Facts about The Super Bowel and Domestic Violence

Facts about The Super Bowel and Domestic Violence

The professional football season is coming to an end quickly. This means that Super Bowl weekend will be here very soon. For many people Super Bowel Sunday is a day of fun and to have a party. Many people look forward to Super Bowl parties and having a fun weekend. However, it is not a fun weekend for everyone. For many it is a weekend of terror. Super Bowel Sunday is when the most incidents of domestic violence occurs. The domestic violence is not only limited to adult couples in a relationships. Domestic violence occurs in teenage dating relationships too. Additionally, domestic violence occurs in heterosexual and homosexual relationships.

Because people tend to drink more alcohol at the parties this can raise tensions between people. The result can be arguments and physical violence. In fact, as I stated above, some statistics rate Super Bowl Sunday as the day of the year that the most domestic violence occurs. If a woman is pregnant and there is already domestic violence occurring, she is at a greater risk of being a victim of domestic violence on Super Bowel Sunday. In fact, it is serious enough that the NFL has started running PSAs regarding domestic violence around Super Bowl Sunday.

To get a better idea click this link http://jezebel.com/the-super-bowl-domestic-violence-ad-was-a-real-woman-ca-1683220170 and read the statistics and watch the PSA.

The other issue is that children are exposed to the domestic violence which occurs on Super Bowl Sunday and the rest of the year. This can have a serious impact on children. They can grow up thinking it is acceptable to hit their partner or to be verbally abusive to their partner. They may also grow up thinking that if they are hit by a boyfriend or girlfriend that they deserve it. So they do not end the relationship or seek help because they believe the deserve to be abused.

Domestic Violence is a very complex problem that can go back many generations in a family. It can also be the source of bullying that we see at schools. Therefore, domestic violence effects the entire family. It effects adults and children in very dramatic ways. If you are experiencing domestic violence in your family or relationship, please seek professional help. Click on the following link https://www.thehotline.org/, it will provide you access to the National Domestic Abuse Help Line where you can call or chat on line to get help 24 hours a day, 356 days a year.

As I stated above, children who witnessed domestic violence are impacted by it too. Domestic violence occurs with teenagers too and is just as serious. Click this link and learn the shocking facts https://youtu.be/DdkTefhy6JM.

I encourage you to learn more about this issue and to talk to your teenagers about it. No one has a right to hit them or to verbally tear them apart. Again, if you are a victim of domestic violence or there is domestic violence in your family reach out for help. Domestic violence does not improve on its own, it only gets worse. Click on the link above or talk to your primary care doctor or a teacher, but reach out for help, it is out there.

Dr. Michael Rubino specializes in treating children and adolescents and he is certified in the assessment and treatment of Domestic Violence. Dr. Rubino has over 20 years experience as a psychotherapist. For more information about his work or private practice visit his website at http://www.rubinocounseling.com or his Facebook page http://www.Facebook.com/drrubino3 or follow him on Twitter @Rubinotherapy.

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Help, I Can’t Find a Psychiatrist

Help, I Can’t Find a Psychiatrist

With it being very difficult to get a psychiatrist office to return your call or to schedule an appointment within 2 weeks instead of 6 weeks later, here is a good option that can help a lot of people. In addition to the wait many psychiatrist are no longer taking insurance or only accepting private pay patients at $250 a visit. Many patients I see for psychotherapy have this problem. Here is an option that can help. https://www.wsj.com/articles/the-psychiatrist-can-see-your-child-now-virtually-11546877610

Trying to Understand a Teenage Brain

Trying to Understand a Teenage Brain

Parents there is something you can do that can make your life as a parent much easier. You can remember that your children, especially your teenagers, are children not little adults. Many parents expect their teenagers to be able to function as adults. It is an easy mistake to make. Teenagers are as tall as adults, as strong as adults and biologically function as adults. However, their brains do not function as adults and therefore teenagers often act like children, but look like adults. When this occurs, parents often get mad because they do not know are they dealing with a young adult or a child. As a result of this confusion, arguments tend to happen.

Remember when a baby is born their brain is still placid. What this means is their brains are still developing. Just like the “soft spot” in a baby’s skull. When they are born all of the bones in a baby’s skull have not grown together. They are still developing. In fact the skull is not fully developed until the age of 30.

This placidly is there usually until a child is around 18 years old. If any of your children have had a head injury around age 9 or 12 and the physician tells you their body can compensate, this is what they are referring to. Since their central nervous system (brain and spinal cord) is not completely developed, if there is an injury, their neurological system can find away to bypass the injury.

This is a wonderful thing for children considering how often they are injured. However, there is a cost to this developing neurological system. Children’s frontal and prefrontal cortex do not fully develop until the age of 18 or 21. Therefore, while they may look like an adult at times they will act and make decisions as child because developmentally they still have the brain of a child.

What does this mean to you as a parent? It means that you cannot expect your teenager to reason as an adult would reason. Children and teens typically have concrete reasoning skills until their brain is fully developed. In other words, there thinking tends to black and white. They have difficulties handling ambiguous situations. When the brain is fully developed then they have abstract reasoning and can think a head about consequences. Until such time their ability to do so is limited. This makes teenagers more vulnerable to peer pressure and making impulsive decisions which can result in trouble for the teenagers that they never expected.

If parents will remember this fact and adjust to it, you can decrease your stress. This is why I recommend parents develop behavior contracts and agreements. You can find many template for these contracts on line. If you Google Behavior contracts, you will find a number of free templates that you can adapt for your family. These contracts reduce the need for a child or teen to have to do abstract thinking right on the spot. When you make agreements and contracts with your teen you assist them with and model abstract reasoning. You also increase the likelihood that they will make a good choice versus a poor choice. Additionally, these contracts assist teenagers in assuming responsibility for their behavior. If they violate the contract and you impose a consequence, you are only following the agreement you made with them. The consequence is a result of their choice they made not you being mean.

Also if you remember the limitations your child is dealing with, if they make a mistake you can respond in a more appropriate manner. If you expect them to reason like an adult and they make a mistake, you are going to be more stern in your reaction. If you remember that they cannot handle abstract reasoning yet, your response and consequences you set will be more appropriate. As a result, your teen will learn more.

Remember, we are always telling kids you will have to wait until you are an adult. Therefore, when they make a mistake even if they are 15, we need to remember they are not an adult yet and respond in that manner.

Dr. Michael Rubino specializes in treating children and teenagers. He has over 20 years experience working with teens. For more information about Dr. Michael Rubino or his private practice visit his websites at http://www.RubinoCounseling.com or http://www.rcs-ca.com or his Facebook page at http://www.facebook.com/drrubino3.

The New High School Drugs

The New High School Drugs

High school students are out of school for the next two weeks for Winter Break. They are looking forward to spending time with their friends at school and those returning from college. This usually means a lot of late nights and parties. Many parents are concerned about the challenges their children will experience in these environments. A common one is peer pressure and drugs. As a psychotherapist who treats teenagers, I hear about what is going on with teenagers and what they are doing. I have been hearing from many teens about new designer drugs they are taking. Many people assume teenagers are primarily using marijuana. However, teenagers are looking for new drugs and ways to modify how they use marijuana. These new drugs can be very dangerous, even deadly. However, many teenagers are not aware of the dangers and risks they are taking.

Winter break is only two weeks so many teens will want to get in as many parties as they can. During winter break for many teenagers this means partying with old and new friends. Drugs are often part of these parties. One major problem facing teens is the fact that many Emergency Room physicians cannot keep up with all the new drugs teenagers are using. Therefore, if a teenager ends up in the Emergency Room due to overdosing or having a bad reaction to one of these new drugs, a teenager may die before an Emergency Room physician determines what the teenager took and how to treat it. The show The Good Doctor had an episode which addressed this issue. The teen had used, Molly, not a new drug but because there were so many options, the teenager almost died before they could determine how to treat him.

Recently I read an article by Angela Chen. The article discusses these new dangerous drugs and how deadly these drugs can be. I have included her article below so parents can be aware of the dangers facing their teenagers. Hopefully, parents will also take this opportunity to discuss this issue with their teenagers.

On a July day a little over a year ago, over 30 people collapsed on a street in Brooklyn. They lay on the ground, vomiting down their shirts, twitching and blank-faced. Some, half-naked, made jerking movements with their arms, eyes rolled back. Others groaned and clutched onto fire hydrants to try to stay upright. Witnesses said the scene was like The Walking Dead. Headlines claimed that people had turned into “zombies,” while police said that the 33 affected were lucky to be alive.

All had smoked an “herbal incense” product called AK-47 24 Karat Gold. Eighteen people were sent to the hospital by ambulance. The situation had all the signs of a drug overdose, and so doctors ordered the usual tests: blood count, urine analysis, heart rate monitoring.

The first patient tested was a 28-year-old man who was slow to respond, but otherwise showed few clear signs of trauma. Heart sounds: normal. Blood count: normal. His lungs were clear and there were no major neurological problems, no excessive sweating or skin lesions. He tested negative for opiates, cocaine, amphetamines. Nothing came up.

The case went to the Department of Homeland Security and the Drug Enforcement Agency. They knew who to call to get a second opinion. They packed blood and urine samples on dry ice and shipped them to a small lab 3,000 miles away in San Francisco, run by toxicologist Roy Gerona. If anyone in the country could figure out what was in 24 Karat Gold, it would be him.

Forty years ago, drugs had easy names: cocaine, meth, heroin. Today, the names can read like an ingredients list for a chemistry class: 5F-AMB, PX-2, MDMB-CHMINACA. Today’s designer drugs are made by synthesizing chemicals and hoping they give you a high that’s strong enough to be worth it, but not strong enough to send you to the hospital.

Designer drugs are volatile. If you tweak just one molecule, you can get an entirely differently substance, one you hadn’t bargained for. They’re also easy to get. There’s no shortage of “research chemicals” vendors on the dark web are willing to sell. And they’re growing more popular. These so-called “novel psychoactive substances” entered the mainstream in 2009. That year, according to the United Nations Office on Drug and Crime, there were about 100 of these substances reported; six years later, there were nearly 500. Because designer drugs don’t show up on traditional drug tests, they’re hard to track and identify. It’s a public health problem that requires a special set of skills to handle.

One of the most prominent categories of designer drugs are those intended to mimic marijuana, called synthetic cannabinoids. Marijuana, or cannabis, is widely considered one of the safest drugs, but synthetic cannabinoids are some of the most dangerous synthetic drugs. The Global Drug Survey (GDS) found that last year, for the fourth year running, the risk of seeking emergency medical treatment was higher after using synthetic weed than for any other drug.

When you smoke a regular joint, a chemical called tetrahydrocannabinol (THC) travels through your blood. It binds with receptors called CB1 and CB2. Because of the structure, there’s “kind of a limit on how stoned you can get,” says Adam Winstock, a London-based psychiatrist who administers the GDS. If you’re smoking a popular cannabinoid like K2 Spice, a chemical travels through your blood, but this time, it’s not THC. It’s something else that also binds with CB1 and CB2 — but unlike with regular weed, we don’t know exactly how these chemicals bind, especially when they’re illicit drugs from the black market. This mystery makes synthetic marijuana likely to lead to “much more extreme responses,” like seizures and psychosis, according to Winstock.

Synthetic cannabinoids originated in a quest to create a better pain medication. A Clemson University chemist named John W. Huffman synthesized hundreds of compounds in an attempt to find a better painkiller, but often created incredibly psychoactive substances with no medicinal properties at all. When he published the results of these compounds — called JWH compounds, after his initials — he made the information available to be copied.

There are more than 300 JWH compounds alone, and around 2004, labs in China began studying old research papers, synthesizing the compounds and distributing them as “herbal incense” products. K2 Spice itself — often partly based off the JWH-018 compound — started in China, became popular in Germany around 2008, and entered the US around 2009.

Labs can also turn to the expired patents — patents that are rich fodder, even if (or perhaps because) there was a good reason said drugs never made it to market. It’s nearly impossible to figure out how to shut down the overseas labs producing these drugs. As soon as you ban one substance, the labs move on to another.

Gerona, a toxicologist with gray hair styled in an undercut, was the one who received the biological samples from the DEA. From a small lab in the Medical Sciences Building at the University of California, San Francisco, Gerona says he and his team are playing a “cat and mouse game” with illicit international drug manufacturers. When an overdose happens, Gerona’s team tries to identify the drug in question — often synthetic substances no one has seen before. But the lab goes one further: Gerona’s lab attempts to identify and classify these substances before the mass overdoses even happen.

Inside, the lab is meticulously neat: rows of spotless tables are covered in bottles with orange rubber caps, all labeled with orange duct tape, and small gray centrifuges. A window overlooking a courtyard has molecular structures scribbled over it in pink and green marker. Near the door sits an enormous freezer, filled with thousands of brightly colored, frost-covered boxes of drug samples kept at -112 degrees Fahrenheit.

Gerona launched his toxicology lab in 2010, in partnership with the San Francisco Poison Control Center. The date wasn’t a coincidence; he says that 2010 was the year that a designer drug called “bath salts” began flooding the market. “Bath salts” is a blanket term for a group of designer drugs made from stimulants; they create a euphoric high like MDMA, sometimes with hallucinations thrown in. The drugs usually come in powdered and capsule form, and can cause freak-outs that were well-documented on YouTube at the time. The most famous of these was a viral story of a 31-year-old Miami resident attacking and then eating a homeless man. (Scientists dispute the drugs’ role.)

For users and the DEA, the spike in bath salts use was a nightmare. For Gerona, the increased interest in designer drugs led to more work and more samples from around the country. Eventually, the lab caught the notice of both Michael Schwartz, a toxicologist at the Centers for Disease Control and Prevention, and DEA pharmacologist Jordan Trecki. A collaboration between Gerona’s lab and the DEA was formed. (Neither the DEA nor the CDC responded to repeated requests for comment.)

The first step in doing an analysis at Gerona’s lab is getting the sample — urine, blood or, rarely, a tiny bit of drug itself — shipped over on dry ice. In traditional drug testing, you check to see if the sample matches any of the known substances: marijuana, heroin, cocaine, and so on. They match, or they don’t. Designer drugs, almost by definition, are made of chemical combinations we haven’t seen before. They almost never match traditional databases, and the chemists often don’t know what they’re looking for. So Gerona’s lab gathers as much information about the substance as possible.

A tiny vial of the biological sample — usually plasma, the colorless part of blood — goes into a bulky, printer-like machine. That machine is called a liquid chromatography mass spectrometer, and very crudely put, it separates out all the different parts of the plasma by mass. (Think of it like an extremely sensitive centrifuge.) That process makes it easier to identify chemicals, and the mass spectrometer then spits out the different measurements in a computer chart with peaks and valleys called a chromatogram.

Then, says Axel Adams, a graduate student in Gerona’s lab, you turn to the so-called “prophetic library.”

“ RESEARCHES LOOK FOR POSTS ABOUT DRUGS ON SUBREDDITS LIKE R/RESEARCHCHEMICALS

Gerona’s “prophetic library,” about three years in the making, is a detailed catalog of already synthesized variants that his team believes is going to be the next big street drug. The library was made possible with the help of Samuel Banister, a synthetic chemist at Stanford University. Banister synthesizes variants of popular street drugs and takes down their chemical information to create “reference standards.” Synthesizing can take anywhere from a few days to a couple of weeks; the lab now has almost 150 variants on file. It’s a side job for Banister, but at one point, he says, “I was pumping out five to 10 a week.” The final products look like white crystalline solids and are kept in drawers in the lab, ready for when a case like AK-47 24 Karat Gold comes along.

In addition, lab members spend hours each week on drug forums, researching trends. It’s more of an art than a science. Researches look for posts about drugs on subreddits like r/researchchemicals. They reference surveys like the Global Drug Survey and survey “trip reports” from experiential documentation sites like Erowid and PsychonautWiki.

They look for terms like synthetic pot, K2, Spice, and sometimes, scientific terms like “cannabinoids,” or a specific popular class of cannabinoids, like “FUBINACA” or “JWH compounds.” Often, the posts themselves will include the name of the chemical. Gerona has ordered drugs off the dark web. In one case, the invoice billed him for “cosmetics,” and the package included lipstick, fake eyelashes, and tabs labeled “powder.” The “powder,” unsurprisingly, turned out to be drugs. But most of the time, the drugs in the powder were not the drug that was ordered.

“ THE INVOICE BILLED HIM FOR “COSMETICS,” AND THE PACKAGE INCLUDED LIPSTICK, FAKE EYELASHES, AND TABS LABELED “POWDER”

If there is a match because the compound is already in the library, finding the right variant is “only going to take 15 minutes,” says Gerona. “Otherwise, it could take a week, or it could not be solved.”

Adams checked the results of a blood sample tied to AK-47 24 Karat Gold against the prophetic library. The computer pulled up a chart that indicated a line — jagged, up and down — that shows the mass of the components of AK-47 24 Karat Gold, versus the same information for AMB-FUBINACA.

Drugs don’t pass through the body untouched. Once they’re ingested, the body processes the compounds. So by the time they’re in the blood or urine, it’s not exactly the same compound as the drug that was ingested. It’s hard enough to find a reference standard for the original compound; it’s even more difficult to find a reference standard for the possible variants. In the case of AMB-FUBINACA, the chemical in the biological sample from Brooklyn wasn’t the parent compound. It was a derivative. Luckily, Banister had already synthesized that variant, too.

The peaks and valleys of the two lines of AK-47 24 Karat Gold and AMB-FUBINACA matched up precisely. It took the team only seven days to identify the substance in the Brooklyn case — and most of that time was spent waiting for the sample to get there.

Gerona’s lab has worked on cases across the country, from New York City to Sacramento to Colorado. The number of cases varies. Sometimes, they’ll get 15 to 25 samples a month. One Mississippi case involving synthetic cannabinoids resulted in over 400 samples. The average turnaround on results is about six months, says Adams. That’s not good enough for Gerona.

And it’s not likely that the problem will go away. Marijuana legalization advocates claim that people will stop with the synthetic stuff once the real thing is okay. But that’s not true in the experience of Andrew Monte, a clinical toxicologist at the University of Colorado School of Medicine who collaborates with Gerona’s lab. Recreational marijuana is legal in Colorado, but he sees patients who are on these synthetic compounds anyway. Monte’s team has surveyed people who come into the ER and even set up at music festivals to ask attendees questions. Synthetic drug users are “taking it for a different reason, to get a different high,” Monte says. “They’re really looking for something different than what pot gives, the same way you might choose cocaine over pot or meth over pot.”

“ ONE MISSISSIPPI CASE INVOLVING SYNTHETIC CANNABINOIDS RESULTED IN OVER 400 SAMPLES

To help address this problem, in 2016 Gerona started a new research consortium called P SCAN, or the Psychoactive Surveillance Consortium and Analysis Network. (Yes, the double entendre is intended.) They’re working with about 10 poison control centers in places like Kansas and Colorado. They’ve had more than 100 cases referred to them and are writing up case reports and manuscripts. (The 24 Karat Gold case was published by the New England Journal of Medicine.)

P SCAN will continue to do the surveillance work Gerona has been doing for years, but also create a database of clinical data connected to the specific synthetic drugs they track and discover. Think of it like a medical version of Erowid. This way, the next time there’s an outbreak like the one in Brooklyn, investigators and researchers can look at specific physical indicators (heart rate, respiratory information, neurological information, and more) and say, “Ah, this matches the symptoms of AMB-FUBINACA” — all without shipping samples across the country.

But even with P SCAN and the prophetic library, the task is huge. “The identity of a lab needs to constantly expand and rework in order for it to stay relevant,” says Gerona.

Gerona is a biochemist by training. Before launching his lab, he didn’t know anything about Spice, or AK-47 Gold, or the dark net. But now, Gerona says, “I have no other choice but to really learn about it, so that I am relevant and retain my relevance in the field.” He’s hoping to work with people in technology to automate this “market research” to glean new insights and make the prediction process even faster. “It would be so great if we could predict the drugs coming in with more accuracy, instead of after people are hurt,” he says.

Weeding out designer drugs is a Sisyphean task, Gerona admits. It may be impossible to shut down the overseas labs, but he wants to have even better methods for predicting what’s going to get big and then, instantly identifying the substances. He compares the endless drug variations to nature: the cold virus is still around because it changes all the time. HIV has never been cured because it continues mutating. “In a sense, they’re reinventing themselves all the time, so reinvention is key to persistence. As long as you’re reinventing yourself, you can persist.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers. He treats teenagers with drug issues and has seen many end up in the Emergency Room because teenagers think they are the experts. For more information about Dr. Rubino’s work or his private practice visit his website http://www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/Drrubino3.

The Importance of Screen Time Agreements

The Importance of Screen Time Agreements

Many children received new IPhones, lap tops & play stations for the Holidays. A family contract about how they will be used can help decrease arguments. Screen-time arguments? Here’s how to reduce family conflict around technology https://www.abc.net.au/news/science/2018-12-26/screen-time-fights-reduce-family-conflict-with-a-media-plan/10567998

Helping a Teenager Grieve a Death

Helping a Teenager Grieve a Death

It is the Holiday Season and many people are grieving for loved ones who past away during this past year. Also many people are dealing with a recent death due to a motor vehicle accident possible as a result of someone drinking while driving. Our society does not deal with death in a healthy manner. Therefore, many people do not know what to do for or what to say to someone who is grieving. Many patients have asked me about what to do in these situations. While doing research regarding grief for patients, I found this information from the grief center. I think it is very good information and very easy to understand. Therefore, I will present the information in three sections.

The 10 Best and 10 Worst Things to Say to Someone in Grief

Sheryl Sandberg’s post on Facebook gave us much insight into how those in grief feel about the responses of others to loss. Many of us have said “The Best” and “The Worst.” We meant no harm, in fact the opposite. We were trying to comfort. A grieving person may say one of the worst ones about themselves and it’s OK. It may make sense for a member of the clergy to say, “He is in a better place” when someone comes to them for guidance. Where as an acquaintance saying it may not feel good.

You would also not want to say to someone, you are in the stages of grief. In our work, On Grief and Grieving, Elisabeth Kubler-Ross and I share that the stages were never meant to tuck messy emotions into neat packages. While some of these things to say have been helpful to some people, the way in which they are often said has the exact opposite effect than what was originally intended.

The Best Things to Say to Someone in Grief

1. I am so sorry for your loss.

2. I wish I had the right words, just know I care.

3. I don’t know how you feel, but I am here to help in anyway I can.

4. You and your loved one will be in my thoughts and prayers.

5. My favorite memory of your loved one is…

6. I am always just a phone call away

7. Give a hug instead of saying something

8. We all need help at times like this, I am here for you

9. I am usually up early or late, if you need anything

10. Saying nothing, just be with the person

The Worst Things to Say to Someone in Grief

1. At least she lived a long life, many people die young

2. He is in a better place

3. She brought this on herself

4. There is a reason for everything

5. Aren’t you over him yet, he has been dead for awhile now

6. You can have another child still

7. She was such a good person God wanted her to be with him

8. I know how you feel

9. She did what she came here to do and it was her time to go

10. Be strong

Best & Worst Traits of people just trying to help

When in the position of wanting to help a friend or loved one in grief, often times our first desire is to try to “fix” the situation, when in all actuality our good intentions can lead to nothing but more grief. Knowing the right thing to say is only half of the responsibility of being a supportive emotional caregiver. We have comprised two lists which examine both the GOOD and the NOT SO GOOD traits of people just trying to help.

The Best Traits

Supportive, but not trying to fix it

About feelings

Non active, not telling anyone what to do

Admitting can’t make it better

Not asking for something or someone to change feelings

Recognize loss

Not time limited

The Worst Traits

They want to fix the loss

They are about our discomfort

They are directive in nature

They rationalize or try to explain loss/li>

They may be judgmental

May minimize the loss

Put a timeline on loss

The above information is meant to be used as a guideline. Everyone goes through the grieving process in their own way. It is very important to understand that point. It is also important to remember while the above is a guideline, the most important thing is your intent. So if you say a worse thing but you said it out of love the person will understand. The guideline will hopefully make you more comfortable to offer support to your grieving loved one or friend. Because someone who is grieving need people to talk to without people feeling awkward. Also everyone is around immediately after the death and through the funeral services. Most people then go back to their normal lives. However, those who were really close to the person are still grieving and trying to figure out how to proceed with life. So don’t forget the person who is grieving can use emotional support for the first year especially. Therefore, do not forget to call, send a card or stop by occasionally. Especially around the holidays and birthdays.

Dr. Michael Rubino has over 20 years experience as a psychotherapist treating adolescents, children and their families. For more information regarding Dr. Rubino visit his website http://www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/drrubino3 or follow him on Twitter @RubinoTherapy