natgillin/translations-raw huggingface dataset:
In addition, regular monitoring of renal function is advised during concomitant administration of potentially nephrotoxic agents, regardless of the patient's pre-existing renal function (see section 4.5). 
Poleg tega je redno spremljanje delovanja ledvic priporočljivo tudi pri sočasnem dajanju potencialno nefrotoksičnih zdravil, ne glede na bolnikovo predhodno delovanje ledvic (glejte tudi poglavje 4.5).
Indicationfor use Creatinine clearance Dose recommendation 
Indikacija za uporabo Očistek kreatinina
Subjects achieving clinical success (Clinical Response of “Cure” or “Improved”) and microbiological success (pathogen-level response of “Eradicated” or “Presumed Eradicated”) are classified as overall therapeutic success. 
Bolniki, pri katerih pride do kliničnega uspeha (klinični odziv je “ozdravitev” ali “izboljšanje”) in do mikrobiološkega uspeha (odziv s stopnjo prisotnosti patogenov “izkoreninjen” ali “domnevno izkoreninjen”), so opredeljeni kot skupni terapevtski uspeh.
Interaction studies for daptomycin were performed with aztreonam, tobramycin, warfarin and probenecid. 
Študije medsebojnega delovanja za daptomicin so izvedli z aztreonamom, tobramicinom, varfarinom in probenecidom.
Within these trials, 1,221 subjects received a daily dose of 4 mg/kg, of whom 1,108 were patients and 113 were healthy volunteers; 460 subjects received a daily dose of 6 mg/kg, of whom 304 were patients and 156 were healthy volunteers. 
V okviru teh preskušanj je 1.221 preskušancev, med katerimi je bilo 1.108 bolnikov in 113 zdravih prostovoljcev, prejemalo dnevni odmerek 4 mg/kg; 460 preskušancev, med katerimi je bilo 304 bolnikov in 156 zdravih prostovoljcev, pa je prejemalo dnevni odmerek 6 mg/kg.
In a separate study, no metabolites were observed in plasma, and minor amounts of three oxidative metabolites and one unidentified compound were detected in urine. 
V ločeni študiji niso opazili nobenih presnovkov v plazmi, v urinu pa so odkrili manjše količine treh oksidativnih presnovkov in ene neznane spojine.
Effects on peripheral nerves were observed at higher doses than those associated with skeletal muscle effects in adult rats and dogs, and were primarily related to plasma Cmax. 
Učinke na periferne živce so opazili pri odmerkih, ki so bili večji od tistih, povezanih z učinki na skeletne mišice pri podganah in psih, povezani pa so bili predvsem z vrednostjo Cmax v plazmi.
To minimise foaming, AVOID vigorous agitation or shaking of the vial during or after reconstitution. 
Da zmanjšate penjenje, se IZOGIBAJTE močnemu stresanju viale med rekonstitucijo ali po njej.
- The dosage card should contain the appropriate algorithms for calculating the Daptomycin Hospira dose for reconstitution, to help minimise the risk of medication errors (high osmolarity, overdose). 
- kartica za odmerjanje mora vsebovati ustrezne algoritme za izračunavanje odmerka zdravila Daptomicin Hospira za rekonstitucijo, kar pripomore k zmanjšanju tveganja za napake pri odmerjanju (visoka osmolarnost ali preveliko odmerjanje).
There was no histopathological correlation in the peripheral and central nervous system tissue, or in the skeletal muscle, at any dose level, and the mechanism and clinical relevance for the adverse clinical signs are therefore unknown. 
Pri nobeni ravni odmerka niso opazili histopatološke korelacije v tkivih perifernega in centralnega živčevja ali v skeletnih mišicah, zato mehanizem in klinični pomen teh neželenih kliničnih znakov nista znana.
Microscopic changes in skeletal muscle were minimal (approximately 0.05% of myofibres affected) and at the higher doses were accompanied by elevations in CPK. 
Mikroskopskih sprememb v skeletnih mišicah je bilo zelo malo (prizadetih je bilo približno 0,05 % mišičnih vlaken), večji odmerki pa so bili povezani z zvišanjem vrednosti CPK.
Tell your doctor straight away if you experience unexplained muscle pain, tenderness, or weakness. 
Takoj obvestite zdravnika, če se vam pojavijo nepojasnjene bolečine v mišicah, občutljivost mišic ali mišična oslabelost.
Patients at higher risk of developing myopathy should have more frequent CPK measurements. 
Pri bolnikih s povečanim tveganjem za nastanek miopatij je treba vrednosti CPK meriti pogosteje.
4 mg/kg every 48 hours 
4 mg/kg vsakih 48 ur
Tell your doctor straight away if you develop any of the following symptoms: - Serious, acute allergic reactions have been observed in patients treated with nearly all antibacterial agents, including Daptomycin Hospira. 
Takoj obvestite zdravnika, če se vam pojavi kateri koli od naslednjih simptomov: - pri bolnikih, ki so jih zdravili s skoraj vsemi antibiotiki, vključno z daptomicinom, so opazili resne akutne alergijske reakcije.
The symptoms generally go away within a few days of stopping Daptomycin Hospira. 
Simptomi običajno izzvenijo v nekaj dneh po prenehanju uporabe zdravila Daptomicin Hospira.
Tissue distribution studies in rats showed that daptomycin appears to only minimally penetrate the blood-brain barrier and the placental barrier following single and multiple doses. 
Študije o porazdelitvi v tkivih na podganah so pokazale, da naj bi daptomicin le minimalno prehajal skozi krvno-možgansko pregrado in skozi placento po enkratnem in večkratnih odmerkih.
It is possible that the risk of side effects affecting the muscles may be higher when any of these medicines (and some others that can affect muscles) is taken during treatment with Daptomycin Hospira. 
Tveganje za pojav neželenih učinkov, ki vplivajo na mišice, je lahko večje, če med zdravljenjem z daptomicinom jemljete katerokoli od teh zdravil (in nekatera druga zdravila, ki lahko vplivajo na mišice).
- If any of these applies to you, tell your doctor or nurse before you are given Daptomycin Hospira. 
Če karkoli od navedenega velja za vas, se posvetujte z zdravnikom ali medicinsko sestro, preden vam dajo zdravilo Daptomicin Hospira.
Mechanism of action Daptomycin is a cyclic lipopeptide natural product that is active against Gram positive bacteria only. 
Daptomicin je ciklični lipopeptid naravnega izvora, ki deluje samo proti po Gramu pozitivnim bakterijam.
Enterococcal infections 
Enterokokne okužbe
Minimum inhibitory concentration (MIC) breakpoint established by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) for Staphylococci and Streptococci (except S. pneumoniae) are Susceptible ≤1 mg/l and Resistant >1 mg/l. 
Mejni vrednosti minimalnih inhibitornih koncentracij (MIK), ki jih je ugotovil Evropski odbor za testiranje občutljivosti za protimikrobna zdravila (EUCAST - European Committee on Antimicrobial Susceptibility Testing) za stafilokoke in streptokoke (razen za bakterijo S. pneumoniae), sta ≤ 1 mg/l za občutljive in > 1 mg/l za odporne bakterije.
There were no differences in Cmax. 
Razlik v vrednosti Cmax.
Wipe the top of the rubber stopper with an alcohol swab or other antiseptic solution and allow to dry (perform the same for the sodium chloride solution vial, if applicable). 
Obrišite vrh gumijastega zamaška z alkoholnim zložencem ali uporabite drugo antiseptično raztopino in pustite, da se posuši (enako naredite z vialo z raztopino natrijevega klorida, če je to primerno).
The laboratory susceptibility testing leaflet should contain the following key messages: - That susceptibility testing minimises the risk of treatment failure by identifying strains with potential resistance to daptomycin. 
Letak za laboratorije s pojasnili glede testiranja na občutljivost mora vsebovati naslednja ključna sporočila: - da testiranje občutljivost zmanjša tveganje za neuspešno zdravljenje, saj pokaže, kateri sevi so potencialno odporni proti daptomicinu.
It may be necessary for your doctor to monitor your blood clotting times. 
Zdravnik bo morda moral večkrat določati čas strjevanja vaše krvi.
The fully reconstituted product will appear clear and may have a few small bubbles or foam around the edge of the vial. 
Povsem rekonstituirano zdravilo je videti bistro in ima lahko ob robu viale nekaj majhnih mehurčkov ali pene.
Daptomycin is reversibly bound to human plasma proteins in a concentration independent manner. 
Daptomicin se reverzibilno veže na humane plazemske beljakovine na način, ki ni odvisen od koncentracije.
- Oral anti-coagulants (e.g. warfarin), which are medicines that prevent blood from clotting. 
- peroralne antikoagulante (na primer varfarin), to so zdravila, ki preprečujejo strjevanje krvi.
The recommended doses should be used in elderly patients except those with severe renal impairment (see above and section 4.4). 
Pri starejših bolnikih, razen pri tistih s hudo okvaro ledvic, je treba uporabljati priporočene odmerke (glejte zgoraj in poglavje 4.4).
If you are receiving dialysis, and your next dose of Daptomycin Hospira is due on a dialysis day, you will be usually given Daptomycin Hospira after the dialysis session. 
Če ste na dializi in je vaš naslednji odmerek daptomicina predviden na dan dialize, boste daptomicin običajno prejeli po končani dializi.
In a randomised controlled open-label study in 235 adult patients with Staphylococcus aureus bacteraemia (i.e., at least one positive blood culture of Staphylococcus aureus prior to receiving the first dose) 19 of 120 patients treated with daptomycin met the criteria for RIE. 
V randomizirani nadzorovani odprti študiji z 235 odraslimi bolniki, ki so imeli bakteriemijo s Staphylococcus aureus (tj. vsaj eno hemokulturo, pozitivno na Staphylococcus aureus pred prvim odmerkom), je 19 od 120 bolnikov, ki so jih zdravili z daptomicinom, izpolnjevalo merila za RIE.
The dose will depend on how much you weigh and the type of infection being treated. 
Odmerek zdravila bo odvisen od vaše telesne mase in vrste okužbe, ki vam jo zdravijo.
Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/foetal development, parturition or postnatal development (see section 5.3). 
Študije na živalih ne kažejo neposrednih ali posrednih škodljivih učinkov na nosečnost, razvoj zarodka/plodu, porod ali postnatalni razvoj (glejte poglavje 5.3).
Patients who develop these signs and symptoms while receiving daptomycin should undergo prompt medical evaluation, including, if appropriate, bronchoalveolar lavage, to exclude other causes (e.g. bacterial infection, fungal infection, parasites, other medicinal products). 
Pri bolnikih, pri katerih se v času jemanja daptomicina pojavijo ti znaki in simptomi, je treba takoj opraviti zdravniški pregled in po potrebi bronhoalveolarno lavažo, da lahko izključimo druge vzroke bolezni (na primer bakterijsko okužbo, glivično okužbo, parazite, druga zdravila).
The findings of in vitro and some in vivo studies designed to investigate the mechanism of daptomycin myotoxicity indicate that the plasma membrane of differentiated spontaneously contracting muscle cells is the target of toxicity. 
Ugotovitve študij in vitro in nekaterih študij in vivo, ki so jih zasnovali za preučevanje mehanizma toksičnosti daptomicina na mišice, kažejo, da je tarča toksičnosti plazemska membrana diferenciranih celic skeletnih mišic, ki se spontano krčijo.
Your doctor may need to change the dose of Daptomycin Hospira (see section 3 of this leaflet). 
Zdravnik bo morda moral spremeniti odmerek zdravila Daptomicin Hospira (glejte poglavje 3 tega navodila).
The interaction between daptomycin and tobramycin with an approved dose of daptomycin is unknown. 
Medsebojno delovanje daptomicina in tobramicina pri odobrenem odmerku daptomicina ni znano.
There is a possibility that your blood levels of Daptomycin Hospira could be higher than those found in persons of average weight and you may need careful monitoring in case of side effects. 
Obstaja možnost, da bo raven daptomicina v vaši krvi višja kot pri osebah z normalno telesno maso in morda vas bo treba pozorno spremljati glede pojava neželenih učinkov.
In neonatal dogs, daptomycin caused marked clinical signs of twitching, muscle rigidity in the limbs, and impaired use of limbs, which resulted in decreases in body weight and overall body condition at doses ≥50 mg/kg/day and necessitated early discontinuation of treatment in these dose groups. 
Pri novoskotenih pasjih mladičih je daptomicin povzročil izrazite klinične znake trzanja, mišične okorelosti v okončinah in težav pri premikanju okončin, kar je povzročilo zmanjšanje telesne mase in splošne telesne kondicije pri odmerkih ≥ 50 mg/kg/dan in zaradi česar je bilo treba v teh odmernih skupinah predčasno prekiniti zdravljenje.
Excretion of daptomycin into milk of lactating animals has not been studied. 
Izločanja daptomicina v mleko doječih živali niso raziskovali.
Long-term carcinogenicity studies in rodents were not conducted. 
Dolgotrajnih študij kancerogenosti pri glodalcih niso izvedli.
These transaminase increases were likely to be related to the skeletal muscle effects. 
Ta zvečanja vrednosti aminotransferaz so verjetno povezana z učinki na skeletne mišice.
Reproductive toxicity testing showed no evidence of effects on fertility, embryofoetal, or postnatal development. 
Testiranje vpliva na sposobnost razmnoževanja ni pokazalo nobenih učinkov na plodnost, razvoj zarodka/plodu ali postnatalni razvoj.
How to store Daptomycin Hospira Contents of the pack and other information 
Shranjevanje zdravila Daptomicin Hospira Vsebina pakiranja in dodatne informacije
This dose is given directly into the blood stream (into a vein), as an infusion lasting about 30-60 minutes. 
Ta odmerek se aplicira v krvni obtok (v veno) kot infuzija, ki traja okrog 30-60 minut.
If co-administration cannot be avoided, CPK levels should be measured more frequently than once weekly and patients should be closely monitored for any signs or symptoms that might represent myopathy (see sections 4.4, 4.8 and 
Če se sočasnemu dajanju zdravil ni moč izogniti, je treba ravni CPK meriti pogosteje kot enkrat tedensko, bolnike pa je treba skrbno spremljati glede kakršnihkoli znakov ali simptomov, ki bi lahko predstavljali miopatijo (glejte poglavja 4.4, 4.8 in 5.3).
In some cases of myopathy involving raised CPK and muscle symptoms, the patients also presented with elevated transaminases. 
V nekaterih primerih miopatije z zvečano vrednostjo CPK in mišičnimi simptomi so imeli bolniki tudi zvečane vrednosti aminotransferaz.
For example, patients with any degree of renal impairment (creatinine clearance <80 ml/min; see also section 4.2), including those on haemodialysis or CAPD, and patients taking other medicinal products known to be associated with myopathy (e.g. HMG-CoA reductase inhibitors, fibrates and ciclosporin). 
V to skupino sodijo na primer bolniki s kakršnokoli stopnjo okvare ledvic (z očistkom kreatinina < 80 ml/min; glejte tudi poglavje 4.2), vključno s tistimi na hemodializi ali CAPD, ter bolniki, ki jemljejo druga zdravila, za katera je znano, da so povezana z nastankom miopatij (npr. zaviralci reduktaze HMG-CoA, fibrati in ciklosporin).
Steady-state concentrations are achieved by the third daily dose. 
Koncentracije v stanju dinamičnega ravnovesja dosežemo s tretjim dnevnim odmerkom.
Adverse reactions (i.e. considered by the investigator to be possibly, probably, or definitely related to the medicinal product) were reported at similar frequencies for daptomycin and comparator regimens. 
O neželenih učinkih (tj. tistih učinkih, za katere raziskovalec meni, da so mogoče, verjetno ali zagotovo povezani z zdravilom) daptomicina in primerjalnih shem zdravljenja so poročali s podobno pogostnostjo.
6 mg/kg every 48 hours cSSTI = complicated skin and soft-tissue infections; SAB = S. aureus bacteraemia; RIE = right-sided infective endocarditis (1) The safety and efficacy of the dose interval adjustment have not been evaluated in controlled clinical trials and the recommendation is based on pharmacokinetic (PK) studies and modelling results (see sections 4.4 and 5.2). 
6 mg/kg vsakih 48 ur cSSTI = zapletene okužbe kože in mehkih tkiv, SAB = bakteriemija z bakterijo S. aureus (1) Varnost in učinkovitost prilagajanja intervalov med odmerki nista bili ovrednoteni v kontroliranih kliničnih preskušanjih in priporočila temeljijo na farmakokinetičnih študijah in rezultatih modeliranja (glejte poglavji 4.4 in 5.2).
Patients with deep-seated infections should receive any required surgical interventions (e.g. debridement, removal of prosthetic devices, valve replacement surgery) without delay. 
Bolnike z globokimi okužbami je treba brez odlašanja ustrezno kirurško oskrbeti (npr. odstraniti odmrlo tkivo, odstraniti protetične pripomočke ali operativno zamenjati zaklopke).
At lower dose levels (25 mg/kg/day), mild and reversible clinical signs of twitching and one incidence of muscle rigidity were observed without any effects on body weight. 
Pri manjših odmerkih (25 mg/kg/dan) so opažali blage in reverzibilne klinične znake trzanja in en primer mišične okorelosti brez kakršnegakoli vpliva na telesno maso.
12 to 17 years 
Od 12 do 17 let
Daptomycin exhibits rapid, concentration dependent bactericidal activity against Gram positive organisms in vitro and in in vivo animal models. 
Daptomicin ima hiter, od koncentracije odvisen baktericiden učinek proti po Gramu pozitivnim organizmom in vitro in na živalskih modelih in vivo.
In some instances treatment failure has been associated with the selection of organisms with reduced susceptibility or frank resistance to daptomycin (see section 5.1). 
V nekaterih primerih je bil neuspeh zdravljenja povezan z organizmi, ki so postali manj občutljivi za daptomicin ali odkrito odporni proti njemu (glejte poglavje 5.1).
The following have been shown to be compatible when added to Daptomycin Hospira containing infusion solutions: aztreonam, ceftazidime, ceftriaxone, gentamicin, fluconazole, levofloxacin, dopamine, heparin and lidocaine. 
Za naslednje učinkovine so dokazali, da so združljive in jih lahko dodajamo v raztopine za infundiranje, ki vsebujejo zdravilo Daptomicin Hospira: aztreonam, ceftazidim, ceftriakson, gentamicin, flukonazol, levofloksacin, dopamin, heparin in lidokain.
The dosage card should contain the following key messages: - That there is a risk of severe skeletal muscle toxicity and so measuring the CPK at treatment initiation and at regular intervals is important. 
Kartica za odmerjanje daptomicina mora vsebovati naslednja ključna sporočila: - da obstaja tveganje za hudo toksično delovanje na skeletne mišice, zato je pomembno meriti vrednosti kreatin-fosfokinaze (CPK - Creatine Phosphokinase) pred začetkom zdravljenja in nato v rednih intervalih.
ITT (intention to treat) Population RIE 
ITT-populacija (populacija, ki so jo nameravali zdraviti) RIE
Clinically evaluable (CE) 
Klinično ocenljivi (CEclinically evaluable)
In addition, dose regimens of daptomycin that might be appropriate for the treatment of enterococcal infections, with or without bacteraemia, have not been identified. 
Poleg tega niso določili shem odmerjanja daptomicina, ki bi lahko bile primerne za zdravljenje enterokoknih okužb z bakteriemijo ali brez nje.
If an allergic reaction to daptomycin occurs, discontinue use and institute appropriate therapy. 
Če pride do alergijske reakcije na daptomicin, je treba prekiniti uporabo zdravila in uvesti ustrezno zdravljenje.
Therefore, caution is advised when daptomycin is co-administered with any other medicinal product known to reduce renal filtration. 
Zaradi tega je priporočljiva previdnost pri sočasni uporabi daptomicina in kateregakoli drugega zdravila, za katerega je znano, da zmanjšuje ledvično filtracijo.
Modified intent-to-treat (MITT) Microbiologically modified intent-to-treat (mMITT) 
Modificirana z-namenomzdravljenja (MITT - modified intent-to-treat)
Due to limited clinical experience (see table and footnotes below) daptomycin should only be used in adult patients with any degree of renal impairment (CrCl <80 ml/min) when it is considered that the expected clinical benefit outweighs the potential risk. 
Zaradi omejenega obsega kliničnih izkušenj (glejte spodnjo preglednico in opombe pod črto) lahko pri odraslih bolnikih z okvaro ledvic katerekoli stopnje (z očistkom kreatinina < 80 ml/min) daptomicin uporabljamo le, če pričakovana klinična korist odtehta morebitno tveganje.
Reconstituted solutions of Daptomycin Hospira range in colour from yellow to light brown. 
Rekonstituirane raztopine zdravila Daptomicin Hospira so v barvnem razponu od rumene do svetlo rjave barve.
- Daptomycin Hospira should not be administered to patients who are taking other medicinal products associated with myopathy unless it is considered that the benefit to the patient outweighs the risk. 
• Daptomicina ne smemo dajati bolnikom, ki jemljejo druga zdravila, povezana z nastankom miopatij, razen če menimo, da korist za bolnika odtehta tveganje.
In animal models AUC/MIC and Cmax/MIC correlate with efficacy and predicted bacterial kill in vivo at single doses equivalent to human adult doses of 4 mg/kg and 6 mg/kg once daily. 
Na živalskih modelih razmerji vrednosti AUC/MIK in Cmax/MIK korelirata z učinkovitostjo in pričakovanim uničenjem bakterij in vivo pri enkratnih odmerkih, ki ustrezajo odmerkoma pri odraslem človeku 4 mg/kg in 6 mg/kg enkrat dnevno.
Uncommon: Renal impairment, including renal failure and renal insufficiency, serum creatinine increased 
okvara ledvic, vključno z odpovedjo in insuficienco ledvic, zvišane vrednosti kreatinina v serumu
It is also used to treat infections in the blood caused by the same type of bacteria when associated with heart infection. 
Uporablja se tudi za zdravljenje okužb krvi, ki jih povzroča ista vrsta bakterij, kadar so povezane z okužbo srca.
Anaphylaxis/hypersensitivity reactions 
Anafilaktične/preobčutljivostne reakcije
Animal studies showed that daptomycin is not absorbed to any significant extent after oral administration. 
Študije na živalih so pokazale, da se daptomicin po peroralnem dajanju ne absorbira v pomembnem obsegu.
It is unlikely that daptomycin will inhibit or induce the metabolism of medicinal products metabolised by the P450 system. 
Malo verjetno je, da bi daptomicin zaviral ali induciral presnovo zdravil, ki se presnavljajo preko sistema citokroma P450.
2 to 6 years 
Od 2 do 6 let
Studies of daptomycin with anticoagulants other than warfarin have not been conducted. 
Študij z daptomicinom in drugimi antikoagulanti, razen varfarinom, niso opravili.
The symptoms can include difficulty breathing, new or worsening cough, or new or worsening fever. 
Simptomi lahko vključujejo težko dihanje ter pojav ali poslabšanje kašlja in zvišane telesne temperature.
If unexplained abnormalities of PT/INR are observed in patients taking daptomycin, consideration should be given to a possible in vitro interaction with the laboratory test. 
Če pri bolnikih, ki jih zdravimo z daptomicinom, opazimo nepojasnjene nepravilnosti v PČ/INR, moramo pomisliti na možnost interakcije in vitro z laboratorijsko preiskavo.
A total of 389 subjects were treated in the study, including 256 subjects who received daptomycin and 133 subjects who received standard-of-care. 
Skupno so v študiji zdravili 389 preiskovancev, med katerimi jih je 256 prejemalo daptomicin, 133 pa standardno oskrbo.
Depending on the type of infection(s) that you have, your doctor may also prescribe other antibacterials while you are receiving treatment with Daptomycin Hospira. 
Glede na to, kakšno vrsto okužb(e) imate, vam bo zdravnik med zdravljenjem z zdravilom Daptomicin Hospira morda predpisal tudi druge antibiotike.
In addition, there is a potential for a pharmacodynamic interaction to occur during co-administration due to additive renal effects. 
Poleg tega obstaja možnost, da pri sočasni uporabi zaradi dodatnega delovanja na ledvice pride do farmakodinamične interakcije.
- That Daptomycin Hospira can interfere with coagulation tests (PT/INR) and this might lead to false results. 
- da zdravilo Daptomicin Hospira lahko moti koagulacijske teste za določanje protrombinskega časa/mednarodno umerjenega razmerja (PČ/INR), kar ima lahko za posledico napačne rezultate.
After infusion of 14C-daptomycin in healthy adults, the plasma radioactivity was similar to the concentration determined by microbiological assay. 
Po infundiranju 14C-daptomicina zdravim odraslim osebam je bila koncentracija radioaktivno označenega daptomicina v plazmi podobna koncentraciji, ugotovljeni v mikrobiološkem preskusu.