Project ECHO Announces Upcoming Clinic Dates With Registration Now Open

By | News

The goal of Project ECHO Nevada is to meet the needs of primary care providers by offering an alternative to costly travel and long waits for patients who need specialty care. Project ECHO has announced upcoming clinics, and invites those interested in attending to click to learn more and/or sign up now.

Interdisciplinary Approach to Emergent Infectious Diseases & Public Health Threats ECHO

Launching Wednesday, October 27th @ 12:00pm PST

This series will connect healthcare professionals with an interdisciplinary team of subject matter experts from the Kirk Kerkorian School of Medicine. Sessions will occur on a monthly basis each 4th Wednesday from 12-1pm and will address topics in the areas of COVID-19, infectious disease, and public health preparedness. This series will provide participants with training, continuing education, and opportunities for case review with experts and colleagues across the State. Please register using the link below or contact ProjectECHO@med.unr.edu for more information. Free CME/CEU Credit (pending approval): AMA PRA Category 1, Nursing, MFT, & CPC (1.0 hour per session)

Link to register

About Project ECHO
The goal of Project ECHO Nevada is to meet the needs of primary care providers by offering an alternative to costly travel and long waits for patients who need specialty care. By developing the knowledge base of primary care providers through the innovative telehealth consultations offered by Project ECHO, patients in rural and under-served areas benefit from specialty care becoming available locally, and without the cost and time of accessing specialists directly. Learn more on the organization’s website.

Health Plan of Nevada’s Five Things People May Not Know About Breast Cancer

By | News

About 1 in 8 women in the U.S. will develop invasive breast cancer over the course of her lifetime. Fortunately, with better screenings, early detection, increased awareness, and improved treatment options, many types of breast cancer may be curable.

In honor of October being Breast Cancer Awareness Month, Health Plan of Nevada would like to share five things that people may not know about breast cancer.

Five Key Facts Include:

  1. Early diagnosis may be a game changer.
    On average, the five-year breast cancer survival rate is 90 percent. For patients diagnosed with early-stage breast cancer, the five-year survival rate is close to 100 percent.
  2. Mammograms matter.
    According to the American Cancer Society, the COVID-19 pandemic has led to a substantial decline in cancer screenings. While it is recommended that women between the ages of 45 and 55 get an annual mammogram, many have postponed their screenings and continue to delay scheduling these important appointments. Mammograms may detect breast irregularities that can be further examined with techniques, such as a biopsy to help determine a cancer diagnosis. Talk with your doctor to determine what kind of screening plan works best for you given your health, age, and family history of breast cancer.
  3. Most breast cancer isn’t hereditary.
    Only 5 to 10 percent of all breast cancers are caused by genetic factors, such as gene mutations that significantly increase a person’s chance of developing breast and other cancers during their lifetime. Ask your doctor whether genetic testing makes sense for you.
  4. Breast changes are normal, but don’t ignore symptoms that persist.
    Breasts come in all shapes and sizes, and they can change based on a woman’s age, menstrual cycle, and other factors. Breast lumps, rashes and discharge are common, and these things don’t necessarily mean you have cancer. If you notice changes to your breast that persist, seek evaluation. Rarer symptoms such as bloody nipple discharge or hard lumps in the breast or under the armpit should be checked out right away.
  5. A healthy lifestyle can make a difference.
    The most important way to prevent breast cancer is by exercising and maintaining a healthy weight. The American Cancer Society recommends 2.5 hours of physical activity each week to help lower the risk of cancer. In addition to exercise, the American Institute for Cancer Research recommends new dietary guidelines. These include limiting alcohol, reducing added sugar consumption, and eating a diet rich in whole grains, fruits, and vegetables.

About Health Plan of Nevada
Health Plan of Nevada is dedicated to helping people live healthier lives and making the health system work better for everyone by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. In Nevada, Health Plan of Nevada offers health benefit programs for individuals, employers, and Medicaid beneficiaries. Health Plan of Nevada is part of UnitedHealthcare, one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified health care company. For more information, visit Health Plan of Nevada’s website, or follow on Facebook and Instagram.

Local Breast Cancer Survivor Raises Awareness and Funds for Cold Capping

By | News

Las Vegas native Krystal Galindo of Galindo Real Estate, house flipper expert along with her husband, Josh Galindo and busy Mom of four was recently diagnosed with breast cancer. Her treatment included 16 rounds of chemotherapy, a double mastectomy and a hysterectomy in 10 years.

Krystal is using her podcast, Going Galindo: Rugrats and Renovations (find ways to listen to the podcasts by clicking here), to help raise awareness for Cold Capping as well as for fundraising efforts for the inaugural GALINDO GIVES Presents “Ping Pong for Ta Tas” scheduled to take place on Friday, Oct. 22

Following a devastating diagnosis, Krystal grappled with the idea of telling her young children (all under eight years old) about their Mom’s life-threatening condition. Once she was able to process the magnitude of what her journey would entail, she decided it was too much to put upon her children. Krystal made the difficult decision to keep this part of her life from her children to protect them.

Not long after her diagnosis, Krystal discovered Cold Capping, a process that would allow her to keep her hair from falling out by freezing the hair follicles so they don’t absorb any chemotherapy drugs. The Cold Capping hat chills to extremely cold temperatures ranging from -15 to -40 degrees Fahrenheit and must be worn before, during and after cheomotherapy treatment. It’s not an easy process and for some it may add more pain to an already painful journey, but for Krystal, this would enable her to protect her children from the trauma of trying to understand cancer at such a young age, and that was all that mattered.

Krystal Galindo.

16 Cold Caps later – each worn up to 10 hours a day, swapping out caps for colder ones every 20 minutes – not only was Krystal able to keep all her hair and her secret, she also quickly discovered that through Cold Capping she was able to preserve her mental health and subsequently the confidence in herself to beat cancer. Because Krystal was able to wake up every morning and see her normal, strong self in the mirror, she felt empowered and healthy as opposed to sickly and hopeless. This positive mindset proved to be instrumental in her battle against cancer.

Krystal shared her journey on social media to help raise awareness for Cold Capping and the importance of making it more accessible for cancer patients nationwide. Cold Capping is an out-of-pocket expense as it’s not yet standard practice in the U.S. and at $500+ a month, it may not be an option for many patients. Krystal believes Cold Capping should be more affordable so that others would be able to endure the trauma that is cancer with the same sense of dignity and strength that she was afforded.

Today, Krystal is recovering from a double mastectomy, but thanks to Cold Capping she has the hope and confidence she needs to face the remainder of her journey. Krystal firmly believes that Cold capping gave her choice in a process that was none of her choosing. 

Click HERE to watch highlights from Krystal’s journey.

Nevada Donor Network Ranks Among Top 5 Organ Procurement Organizations in the U.S. for Organ Donation and Organ Transplantation Rates

By | News

Centers for Medicare and Medicaid Services (CMS) recently released its annual Organ Procurement Organizations’ (OPO) Aggregate Performance Report, naming Nevada Donor Network (NDN) one of the top five highest ranked OPOs in the country for both organ donation rates and organ transplantation rates.

According to the public report, which utilizes the most recently available data collected from an independently reported CDC database of death certificates (in this case, from the 2019 calendar year), NDN is one of 27 OPOs classified as a Tier 1 OPO during this assessment period, meaning the organization is among the top 25th percentile for overall performance. This is the first report released since implementing new criteria for measuring OPO performance in the U.S., effective March 30, 2021, replacing the previous outcome measures and increasing competition amongst OPOs for donation service areas (DSAs) who do not meet expected performance thresholds.

When using the only internationally recognized metric for rating OPO performance, NDN is the nation’s highest-performing OPO in both organs transplanted per million population, and organ donors per million of population served.

“We are proud of the performance rates that NDN boasts based on both the country’s new regulatory metrics and the internationally recognized metrics,” said President and CEO of NDN Joe Ferreira. “Our team’s performance in collaboration with our community partners is a tribute to the heroic donors, their courageous families and the recipients we serve. While we’re happy with the current ranking, we will continually improve and innovate until all patients in need receive the gift of life and health.”

The full CMS OPO Aggregate Performance Report and methodology for how CMS calculates OPO rankings can be found here.   

About Nevada Donor Network 

Nevada Donor Network is a federally designated 501©(3) not-for-profit organ procurement organization (OPO) committed to maximizing the gift of life and health through organ and tissue donation. Established in 1987, Nevada Donor Network is one of only 57 OPOs in the U.S. serving more than 3 million people in the state of Nevada and over 100,000 potential transplant recipients across the country. We work collaboratively with hospital staff and community partners to promote research and provide a strong support network to courageous donor families who’ve turned loss into hope.

At Nevada Donor Network, we encourage Nevadans to help individuals in need of life-saving transplants through education, research and action. Nevada Donor Network is a member of

Donate Life Nevada, an affiliate of Donate Life America, whose state-wide efforts encourage Nevadans to register as organ, eye and tissue donors. For more information, please visit www.nvdonor.org.

Southern Nevada Health District East Las Vegas Public Health Center Relocates

By | News

The Southern Nevada Health District’s East Las Vegas Public Health Center will close at its current location on Wednesday, Nov. 10 and reopen Thursday, Nov. 18 at 2950 E. Bonanza Rd., Las Vegas NV 89101. This location will serve clients through Spring 2022 when the public health center moves into its permanent facility at 2830 E. Fremont St., Las Vegas, NV 89104.

The public health center will be open Monday through Friday. Service information and hours for the East Las Vegas Public Health Center are below:

  • Food Handler Safety Training Card services will be provided until Wednesday, Nov. 10. Beginning Friday, Nov. 12, clients with appointments scheduled at the East Las Vegas public health center will be seen at the 280 S. Decatur Blvd. location on the same date and time as the original appointment. Appointments for the new location will be available starting November 18 and can be made by calling (702) 759-0595 or through the online scheduling system.
  • Immunization clinic services are available until Wednesday, Nov. 10. Services resume at the new location on Thursday, Nov. 18. Immunizations are available by appointment only and clients can call (702) 759-0850 to schedule.
  • Family Planning clinic clients can be seen for IUD/implant procedures, PAP smear and STI services, and wellness and breast exams until Friday, Nov. 5. The last day for birth control refills will be Wednesday, Nov. 10. All Family Planning clinical services resume Thursday, Nov. 18 by appointment and clients can call (702) 759-1700 to schedule.

For more information, visit East Las Vegas Public Health Center page on the Health District’s website.

The Southern Nevada Health District serves as the local public health authority for Clark County, Boulder City, Henderson, Las Vegas, Mesquite and North Las Vegas. The agency safeguards the public health of the community’s residents and visitors through innovative programs, regulations, and initiatives focused on protecting and promoting their health and well-being. More information about the Health District, its programs, services, and the regulatory oversight it provides is available at www.SNHD.info. Follow the Health District on Facebook, Twitter, and Instagram.

Southern Nevada Health District COVID-19 Update – October 8, 2021

By | News

The Southern Nevada Health District is providing a weekly summary of COVID-19 data and new or updated information about COVID-19 clinics and resources.

COVID-19 Cases

As of October 8, there have been 323,940 cases of COVID-19 reported in Clark County. The Health District is also reporting the seven-day average of new positive cases as of October 4, is 356.6. A total of 5,743 Clark County residents have died from COVID-19.

The Health District encourages people who have symptoms of COVID-19 or who have had contact with a confirmed or suspected case of COVID-19 to get tested. Testing location information is available at www.snhd.info/covid-testing. Home testing kits are now widely available. More information on self-testing kits is available on the Health District website.

COVID-19 Vaccination Status Report

As of October 8, 2021:

  • Total Doses Reported Administered: 2,524,151

Total Doses Reported Initiated: 1,407,301

  • Percent initiated vaccination:
    • Overall: 60.71%
    • 18 years and older: 74.45%
    • 12 years and older: 69.52%
  • Total Doses Reported Completed: 1,179,104
    • Overall: 50.86%
    • 18 years and older: 62.87%
    • 12 years and older: 58.05%

Additional vaccination information is available at www.snhd.info/covid-cases. In keeping with a recent update by the Nevada Department of Health and Human Services, the Southern Nevada Health District completed a review and update of its vaccine data. Records that had duplicates were removed and others were reclassified as needed. Vaccine data will be reviewed on an ongoing basis to ensure reporting is consistent and transparent.

COVID-19 after Vaccination

This report was not generated this week due to the recent revisions in methodology. Previous reports are available at www.snhd.info/covid-breakthrough.

Variants

Variants of the virus that cause COVID-19 are tracked by the Health District, throughout the United States and globally by public health organizations. The virus that causes COVID-19 is constantly changing, and the best way to reduce the spread and slow the emergence of new variants is to get vaccinated. More information about variants, including classifications and definitions, is available on the Centers for Disease Control and Prevention website at www.cdc.gov/coronavirus/2019-ncov/variants/index.html.

The CDC continues to learn about COVID-19 variants and reports them as follows: Variants Being Monitored (VBM), which may include variants previously designated as Variants of Interest (VOI) or Variants of Concern (VOC), and Variants of High Consequence (VOHC).

As of October 7, the Health District is reporting the following variants being monitored (VBM) in Clark County:

Variant Being Monitoring Count Percent
Alpha 942 59.8
Beta 9 0.6
Epsilon 227 14.4
Gamma 230 14.6
Eta 0 0.0
Iota 72 4.6
Kappa 0 0.0
Lambda 5 0.3
Mu 91 5.8
Total 1576 100

 

As of October 7, the Health District is reporting the following variants of concern (VOC) in Clark County:

 

Variant of Concern Count Percent
Delta 5913 98.2
Delta Plus 109 1.8
Total 6022 100

 

In the past 30 days, the Health District identified the following variants in Clark County:

 

Variant Count Percent
Alpha
Beta
Delta 507 100
Delta Plus
Epsilon
Gamma
Total 507 100

Expanded COVID-19 vaccine clinic hours

Continuing through Saturday, October 25, the Health District has evening and weekend COVID-19 vaccine clinic hours at its 280 S. Decatur Blvd. Southern Nevada Community Health Center, Friday and Monday from 5 p.m. – 8 p.m. and Saturday and Sunday from 12 p.m. – 7 p.m. These expanded hours are in addition to the Southern Nevada Community Health Center’s regular COVID-19 vaccine clinic hours, Monday – Friday, 6:15 a.m. – 2:30 p.m.

Clinic Locations

Clinics offering COVID-19 vaccines to the public are available throughout Clark County including at the Health District’s four Clark County School District sites, Monday – Friday, 10 a.m. – 5 p.m.

 

  • Centennial High School, 10200 W. Centennial Pkwy, Las Vegas, NV 89149
  • Cheyenne High School, 3200 W. Alexander Rd., Las Vegas NV 89032
  • Desert Pines High School, 3800 E. Harris Ave, Las Vegas, NV 89110
  • Sierra Vista High School, 8100 W. Robindale Rd., Las Vegas, NV 89113

Updated Health District and community vaccine clinic information is posted to the Health District website at www.snhd.info/covid-vaccine. The website includes a feature that allows people to search for clinic listings by ZIP code.

The Southern Nevada Health District serves as the local public health authority for Clark County, Boulder City, Henderson, Las Vegas, Mesquite and North Las Vegas. The agency safeguards the public health of the community’s residents and visitors through innovative programs, regulations, and initiatives focused on protecting and promoting their health and well-being. More information about the Health District, its programs, services, and the regulatory oversight it provides is available at www.SNHD.info. Follow the Health District on Facebook, Twitter, and Instagram.

 

Nevada Donor Network Foundation and Henderson Silver Knights Announce the Inaugural ‘Swing for Hope’ Golf Tournament

By | News

Nevada Donor Network Foundation (NDNF) together with the Henderson Silver Knights are proud to announce the Inaugural “Swing for Hope” Golf Tournament. The event will take place at 9 a.m. on Monday, Oct. 18, 2021, at the DragonRidge Country Club, 552 S Stephanie St. in Henderson.

All proceeds from the golf tournament will help fund NDNF’s “End the Wait” campaign, aimed at raising $35 million to expand transplantation in Nevada. Once achieved, Nevada residents would no longer have to seek life-saving care in surrounding states; they would be able to be evaluated, transplanted and cared for locally.

“We are incredibly excited to host our inaugural ‘Swing for Hope’ Golf Tournament,” said NDNF President, Steven Peralta. “By supporting this event and the Nevada Donor Network Foundation, we are one step closer to a Nevada where no one must face the financial, physical and emotional burden of traveling to a neighboring state to receive the lifesaving and healing care they desperately need,”

“The Henderson Silver Knights were faced with an inaugural season unlike any other, one where their opportunities to interact with fans — the heart and soul of any sports franchise — were essentially nonexistent,” said Vegas Golden Knights President Kerry Bubolz. “We’re excited to share that the ‘Swing for Hope’ Golf Tournament will be the first full-team event in franchise history. Our organization and Nevada Donor Network are taking all the necessary precautions to ensure it’s a safe and enjoyable event for fans and players alike, and one that supports such an important cause. Go Knights Go!”

For tickets and sponsorship information on Nevada Donor Network Foundation’s ‘Swing for Hope” Golf Tournament, please visit www.NVDonor.org/SFH.

About Nevada Donor Network 
Nevada Donor Network is a federally designated 501©(3) not-for-profit organ procurement organization (OPO) committed to maximizing the gift of life and health through organ and tissue donation. Established in 1987, Nevada Donor Network is one of only 57 OPOs in the U.S. serving more than 3 million people in the state of Nevada and over 100,00 potential transplant recipients across the country. We work collaboratively with hospital staff and community partners to promote research and provide a strong support network to courageous donor families who’ve turned loss into hope.

At Nevada Donor Network, we encourage Nevadans to help individuals in need of life-saving transplants through education, research and action. Nevada Donor Network is a member of Donate Life Nevada, an affiliate of Donate Life America, whose state-wide efforts encourage Nevadans to register as organ, eye and tissue donors. For more information, please visit www.nvdonor.org

About The Henderson Silver Knights
The Henderson Silver Knights are the American Hockey League affiliate of the Vegas Golden Knights and is operated by Black Knight Sports and Entertainment LLC. For the latest news and information on the Silver Knights visit hendersonsilverknights.com. Fans can follow the team on Facebook, Twitter, Instagram and TikTok.

Organizations Partnering to Improve Access to Eye Health in Southern Nevada

By | Featured, News

Efforts Increasing Access to Early Eye Exams & Prioritizing Eye Health in Preventive Healthcare for Those in Need in the Community

By Frances-Lynn Jones, O.D.
President, Southern Nevada Optometric Society

We often hear the phrase “the eyes are the window to your soul” but in truth, the eyes are a window to your overall health. Our eyes contain fine blood vessels, nerves, and connective tissues ­– potential issues within these delicate ocular areas often point to the first sign of disease elsewhere in the body. We know that dozens of serious diseases can be detected through a comprehensive eye exam. These diseases include Diabetes, high blood pressure, high cholesterol, some autoimmune diseases, and certain types of cancers.

Frances-Lynn Jones, O.D. and friends.

Eye care professionals have long understood the important role comprehensive eye examinations play as a means of early disease detection and as part of a quality preventive healthcare plan – especially when started in early childhood. We believe that early access to routine, comprehensive eye exams is a foundational component of a child’s developmental and educational success. More is, and is becoming, known that when undiagnosed, vision issues can have an enormous impact on a child’s social, motor, cognitive and academic achievement.

Unfortunately, despite the prevalence of eye and vision problems in pediatric populations, access to routine eye care is a struggle for many Nevada families, and for that matter, families across the United States. Whether it be cost, physical access to eye care practices or even a lack of knowledge in understanding how to spot potential vision issues in children, all of these reasons create substantial barriers to helping children access they care they need. In addition, because children assume that how they see is “normal”, they are less likely to complain. It is common for children with undetected vision issues to struggle in school and other activities, often feeling isolated or at times, being labeled as having behavioral issues.

As an eye care provider, I know that we can change this paradigm and stigmatization – we can create better access and brighter futures for our area children. With timely diagnosis and treatment, many vision issues in children are correctable and/or treatable.

Recently, the Southern Nevada Optometric Society, as part of the Nevada Optometric Association, partnered with two eye care organizations to help area children receive much-needed access to eyecare in Clark County schools: The Vision Council’s recently launched consumer initiative, Vision Health Alliance, and the not-for-profit organization EyeCare4Kids™, dedicated to providing important eye care services through school-based, mobile clinics to low income, visually impaired children, and their underserved families.

Our mobile vision clinic held at Dr. C. Owen Roundy Elementary School gave dozens of children the opportunity of vision screening, an eye exam and if they need eyeglasses based on the results of those diagnostic tests, they could choose their frame with the eyeglasses ordered and delivered through an optometric lab – all at no cost. The Vision Health Alliance also provided 600 eye care kits for glasses and contact lens emergencies. The kits have been donated and distributed to the EyeCare4Kids provider network across Nevada. By bringing these services directly to our area schools, we are breaking down these critical, access to care barriers.

This is just one example of how the eye care community is helping to address access and equity in healthcare through strategic partnerships and investment, reflecting the Nevada Optometric Association’s mission to champion eye health as an important part of overall health.

We know that when eye health is prioritized and begins at the earliest ages, it sets future generations up for a lifetime of better health. My colleagues and are I are dedicated to educating families about the benefits of prioritizing eye health in their care planning. By partnering with our schools, along with our industry leaders and being present in our communities – no matter how large or small – we are part of the solution to improving healthcare access and equity, creating a brighter future for our children, their families and our communities.

To learn more about each of these organizations, please visit their websites: Nevada Optometric Association, EyeCare4Kids, and The Vision Council’s Vision Health Alliance.

United Health Foundation’s America’s Health Rankings: 2021 Health of Women and Children Report

By | News

This week, the United Health Foundation released the America’s Health Rankings “2021 Health of Women and Children Report,” which highlights improvements, challenges and disparities in health and well-being of women and children across all 50 states.

Most notably, behavioral health measures for children highlighted significant challenges before and during the COVID-19 pandemic:

  • Anxiety among children ages 3-17 has risen 21% since 2017
  • Teen suicide has increased 26% since 2014, from 8.9 to 11.2 deaths per 100,000 adolescents. Among minorities, the teen suicide rate was 4.7 times higher among American Indian/Alaska Native adolescents than Black adolescents.

The report also found:

  • Increased frequent mental distress in women, increasing levels of obesity among women, and lack of physical activity among children.
  • Maternal mortality and maternal morbidity are rising, especially in certain states and among Black mothers.

Here in Nevada, the 2021 Women and Children Report finds:

  • An 18% increase in infant mortality from 5.1 to 6.0 deaths per 1,000 live births between 2012-2013 and 2017-2018.
  • Frequent mental distress increased 60% from 13.2% to 21.1% in women ages 18-44, between 2013-2014 and 2018-2019.
  • There was a 39% decrease in teen births, between 2013 and 2019, from 30.8 to 18.9 births per 1,000 females ages 15-19.
  • Children in poverty decreased 26% from 22.7% to 16.9% of children ages 0-17, between 2013 and 2019.

Additionally, the report found that Nevada ranks 50th in clinical care for children and 49th in clinical care for women. Other notable findings in the report include a low prevalence of female college graduates, a high prevalence of illicit drug use among women, as well as a low enrollment in early childhood education. Read more about the findings here.

Henderson CSN Vaccine and Testing Site Clinic Temporarily Relocated

By | News

The Southern Nevada Health District’s COVID-19 testing and vaccine clinic site located at the College of Southern Nevada Henderson campus located at 700 College Dr., Henderson, NV 89002 will be temporarily relocated to the Student Union on Thursday, October 7, and Friday, October 8. Services will resume at its current location in expanded modular units off Heather Dr. near Building C and the Student Union on Tuesday, October 12.

The site provides COVID-19 testing and COVID-19 vaccinations. Johnson & Johnson, Moderna and Pfizer vaccines are available as resources allow. Pfizer is currently the only vaccine authorized for children 12 years of age and older. Children must be accompanied by a parent or guardian.

Vaccines are free, safe and effective and preventing hospitalizations and death. People who are not yet vaccinated are encouraged to find a clinic and get a COVID-19 vaccine. Testing is an important to help reduce the spread of the virus. People who have symptoms of COVID-19, have had exposure to someone with suspected or confirmed COVID-19 should get tested.=

Additional vaccine and testing site locations, as well as COVID-19 information and resources, are available on the Health District’s website at www.SNHD.info/covid.

The Southern Nevada Health District serves as the local public health authority for Clark County, Boulder City, Henderson, Las Vegas, Mesquite and North Las Vegas. The agency safeguards the public health of the community’s residents and visitors through innovative programs, regulations, and initiatives focused on protecting and promoting their health and well-being. More information about the Health District, its programs, services, and the regulatory oversight it provides is available at www.SNHD.info. Follow the Health District on Facebook, Twitter, and Instagram.