Courtesy of: Your Rio Vista Chiropractor Dr. Joseph T. Megna

Health Alert: Gene Discovery May Offer New Avenue to Combat Alzheimer’s. In a recent study that included individuals at elevated risk for Alzheimer’s disease, researchers observed that those who did not develop the neurodegenerative condition carried a gene variant that helps the brain more efficiently remove the beta amyloid plaques from the brain that are a hallmark of the disease. If scientists are able to develop a therapy that mimics the gene’s effect in the brain, it’s hoped that Alzheimer’s cases may be reduced by up to 70%.
Columbia University, April 2024

Diet: Intermittent Fasting Benefits Intestinal Health. Intermittent fasting is a dietary strategy that alternates between periods of eating and fasting, typically within a structured time frame each day or week. A recent animal study found that intermittent fasting is associated with reduced inflammation and improved glucose control in the small intestine, which suggests this dietary practice may improve intestinal health.
American Physiology Summit, April 2024

Exercise: Sedentary Behaviors Raises COPD Risk. Chronic obstructive pulmonary disease (COPD) is a chronic lung disease that makes breathing difficult, and it is a leading cause of death in the United States. An analysis of data from several long-term studies found that for every 2.8 hours an individual averages per day watching television, their risk for COPD doubles.                                                                                    BMJ Open Respiratory Research, April 2024

Chiropractic: Manual Therapy’s Impact on Ankle Dorsiflexion. For individuals with reduced ankle dorsiflexion following a lower limb injury, a recent study found that ankle joint mobilization and calf muscle massage are effective interventions for improving ankle range of motion. Doctors of chiropractic are trained in the use of these and other therapies in the management of musculoskeletal disorders of the extremities,
including the ankle and foot.                                                                                                            Journal of Bodyworks and Movement Therapies, January 2024

Mental Attitude: Long Commute and Musculoskeletal Pain Linked to Burnout. Questionnaire completed by 1,615 healthcare professionals revealed that the combination of a commute lasting longer than 50 minutes and either neck and shoulder pain or ankle pain alone are linked to an elevated risk for burnout.
BMC Health Services Research, April 2024

Wellness/Prevention: New Urine Test May Streamline Bladder Cancer Follow-Up. Researchers have developed a new urine test that can look for genetic markers of bladder cancer, which may reduce the need for follow-up cystoscopies in bladder cancer survivors while also detecting cancer recurrence for earlier treatment.
European Association of Urology, April 2024       

Quote: “The only failure is not to try.” ~ George Clooney

Your Rio Vista Chiropractor Dr. Joseph T. Megna

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Health Alert: Don’t Use Tap Water for Nasal Rinse. Individuals with sinusitis and allergic rhinitis often find relief using a nasal rinse—like a neti pot. However, officials from the Centers for Disease Control and Prevention remind users to use sterile water and avoid using tap water. The primary reason is that tap water may contain
microbes like the amoeba Acanthamoeba that can lead to a severe and potentially deadly infection.
Emerging Infectious Diseases, March 2024

Diet: Nutrition Education Benefits Adolescents. A recent literature review found that not only do nutrition education interventions help teens make healthier food choices, but they may also experience an improved selfimage.                                    Frontiers in Nutrition, March 2024

Exercise: Physical Activity Reduces Atrial Fibrillation Risk in Type 2 Diabetics. Past research has shown that type 2 diabetics are at elevated risk for developing atrial fibrillation, a heart rhythm disorder that can lead to stroke, heart failure, and other cardiovascular complications. In a recent study, researchers observed that diabetics who engaged in at least 214 minutes a week of moderate-intensity physical activity a week had a lower incidence of atrial fibrillation than less active diabetes patients.                                                                                                                                          Cardiovascular Diabetology, March 2024

Chiropractic: Chiropractic Care for Trigeminal Neuralgia. This case study involved a 55-year-old female with trigeminal neuralgia that failed to respond to conventional treatment. A chiropractic examination revealed joint dysfunction at several levels of the cervical and thoracic spine, as well as trigger points in the trapezius and levator scapulae muscles. The patient underwent a multimodal treatment plan that included spinal manipulative therapy, mechanical cervical traction, and focused radial shockwave therapy that led to a significant reduction in her symptoms that maintained at a six-month follow-up appointment. The authors conclude, “The lasting nature of the
pain reduction provides a compelling argument for the long-term benefits of chiropractic intervention in the management of [trigeminal neuralgia].”                    Cureus, February 2024

Mental Attitude: Depression Linked to Increased Heart Risks in Women. University of Tokyo researchers analyzed data concerning 4.2 million adults and found among women, depression is associated with an elevated risk for heart issues like heart attack, stroke, angina, heart failure, and atrial fibrillation.
American College of Cardiology, March 2024

Wellness/Prevention: Warning Signs of Colorectal Cancer. The Mayo Clinic notes that the incidence of colorectal cancer is on the rise in adults under age 50. Warning signs for this type of cancer include abdominal pain, diarrhea, blood in bowel movements, and iron deficiency anemia. Individuals experiencing these symptoms should contact their healthcare provider.                                                                                Mayo Clinic, March 2024

Quote: “I believe that fate is choices – it’s not chance.” ~ Wayne Newton

Your Rio Vista Chiropractor Dr. Joseph T. Megna

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Health Alert: Early-Life Tobacco Exposure May Set Stage for Type 2 Diabetes. New research suggests that individuals exposed to secondhand smoke during gestation or early life have up to a 22% elevated risk for type 2 diabetes in adulthood, while those who start smoking during adolescence may be up to 57% more likely to develop type 2 diabetes.                                                                                                      American Heart Association, March 2024

Diet: Healthy Diet May Keep Muscles Strong. An analysis of dietary questionnaire data collected from 528 middle-aged and older adults revealed an association between greater adherence to a healthy eating pattern, such as the Mediterranean diet, and both a stronger grip and greater muscle mass in the arms and legs. The findings suggest that consuming a healthy diet may preserve muscle mass in aging adults.                                                                                                                                  European Journal of Nutrition, April 2024

Exercise: Carrot or Stick? In a recent study, researchers observed that a system offering small rewards for meeting physical activity recommendations and small penalties for non-compliance resulted in more significant improvements in exercise behavior than a reward-only or penalty-only system.                                                        Leiden University, February 2024

Chiropractic: Conservative Treatment for Tennis Elbow. For patients with lateral elbow tendinopathy, a systematic review that included twelve studies found that a conservative treatment plan that includes manual therapy, electrotherapy, and exercise may provide greater long-term benefits and a lower risk of recurrence than corticosteroid injections. Doctors of chiropractic often manage patients with tennis elbow using such a multimodal approach.                                                                                Shoulder Elbow, March 2024

Mental Attitude: Establish a Cognitive Baseline. Experts from Northwestern Medicine recommend individuals begin undergoing cognitive assessments at midlife to both establish a baseline and to measure their thinking and memory skills over time. Neuropsychologist Dr. Sandra Weintraub notes, “All of us go to the doctor every year, and we know our blood pressure and heart rate, our sugar levels and bone density… But at no time are we ever told what our baseline cognitive functioning is. Because we know aging can bring potential problems with your thinking abilities, it is very important to know how a person is functioning even in their 50s or 60s. That way when those agerelated changes start to occur, we have a baseline to know if you have changed or not.”
Northwestern University, February 2024

Wellness/Prevention: Greenspace Access and Dementia. Using data from the Healthy Brain Project, researchers observed that greater access to green spaces is associated with a reduced risk for dementia for residents of socioeconomically disadvantaged neighborhoods. The findings suggest that measures to make parks and natural spaces easier to access could reduce the incidence of dementia in less affluent areas.
Preventative Medicine Reports, March 2024

Quote: “Winning isn’t everything. Wanting to win is.” ~ Jim “Catfish” Hunter

Your Rio Vista Chiropractor Dr. Joseph T. Megna

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Health Alert: Shortage of Primary Care Providers Leading to More Emergency Surgeries. Primary care providers (PCP) are essential for identifying health issues early on when they’re easier to manage. However, in areas with a PCP shortage, individuals are more likely to seek care for health issues once they’ve progressed to the point of requiring emergency treatment, which may lead to worse outcomes, including complications. The findings highlight the need for greater access to healthcare services for individuals in underserved areas.
Health Affairs, March 2024

Diet: Healthy Diet Can Aid in Stress Management. The Mediterranean diet is an eating pattern focused on fruit, vegetables, nuts, fish, olive oil, and whole grains while avoiding red and processed meats, dairy, saturated fats, and refined sugars. A study that looked at data from the Korean Genome and Epidemiology Study found that greater
adherence to the Mediterranean diet pattern is associated with greater resilience to stress among middle-aged and older adults.                                                                                Nutrition Research and Practice, April 2024

Exercise: Yoga Provides Unique Cognitive Benefits for Women at Risk for Alzheimer’s. According to a recent study, older women at risk for Alzheimer’s disease who participated in a yoga intervention experienced greater improvements with respect to subjective memory complaints, brain connectivity, and anti-inflammatory gene
expression than women who performed memory training exercises.                                Translational Psychiatry, February 2024

Chiropractic: Treatment for Mechanical Neck Pain. Mechanical neck pain is a term used to describe neck pain that results from the application of stress or strain on the anatomical structures of the neck. A recent study that included 78 mechanical neck pain patients found that a treatment plan that included a combination of manual
therapies and therapeutic exercises—an approach commonly used by chiropractors—provided significant improvements with respect to pain, disability, and function. Physical Therapy, March 2024

Mental Attitude: After-School Activities Can Harm Teen Mental Health. While parents are often advised to encourage their teenagers to participate in afterschool sports and other activities to bolster their college resume and facilitate healthy social growth, a recent study found that overloading a teen’s schedule can have detrimental effects on their mental health and academic performance.                 Economics of Education Review, March 2024

Wellness/Prevention: Green Spaces Lower Osteoporosis Risk. Using data from the UK Biobank study, researchers report that residents of neighborhoods with more greenery may have a 5% lower risk for osteoporosis. The researchers speculate this may be due to the effect greenspaces can have on reducing air pollution, which can
benefit bone health, as well as an increase in physical activity that previous studies have associated with greater access to parks and natural spaces.                                           Annals of the Rheumatic Diseases, March 2024

Quote: “To begin, begin.” ~ William Wordsworth

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Health Alert: Oral Bacteria Linked to Accelerated Colon Tumor Growth. Researchers from the Fred Hutchinson Cancer Center report that when swallowed, a subtype of the common oral bacteria Fusobacterium nucleatum, called Fna C2, can accelerate tumor growth in the colon and may contribute to up to 50% of colon cancer
cases. It’s hoped this discovery will help scientists craft more effective treatments for colon cancer.
Nature, March 2024

Diet: Unhealthy Diet Before Surgery May Impair Memory. Ohio State University researchers report that rats fed a diet high in unhealthy fats in the time leading up to surgical procedure experienced increased inflammation in the brain that hindered their memory during recovery. On the other hand, rats given a supplement of omega-3 fatty acids did not experience any post-surgical cognitive impairment. Brain, Behavior, and Immunity, February 2024

Exercise: Exercise Boosts Beneficial Hormone in Breast Milk. Adiponectin is a metabolic hormone that helps regulate glucose levels and fatty acid breakdown. In a recent study, researchers observed that new mothers who engaged in vigorous exercise experienced an increase in adiponectin in their breast milk that can benefit the
metabolism of their offspring, potentially reducing the risk for childhood obesity.
Frontiers in Nutrition, December 2023

Chiropractic: Two Manual Therapies That May Benefit Patients with Knee Pain. When trigger points affect the function of the gluteus medius muscle, it can lead to altered gait, reduced hip stability, misalignment of the patella, and increased force on the knee, all of which can contribute to patellofemoral pain syndrome. A recent study found that for patients with patellofemoral pain syndrome associated with gluteus medius trigger points, positional release technique and myofascial release technique–two manual therapies that may be provided by doctors of chiropractic— are effective treatments for improving pain, function, strength, pressure pain threshold, and quality of life when combined with exercise therapy.                                                                        Journal of Pakistan Medical Association, February 2024

Mental Attitude: Social Life During Middle Age Can Protect Against Dementia. Using data from the Atherosclerosis Risk in Communities study, researchers report that strong social relationships during midlife are associated with a reduced risk for dementia over the following three decades.                                                      Alzheimer’s & Dementia, April 2024

Wellness/Prevention: Self-Help Techniques for Acute Insomnia. Researchers at Northumbria University report that the following self-help techniques may benefit individuals with new-onset insomnia: keep the bedroom cool, dark, and quiet; maintain a sleep diary to track when you go to bed and wake, as well as if you get up in the middle
of the night and how long before you fall back asleep; only use the bedroom for sleep; establish a wind-down routine in the hour before bedtime; and try word games or visualizations to help you fall asleep.                                                                                          SLEEP, March 2024

Quote: “If you avoid failure, you also avoid success.” ~ Robert Kiyosaki

Your Rio Vista Chiropractor Dr. Joseph T. Megna

 

 

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Health Alert: New-Onset Hypertension May Signal Atrial Fibrillation. Atrial fibrillation (A-Fib) is a common heart rhythm disorder that can lead to stroke, heart failure, and other cardiovascular complications. In a recent study that included 4,161 older adults, researchers observed that those with new-onset hypertension were two-times more likely to be diagnosed with atrial fibrillation in the next two years than seniors with a previous history of high blood pressure. The findings suggest that individuals over age 65 with new-onset hypertension should be screened for arrhythmia. Hypertension Research, March 2024

Diet: Protein-Rich Breakfast for Better Concentration? In a recent experiment, researchers observed that participants who consumed a protein-rich breakfast had better performance on a cognitive concentration test 150 minutes after their mealtime than those who either skipped breakfast or ate a carbohydrate-rich morning meal. Journal of Dairy Science, December 2023

Exercise: Fitness May Help Reduce Risk for Pregnancy-Related Low Back Pain. In a sample of 180 women whom researchers monitored throughout pregnancy, 75% experienced pregnancy-related low back pain. Further analysis revealed an association between higher fitness, particularly stronger back and leg muscles, and
a reduced risk for low back pain.                                                                                                PLoS One, December 2023

Chiropractic: Scapula Stabilization Exercises Benefit Chronic Neck Pain Patients. A systematic review that included five clinical trials found that including scapular stabilization exercises in a treatment plan for chronic neck pain resulted in better outcomes with respect to pain. The finding demonstrates how issues in one area of the body can lead to problems elsewhere, thus the importance of the chiropractic practice of examining the whole patient and not just focusing on the area of chief complaint.
Spine Surgery and Related Research, January 2024

Mental Attitude: Parenting Style Adjustment May Ease ADHD Symptoms in Kids. For parents of children with attention-deficit/hyperactivity disorder (ADHD), new research suggests that a parenting style that guides a child with verbal and physical cues may be more effective at mitigating ADHD symptoms than a more controlling parental approach.                                                                                                                              University of Waterloo, February 2024

Wellness/Prevention: Vitamin D Status and Type 2 Diabetes. Using data from the SUN Project study, researchers observed that participants who maintained low vitamin D levels were more likely to develop type 2 diabetes in the following decade. On the other hand, those with healthy vitamin D status were less likely to be diagnosed with type 2 diabetes. Journal of Endocrinological Investigation, March 2024

Quote: “Reading is to the mind what exercising is to the body.” ~ Richard Steele

Your Rio Vista Chiropractor Dr. Joseph T. Megna

Courtesy of: Your Rio Vista Chiropractor Dr. Joseph T. Megna

Health Alert: Symptoms Linked to Increased Cardiovascular Risks in Menopausal Women. According to a recent study, the combination of migraine and vasomotor symptoms (night sweats or hot flashes, for example) is linked to a more than 50% increased risk for either heart attack or stroke in women undergoing menopause.
Menopause Society, February 2024

Diet: Sweetened Beverages Linked to Atrial Fibrillation. An analysis of data concerning more than 200,000 adults revealed that consuming more than two liters of either sugar-sweetened or artificially sweetened beverages a week is linked to a 10-20% increased risk for atrial fibrillation diagnosis in the next decade. Meanwhile, drinking a liter a week of pure fruit juice can cut the risk for heart arrhythmia disorder by 8%.
Circulation: Arrhythmia and Electrophysiology, March 2024

Exercise: Isometric Exercises for Lower Blood Pressure. Isometric exercises are performed in static positions using the body’s weight to build strength and stability such as planks, bridges, and wall sits. New research suggests that isometric exercises offer an excellent approach for reducing both systolic and diastolic blood pressure.  Mayo Clinic, January 2024

Chiropractic: Neck Pain Is a Worldwide Problem. In 2020, more than 203 million people worldwide experienced at least one episode of neck pain. Due to a variety of factors, including the aging of the world population, experts estimate that cases of neck pain will increase by 32.5% by 2050, affecting nearly 270 million people.                The Lancet Rheumatology, March 2024

Mental Attitude: Relationship Between Loneliness and Back Pain in Later Life. Using data from the English Longitudinal Study of Ageing, researchers found that older adults experiencing loneliness had a higher risk for back pain in the following one-to-two years. Likewise, seniors with back pain were more likely to report loneliness in the same time frame. The findings suggest that back pain and loneliness may be risk factors for one another in older adults                                                                                Annals of Geriatric Medicine and Research, December 2023   

Wellness/Prevention: Ergonomic Seat Design May Help Make Mountain Biking Easier on the Back. Researchers report that a new mountain bike seat featuring a raised rear, longitudinal dip, and subtle lateral instability may have a positive effect on muscle activation and pelvic-spine kinematics, reducing the risk for low back pain associated with mountain biking.                                                                                  Sports Biomechanics, February 2024

Quote: “I may not have gone where I intended to go, but I think I have ended up where I intended to be.”
~ Douglas Adams

Your Rio Vista Chiropractor Dr. Joseph T. Megna

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Health Alert: Hypertension and Stoke Risk. An analysis of data concerning nearly one million middle-aged adults revealed that stage 1 hypertension (blood pressure 130-139/80-89 mmHG) is linked to a 1.4 times increased risk for stroke in men and a 2.4 times elevated risk for stroke in women in the following decade. The findings highlight the importance of maintaining healthy blood pressure readings during midlife.
Journal of Clinical Neuroscience, March 2024

Diet: Fructose Overconsumption Can Have Lifelong Effect on Offspring’s Health. A recent animal study found that the offspring of rats fed a high-fructose diet experienced disturbances to their autonomic nervous, cardiovascular, and metabolic systems early in life that elevated the risk for metabolic disorders and poor cardiovascular health in adulthood.                                                                                International Journal of Obesity, November 2023

Exercise: Tai Chi Can Help Reduce Blood Pressure. Among a group of 349 pre-hypertensive adults, those who practiced tai chi for one year experienced greater improvement in their blood pressure and were less likely to progress to hypertension than participants in an aerobic exercise group.                                                                    JAMA Network Open, February 2024

Chiropractic: Neck Pain Affects Walking Ability. Examinations of 14 older adults with chronic neck pain and 36 seniors without neck pain revealed that when walking with head movement, chronic neck pain is associated with a slower, more laborious, and asymmetrical gait. The authors of the study speculate this alteration in walking ability may be the result of structural instability and proprioception impairments in the
cervical spine. Doctors of chiropractic often address chronic neck pain and its associated symptoms with a multimodal approach that includes manual therapies and specific exercises.
Frontiers in Medicine, February 2024

Mental Attitude: Childhood Bullying Can Result in Long-Term Mental Health Issues. In a recent study that monitored nearly 10,000 boys and girls from age 11 until 17 found that those subjected to bullying at age 11 who developed interpersonal trust issues by age 14 were 3.5 times more likely to be diagnosed with significant mental health problems by age 17.                                                                                                      Nature Mental Health Month and Year, February 2024

Wellness/Prevention: Vitamin D Status and Pregnancy. A systematic review that included 42 studies found that vitamin D deficiency during pregnancy is linked to an increased risk for miscarriage, preterm labor, preeclampsia, and postpartum depression and healthy vitamin D status during pregnancy is associated with a
reduced risk for gestational diabetes and low birth weight.
Gynecologic and Obstetric Investigation, March 2024

Quote: “Truth is the cry of all, but the game of few.” ~ George Berkeley

Your Rio Vista Chiropractor Dr. Joseph T. Megna

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Health Alert: Short Sleepers at Risk for Type 2 Diabetes. Following an analysis of data concerning nearly 250,000 adults, researchers report that consistently sleeping only five hours a night is associated with a 16% elevated risk for type 2 diabetes in the next decade. For individuals averaging three to four hours a night of sleep, the risk jumps to 41%.                                                                                                                             JAMA Network Open, March 2024

Diet: What Are “Naked” Carbs? Individuals looking to make healthier food choices may be confused by the term naked carbs. In essence, naked carbs are added sugars found in sugary drinks and pre-packaged snacks that cause a rapid spike in blood sugar levels when consumed. On the other hand, dressed carbs are those found in whole foods accompanied by vitamins, minerals, and dietary fiber that are absorbed more slowly into the body without a corresponding spike in blood sugar levels.                                                The Conversation, March 2024

Exercise: Exercise Helps Concussion Recovery. For children and teens who sustain a mild-traumatic brain injury, new research suggests that engaging in at least 40 minutes of total moderate-to-vigorous exercise a day in the first two weeks post-injury can result in a greater reduction in post-concussion symptoms than less or no exercise at all.                                                                                                                                                        JAMA Network Open, February 2024

Chiropractic: Excess Weight Increases Low Back Pain Risk in Youth Population. A meta-analysis that included 34 studies concluded that obesity is a risk factor for low back pain in children and adolescents. In particular, the research team found that obese kids and teens have a 27% elevated risk for low back pain.
International Journal of Obesity (London), January 2024

Mental Attitude: Pets Help Boost Mental Health. A survey conducted jointly by the American Psychiatric Association and American Veterinary Medical Association found that 84% of pet owners in the United States believe that pets positively affect their mental health. The team that interpreted the survey results believes this may be due to several factors including stress reduction, companionship, comfort, and increased physical activity.                                                                                                                          American Psychiatric Association & American Veterinary Medical Association, March 2024

Wellness/Prevention: Personality and Cancer Screenings. Using data from the German National Cohort study, which included nearly 133,000 middle-aged adults, researchers found that individuals with certain personality traits—particularly high levels of extraversion, neuroticism, and conscientiousness—are more likely to attend cancer screenings. The findings suggest that efforts to increase cancer screening should take personality traits into account.                                                                            Preventative Medicine Reports, March 2024

Quote: “Great things are done by a series of small things brought together.” ~ Vincent Van Gogh

Your Rio Vista Chiropractor Dr. Joseph T. Megna

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Health Alert: Extreme Heat Affects Pregnancy & Premature Birth Risk. Following an analysis of data concerning 1.2 million births in Sydney, Australia between 2000 and 2022, researchers report that extreme heat during the third trimester of pregnancy is associated with an increased risk for premature birth. The authors
speculate that high temperatures overnight can disrupt an expectant mother’s circadian rhythms and blood pressure, which have been linked to premature birth in past studies. JAMA Pediatrics, February 2024

Diet: Many Kids Consume Too Many Ultra-Processed Foods. A commentary published in the American Journal of Medicine warns that a high intake of ultra-processed foods—food products include added sugars, fats, and salt to enhance flavor and prolong shelf life—has been linked to several poor health outcomes including obesity, diabetes, heart disease, and inflammatory bowel disease. Unfortunately, ultra-processed food products make up a significant portion of the American diet, including 70% of the average child’s total calorie intake.                                                                American Journal of Medicine, February 2024

Exercise: Sitting Less, Moving More Reduces Depression and Stress in College Students. Questionnaires completed by more than 8,000 university students revealed that exchanging 30 minutes of sedentary behavior for physical activity of any intensity can reduce depressive symptoms and stress.
Psychology of Sport and Exercise, February 2024

Chiropractic: See a Chiropractor First for Spine Pain. A systematic review that included 44 studies concluded that patients who initially consult with a doctor of chiropractic for spinal conditions are less likely to subsequently receive an opioid prescription or injection, undergo surgery, be hospitalized, visit the emergency
room, or be referred to a specialist—all of which results in reduced healthcare expenditures overall.
Chiropractic & Manual Therapies, March 2024

Mental Attitude: Grief Takes a Toll on the Body. According to a recent study, grief can manifest in the body as low-grade inflammation, increased sensitivity to pain, and disruption to the gut microbiome—all of which may hinder the immune system and increase the risk for illness.
University of California, Los Angeles, February 2024

Wellness/Prevention: Can Vitamin D Reduce Breast Cancer Risk? Past research has identified various pathways by which vitamin D can inhibit breast cancer tumors, both directly and indirectly. In a recent literature review, the authors concluded that maintaining vitamin D serum levels above 40 ng/mL is necessary to experience vitamin D’s protective effects against breast cancer.                                                    Nutrients, February 2024

Quote: “The road to hell is paved with works-in-progress.” ~ Philip Roth

Your Rio Vista Chiropractor Dr. Joseph T. Megna