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    Serious - Vital signs may be unstable or outside normal limits. The patient is acutely ill or injured and may have major complications.

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    Note: "Stable" is not a condition.

Press Releases

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    • Friday, Nov 03, 2023

    Renown Health Recognized for Excellence with ACC Transcatheter Valve Certification

    Renown developed processes to standardize patient care, increase quality measurement The American College of Cardiology has recognized Renown Health for its demonstrated expertise and commitment in treating patients receiving transcatheter valve repair and replacement procedures. Renown Health was awarded Transcatheter Valve Certification in February based on evaluation of the staff’s ability to meet standards for multidisciplinary teams, formalized training, shared decision-making and registry performance. The ACC’s Transcatheter Valve Certification is an external review and certification process that pairs with established national clinical databases to monitor patient safety and real-world outcomes related to transcatheter valve therapies. Participation in established national clinical databases such as the STS/ACC TVT Registry is required for hospitals interested in achieving Transcatheter Valve Certification. “Renown Health has demonstrated its commitment to providing northern Nevada with excellent heart care,” said Deepak L. Bhatt, MD, MPH, FACC, chair of the ACC Accreditation Management Board. “ACC Accreditation Services is proud to award Renown Health with Transcatheter Valve Certification.” The certification uses established national clinical measures to support clinical decisions and links process improvement to patient outcomes. Hospitals that achieve Transcatheter Valve Certification learn best practices for implementing evidence-based medicine to support patient-centered decision-making and can track key performance metrics to better identify opportunities for improvement. The nationally acclaimed Renown Institute for Heart & Vascular Health provides the region with top-tier cardiovascular care, including 11 cardiovascular specialties, 52 providers and 69,000 patient visits per year. “Renown was the first healthcare system in the region to offer our patients the minimally invasive Transcatheter Aortic Valve Replacement (TAVR) and in 2022 our team performed 128 TAVR procedures, exceeding the national TAVR quality average,” said Dr. Jayson Morgan, FACC, Director of Cardiovascular Services. “This advanced 60-to-90-minute procedure treats aortic stenosis, a progressive disease that affects the aortic valve in the heart. During the procedure, a new valve is inserted within the diseased aortic valve while the heart is still beating.” The ACC offers U.S. and international hospitals like Renown Health access to a comprehensive suite of cardiac accreditation services designed to optimize patient outcomes and improve hospital financial performance. These services are focused on all aspects of cardiac care, including transcatheter valve therapies. About Renown Health Renown Health is the region’s largest, locally governed, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe, and northeast California. With a diverse workforce of more than 7,000 employees, Renown has fostered a longstanding culture of excellence, determination, and innovation. The organization comprises a trauma center, two acute care hospitals, a children’s hospital, a rehabilitation hospital, a medical group and urgent care network, and the region’s largest, locally owned not-for-profit insurance company, Hometown Health.   About the American College of Cardiology The American College of Cardiology (ACC) is the global leader in transforming cardiovascular care and improving heart health for all. As the preeminent source of professional medical education for the entire cardiovascular care team since 1949, ACC credentials cardiovascular professionals in over 140 countries who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. Through its world-renowned family of JACC Journals, NCDR registries, ACC Accreditation Services, global network of Member Sections, CardioSmart patient resources and more, the College is committed to ensuring a world where science, knowledge and innovation optimize patient care and outcomes. Learn more at acc.org or follow @ACCinTouch.

    Read More About Renown Health Recognized for Excellence with ACC Transcatheter Valve Certification

    • Friday, Sep 29, 2023

    Renown Health Nationally Recognized for Commitment to Providing High-Quality Stroke Care With Three American Heart Association Recognitions

    The American Heart Association presents Get With The Guidelines®- Stroke Gold Plus awards for proven dedication to ensuring all stroke patients have access to best practices and life-saving care. Renown Health emergency, medical and surgical providers have received three American Heart Association’s Get With The Guidelines® awards. These awards demonstrate commitment to ensuring stroke patients receive the most appropriate treatments according to nationally recognized, research-based guidelines; reducing disabilities and increasing the number of lives saved. Every 40 seconds, someone in the U.S. has a stroke. Stroke is the 5th leading cause of death in the U.S. and the main cause of adult disability. Studies show patients recover better when providers consistently follow treatment guidelines. Get With The Guidelines puts the expertise of the American Heart Association and American Stroke Association to work for hospitals nationwide, helping ensure patient care is aligned with the latest research and evidence-based guidelines. “A stroke is an extremely serious condition that requires emergent medical treatment. The faster treatment is provided, the lower the risk of brain injury. We are proud of our thousands of physicians, nurses and clinicians who consistently practice exceptional patient care by adhering to the latest treatment guidelines,” said Brian Erling, MD, MBA, President and CEO, Renown Health. “Get With The Guidelines makes it easier for our teams to put proven knowledge and consistent protocols to work on a daily basis, which studies show can help people live longer and better lives.” “As a participant in Get With The Guidelines programs, Renown qualified for the awards by demonstrating that physicians and clinicians across our integrated health system are committed to improving quality care for stroke patients,” said Bill Plauth, MD, MMM, CPE, Chief Medical Officer for Renown Health and Associate Dean for Clinical Affairs at the University of Nevada, Reno School of Medicine. “If you or a loved one is experiencing a stroke, call 911, as you need skilled medical care immediately. Stroke care focuses on helping people recover as much function as possible and return to independent living. The Renown Neurovascular and Stroke Program and Renown Rehabilitation Hospital teams provide expert emergency stroke care and comprehensive neurovascular care and rehabilitation services.” “We are pleased to recognize Renown Health for its commitment to caring for those in their community who need cardiovascular care,” said John Warner, MD, FAHA, past president of the American Heart Association and CEO of The Ohio State University Wexner Medical Center. “Hospitals that follow the American Heart Association’s quality improvement protocols often see improved patient outcomes, fewer readmissions and lower mortality rates – a win for health care systems, families and communities.” “Renown Regional Medical Center is the only designated Comprehensive Stroke Center in northern Nevada,” says Benjamin Pence, DO, Director, Institute for Neurosciences at Renown. “This means that we have the highest level of certification to receive and treat the most complex stroke cases. Our Institute for Neurosciences team is led by the area's top neurologists, and we conduct research studies involving new ways of preventing, diagnosing, and managing neurological disorders. We care for patients suffering from nerve and brain disorders due to stroke, headache, epilepsy, and other acute causes. We also monitor and develop treatment options for patients with memory and movement disorders such as Alzheimer’s, Parkinson's Disease or Multiple Sclerosis.” Renown Health also received the American Heart Association’s Target: Stroke Honor Roll Elite award. To qualify for this recognition, hospitals must meet specific criteria that reduce the time between an eligible patient’s arrival at the hospital (within 60 minutes or less) and treatment for at least 85 percent of applicable patients. “It is an honor to be among the American Heart Association’s Stroke Honor Roll Elite award recipients,” said Bret Frey, MD, president of Northern Nevada Emergency Physicians Care teams at Renown Health. “We adhere to these rigorous guidelines daily and demonstrate our unwavering commitment to ensuring more people in northern Nevada receive leading emergency and trauma care and the gift of extended, healthier lives.” Renown Health also received the American Heart Association’s Target: Type 2 Diabetes Honor Roll - Stroke award. Target: Type 2 Diabetes aims to ensure patients with Type 2 diabetes, who might be at higher risk for complications, receive the most up-to-date, evidence-based care when hospitalized due to stroke. This award is given to hospitals that qualify for the silver level or higher achievement award within the Get With The Guidelines – Stroke program and achieve an overall Diabetes Cardiovascular Initiative Composite Score of more than 80 percent. About Renown Health Renown Health is Nevada’s largest, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe, and northeast California. With a diverse workforce of more than 7,000 employees, Renown has fostered a longstanding culture of excellence, determination, and innovation. The organization comprises a trauma center, two acute care hospitals, a children’s hospital, a rehabilitation hospital, a medical group and urgent care network, and the locally owned not-for-profit insurance company, Hometown Health. To join the Renown team, visit renown.org/careers. About Get With The Guidelines Get With The Guidelines® is the American Heart Association/American Stroke Association’s hospital-based quality improvement program that provides hospitals with the latest research-based guidelines. Developed with the goal of saving lives and hastening recovery, Get With The Guidelines has touched the lives of more than 12 million patients since 2001. For more information, visit heart.org.

    Read More About Renown Health Nationally Recognized for Commitment to Providing High-Quality Stroke Care With Three American Heart Association Recognitions

    • Wednesday, Jul 26, 2023

    Renown Health Is Nationally Recognized for Its Commitment To Providing High-Quality Heart Failure Care With Three American Heart Failure Recognitions

    Renown Health Cardiology has received the American Heart Association’s Get With The Guidelines® - Heart Failure Gold Plus quality achievement award for its commitment to improving outcomes for patients with heart failure, meaning reduced readmissions and more healthy days at home. The heart care team also received Target: Heart Failure Honor Roll and Target: Type 2 Diabetes Honor Roll. About 6 million U.S. adults are living with heart failure (HF), a number that is expected to increase to more than 8 million by 2030. Despite the name, HF doesn’t mean that the heart has stopped working – it means the heart is having a hard time pumping blood and oxygen throughout the body. While there’s no cure for HF, patients can live a quality life by working with their health care team to create and stick with a plan that may include medication, symptom monitoring and lifestyle changes. The Get With The Guidelines - Heart Failure quality achievement award is earned by hospitals that demonstrate a commitment to treating patients according to the most up-to-date guidelines as outlined by the American Heart Association. Get With The Guidelines puts the expertise of the American Heart Association to work for hospitals nationwide, helping ensure patient care is aligned with the latest research- and evidence-based guidelines. The program aims to increase healthy days at home and reduce hospital readmissions for heart failure patients. “Renown Health is committed to improving patient care by adhering to the latest treatment guidelines,” said Jayson Morgan, MD, Director of Cardiovascular Services at Renown Health. “Get With The Guidelines makes it easier for our teams to put proven knowledge and guidelines to work on a daily basis, which studies show can help patients recover better. The end goal is to ensure more people in northern Nevada can experience longer, healthier lives.” Each year, program participants qualify for the award recognition by demonstrating how their organization has committed to providing quality care for HF patients. In addition to following treatment guidelines, Get With The Guidelines participants also provide education to patients to help them manage their HF at home. “We are pleased to recognize the leaders and teams at Renown Health for a strong commitment to caring for people with heart failure,” said Clyde W. Yancy, MD, MSc, MACC, FAHA, MACP, FHFSA, national chairperson of the American Heart Association Heart Failure systems of care advisory group and chief, division of cardiology at Northwestern University, Feinberg School of Medicine. “Hospitals that participate in Get With The Guidelines quality improvement programs often see better patient outcomes, fewer readmissions and lower mortality rates – a win for health care systems, families and communities.” Renown Health is also recognized on the American Heart Association’s Target: Heart FailureSM Honor Roll. Hospitals on the Honor Roll meet specific criteria that improves medication adherence, provides early follow-up care and coordination and enhances patient education. The goal is to further reduce hospital readmissions and help patients improve their quality of life in managing this chronic condition. Renown Health additionally received the American Heart Association’s Target: Type 2 Diabetes Honor Roll™ award. Target: Type 2 Diabetes aims to ensure patients with Type 2 diabetes, who might be at higher risk for complications, receive the most up-to-date, evidence-based care when hospitalized due to heart disease or stroke. About Renown Health Renown Health is Nevada’s largest, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe, and northeast California. With a diverse workforce of more than 7,000 employees, Renown has fostered a longstanding culture of excellence, determination, and innovation. The organization comprises a trauma center, two acute care hospitals, a children’s hospital, a rehabilitation hospital, a medical group and urgent care network, and the locally owned not-for-profit insurance company, Hometown Health. Renown is currently enrolling participants in a community-based genetic population health study, the Healthy Nevada Project®. About Get with the Guidelines Get With The Guidelines® is the American Heart Association/American Stroke Association’s hospital-based quality improvement program that provides hospitals with the latest research-based guidelines. Developed with the goal of saving lives and hastening recovery, Get With The Guidelines has touched the lives of more than 12 million patients since 2001. For more information, visit heart.org.

    Read More About Renown Health Is Nationally Recognized for Its Commitment To Providing High-Quality Heart Failure Care With Three American Heart Failure Recognitions

    • Monday, Oct 18, 2021

    Leading Experts Convene in Tahoe to Focus on Scientific Advancements and the Prevention of Cardiovascular Disease, the #1 Cause of Death Globally

    Three-day medical education conference advances research, education, prevention and treatment. Physicians and medical professionals from throughout the Mountain West will soon be convening in Lake Tahoe to explore emerging treatments, the most recent advances and new clinical guidelines for the diagnosis, treatment and prevention of cardiovascular disease, diabetes mellitus, stroke and heart disease. Hosted by Renown's Institute for Heart & Vascular Health and the Nevada Academy of Family Physicians, the three-day Trends in Cardiovascular Medicine conference will bring together national experts to explore challenges and solutions to cardiovascular diseases, the leading cause of death globally, taking an estimated 17.9 million lives each year. "Our mission is to advance health in America. As Nevada's first integrated health system, with our University of Nevada, Reno School of Medicine affiliation, we are advancing health and health care through world-class medical education, clinical research and patient care for our community, our state and our nation," says Anthony D. Slonim, MD, DrPH, President & CEO, Renown Health. "And, we have so much work to do. In 2019, 9.5% of Nevadans reported being told by a health professional that they had angina or coronary heart disease; which is significantly above the national average of 8.4%. As public health and health care providers, we can do more to encourage people to adopt healthy lifestyle habits to keep their heart healthy and help prevent heart disease through the Healthy Nevada Project®, where people can understand their genetic risks at no-cost." "The driving force behind this collaborative event is the shared missions of all our organizations, across the country, to advance progress in cardiovascular research, education, prevention and treatment," says Jayson Morgan, MD, FACC, Director Cardiovascular Services at Renown. "We will be joined by colleagues from Johns Hopkins, Cedars-Sinai, Scripps, University of New Mexico Health Sciences, University of Utah, Medical College of Wisconsin, the Metabolic Institute of America and locally- with experts from Renown's Institute for Heart & Vascular Health/UNR Med, St. Mary's and Barton Health - to discuss contemporary trends in providing excellent cardiovascular care and prevention." New research will be presented each day, including: “Vaping and Electronic Cigarettes – The Hidden Epidemic: What the Clinician Needs to Know” Michael J. Blaha, MD, MPH, FACC, Professor of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Director of Clinical Research, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD “Optimizing Glycemic Control in the Inpatient Setting” Kendall M. Rogers, MD, CPE, FACP, SFHM, Professor, Department of Internal Medicine, University of New Mexico School of Medicine, Chief, Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Sciences, Albuquerque, NM “Perioperative Medicine Update”                                                                                                                                                                                             Barbara A. Slawski, MD, MS, SFHM Professor of Medicine & Orthopaedic Surgery, Chief, Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI “Understanding hATTR Amyloidosis: Clinical Presentation and Treatment Landscape” Jignesh K. Patel, MD, PhD, FACC, FRCP, FAST, FAHA, Clinical Professor of Medicine, Medical Director, Heart Transplant Program, Director, Cardiac Amyloid Program, Director, Heart Transplant Research, Cedars-Sinai Medical Center, Los Angeles, CA “Coronary Artery Calcium in 2021: Guideline-Endorsed and Ready for Prime Time” “The Evolving Landscape of Obesity Management – A 2021 Update” Ken Fujioka, MD, Director of the Center for Weight Management, Director of the Nutrition and Metabolic Research Center, Scripps Clinic, Department of Diabetes and Endocrine, San Diego, CA “The Evolving Landscape of Obesity Management – A 2021 Update” Ken Fujioka, MD, Director of the Center for Weight Management, Director of the Nutrition and Metabolic Research Center, Scripps Clinic, Department of Diabetes and Endocrine, San Diego, CA “Management of Atrial Fibrillation: Where We Are; Where We Are Headed” Matthew A. Cain, MD, Electrophysiologist, Renown Institute for Heart & Vascular Health, Renown Medical Group, Reno, NV "The Story of a Murmur” Abhilash Akinapelli, MD, Cardiac Valve & TAVR Program Director, Renown Institute for Heart & Vascular Health, Renown Medical Group, Reno, NV "Update on the Cardiovascular Effects of COVID-19” Siddharth Singh, MD, Assistant Director, Echo Fellowship Training Program, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA “Antibiotic Stewardship: How to Improve Our Prescribing for Now and Later”                                                                                                                            Valerie M. Vaughn, MD, MSc, FACP, FHM, Assistant Professor, Instructional Track Director of Hospital Medicine Research, Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT "Emerging Trends in the Clinical Management of VTE”                                                                                                                                                                Victor F. Tapson, MD, FCCP, FRCP, Director, Clinical Research for the Women’s Guild Lung Institute, Director, Venous Thromboembolism & Pulmonary Vascular Disease Research Program, Associate Director, Pulmonary and Critical Care Division, Cedars-Sinai Medical Center, Los Angeles, CA “Contemporary Approach to the Management of Diabetes as a Cardiovascular Disease”                                                                                               Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE, Medical Director & Principal Investigator, Metabolic Institute of America, Tarzana, CA The Arthur J Lurie, MD Memorial Dinner and Keynote Presentation, sponsored by the charitable Renown Foundation and the Lurie Family, is an evening ceremony to honor and memorialize the devotion and innovation of the lake Dr. Arthur J. Lurie, who personified humanitarian, medical and community service. Dr. Lurie devoted modernized heart surgery and was steadfast in his commitment to introduce new and groundbreaking techniques cardiovascular techniques to Nevada. He promoted and inspired life-changing research and advancements in heart surgery, as well as cancer research, until his passing in 1996. Medical professionals are invited to attend the 31st Annual Trends in Cardiovascular Medicine conference will take place at the Resort at Squaw Creek in Olympic Valley, CA from Friday, Nov. 5 through Sunday, Nov. 7, 2021. Those interested in registering or learning more may visit www.renown.org/trends. The clinical team at Renown Institute for Heart and Vascular Health is the recipient of a number of national awards for outstanding clinical care and service, including: In U.S. News and World Report Best Hospital rankings for 2021, Renown Regional Medical Center - #1 in the State of Nevada for 2021. No other hospital in Nevada earned recognition from U.S. News. Renown Regional Medical Center is High Performing, its highest rating possible, for Heart Failure and Chronic Obstructive Pulmonary Disease. Awarded by the American College of Surgeons for the Renown Regional earned America's 100 Best Hospitals for Critical Care Award (2021) for Superior clinical outcomes in treating pulmonary embolism, respiratory system failure, sepsis, and diabetic emergencies. Regional also earned the Pulmonary Care Excellence Award™ (2021), for superior outcomes. Designated Level II Trauma Center. For the 30th year, Renown Regional Medical Center is northern Nevada's only designated level II trauma center. Renown Regional awarded The Get with the Guidelines - Heart Failure Gold Plus Quality Achievement award for continually ensuring heart failure patients receive the most appropriate treatment according to nationally recognized, research-based guidelines, as well as AHA's mission: Lifeline Gold Receiving honor for the treatment of patients who suffer severe heart attacks. American College of Cardiology's NCDR Chest Pain-MI Registry Platinum Performance Achievement Award. Renown Regional Medical Center is one of only 225 hospitals nationwide to receive the honor. The award recognizes Renown's success in implementing a higher standard of care for heart attack patients and signifies that Renown has reached an aggressive goal of treating these patients to standard levels of care as outlined by the American College of Cardiology/American Heart Association clinical guidelines and recommendations.  To make an appointment with a provider at Renown's Institute for Heart and Vascular Health, request that your primary care provider make a referral. For more information on Renown's Institute for Heart and Vascular Health, visit renown.org/Health-Services/Heart-Care.     About Renown Health Renown Health is a locally governed, not-for-profit integrated healthcare network serving northern Nevada, Lake Tahoe and northeast California. In U.S. News and World Report Best Hospital rankings, Renown Regional Medical Center was listed #1 in the State of Nevada. Renown has a long tradition and commitment to improve the care and the health of our community. For more information, visit renown.org.

    Read More About Leading Experts Convene in Tahoe to Focus on Scientific Advancements and the Prevention of Cardiovascular Disease, the #1 Cause of Death Globally

    • Monday, Sep 14, 2020

    Renown Cardiologist Shares Insight on Warfarin

    Renown Health's Dr. Christopher Rowan recently joined a distinguished panel of experts on the "Game Changers in Medicine" podcast to discuss the science behind the discovery of warfarin. Renown Health Cardiologist Dr. Christopher Rowan was just featured on an episode of Game Changers in Medicine, a groundbreaking medical history podcast from Dramatic Health about some of the world’s most significant medical discoveries. The episode, Warfarin: How a rat poison became one of the world's most widely prescribed drugs, dives into the fascinating history of Warfarin and its life-saving effects on humans.  During the episode, Dr. Rowan, whose research focus is heart disease and atherosclerosis, is joined by experts Kevin Walters, Historian and Strategic Research Coordinator at the Wisconsin Alumni Research Foundation (WARF); and Ramya M. Rajagopalan, Ph.D. of the Institute for Practical Ethics at UC San Diego. Listen to the episode now or download it wherever you listen to podcasts.  History of Warfarin Warfarin prevents blood clots from forming or expanding. The drug is especially important for individuals who have experienced a heart attack or stroke, or are at risk of experiencing either. However, the backstory of the drug is rather fascinating.  Beginning in the 1920s, an unknown disease was killing cattle throughout the U.S. and Canada. Desperate to find a solution, one farmer drove 200 miles to the University of Wisconsin with a dead cow, bales of spoiled hay and a milk can of unclotted blood in tow. He crossed paths with a scientist, whose team set out to determine the hemorrhagic component of the spoiled hay, resulting in a series of medical discoveries that would revolutionize medicine.  After learning more about Warfarin and how Vitamin K could reverse its blood thinning properties, doctors first prescribed the drug for human use in 1954. It is perhaps most widely known for saving President Dwight D. Eisenhower after he suffered a heart attack in 1955. Today, Warfarin continues to saves millions of lives each year. “Before blood thinners like Warfarin, people would experience strokes, blood clots in their lungs, blood clots in their legs, blood clots in their hearts, along with countless other clotting disorders - these conditions likely cutting their lifespans short,” Dr. Rowan said during the podcast. “Warfarin revolutionized the treatment of patients who suffer from heart attacks and strokes, helping them to live normal and healthy lives. The drug changed medicine forever and helped make incredible innovations such as mechanical heart valves a reality.” Interview Opportunity Dr. Rowan is available for interviews to discuss the importance of this unique medical discovery and the positive impact it has on many of the patients he treats every day. Please email news@renown.org or call 775-691- 7308 to coordinate an interview.      About Renown Health Renown Health is the region’s largest, locally owned and governed, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe and northeast California. With a diverse workforce of more than 7,000 employees, Renown has fostered a longstanding culture of excellence, determination and innovation. The organization comprises a trauma center, two acute care hospitals, a children’s hospital, a rehabilitation hospital, a medical group and urgent care network, and the region’s largest, locally owned not-for-profit insurance company, Hometown Health. Renown’s institute model addresses social determinants of health and includes: Child Health, Behavioral Health & Addiction, Healthy Aging and Health Innovation. Clinical institutes include: Cancer, Heart and Vascular Heath, Neurosciences and Robotic Surgery. Renown is currently enrolling participants in the world’s largest community-based genetic population health study, the Healthy Nevada Project® . For more information, visit renown.org. About Dramatic Health Dramatic Health, a national healthcare video company, is the producer of the six-part podcast series Game Changers in Medicine. The series premiered in July with an episode about Vitamin K and an enterprising Boston house doctor. The August episode showcased the creation of a smallpox vaccine and its parallels to today's urgent search for a COVID-19 vaccine. Game Changers in Medicine ranked #27 in Apple Podcasts: Life Sciences in the United States according to Chartable as of August 21, 2020. Both episodes, a series backgrounder, and additional material about the podcast series are available at www.gamechangersinmedicine.com and can be accessed wherever you listen to podcasts.

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