Author: 1888TheLawyer

Irbesartan, and Losartan, that contained the active ingredient Valsartan could contain a cancer causing agent known as NDMA (Nitrosodimethylamine).

If you took Valsartan or a generic blood pressure medication, such as Irbesartan or Losartan, during the past 3 – 4 years for 12 months or longer and then developed Cancer you may be eligible for compensation.

In July 2018, the FDA issued a Valsartan recall. If you took Valsartan or a Valsartan generic blood pressure medication, such as Irbesartan or Losartan, during the past 3 – 4 years for 12 months or longer and then developed Cancer you may be eligible for compensation. The blood pressure medications such as Valsartan, Irbesartan, and Losartan, that contained the active ingredient Valsartan could contain a cancer causing agent known as NDMA (Nitrosodimethylamine).

According to CDC health statement exposure:

“HOW CAN N-NITROSODIMETHYLAMINE AFFECT MY HEALTH? NDMA is very harmful to the liver of animals and humans. People who were intentionally poisoned on one or several occasions with unknown levels of NDMA in beverage or food died of severe liver damage accompanied by internal bleeding. Animals that ate food, drank water, or breathed air containing high levels of NDMA over a period of days or several weeks also developed serious, non-cancerous, liver disease. When rats, mice, hamsters, and other animals ate food, drank water, or breathed air containing lower levels of NDMA for periods more than several weeks, liver cancer and lung cancer as well non-cancerous liver damage occurred. The high level short term and low level long-term exposures that caused non-cancerous liver damage and/or cancer in animals also usually resulted in internal bleeding and death. Although there are no reports of NDMA causing cancer in humans, it is reasonable to expect that exposure to NDMA by eating, drinking, or breathing could cause cancer in humans. Mice that were fed NDMA during pregnancy had offspring that were born dead or died shortly after birth. However, it is not known whether NDMA could cause the death of human babies whose mothers are exposed during pregnancy. It should be realized that exposure to NDMA does not mean that any effect on health will definitely occur.” 

This contaminated medication that contains NDMA has been linked to liver damage (fibrosis, scarring, abnormal liver function tests) along with kidney and liver tumors – both malignant and benign. The longer period of time one consumed the contaminated blood pressure medication, the more likely the user is to develop these chronic or catastrophic injuries.

If you or a loved one took Valsartan, Irbesartan or Losartan during the past 3-4 years for 12 months or more and have developed liver damage or cancer, you may be entitled to compensation.  Call Now for Your Free No Obligation Consultation toll free: 1888-TheLawyer (1888-843-5299 toll free)

in arkansas income prevents many from pursuing justice unbundled attorney can help

Unbundled Attorney – In Arkansas, income prevents many from pursuing justice. Situation similar to circumstances in Australia.

  • Australia facing means crunch for legal representation.
  • Limited-scope legal representations, or unbundled legal services, allow people with limited resources to seek redress.
  • Many Arkansans face similar difficulty paying for legal fees.

NORTH LITTLE ROCK, Ark. — Make no mistake, availing yourself of top-notch legal representation is not inexpensive. Knowledge, experience, and familiarity of the judicial system — those things come with a price, and that price can be hefty, especially to Arkansans of limited means.

And it’s not only in Arkansas and the United States this is true.

A story from Queensland, Australia, published by the Sunshine Coast Daily, “Price of justice too high for our poor”, highlights that nation’s struggle to ensure access to its judicial system for all of its residents.

The story notes legal aid centers turn away 170,000 people each year and suggests that only about two out of every three people who need legal representation receive it. According to the story, Australia’s economics work out to where a single-income couple with two children earning $48,100 per year or a single parent with two children earning more than $37,960 per year would be ineligible for free legal aid.

Out of that need has arisen limited-scope legal representation, the unbundling of legal services, in which an attorney performs only some services in a given case, while the client himself/herself handles other aspects. These “alternative fee structures” lower the cost of legal representation and allow those who would have no other recourse to pursue their claim.

Attorney Lisa G. Douglas of North Little Rock said the United States is not alone in having a legal system that does not fully serve those of limited means.

“A working family in Arkansas might bring in $50,000 a year, but after paying for a place to live and clothes for the children and food for the family, there isn’t a lot left over if an unfortunate circumstance leads to a situation requiring the assistance of an attorney,” she contended. “In these cases, limited-scope representation can be the only way these families would be able to proceed with their action.”

If you or someone you know has a potential cause of action but is unsure of how to proceed, contact the Law Office of Lisa G. Douglas: 2300 Main Street, North Little Rock, AR 72114; (501) 798-0004, 24 hours a day; or online,

American Bar Association supports limited-scope legal representations

American Bar Association supports limited-scope legal representations. Florida considering changing rules to expand unbundled services

NORTH LITTLE ROCK, Arkansas. — The American Bar Association has explained the need for limited-scope legal representations in a simple way.

A story, published by the legal news website Florida Record, “Individuals, attorneys benefit from a la carte legal services, one Florida attorney says” , quotes an ABA analysis of limited-scope legal representations: “Even though the courts and the marketplace are providing substantial assistance to self-represented litigants, the scope of this assistance is limited. Many, if not most, litigants need more than the procedural assistance offered by these resources. They need to know more than which forms to use, how to docket their cases and what time to appear in court. They need assistance with decision-making and judgment. They need to know their options, possible outcomes and the strategies to pursue their objectives. In some cases, self-represented litigants need advocates for some portion of their matter. These services can only come from lawyers.”

The analysis, compiled by the association’s legal services delivery committee, responded directly to the recent proliferation of online legal assistance websites. While the committee noted such information can help people navigate some parts of the judicial system, members also contended information online only goes so far.

However, in some states, court rules may hinder such “unbundled” legal services. The story notes Florida’s rules encourage attorney-client partnerships to achieve the best possible judicial outcome.

“If, for example, a client’s objective is limited to securing general information about the law the client needs in order to handle a common and typically uncomplicated legal problem, the lawyer and client may agree that the lawyer’s services will be limited to a brief consultation. Such a limitation, however, would not be reasonable if the time allotted was not sufficient to yield advice upon which the client could rely,” the story notes.

The state bar association in Florida is considering changes to its rules to allow further limited-scope representations, according to the story.

Attorney Lisa G. Douglas of North Little Rock said limited-scope legal representations are gaining popularity but will require state courts and bar associations to recognize the need.

“Arkansas is a state in which a number of potential litigants simply don’t have the resources to proceed. This type of a la carte service makes economic sense for them,” she contended.

If you or someone you know has a potential cause of action but is unsure of how to proceed, contact the Law Office of Lisa G. Douglas: 2300 Main Street, North Little Rock, AR 72114; (501) 798-0004, 24 hours a day; or online,

Illinois Supreme Court allows limited scope legal representations

Illinois high court endorses limited-scope legal representations

  • Illinois Supreme Court allows limited-scope legal representations.
  • Limited-scope legal representations, or unbundled legal services, allow people with limited resources to seek redress.
  • The concept is gaining widespread acceptance in the United States after becoming popular around the world.

A National Law Review story from 2013 explains how the Illinois courts have embraced limited-scope legal representation as a way to ensure clients from all socioeconomic strata have the ability to pursue claims.

The piece, Improving Access to Justice — “Unbundling” Legal Services in Illinois  — notes potential legal clients who earn less than 125 percent of the federal poverty line can qualify for legal aid in some cases. Those for whom fiscal issues are of no concern can hire the best legal representation possible. Those who fall in the middle, though, may find themselves without the resources to hire adequate legal representation even though they have a legitimate claim.

In 2013, recognizing this fact, the Illinois Supreme Court changed its rules, allowing attorneys in the state to offer “unbundled” services. These “limited-scope” representations allow attorneys to perform some services in a given case while the client handles other parts of the case himself/herself.

Announcing the changes, Chief Justice Thomas Kilbride said, “These rules will improve access to Illinois courts for people with limited means. … The Rules enable an attorney to represent a client on a limited part of a lawsuit and then withdraw from the case.  The nature of some cases requires full legal representation, but many do not. This will allow lawyers to offer their pro bono services more efficiently, and provide a person with the possibility of hiring a lawyer to protect their interests without the burden of paying for complete representation.”

The high court’s actions involved two rules, Rule 13 and Rule 11.

Rule 13 changed to allow a limited-scope representation when the attorney and client enter into a written agreement stipulating what services the attorney will provide.

Rule 11 changed to require notice to both the client and the attorney, even in limited-scope cases.

The court also clarified another rule to allow attorneys to assist someone in drafting pleadings, motions or other statements to the court.

The Law Review article notes the changes “were meant to encourage attorneys to provide representation to people who could not otherwise afford representation.”

Attorney Lisa G. Douglas of North Little Rock said limited-scope legal representations enable anyone to pursue justice.

“This type of arrangement allows someone with limited means to seek justice, to right a wrong. It is not a second tier of service; it is a partnership between attorney and client,” she explained

If you or someone you know has a potential cause of action but is unsure of how to proceed, contact the Law Office of Lisa G. Douglas: 2300 Main Street, North Little Rock, AR 72114; (501) 798-0004, 24 hours a day; or online, -Rick Fahr

Investors Sue Johnson & Johnson for Losses

Investors Sue Johnson & Johnson for Losses

Johnson & Johnson officials may already be wondering if past profits from its nearly ubiquitous Baby Powder will pay for the ongoing losses from lawsuits brought by cancer patients or their living relatives.

The company has faced thousands of lawsuits from women and/or their relatives after victims contracted ovarian cancer. Medical studies have shown that talc-containing personal hygiene products, such as Johnson & Johnson Baby Powder, can increase the risk of ovarian cancer as much as 30 percent for women who used the product in their genital area.
Talc particles can make their way through the reproductive system and land in the ovaries, where they can grow into cancerous tumors.

Juries have awarded hundreds of millions of dollars in verdicts to cancer victims across the country who sued Johnson & Johnson after contracting ovarian cancer.

Another line of litigation that has begun in recent months involves asbestos-contaminated talc. Documents revealed in trials showed that Johnson & Johnson and other companies knew for many years several talc mines had been contaminated with asbestos.
In those cases, victims contracted cancers such as mesothelioma after being exposed to talc-containing products.
Mesothelioma is an aggressive and deadly cancer that usually comes from inhaled or ingested asbestos fibers. The fibers attach to the lining of internal organs such as the lungs or heart and become cancerous, sometimes after many years of dormancy.

Asbestos, now restricted, was a common building material because of its sturdiness and fire-resistant qualities. It was used in concrete, ceiling and floor tiles, insulation and various automotive parts such as brake pads and gaskets.

Until the industry documents came to light, mesothelioma cases involving people who had been exposed to talc-containing products but not asbestos-containing materials didn’t fit normal patterns. Now, many cancer victims can understand where their cancer came from and who is responsible for it.
As if those lines of liability weren’t enough, Johnson & Johnson is now facing a third threat — investor lawsuits.
A Bloomberg story written by Jennifer Bennett notes that an investor class-action suit against Johnson & Johnson contends the investors lost money because of the revelations the company knew of the risks posed by its products but did nothing to alert the public or change the elements of its products. The suit has been filed in federal court in New Jersey.
According to the story, the investors claim “the company misled them about the decades-old link, repeatedly saying its talc products were asbestos-free and safe.” Negative media coverage coming from lawsuits against the company have led to stock price declines.
A spokesman for Johnson & Johnson dismissed the case as “baseless.”
“Johnson’s Baby Powder does not contain asbestos or cause mesothelioma or ovarian cancer, and we are confident that our talc products are, and always have been, free of asbestos, based on decades of monitoring, testing and regulation dating back to the 1970s,” Knewitz said. “Sample testing by independent laboratories, independent scientists, governmental agencies and academic institutions spanning decades have all confirmed the absence of asbestos in our talc products.”

hip replacement implant

FDA Holds Metal-on-Metal Hip Replacement System Makers Accountable

Federal regulators have taken numerous steps to ensure that manufacturers providing metal-on-metal hip replacement systems are following stringent guidelines and adhering to several reporting procedures.

These steps come in the wake of thousands of failures of metal-on-metal hip replacement systems, such as the Pinnacle system made by DePuy Orthopaedics, a subsidiary of Johnson & Johnson.

There is lots of buzz around the Depuy Hip Replacement Lawsuit

Metal-on-metal hip replacement systems use a metal ball and joint, rather than a plastic or ceramic joint. However, these systems have failed at a higher than normal rate, requiring revision surgery or surgeries and causing other problems, such as irritation at the implantation site. Another problem has been the heavy metal shavings that can lead to bleeding at the implant site or leech into the patient’s bloodstream. This condition is called “metallosis.”

Metal-on-metal hip replacement systems use cobalt and chromium, both of which can cause various health issues and have been linked in medical research to depression and symptoms of dementia.

The U.S. Food and Drug Administration has ordered metal-on-metal hip replacement system manufacturers to submit premarket approval applications, which allows FDA officials to review the design, testing and production of the systems before they are available for use.

DePuy hip replacement lawsuit.

According to court documents, DePuy Orthopaedics had design, testing and production flaws with some of its metal-on-metal hip replacement systems. Juries have awarded hundreds of millions of dollars in damages to patients whose systems failed

The FDA premarket approval application will require manufacturers to address any risks known, or that should reasonably be known; the effectiveness of the device; full reports from investigations on the safety and effectiveness of the device.

Regarding metal-on-metal hip replacement systems, FDA has also taken steps to:

• evaluate such devices using magnetic resonance imaging (MRI);

• support new technologies to improve imaging around metal implants to better locate problems before they become serious;

• encourage metal ion testing procedures to ensure consistent practices and reporting;

• review literature regarding devices and results in the United States and around the world;

• review reports involving failed devices to determine why and how the device failed;

• direct manufacturers to conduct a postmarket surveillance study to gather “additional information about the safety profiles of the implants, including the effect of metal ion concentrations in the bloodstream”;

• organize orthopaedic registries around the world to more consistently report and catalogue issues with the devices; and

• provide safety information to patients and health care providers.

That’s not all!
In 2005, J&J pushed their DePuy ASR Hip implants in the United States as a new design that would last 20 years and would provide a greater range of motion. The DePuy ASR metal on metal hip implant design has a metal femur head that rotates within a metal cup, known as a metal on metal design. According to the FDA metal on metal (MoM) Hip Implant Systems consist of a metal ball, metal stem and a metal shell. These metal on metal hip implants were designed to have less device wear, decreased chance of dislocation, and decreased chance of fracture.
However, the metal ball and the metal cup slide against each other during movement causing metal particles to be released. Over time, the metal particles can cause damage to bone and/or tissue surrounding the implant and joint. Soft tissue damage may lead to pain, implant loosening, implant failure, and/or revision surgery. –authored by Rick Fahr

personal injury child support

Will My Personal Injury Settlement Affect My Arkansas Child Support Payments

your injury settlement may affect your child support obligations
Child support obligations may be affected by your personal injury income

Following the decision of your personal injury lawsuit, you must bring up to date the Arkansas office of child support. Subsequently, the income you’re compensated in your settlement may affect your child support obligations. There are numerous potential complicating aspects, nonetheless, so it’s wise to talk to a family lawyer. Your attorney can advise you with regards to your legal rights and obligations. What follows is some general information that could be to your benefit on this subject.

A Settlement Award as Personal Income

Many states address the earnings from the compensation for pain and suffering like a personal income to use at least in some measure to cover supporting your children. In Arkansas, everything established to be “income” is subject to the child support guidelines. Ark. 36

Overdue Payments

After the exceptional suffering of any severe injury, delinquent child support obligations could add to one’s level of stress. Having said that, you’re by law required to meet your financial obligations to your kids. Once you collect your personal injury payout, you could be required to apply some or the entire thing for child support payments.

Your Personal Injury Award and Child Support

Should your injuries leave you not able to work plus the personal injury award consists of recovery of your lost income, that part you recover for income might be deemed regular income.

  • The percentage of your settlement award from the insurance company that will go toward paying child support will likely be the same as your normal earnings percentage.
  • A family law attorney will tell you how much of your personal injury award may go toward your doctor bills and other expenses and just how much should be given out for supporting your children to the custodial parent

Upcoming Child Support Installments

Payment gained due to a jury judgment and even out-of-court settlement is typically thought to be income, at least partly.

Often personal injury income according to Arkansas law is the same as regular income
Your settlement earnings will probably be treated normal income that will go toward paying Arkansas child support
  • If the earnings are significant, it could possibly modify the sum of money you’re required to pay for child support into the future.
  • This may, in particular, be true if the amount incorporates reimbursement apart from medical bills.
  • After reviewing your case, Lisa Douglas offers legal advice and will outline precisely what you’ll be required to pay with regards to your Arkansas child support.  Zero cost consult.  (501) 798-0004/ out the form.  Your contact information is private.

Leave a comment for a Arkansas Disability/Family Attorney

Depositions in Medical Malpractice Lawsuits

If you have filed a medical malpractice lawsuit, there may be one or more oral depositions conducted in connection with your case. It’s a good idea to have an understanding of depositions and how they may affect your malpractice claim.
What is an Oral Deposition?
An oral deposition is customary in most types of court cases.
  • Depositions are one of several pretrial tools available to learn what an individual knows about the case and to preserve their testimony for use in court.
  • The party being questioned at a deposition swears to tell the truth, and the attorneys involved then ask questions.
  • Cross examination may also take place.
  • Although the deposition will be held in an office outside of the courthouse, the questioning is conducted very much like it would be in a courtroom at a trial.
  • A New York court reporter will take down the questions and answers verbatim using a stenograph machine. Electronic recording using a tape recorder or video camera may occur as well.
What Will be Discussed During the Deposition?
There may be things said during the deposition other than questions and answers. All discussion is recorded unless the attorneys agree otherwise.
  • The lawyers may make objections or engage in conversations with each other.
  • The claimant in a malpractice suit, known as the plaintiff, will be asked to give basic background information such as home address, birthdate, and marital status.
  • The plaintiff will also be asked questions about the history of the underlying medical problem or condition, medical treatment sought, medicine taken and complications resulting from any treatment.
  • The defense attorney will delve into all details of the underlying claim and will probably ask what the plaintiff believes the doctor did wrong. The plaintiff will also be asked about injuries or conditions resulting from the malpractice and about any similar injuries or conditions from before or after the malpractice incident.
  • The doctor’s lawyer will also explore the damages claimed by the patient. This could include medical expenses, wage loss, pain and suffering, permanent injuries, limitations and loss of enjoyment of life.
  • The defendant’s doctor in a malpractice case may also attend a deposition. The doctor will be asked about his or her education, licenses held, board certifications and years in practice. The doctor will be questioned in detail about the plaintiff’s medical history, about the treatment given to the plaintiff and about any other health care professionals involved in that treatment.
  • The available medical records will be thoroughly examined and discussed.
  • Plaintiff’s counsel will want to explore the risks and complications of the procedure or treatment rendered to the plaintiff and any appropriate alternatives.
What Happens After the Deposition?
After the deposition has concluded, the court reporter finalizes their notes. This final deposition can be used in court as a legal document. The written transcript, or parts of it, may be read to the jury during proceedings. This is one reason why depositions are an important part of any malpractice case. They can have a profound impact on its outcome. A qualified medical malpractice attorney will have extensive experience with depositions. That experience may help a malpractice plaintiff receive fair compensation for their medical malpractice damages. Contact a malpractice attorney if you have been seriously injured by a negligent healthcare provider.
Veritext_Logo_ColorThanks to our friends and contributors from Veritext for their insight into depositions and medical malpractice lawsuits.
Insurance Company is not your friend. Hire a personal injury attorney today!

Where do Most Car Accidents Occur?

Whether you own a vehicle or take a bus or train to commute, you may already know car accidents are quite common, and in some situations, unavoidable. Strictly following traffic rules and laws, making repairs, and getting regular inspections are great ways of mitigating the risk of accidents. But not all of us are responsible when it comes to car maintenance and driving on the road. In a majority of the cases in the United States, there is a negligent driver involved in the accident whose carelessness resulted in a collision as a car accident lawyer Delray Beach FL relies on can attest.
If you are wondering where most of such collisions take place, you will be surprised to learn about the following three common areas:

    Near Home
Neighborhoods are the most common areas where a car accident is likely to happen. According to a survey performed by an insurance company, more than 50 percent of car accidents happen within five miles of a driver’s house.
It is easy for a driver to become relaxed when they are off the busy freeway and nearing their home, getting a false sense of security. During this time, they are likely to be easily distracted and crash into a car while turning or pulling out from a driveway. Typical neighborhood collisions include sideswiping a car to avoid hitting pedestrians or bicyclists, crashing into parked cars or trees, and backing out of a driveway.

    Parking Lots
The second most common location for car accidents is a parking lot. This type of accidents often happens when two cars are parked back to back and the drivers back out their cars out at the same time. It may also occur when two drivers are backing out from adjacent spots, but in the opposite direction, resulting in a collision. When a parking lot is densely packed or too small, drivers of larger vehicles may find it difficult to maneuver around tight corners, increasing the risk of swiping the side of another car.
However, since collisions usually happen at a slow speed, there may be only minor or no damage or injury to the vehicles or drivers/pedestrians.

    Metropolitan Areas
Big cities are the third most likely area where the risk of an accident is high. Traffic signals often encourage drivers to relax and take their eyes off the road, eat and drink, spend time on smartphones, and even doze off while driving. Many drivers use traffic jams as an opportunity to multitask, such as check emails or social media notifications, reply to text messages, engage in personal grooming, and even reading a newspaper. Because of such distractions, pedestrian accidents, collisions, and fender benders often take place.
Vehicle accidents occur every single day – most of them are minor where no one is harmed, while others are serious, resulting in serious injuries and even death. It is important that drivers stay alert at all times during their commute and abide by all traffic laws to ensure no gets hurt because of their carelessness or negligence.
Logo-EHLThanks to our friends and contributors from Law Office of Eric H. Luckman, P.A. for their insight into car accident cases.

5 Common Knee Injuries in Personal Injury Cases

The knee is one of the most complex joints in the human body — and it’s also very often the location of an injury. Our knees are responsible for bearing a great deal of our weight while having a fairly small range of motion (much smaller than the shoulder joint, for example). If you’ve suffered injuries from an accident, you might be facing a knee injury. Here are just a few of the more common types of knee injuries that are often tied to personal injury claims:


  1. Tendon Tears and Ruptures

As a chiropractor can explain, there are two primary tendons around the knee that can be injured: the patellar tendon, which connects to the upper tibia, and the quadriceps tendon, which attaches to the quadriceps muscle. These two tendons can tear very easily and surgery may be necessary.


  1. Fractures

When there is a fracture in the knee, it most often affects the kneecap or patella. Other knee-related fractures may involve the tibia, fibula, and femur bones. Motor vehicle accidents and falls are two common causes of knee fractures; both of these accidents can put substantial stress on the front of the knee.

Fractures of the patella, which are much more common, are grouped into four categories: stable, displaced, comminuted, and open.

  • Stable fractures The bone sections on either side of the fracture are not displaced. This type of patellar fracture usually heals with rest and immobilization.
  • Displaced fractures The bone sections are no longer in alignment, and there may be a considerable gap between the fractured pieces. These injuries usually require surgery to repair and there may be associated tendon and/or ligament damage.
  • Comminuted fractures These occur when the patella is broken into 3 or more pieces. These fractures are unstable and always requires surgery.
  • Open fractures Also known as compound fractures, they involve exposure of the bone fragments through breaks in the skin. Open fractures will always require surgery and often lead to instability of the knee well after healing is complete.
  1. Meniscal Injuries

In between the femur and tibia bones are wedge-shaped bands of tissue called meniscus cartilage. These fibrous tissues are often called “shock absorbers” and they play a crucial role in allowing the knee joint to move freely. A tear in the meniscus can be either partial or complete; partial tears may heal with splinting, but complete tears may require surgery.



  1. Collateral Ligament Injuries

The collateral ligaments lie on either side of the knee, with the medial collaterals lying along the inside of the joint and the lateral collaterals along the outside of the joint. These injuries are usually caused by direct contact force applied to the lateral (outside) aspect of the knee during athletics, but are also common in motor vehicle/pedestrian accidents. In the latter type of trauma, there are usually fractures associated with the ligament injuries and recovery can take several months.

  1. Posterior Cruciate Ligament (PCL) Injuries

The posterior cruciate (“cross-shaped”) ligament lies at the back of the knee and helps connect the tibia and femur. It also is most commonly injured in motor vehicle accidents or falls that involve a twisting movement. PCL injuries are usually incomplete tears that respond well to rest and immobilization in a cast or splint.


If you’ve been injured because of someone else’s negligence or wrongdoing, you may be entitled to compensation. Knee injuries can range from mild to severe — but even small knee injuries can require substantial medical treatment. Financial compensation could help you pay for the diagnosis, treatment, and ongoing medical care that you may need. For more information, contact a personal injury lawyer today.

Thanks to our friends and contributors from Pain & Arthritis Relief Center for their insight into knee injuries common to personal injury claims.