Why does every OD I attend not give straight answers

[beta chem]

I am a chem major and have been studying the UV spectrum and its affects on the chemical reactions in the eye. Why do all these companies and doctors want to put everyone
in UV and near UV blocking leses when the main spectral line is the near UV line for melatonin suppression. I believe the UV blocking contacts have contributed to increases of a condition called narcolepsy. Elevated melatonin levels decrease the neurotransmitters neccessary for maintaining wakefullness and a healthy regular circadian rhythym. These neurotransmitters are dopamine and the other catecholamines. I went to two different places asking for non-UV and non visibility tinted lenses and was met with a large resistence for my specifications. At the present I am looking for a contact and frame lens that offers the most UV and near UV transmittance possible. If there are any good doctors out there I would appreciate your response.

[Dave Nelson]

We used to use a type of lens known as "full-spectrum" just for that reason: it transmitted more UV than ordinary lenses, which have uv inhibitors in them. The Dr. who prescribed them felt, as you do, that some metabolic functions needed ultra-violet light to work. If you want them, ask your optician or optometrist to check with their lab and see if you can still get them. You may wish to consider, however, the rarity of narcolepsy as opposed to the prevalence of cataracts and macular degeneration, which studies strongly link to ultraviolet exposure.

[beta chem]

I have read that elevated amounts of melatonin in the eye actually cause retinal damage. That was in only one or two studies and I am not going to base all my information on that but at the same time I have also read that cataracts are related to a elevation of tryptamine and tryptophan derivitives in the lens of the eye. These substances flouresce under UV light and Melatonin is a tryptophan derivitive. I have asked my OD for a contact
that is a full spectrum contact and she said that a WJ dura-soft 3 is the answer. I am not so sure now especially since you said that they put UV blockers are in all contacts. Please, if you could, give me the name of the manufacturer that produced these full spectrum contacts. Currently I am researching the energies associated with cyclization of melatonin which produces a structure with similar pharmacodynamics as a popular medication for narcolepsy. I believe that these energies are in the 300nm to 450nm range of the EM spectrum.

[RP]

I'm not sure how your post relates to OD's not giving you straight answers, but hey!
Spectral absorption in the eye is probably negligible relative to your skin, so the idea that unfiltered UV in your eye makes a difference (or is good for you) may be a stretch. On the other hand, the prevalence of cataract, macular degeneration and other rather significant pathologies can be linked to levels of UV exposure, and generally these correlations can be made to specific ranges of UV.
My suggestion? Examine the spectral transmission properties of ophthalmic materials (any physics or optometry department probably has someone who can help you in this regard, try Ralph Chou at the University of Waterloo (CANADA) if you need a starting point). Find one that maximizes transmission in the range that influences melatonin and reduces transmission at other wavelengths. That should be your 'best lens'.
Optical advice aside, I'd review your physiology to decide if in-eye melatonin production had any measurable effect outside the eye. MEDLINE would be a good resource in this regard. It will also allow you to review the range of problems UV causes in eyes.
Rick

[Darris Chambless]

Hello Beta Chem,

There might be some substance to what you are saying with regard to Melatonin and the reduction of UV to the eye, but the link to Narcolepsy might be a stretch. There are many on going studies that are being done with Melatonin, but very few are conclusive.

I understand the mechanism behind the production of Melatonin and the links to UV (although most are somewhat gray areas). I have even read of a study being done to help curtail the effects of jet lag by placing a UV light behind the knee to "reset" the bodies natural time clock.

The reason I say that the link between UV and Narcolepsy might be a stretch is because the rest of the body is being exposed to direct UV and will absorb it at much the same rate as the eye. This will limit production of Melatonin during daylight hours as well. If I recall correctly I believe that Narcolepsy has been closer link to genetics and heredity.

Melatonin is produced by the Pineal gland and it is speculated (I say speculated because there are several other factors involved) that the production of Melatonin increases as UV absorption diminishes (or as night time moves in). Since Melatonin is released and absorb slowly and not just dumped into the system all at once the link to Narcolepsy gets pretty thin. Narcoleptic episodes, as I recall, are linked more to the brains switching back and forth from REM sleep to being alert. The way it was presented to me was that the brain has both of these processes prerecorded in certain areas of the brain and it is like having a toggle switch between them that accidentally switches back and forth on occasion.

If your research has uncovered something that can be made definitive I would be very interested in hearing about it. I don't think the idea is too far fetched as to the release of Melatonin from diminishing UV to the eye or optic nerve. That would make for some interesting research.

The Full Spectrum lenses are the only lenses I know of as well and I don't even know if they are still available.

Take care,

Darris C.

[beta chem]

RP and Darris

Most of my information does come from Medline
or pub med. They have shown that melatonin is suppressed most in the 500nm range. This can
only be done through the eye. Decreasing the amount of that light and the light near it such as near-UV or UVa will decrease the amount suppressed and I have already explained the consequences of that. Eye problems are most likely associated with a bad diet or medication. It is known that zolmitriptin a tryptamine derivitive migraine medication collects in the eye probably the lens. This in turn when hit by UV light could cause clouding of the lens to cataracts. With out the proper amount of melatonin being suppressed many different tryptamines in the eye could acumulate in the lens and cause the said eye problems.

I should have said also there are different forms of narcolepsy and "mine" in general is
a type that I feel can be corrected by increasing catecholamines naturally the way it was intended to be. Though sleep disorders are rare it is not rare to me, in fact it is 100% prevalent. Falling asleep when driving and part of the time when sitting in class and almost always when the lights are turned off in certain classes is not uncommon to me. So you see I started from there and the more I found out about the chemistry of the eye, the more I realized what my problem is. Melatonin is converted into a beta-carboline in the eye which is a Monoamine oxidase inhibitor. My doctor presribed me a drug that is a monamine oxidase inhibitor and it works but the side effects are horrible and cause parkinson type symptoms because it induces demyelination of the nerve fibers (basically stripping the brains circutry so it cross fires and shorts out) and probably decreases the amount of tyrosinase activity in the hippocampus of the brain. Most of the drugs that they use for narcolepsy and ADD are monoamine oxidase inhibiting dopamine releasers. Any amount naturally that I can increase my bodies own catecholamine system I am going to do it and I don't mean by drinking caffiene. People with good eyesite dont always have a UV inhibitng contact on their eye and why should I have something that is UV inhibiting on mine. If I want to block the UV rays I will put on a pair of sunglasses like a normal person and if I really want to protect my eyes I will not stair directly at the sun for lenghty amounts of time and weld metal without the proper eye attire.

Melatonin and its beta-carboline metabolite should share the same molar amounts in the human retina but in the case of increased melatonin secretion I suredly doubt they do.
I could right up a web page explaing the enzymatic pathway correlating the chemistry involved but at the present I have to little time to do so.

There is a reason why that acetyl group on melatonin is there, it is to ease the production of the correlating beta-carboline.

If I offended any ODs by my topic name, I am sorry. If you want I can discuss a greater scale right up about the process on which I base alot of my reasoning.

Beta Chem

[This message has been edited by beta chem (edited 08-11-2000).]

[This message has been edited by beta chem (edited 08-11-2000).]

[Bob Rihl]

I'm not as learned on this subject as any of the above gentlemen, but I have a friend at The Medical College of Georgia, who is the asst. Chief of The Department of Psychiatry, who has people wearing construction worker helmets with ulltr-violet tubes rigged under the bream, to admit as much UV as possible into their eyes an hour or so a day, to fight depression. He has found that people who live in the cold climates of every hemisphere in the world have more depression, and are less friendly, than those who live in the warmer climates, or nearer the equator. And he's an ex-Yankee himself. He thinks that near UV light is good for you, at least psychologically. And when they first started putting UV filters into plastic lenses, back in the mid-sixties, just to keep them from turning yellow, many people either stuck with glass, because it only screens up to 220 nm, about like the old plastic lenss, instead of up to 360 nm, like regular plastic lenses do, because they felt that the body could not properly assimilate nutrients unless UV was admitted to the body, through the eyes. I have know idea how or why they came up with this, but remember some very outraged customers. This UV filter that people are charging extra for on plastic lenses just screen a little extra, from 360nm to visable light, which is around 400 or 405, I believe. So I personally think all this UV filtering stuff is a bunch of baloney. Cataracts are a natural aging process. So what's the difference if you screen up to 220, 360, or 400? You get cataracts at 72 instead of 74? And what about those poor slobs who don't wear glasses at all? I guess they get cataracts at 71 instead of 72. I don't use any "extra" UV at all, unless somebody sits in front of a computer all day. Then I put it in, because I think that the effects of computer use are yet unknown, and may be tragic. Besides, I figure that anybody who has a job like that is probably pretty depressed anyhow, so the little extra depression I give him with the UV junk won't make much difference. This man is in need of some Jack Daniels Black Label at a nudey bar every night after work. So I'd rather be safe than sorry. But UV filtering up to 360, like a regular, clear plastic lens does, non-UV dipped, seem like a gracious plenty to me. Does anybody know what the UV trasmittance level of that new 1.8 or 1.9 glass is? I know rgular crown glass was 220, and you couldn't get a suntan even through THAT. But I guess they have to put all sorts of AR coatings on the high index glass just so you can see through them, and that probably screens out all the UV. Just trying to help the gentleman out. I get frustrated when somebody is overly concerned with my "safety" too. Just tried to buy a simple bottle of UV stripper, but they wouldn't sell it to me unless they had sold me the whole "kit." I guess my pyrex dish with the lid isn't "safe" enough for the government, or somebody. They ought to see some of the stuff I mix up to put into my 1960 Chrysler, with the 413 Wedge V-8. It runs GOOD. I get 0-60 in 7 seconds with 4000 pounds of car. Can't get that stuff out of the gas pumps anymore. How did weever survive?

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"Come see me now, heah?"

[mikeh]

It's called "nannyism" Bob. All the "warnings" and "bannings" we get are a result of the fact that the governmental agencies appointed to "protect" the public have a zero tolerance criteria. And let's not forget that professionals need to be published to keep their standing. If the agencies don't find something wrong every so often, people will begin to wonder if they're doing their job and maybe reduce their budget.

Remember the sacchrin affair. The FDA found that if lab rats were fed the artificial sweetener they developed cancer. Of course, at the rate they ingested the sweetener, a human would have to eat something like 600 ponds of it per day to duplicate the circumstances of the test.

At our current rate of propogation of government regulations and ridiculous court rulings, it's only a matter of time before the manufacturers of hats and gloves are found liable for the common cold. The logic will be that they didn't explain forcefully enough to consumers how important it is to wear your hat and gloves when it's cold outside.

[Sullivan]

AMEN to BOB !!! I couldn't of said it better!I knew you were cool Bob, just not how cool.

I can't believe we haven't met yet. I spoke to you once a few years back. I was managing Bigger's new optical and you were with M&R. I moved to Minnesota and just moved back about 2 years ago.



[This message has been edited by Sullivan (edited 08-19-2000).]

[beta chem]

Bob, when you said that you could not get a sun tan through regular crown glass at 220nm;
are you saying that regular glass blocks alot to most UV entering the eye? Also what is the thickness of -8.5 high index glass in the middle at the thinest part? And how about for regular glass? I think I got a pair of glasses and they are not what they are supposed to be. Also has anyone found out about full spectrum contacts?

Thank you.
beta chem

[Dave Nelson]

beta chem: the "full spectrum" reference was to spectacle lenses. The thickness at the optical center of any negative power lens ranges from 1 mm to 2.2 mm, and 3.2 mm for some industrial safety applications. I assume you are aware that the optical center coincides with the pupil.

[Bob Rihl]

Originally posted by beta chem:
Bob, when you said that you could not get a sun tan through regular crown glass at 220nm;
are you saying that regular glass blocks alot to most UV entering the eye? Also what is the thickness of -8.5 high index glass in the middle at the thinest part? And how about for regular glass? I think I got a pair of glasses and they are not what they are supposed to be. Also has anyone found out about full spectrum contacts?

Thank you.
beta chem

Beta Chem:
I do not pretend to be an expert on UV light exposure. It has become a concern to people only in the waning years of my career. But I spent 3-6 months a year at the beach, back in the 1940s and 1950s, when ALL crown glass lenses were ground 1.0 mm OR MUCH THINNER at the thinnest point, and NONE of the kids who wore glasses could get even a LITTLE bit of a tan under their glasses. They all looked like racoons. Now I am aware that there are wave lengths of the UV spectrum that do not cause suntans. I do question whether these areas of the spectrum cause any real harm or not. I don't think that there is any coclusive evidence that they do. The good Lord made everything in nature for a purpose, and I assume that He felt that UV was good for something, at least in moderation, as it is with all things. The gentleman from Canada is correct about the thicknesses used on glass, 1,8 Index lenses. But my question was whether they indeed screen much greater amounts of UV than do regular crown glass lenses, which, incidentally, we used to grind as thin as .04 mm on high minus RXs and sometime down to .02 mm on Pince-Nez spectacles, just so they'd stay on. I SUSPECT, but don't know, that those very high index glass lenses, along with the AR coating, are PROBABLY screening up around 390 to 400 nm. We U.S. Opticians have little experience with the new, thin, glass lenses, because in the U.S., it is so much trouble, and the potential for legal problems so high, that I wouldn't sell a pair, and neither would most. Back when we ROUTINELY ground all minuse over about a-4.00 down to less than a half a mm in the center, neither myself, nor any of the "old guys" I knew, had EVER seen an eye injury caused by a thin, glass lens. I'm sure there were some, but they must have been pretty rare. At the time, around 1969 or 1970, when all these rules were being cooked up, the ANSI board was pretty heavilly weighted with MANUFACTURING Opticians. It's a lot harder to ruin a 2 mm thick lens on the edger than it is to ruin a.02 thick lens. We thought at the time that this MAY have had something to do with the thickness caveats: Not so much worry about breakage on your face as breakage in the lab....less profit.
And besides, if a customer wants to buy an "unsafe" lens, he's not about to hurt anybody but himself, so why shouldn't he be allowed to buy it? It's not exactly in the same category with massive, industrial pollution.

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"Come see me now, heah?"

[Bob Rihl]

Originally posted by Sullivan:
AMEN to BOB !!! I couldn't of said it better!I knew you were cool Bob, just not how cool.

I can't believe we haven't met yet. I spoke to you once a few years back. I was managing Bigger's new optical and you were with M&R. I moved to Minnesota and just moved back about 2 years ago.

[This message has been edited by Sullivan (edited 08-19-2000).]

Sullivan:
Where are you now? Back in Augusta? Back at Biggers? Get in touch.
Bob

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"Come see me now, heah?"

[Bob Rihl]

Originally posted by beta chem:
Bob, when you said that you could not get a sun tan through regular crown glass at 220nm;
are you saying that regular glass blocks alot to most UV entering the eye? Also what is the thickness of -8.5 high index glass in the middle at the thinest part? And how about for regular glass? I think I got a pair of glasses and they are not what they are supposed to be. Also has anyone found out about full spectrum contacts?

Thank you.
beta chem

Beta Chem:
I've done a little more research on the UV transmittance of high index, glass lenses. This information is from Zeiss, but I'm sure that any brand would be about the same. It would appear that all of their glass lenses, ranging in refractive index from 1.525 all through 1.604, 1.706, 1.800, and the new 1.894, screen 100% of UV up to 315 nm. And they all screen anywhere from 75% to 83% (the new 1.894) of UV ligt up to 380 nm, which is pretty close to visable light. This is almost as much as regular, non-UV-400 plastic lenses. That surprised me, particularly in the lower index, which is their regular Punktal, which has been around forever, 1930s, I think. So it proves that just about ANYTHING that comes between your eye and light filters SIGNIFICANT amounts of UV light. I would imagine that a piece of Saran wrap would prevent a sunburn, at least. In fact, I think I'll try wearing a piece in my pool this weekend instead of a bathing suit. I imagine I'll have young lady admirers from far and wide coming over to observe my experiment (?????). I'm 58. Or, I might end up in the looney bin. So if somebody DID sell you some kind of a glass or regular plastic lens, telling you that it did not filter a whole lot of UV ligt, they were misinformed. But a whole lot of Opticians are misinformed. They depend on inexpensive "UV Dtection" devices that register "SAFE" or "UNSAFE", but they are DESIGNED to hook folks for an extra $ 15.00 to buy "UV protection." But all of these things don't even start until te UV get up over 380 nm. That's ALMOST visable light. I don't think that anybody is going to develop any pathology from the band of UV light between 380nm and 400nm. When I was a kid, my family used to take me with them to a very expensive ki Reort in the winter. They had a special "soarioum" where one could sit and get a suntan indoors, because they had very expensive, special glass, tat admitted a lot of UV light. Back at that time, most folks smoked....everywhere. But not in te "solarioum." They were afraid that even the film from the cigarette smoke would prevent a suntan. So worry about adding "UV Protection" to ANY lemns? Much to do about noting. But in your cast, where you want UV exposure, I would suggest getting a UV lamp, removing your contacts and glasses, and sitting next to it for an hour or so a day. Don't look directly at it. Just next to it. But I'm jst an od optical man. What do I know?
Bob Rihl, LDO; ABOM

Bob Rihl

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"Come see me now, heah?"

[beta chem]

It sounds like I am doomed then. Most of the
UV light is always going to be blocked. This possibly has other adverse affects. Maybe worms grow better in a persons eye without the proper UV transmitance, joke!!? Seriously,it sounds like my only hope is some sort of refractive surgery, at my prescription though I would have to be under the laser for 30 or so seconds. Could you people tell me a better way for refractive surgery? I have been told that there are 2 other ways besides radial keratomy.


Beta chem

[RP]

There are two common ways besides radial keratotomy (which has largely been abandoned as a technique, but is still available in a few places). They are LASIK (laser-assisted in-situ keratomilieusis) and PRK (photorefractive keratectomy).
Please discuss these options with your eye care provider (OD or MD). And, in keeping with the thread, find one who will give you straight answers!
Rick

[Darris Chambless]

Hello beta chem,

What is your diet like?

Darris C.

[beta chem]

Darris, I assure you that my diet is balanced. This consisting of soy beans, celery root, and a bit of barley grass to curb my sweet tooth...... Not really; its the usual burger, green and lima beans, potatoes, bread, yogurt, fish, carrots, milk,oranges and various fruit juices.


At one part of this thread I am worried about too little UV light entering my eyes;
with Lasik it is too much entering my eyes I am worried about. The receptors in the retina are where melatonin suppression happens and those receptors are close to the near UV. I am concerned that a laser could permanently knock those receptors out if a person where to be under the laser too long. Could someone tell me what wavelength the Excimer laser is at? I know it is supposed to be a cool UV laser. My buddy said he could smell his eye burning, like burning flesh.

beta chem

[Darris Chambless]

Hello again beta chem,

My question wasn't meant to be sarcasm. You were describing the times when you experience your "narcoleptic" episodes and I have to say that the problem is not with diminished UV but with hyperinsulinism caused by diet. You are are experiencing the lull after your insulin levels drop to normal after being spiked by your diet.

You are also experiencing a drop in blood oxygen levels from a lack physical movement i.e. driving, sitting in classes. Getting sleepy when the lights go out is called "conditioning" and when the other two are stacked on top of it you end up with an uncontrollable urge to drift off.

Depending on what your case history is you may have a sleep disorder of some kind, but I would be willing to bet that you've not been properly test for hyperinsulinism. If I were you I would redirect my study concerns in this direction rather than the UV synopsis. You might be surprised at what you find ;-)

Darris "It's not the disease that killed him, it was the cure." Chambless

[Dave Nelson]

Beta chem, the laser works by molecular disruption, not heat to ablate corneal tissue. heat is a byproduct of molecular disruption, but not a means. This enables them to call it a "cold" procedure even though it produces enough heat to cause smoke and or steam, and produce the "burning "smell your friend referred to. I've been offered, but declined the "eye fry." (previously referred to as "slash for cash."

[beta chem]

Darris, I told you seriously what my diet consists of. I was just trying to add some humor to this rather serious subject. I know for a fact alot of my problem has to do with sitting to long and this causing a hypoxic situation. To me though 20 minutes to a half hour should not be too long before I run out of oxygen, but it does seem to be the case. This situation corresponds to my original reason for beta-carboline production. The pathology that I come up with is this, first melatonin is cyclisized to pinoline in the eye, pinoline increases dopamine in the CNS and eye,increased dopamine levels in the eye lower melatonin levels, with this pinoline is released to the blood system from the pineal gland, pinoline inhibits the breakdown of adrenaline, noradrenaline, and serotonin. The main area I am concerned with is the respratory stimulant adrenaline. When my lungs don't "move" so much I become hypoxic; I then become tired from lack of oxygen. So you see there is much detail to the whole mechanism and I am not even touching the surface. I also may note that in the presence of pinoline, norepinephrine is coverted into adrenaline. I have been concerned with the possibility of too little insulin. Do you know that 5-HTP raises insulin levels. With this I believe that serotonin could raise insulin levels also. This once again corresponds to pinoline concentration because of the above pathways.

beta chem

[Darris Chambless]

Hello again beta chem,

I realize that because of your educational background you are trying to find a solution that fits your understanding, but you are making a mountain out of a mole hill. If you want to be more on track with what is happening to you from a physiological standpoint research glucose and carbohydrate as they affect insulin levels, the liver, the pancreas and their processes. UV light is the least of your worries.

If you have any difficulty finding the information you need in this new direction left me know and I will go dig up some references for you. Some of the best studies on this were done by a Dr. Stillman and a couple of German guys that I can't remember names of off the top of my head.

If you want to try a self experiment do this: cut out all sugar, all caffeine, limit your carbohydrate intake to no more than 20 grams per day and increase protein intake to as much as you would like (fat content is irrelevant) After 48 hours you will no longer be tired during the times you speak of and your sleeping disorders will more than likely be gone. If you do decide to try this let me know because there are some things you will need to know before proceeding.

Take care and I hope you will try this little experiment. You'll be surprised.

Darris "Trust me on this one." Chambless

[beta chem]

Hello Darris,

I have done the diet you speak of; for about 1.5 years. This really didn't work for me. At first I thought it did but later found that I was dehydrating my self. This became very bad in that I was ingesting close to 2 gallons of water a day. Low carbohydrates and high protein intakes dehydrate a person to very unhealthy levels as for ammonia levels rising also. I noticed sometimes I would smell like cat ****,literaly.

There is a correlation between a purine enzyme deficiency and low dopamine levels, this same enzyme deficiency causes people to chew their nails and inside of cheeks. Alot of these people tare the skin off their inner cheeks and finger tips till they bleed. I know alot of people like that. In my neck of the woods I would say about 30% of the people do this. I have also found it to be pseudo-hereditary. These also seem to be the same people that have to have a leg bouncing around all the time. It possibly happens more so when people are breathing really slow and becoming hypoxic.

"""THIS **** IS NOT FUNNY"""
Getting the nods and running into a underpass at 70mph is not entertaining, unless you like near death experiences.

I have delved into the realm of MAOI'S and it seems that this is a good place to start for a good many problems. When I say MAOI's I meen natural ones in our bodies. A well balanced diet seems to suit me better than the high protein diet although diabetes does run in my family. There is correlation in the amount of glucose entering the brain and the amount of Oxygen needed to burn the glucose. If you have a deficiency in one or the other you are going to run into problems. Once again it seems to go back to the area of keeping my lungs moving. What causes the lungs to move?Electrical signals from the brain. These signals mediated by
largely by epinephrine. There must be a reasonwhy so many people are addicted to coffee. They think it helps wake them up, which it does, but more so it probably increases respiration or breathing. There are receptors in the brain that caffeine attatches to, these receptors are the same receptors that our bodies own beta-carbolines attatch too.It seems that they are doing the same thing but one is not natural, at least body wise.It would seem that maybe caffeine could suppress the beta-carboline system. I do know that caffeine raises endorphan levels in people that don't drink coffee and other caffeinated beverages but for people that do drink coffee they are only raised slightly to next to none. It is known that beta-carbolines raise endorphan levels by inhibiting there break down.

To be honest, my eyes are very messed up. I have veins grown into my cornea about 1mm and I have floaters the size of Texas. When I look at a very small point of light I see around four points of light or more, this of course is without glasses. I have read different journals of Opthamology and found out that some peoples eyes really get messed up from Laser surgery. With my luck it would probably be me. People that are blind have a circadian rythym that last 72 hours or more. Some of them I guess don't even have a circadian rythym. So you see without the proper receptors in the eye you can be in a state of half awake/half asleep at most parts of the day.

beta chem

[beta chem]

Darris, what was the advice you were going to give me on doing the higher protein diet? Maybe I did something wrong.

ps. Carbohydrates raise serotonin levels also.




[This message has been edited by beta chem (edited 09-01-2000).]

[optixbil]

Beta...If you're still looking for a lens that transmits most UV, check out the link at <http://www.eyeris-ne.com> Go to Lenspex then choose the Transmittance database. I think you'll find clear glass will be what you want for UV passage. "User" is the ID and password if you need it.
Bill