisa S. Weinstock, MD, Mount Kisco, New York

Sidney Zisook, MD, San Diego, California

Psychology

Sue Barton, PhD, PsyD, Behavioral Health, Sacramento, California

Stephanie Bender-Kitz, PhD, Aging and Long-Term Care, Boise, Idaho

J. David Carroll, PhD, Milwaukee, Wisconsin

Jessica Hamblen, PhD, Post-Traumatic Stress Disorder, White River Junction, Vermont

Catherine Serio, PhD, Behavioral Health, Boise, Idaho

Timothy Stockwell, PhD, Public Policy, Victoria, British Columbia, Canada

Stephen I. Sulzbacher, PhD, Clinical Psychology, Seattle, Washington

Edward Z. Tronick, PhD, Developmental Psychology, Boston, Massachusetts

Pulmonology

Robert L. Cowie, MB, ChB, MD, MSc, FCP[SA], MFOM, Respiratory Medicine, Calgary, Alberta, Canada

Susanna A. McColley, MD, Pediatric Pulmonology, Chicago, Illinois

Mark A. Rasmus, MD, Critical Care and Sleep Medicine, Boise, Idaho

R. Steven Tharratt, MD, FACP, FCCP, Pulmonology and Critical Care Medicine, Toxicology, Sacramento, California

Ken Y. Yoneda, MD, Critical Care Medicine, Sacramento, California

Radiology

Myo Min Han, MD, Nuclear Medicine, Oakland, California

Howard B. Schaff, MD, Diagnostic Radiology, Boise, Idaho

Kenneth B. Sutherland, MD, FRCPC, Kingston, Ontario, Canada

Reproductive Toxicology

Ernest L. Abel, PhD, Detroit, Michigan

Respiratory Therapy

Catherine O'Malley, RRT, Chicago, Illinois

Rheumatology

Richa Dhawan, MD, Shreveport, Louisiana

Nancy Ann Shadick, MD, MPH, Boston, Massachusetts

Stanford M. Shoor, MD, Palo Alto, California

Speech Pathology

Robert M. Kroll, PhD, Speech Pathology, Toronto, Ontario, Canada

Surgery

Kenneth Bark, MD, General and Colorectal Surgery, Utica, Michigan

Jeffrey Gilbertson, MD, Vascular Surgery, Boise, Idaho

Mark G. Luciano, MD, Pediatric Neurosurgery, Cleveland, Ohio

C. Dale Mercer, MD, FRCSC, FACS, Kingston, Ontario, Canada

Michael M. Murr, MD, Gastrointestinal Surgery, Tampa, Florida

Brent T. Shoji, MD, Boston, Massachusetts

David C. Stuesse, MD, Cardiac and Thoracic Surgery, Boise, Idaho

David A. Szalay, MD, Vascular Surgery, Hamilton, Ontario, Canada

Ali Tavakkolizadeh, MD, Bariatric Surgery, Boston, MA

Brad W. Warner, MD, Pediatric Surgery/Critical Care, St. Louis, Missouri

Christian G. Zimmerman, MD, FACS, MBA, Neurological Surgery, Boise, ID

Urology

Peter Anderson, MD, FRCS), Pediatric Urology, Halifax, Nova Scotia, Canada

J. Curtis Nickel, MD, FRCSC, Kingston, Ontario, Canada

Avery L. Seifert, MD, FACS, Boise, Idaho

Christopher G. Wood, MD, FACS, Houston, Texas

Last updated: August 2012

Healthwise Content Development Team

Senior Vice President

Karen Baker, MHS

Vice President of Content

Christine Calhoun, MPH

Content Managers

Kerry V. Cooke, BA

Jeannette Curtis, BS

Carrie Henley, BA

Patrick Kilby, BA

Katy Magee, MA

Judi Marsh, BS

Susan Van Houten, RN, MBA

Senior Clinical Consultants

Carolyn Brzezicki, RN, MS

Judy Dundas, BA, BSN

Senior Special Project Manager

Kathleen M. Ariss, MS

Medical Writers

Bill Amos, JD

Nancy Bateman, BS

Deborah Dakins, BA

Eileen Ellig, BJ

Marianne Flagg, BA

Kathe Gallagher, MSW

Christopher Hess, BA

Paul Lehnert, MA

Ryan Powers, MFA

Ellie Rodgers, BA

Cynthia Tank, BA

Lila Havens, MA

Medical Content Specialists

Bets Davis, MFA

Shannon Erstad, RPT, MBA, MPH

Maria G. Essig, MS

Debra Golonka, MPH

Sandy Jocoy, RN, BA

Jan Nissl, RN, BS

Robin Parks, MS, MSTC

Monica Rhodes, BA

Christine Maldonado, PhD

Terry Smith, PhD

Localization Specialists

Jennifer Adams, MLS

Doug Dana, BA

John Kubisiak, BS

Associate Editors

Michele Cronen

Denele Ivins, BA

Tracy Landauer, BA

Pat Truman, MA

Terrina Vail, BA

Research Library Manager

Liisa Rogers, MSW, MLIS

Library Technical Specialist

Karri Alderson, MLIS

Metadata

Bill Coe, BS

Visual Content

Steve Graepel, MS

Last updated: October 2011

Healthwise^® Knowledgebase Editorial Policy and Processes

The field of medicine changes constantly. Each day headlines reveal new ways to diagnose, treat, or prevent health problems. Through a comprehensive topic development process, the Healthwise^® Knowledgebase content is regularly updated to keep pace with the changes in medicine and medical practice.

See What's New in the Healthwise® Knowledgebase for the current release.

Content Written by Healthwise

Healthwise develops content through the collaborative efforts of content and medical teams using a comprehensive research and review process.

The Healthwise content team includes full-time professional medical researchers, writers, and editors who have extensive experience in scientific research and medical writing. They work closely with members of the Healthwise medical team, including the chief medical officer, the medical director, the associate medical directors, and the Healthwise Medical Review Board.

The Healthwise Medical Review Board includes more than 220 health professionals and medical specialists who review Healthwise content from a specialist's point of view. Their credentials include board certification, licensure/registration and/or certification, academic appointments at leading medical schools, involvement in research, and publication in peer-reviewed journals and medical textbooks. Most important, they share the Healthwise commitment to empowering patients with reliable health information and building strong patient-provider relationships.

Healthwise content starts with evidence-based information. Content team members are experts at presenting balanced, unbiased perspectives without influence from commercial interests. Our Conflict of Interest policy enforces our editorial integrity: "All Healthwise personnel should avoid situations where their personal interests could conflict, or reasonably appear to conflict, with the interests of Healthwise. In this regard, personnel must avoid any outside financial interest that might influence, or appear to influence, their corporate decisions or actions."

Topic Development Process

There are four primary steps in the development process: planning, research, writing, and review.

• Writers, editors, and associate medical directors work together to plan the topic.
• Medical librarians develop a research packet for each topic based on extensive research and evaluation of biomedical literature. Research packets include evidence-based journal and database search results, gold standard textbook chapters, guideline statements, and outcome studies, as well as consumer health information.
• Writing and review cycles include collaboration among medical directors and other clinicians. Writers and editors also collaborate to ensure that the content is in plain language, follows literacy standards, and meets user-centered learning theory and behavior-change principles.
• An associate medical director and at least one specialist review topics during the development process. They ensure accuracy and consistency with current practice standards and identify areas of important development. These independent medical reviewers ensure that Healthwise^® Knowledgebase topics contain accurate, unbiased information.

New Topic Development

Healthwise selects new topics on the basis of several criteria, including requests from consumers and organizations using the Healthwise^® Knowledgebase, prevalence of the condition, and the potential of shared decision-making for consumers who have the condition.

Updating Topics

Healthwise updates topics when warranted by changes in medical practice. The content and medical teams continually review medical news sources and journals so they can quickly identify changes that affect the practice of medicine. When important changes occur, we update topics and include them in the next quarterly release of the Healthwise^® Knowledgebase. In addition, Healthwise reviews and updates topics on a regular basis.

Organizations and people using the Healthwise^® Knowledgebase may suggest changes or additions to topics. Healthwise considers these recommendations during the topic development process and includes them in our updates if they meet our standard criteria and pass the medical review process. If a suggested change applies only to a particular sponsoring organization's readers, and if it passes medical review, then we may make the change for that organization's customized version of the Healthwise^® Knowledgebase. Any change to the Healthwise^® Knowledgebase must first pass medical review.

The last revised date is at the bottom of every topic page and in the credits section of each topic.

Citing the Evidence

The Healthwise^® Knowledgebase contains thousands of unique references to help readers find more information on topics. Our processes and policies ensure that entry points of content give readers reasonable access to references. We include citations that:

• Support statistics, particularly those that play a key role in decision making.
• Support outcomes, effectiveness, or risk data.
• Identify testing or treatment recommendations or guidelines.
• Support prevalence data.

Also, for all self-assessment or risk analysis tools in the Healthwise^® Knowledgebase, we provide information that describes the source of the tool, the scientific basis for the tool, how the tool is maintained on the website, the evaluation process, and the last revised date.

Content Written by Third Parties

Cerner Multum, Inc., Drug Reference (not included in all systems)

The drug reference included in the Healthwise^® Knowledgebase is provided by Cerner Multum, Inc., of Denver, Colorado.

Multum updates daily. New information is incorporated into a database as soon as it appears in the literature or in product labeling. Doctors and pharmacists review the new information and make any necessary changes. Multum conducts weekly Current Content searches on all of its drugs, and it surveys all key periodicals. All leaflets are reviewed by one or more practicing clinical specialists. Healthwise receives monthly updates from Multum. The updates are included in the quarterly releases of the Healthwise^® Knowledgebase.

Conflict of Interest Policy: Multum's content is authored by full-time associates with no affiliations with drug companies. Consultants who work with the information in other capacities are required to have no conflicts of interest.

The date of the last update is at the end of each topic.

National Cancer Institute (NCI) Topics

NCI Physician Data Query (PDQ^®) topics in the Healthwise^® Knowledgebase are provided by the National Cancer Institute, National Institutes of Health, Public Health Service, Department of Health and Human Services.

All PDQ cancer information summaries are peer-reviewed and updated monthly by six editorial boards of oncology specialists in adult treatment, pediatric treatment, supportive care, complementary and alternative medicine, screening, prevention, and cancer genetics. They review current literature from more than 70 biomedical journals, evaluate its relevance, and synthesize it into concise, clear summaries. Healthwise receives monthly updates from the National Cancer Institute. The updates are included in the quarterly releases of the Healthwise^® Knowledgebase.

Conflict of Interest Policy: PDQ Editorial Board members are selected by the editor-in-chief of each board. Potential biases or conflicts of interest are discussed as part of the selection process.

The date of the last update is at the end of each topic.

National Organization for Rare Disorders, Inc. (NORD)

The National Organization for Rare Disorders, Inc., of Danbury, Connecticut, provides topics on rare diseases for the Healthwise^® Knowledgebase.

The NORD topics are updated on an ongoing basis as new information. In addition, all topics are periodically reviewed to ensure that all information remains current and accurate. Healthwise receives quarterly updates from NORD. The updates are included in the quarterly releases of the Healthwise^® Knowledgebase.

Conflict of Interest Policy: NORD uses independent sources such as the National Institutes of Health and U.S. Food and Drug Administration for its information on standard and investigational therapies. It does not rely on commercial sources for anything other than brief notices that clinical trials are in progress. NORD does not ask researchers at academic institutions directly involved in studies of particular therapeutics to provide or review information related to treatment of the disease in question. When a report is written by a physician or other medical professional rather than by one of NORD's own writers, NORD has it reviewed by an MD or PhD with appropriate expertise at a different institution. To obtain input from more than one medical perspective, NORD does not allow a report to be reviewed by someone who has participated in research or clinical activities with the author of the report. NORD's staff regularly reviews several medical journals and, if any discrepancies in opinion related to information in a report are found, members of the Medical Advisory Committee provide guidance.

The date of the last update is at the end of each topic.

American Self-Help Clearinghouse Information

The American Self-Help Group Clearinghouse, of Cedar Knolls, New Jersey, provides information on self-help groups.

Healthwise receives semiannual updates from the American Self-Help Clearinghouse. The updates are included in the quarterly releases of the Healthwise^® Knowledgebase. The content verification date is at the end of each listing.

AISLE7 TM/Healthnotes®

Headquartered in Portland, Oregon, Healthnotes, Inc., dba AISLE7 is the premier provider of reliable, easy-to-use health, food, and lifestyle information.

Each year AISLE7 reviews tens of thousands of articles and more than 600 medical and scientific journals to ensure that the content stays current, factual, and balanced. Citations identify the source, the authors, and where and when the information was first published. The AISLE7 editorial team includes medical doctors, pharmacists, chiropractors, naturopaths, and dietitians. The Medical Advisory Board includes medical doctors and experts affiliated with leading medical schools, such as the Robert Wood Johnson Medical School.

Healthwise receives quarterly updates from AISLE7. The updates are included in the quarterly releases of the Healthwise^®Knowledgebase.

The date of the last review is at the end of each topic.

Last updated: February 2011

Healthwise Quality Standards

Healthwise is committed to providing consumers with high-quality health information so that they can make wise health decisions in partnership with their doctors. We adhere to the following principles:

• We will create health information that is in the consumer's best interest.
• We will not allow commercial interests to determine our content.
• We pledge to protect the privacy of individuals using our website.
• We provide referenced, frequently updated, evidence-based health information.

Healthwise ensures compliance with these principles through internal review and URAC accreditation.

Last updated: May 2009

Date adopted: May 2005

Healthwise Privacy Policy

[Note: if you are accessing Healthwise content through a website hosted by a sponsoring organization or other hosting service, the Privacy Policy of that organization's website will apply to your use and should be reviewed.]

Privacy

Healthwise helps people make better health decisions. Healthwise is committed to respecting the privacy of individuals. Healthwise collects usage information to improve the usefulness of our products. The collected information is not personal; it is anonymous and does not identify individuals. Healthwise uses only aggregate information for reporting and improving performance. Healthwise may choose a third-party service to collect and maintain this site usage information. Healthwise may disclose this aggregate information to some organizations when required by law or to comply with legal processes. Healthwise does not release, trade, or sell any individual-identifying information about usage of a Healthwise product to people or organizations outside of Healthwise. Healthwise products may have the look and feel of a sponsoring organization's website. However, the Healthwise product you are using is hosted on servers of Healthwise. All Healthwise information can be identified by the Healthwise logo that is visible at the bottom of each health topic. Consumers should review the privacy policies of the sponsoring organization's website.

Cookies and Web Beacons

Healthwise uses cookies and Web beacons to understand website user behavior and preferences, improve our website users' experiences, and manage our content. This information is not personal information; it is anonymous and it does not identify individuals. Cookies are text files that contain pieces of information that a website transfers to an individual's hard disk for record-keeping purposes. A cookie is created when an individual views the Healthwise product. The Healthwise server uses cookies to capture user movement on the site. These are persistent cookies, which remain on your computer to allow Healthwise to identify your browser, but they are not used to identify you. Healthwise cookies are stored only on your computer, and Healthwise does not release, trade, or sell any individual-identifying information generated from cookies. Web beacons are transparent graphic images located on pages of the Healthwise product. Web beacons allow Healthwise to capture the actions of website users as they move from page to page. This helps us understand how people navigate through the Healthwise content. We use this information to improve the quality of our products.

Additional Privacy Issues

All of the usage information that Healthwise collects is securely stored and is protected against unauthorized use. This information is stored on servers protected by physical and network security, including keys, access codes, and passwords. Access to the servers is restricted to authorized personnel who are trained on security policy and processes. Independent companies perform annual security audits. Healthwise has the right to update this policy at any time without notice. If this policy changes, the "Date last updated" at the bottom of this page will change. If you have any privacy issues regarding any Healthwise product, please contact your sponsoring organization or e-mail Healthwise at comments@healthwise.org. If you contact Healthwise about any privacy issues, you can expect a response from Healthwise in approximately 10 days. Please do not send any personal health information to Healthwise.

Last updated: October 22, 2009

Healthwise Advertising Policy

Healthwise does not include advertisements in the Healthwise^® Knowledgebase; however, sponsoring organizations may include advertisements outside but adjacent to Healthwise^® Knowledgebase content. These advertisements may have been selected based upon the specific topic being viewed. Advertisements are controlled by the sponsoring organization. For more information, check the advertisement policy of the sponsoring organization.

Last updated: August 2007

Date adopted: August 2000

Healthwise Ownership and Funding Disclosure

Healthwise is committed to producing quality health information for consumers so that they can make wise decisions with their doctors. Healthwise health information is not determined by commercial interests.

Healthwise is a 501(C)(3) nonprofit organization.

Healthwise receives revenue from the following sources:

• Sale of self-care guides
• Licensing of health content and software products to hospitals, health plans, employers, health websites and other organizations. Healthwise may receive revenue based on advertising and e-commerce revenue that is generated on our clients' websites.
• Grants from foundations and government agencies
• Other sources that account for minimal revenues

Last updated: August 2007

Date adopted: August 2000

Terms of Use of Healthwise Products

BEFORE USING THIS PRODUCT, PLEASE READ THESE TERMS OF USE CAREFULLY

By using this product, you agree to these Terms of Use ("Terms"). Healthwise reserves the right to modify our Terms of Use from time to time, so please review it frequently. Do not use this product if you do not agree to all of these Terms. Healthwise, Incorporated ("Healthwise") is a nonprofit organization whose mission since 1975 has been to Help People Make Better Health Decisions. Healthwise has not reviewed and does not endorse any information, products, or services other than those clearly marked as from Healthwise.

not medical advice This product is for informational purposes only. This information does not replace professional medical advice, diagnosis, or treatment. If you have questions regarding a medical condition, always seek the advice of your physician or other qualified health professional. Developments in medical research may impact this information. If you think you may have a medical emergency, call your doctor or 911 immediately.

use of content This information is protected by copyright under United States and foreign laws. Title to this information remains with Healthwise or its suppliers. Any use of this information not expressly permitted by these Terms is a breach and may violate copyright, trademark, and other laws. All rights not expressly granted herein are reserved to Healthwise and its suppliers.

liability limitation The use of this product is at your own risk. This product (including this information and any software) is provided on an "as is" basis. HEALTHWISE AND OUR SUPPLIERS, TO THE FULLEST EXTENT PERMITTED BY LAW, DISCLAIM ALL WARRANTIES, EITHER EXPRESS OR IMPLIED, STATUTORY, OR OTHERWISE, INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY, NON-INFRINGEMENT OF THIRD-PARTIES' RIGHTS, AND FITNESS FOR PARTICULAR PURPOSE. Without limiting this disclaimer, Healthwise and our suppliers also make no representations or warranties about the accuracy, reliability, completeness, or timeliness of this information. In no event shall Healthwise, our suppliers, or any third parties mentioned in this information be liable for any damages (including, without limitation, incidental and consequential damages, personal injury/wrongful death, lost profits, or damages resulting from lost data or business interruption) resulting from the use of, misuse of, or inability to use this information, whether based on warranty, contract, tort, or any other legal theory, and whether advised of the possibility of such damages.

indemnity You agree to defend, indemnify, and hold Healthwise, its officers, directors, employees, agents, and suppliers harmless from and against any claims, actions or demands, liabilities, and settlements, including without limitation, reasonable legal fees resulting from, or alleged to result from, your use or misuse of the product. If you access the product from outside the United States, you do so at your own risk and are responsible to comply with the laws of your jurisdiction.

jurisdiction You expressly agree that exclusive jurisdiction for any dispute relating to your use of this product resides in the courts of the State of Idaho governed by the substantive laws of the State of Idaho, without respect to its conflict of laws principles. If any provision of these Terms is found to be invalid by any court having competent jurisdiction, the invalidity of that provision shall not affect the validity of the remaining provisions, which shall remain in full force. If the liability limitation is so deemed invalid, Healthwise, our suppliers, or any third parties mentioned in the product shall be liable only to the extent of actual damages incurred by you, not to exceed U.S. $2,500. No waiver of any of these Terms shall be deemed a further or continuing waiver.

claims Any claims arising from your use of this product must be brought within one year from the date of the event giving rise to the action occurred. Remedies under these Terms are exclusive and are limited to those expressly provided for in these Terms.

information from suppliers for content that may be included in product

SELF-HELP CLEARINGHOUSE. By retrieving and/or utilizing information from the American Self-Help Clearinghouse database, you agree to hold harmless American Self-Help Clearinghouse, its owners, and employees from any and all liability arising directly or indirectly from your use of information contained in the database. You be the judge. The Self-Help Clearinghouse does not evaluate or rate the individual self-help groups, which are contained in the database. Therefore, Self-Help Clearinghouse's listing of a self-help group does not constitute an endorsement of that group. Neither does omission signify disapproval. We include groups in our database based upon a report of their organizations as being focused upon no-fee mutual aid; i.e., members helping one another. The use of any information is entirely the responsibility of the reader. You are the ultimate judge in deciding whether the group is appropriate to your needs. You can send for and review literature or call the phone contact. Self-help means more control, and more responsibility, in your hands.

NATIONAL CANCER INSTITUTE. Healthwise has an agreement with The National Cancer Institute ("NCI") for the use of the Physician Data Query (PDQ®) data files ("NCI Content") in which the following provisions must be met. You shall accommodate these provisions in its use of the Healthwise material.

i. PDQ is a registered trademark of the NCI and must be so referenced in all published material pertaining to PDQ files. The PDQ name must always be used in any public reference to the data files. Healthwise shall include the Software and you shall not alter or delete the notice making users aware at the point of initially entering the PDQ files that the source of the data provided is the NCI's PDQ files.

ii. Healthwise shall include the Software and you shall not alter or delete the following use restrictions (and any updates thereto) in the User License Agreement document and in all updated versions thereof and online in the system "help" message for use restrictions: "Some material in Physician Data Query (PDQ®) is from copyrighted publications of the respective copyright claimants. Users of PDQ are referred to the publication data appearing in the bibliographic citations, as well as to the copyright notices appearing in the original publication, all of which are hereby incorporated by reference."

iii. You agree that, because use of the PDQ data for insurance reimbursement decisions is contrary to the nature of the database, which is designed as a research tool and not to reflect possible treatment options, you are not to use it for reimbursement decision purposes.

The information in the NCI content may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.

NORD'S RARE DISEASE DATABASE. The information provided in this report is not intended for diagnostic purposes. It is provided for information purposes only. This information is presented for further understanding that could lead to the prevention, treatment, and/or cure of rare disorders. NORD recommends that affected individuals seek the advice or counsel of his or her own personal physician(s). It is possible that the title of the topic is not the name you selected. Please check the SYNONYMS listing to find the alternate name(s) and disorder subdivision(s) covered by this report. The disease entry is based upon medical information available through the date at the end of the topic. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about the disorder.

NORD is a private charity. This information is meant to assist patients, their families, educators and health care providers in the understanding, possible prevention, treatment and/or cure of rare disorders. We advise you also to check the "Synonyms" listing to find alternate name(s) and disorder subdivision(s), and with the agencies listed in the "Resources" section for the most current information about this disorder.

Last updated: April 28, 2011

Multum End-User License Agreement

The third party drug information (the "Service"), that may be included in the Healthwise products is for use by United States and Canadian residents only. The Service is a service provided to you by Cerner Multum ("Multum"). The Service and the Healthwise products are separate products provided by separate entities. Every effort has been made to ensure that the information provided in the Service is accurate, up-to-date, and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive. The Service does not endorse drugs, diagnose patients, or recommend therapy. The Service is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and provide consumers with drug specific information. Healthcare practitioners should use their professional judgment in using the information provided. The Service is not a substitute for the care provided by licensed healthcare practitioners and consumers are urged to consult with their healthcare practitioner in all instances. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information the Service provides.

Disclaimer of Warranties

THE END-USER ACKNOWLEDGES THAT THE SERVICE IS PROVIDED ON AN "AS IS" BASIS. EXCEPT FOR WARRANTIES WHICH MAY NOT BE DISCLAIMED AS A MATTER OF LAW, MULTUM MAKES NO REPRESENTATIONS OR WARRANTIES WHATSOEVER, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO REPRESENTATIONS OR WARRANTIES REGARDING THE ACCURACY OR NATURE OF THE CONTENT OF THE SERVICE, WARRANTIES OF TITLE, NONINFRINGEMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. The END-USER acknowledges that updates to the Service are at the sole discretion of Multum. Multum makes no representations or warranties whatsoever, express or implied, with respect to the compatibility of the Service, or future releases thereof, with any computer hardware or software, nor does Multum represent or warrant the continuity of the features or the facilities provided by or through the Service as between various releases thereof. Any warranties expressly provided herein do not apply if: (i) the END-USER alters, mishandles or improperly uses, stores or installs all, or any part, of the Service, (ii) the END-USER uses, stores or installs the Service on a computer system which fails to meet the specifications provided by Multum, or (iii) the breach of warranty arises out of or in connection with acts or omissions of persons other than Multum.

Assumption of Risk, Disclaimer of Liability, Indemnity

THE END-USER ASSUMES ALL RISK FOR SELECTION AND USE OF THE SERVICE AND CONTENT PROVIDED THEREON. MULTUM SHALL NOT BE RESPONSIBLE FOR ANY ERRORS, MISSTATEMENTS, INACCURACIES OR OMISSIONS REGARDING CONTENT DELIVERED THROUGH THE SERVICE OR ANY DELAYS IN OR INTERRUPTIONS OF SUCH DELIVERY. THE END-USER ACKNOWLEDGES THAT MULTUM: (A) HAS NO CONTROL OF OR RESPONSIBILITY FOR THE END-USER'S USE OF THE SERVICE OR CONTENT PROVIDED THEREON, (B) HAS NO KNOWLEDGE OF THE SPECIFIC OR UNIQUE CIRCUMSTANCES UNDER WHICH THE SERVICE OR CONTENT PROVIDED THEREON MAY BE USED BY THE END-USER, (C) UNDERTAKES NO OBLIGATION TO SUPPLEMENT OR UPDATE CONTENT OF THE SERVICE, AND (D) HAS NO LIABILITY TO ANY PERSON FOR ANY DATA OR INFORMATION INPUT ON THE SERVICE BY THE END-USER TO THE SERVICE. MULTUM SHALL NOT BE LIABLE TO ANY PERSON (INCLUDING BUT NOT LIMITED TO THE END-USER AND PERSONS TREATED BY OR ON BEHALF OF THE END-USER) FOR, AND THE END-USER AGREES TO INDEMNIFY AND HOLD MULTUM HARMLESS FROM ANY CLAIMS, LAWSUITS, PROCEEDINGS, COSTS, ATTORNEY'S FEES, DAMAGES OR OTHER LOSSES (COLLECTIVELY, "LOSSES") ARISING OUT OF OR RELATING TO (A) THE END-USER'S USE OF THE SERVICE OR CONTENT PROVIDED THEREON OR ANY EQUIPMENT FURNISHED IN CONNECTION THEREWITH AND (B) ANY DATA OR INFORMATION INPUT ON THE SERVICE BY END-USER, IN ALL CASES INCLUDING BUT NOT LIMITED TO LOSSES FOR TORT, PERSONAL INJURY, MEDICAL MALPRACTICE OR PRODUCT LIABILITY. FURTHER, WITHOUT LIMITING THE FOREGOING, IN NO EVENT SHALL MULTUM BE LIABLE FOR ANY SPECIAL, INCIDENTAL, CONSEQUENTIAL, OR INDIRECT DAMAGES, INCLUDING DAMAGES FOR LOSS OF PROFITS, LOSS OF BUSINESS, OR DOWN TIME, EVEN IF MULTUM HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. THE INFORMATION CONTAINED WITHIN THE SERVICE HAS BEEN DEVELOPED FOR USE BY PHYSICIANS AND OTHER HEALTHCARE PROFESSIONALS WHO RELY ON THEIR CLINICAL DISCRETION AND JUDGMENT IN DIAGNOSIS AND TREATMENT. THE INFORMATION CONTAINED WITHIN THE SERVICE IS NOT INTENDED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE, DIAGNOSIS OR TREATMENT. AS BETWEEN THE END-USER AND MULTUM, THE END-USER HEREBY ASSUMES FULL RESPONSIBILITY FOR INSURING THE APPROPRIATENESS OF USING AND RELYING UPON THE INFORMATION IN VIEW OF ALL ATTENDANT CIRCUMSTANCES, INDICATIONS, AND CONTRAINDICATIONS.

Liability of Multum to the END-USERS

Under no circumstances shall Multum be liable to the END-USER or any other person for any direct, indirect, exemplary, special or consequential damages arising out of or relating to the END-USER's use of or inability to use the Service or the content of the Service provided thereon or any equipment furnished in connection therewith. Multum's total liabilities in connection with this Agreement, whether arising under contract or otherwise, are limited to the fees received by Multum under this Agreement specifically relating to the END-USER's service or product which is the subject of the claim.

Last updated: March 2011