#the majority of resources are controlled by less than 1000 people

[twiggybeing]

I wish I lived in a world where I could lead a simple life just making art and cultivating community but instead I have to live in this capitalist hell where people working 40+ hours a week are barely able to make ends meet.

I wish I lived in a world where I could just pursue one thing for my whole life but instead I live in a world that has brought me to the point where I, a people pleaser with social anxiety and self worth issues feel as though I could try to lead an actual movement to pressure the governments of the world to actually represent and take care of their people.

broadly, I would say I am a pacifist, but if I need to get blood on my hands to alleviate the suffering of billions, then I will.

[lonelypond]

Parent Trap, Ch. 10

NicoMaki, Love Live, 3.1K, 10/?

Summary: Maki panics, Eli saves the day, and we have a clash of the grandmothers.

When Moms Attack

Maki rambled, letting anything she was thinking just spill out of her mouth as she navigated unfamiliar streets, actively not looking at Nico. Nico had seemed so tiny, leaning most of her weight on Maki, letting Maki help her up into the Nissan Rogue Sport. Maki had slid into the driver’s seat, while Nico had slumped against the window. Worrying. Terrifying. So Maki kept rambling. “I spent hours driving down from Wisconsin with no problems, but once you hit the city, there’s traffic and people not paying attention and…”

Nico made a murmuring noise.

“Then suddenly you have to remember to stop at traffic lights. It just slows everything down.” A red light. A hasty switch to brakes. And had she missed a turnoff?

“I think we’re almost there. Nico, do you recognize this street?”

No reply.

“Nico?”

Maki turned to her right, Nico had completely fallen against the door, not holding herself up at all. “Non responsive” lit a panic fire in Maki’s brain. “Nico?!?”

No reply. Should Maki go the hospital? Was Nico breathing? Should she have put Nico on a backboard at the scene? Called 911? What could she do now? Had she hurt Nico? Not rambling anymore, now Maki, Maki was breathing, too fast, with no idea what to do next. Who could help...Eli...Eli’s private line was still in her phone.

“Call Doctor Eli Ayase’s Emergency Number.”

###

Her phone. Eli heard the ringtone. Her emergency number. Immediately, she was alert, no longer in a sleepy haze of Nozomi nearness. Her phone would wake up the twins. Now was not a good time for Vik and Teddy to be wandering around.

“Dr. Ayase’s emergency line.” Nozomi’s voice was crisp and efficient. Of course, Nozomi was faster, Nozomi was used to being a doctor’s wife.“...Calm down, Maki, Eli’s right here, what happened to Nico?”

Eli leapt up in a panic, grabbing the phone, falling over Nozomi. “Maki?”

“Nico was in an accident on the set and hit her head and I’m taking her home but she just passed out and now she’d not responding, maybe, and I don’t know what to…”

“Maki, where are you?”

“Driving to Nico’s house. But I’m lost.”

“Pull over…carefully.” Nozomi had gone to get her robe, wrapping it around Eli, “Then take a couple deep, slow breaths and tell me what happened.”

No reply. Eli willed Maki to get off the road safely. Waiting, pacing, Eli counted the steps from the couch to the bedroom door. And back.

After a long pause, Eli heard an exhale, and Maki’s voice, shaking, “I thought Nico might have a minor concussion after her car stunt so I was driving her to her house, but she just passed out. I made a mistake Eli, we should have gone right to the hospital, what if there's damage…”

Time to interrupt the panic attack. “Maki, I’m sure you made the right call on site. Nico didn’t get much sleep last night, she’s been working 18 plus hours a day, she’s probably exhausted, dehydrated, and might have the same upper respiratory bug the twins are developing. So there’s a lot that could be going on, a bad combination, but not lethal. I need you to stay calm. Use your training. How’s her pulse?”

“Fast but steady.” Maki sounded calmer. “I’m taking her to our hospital. Meet me there. I can’t be her doctor, but I’ll get things started.”

“Maki, you know you won’t have any say in her treatment, if she’s unconscious, her family will. We have to call them.”

“Fuck you, Eli. You owe me. I’ll just say we’re married.” Maki sounded like she was crying.

“Maki…”

Sniffling. “Just meet me there.”

Eli had a panic thought, Dia in the car seat listening to all of this, “Where’s Dia?”

“Rin and Hanayo’s.”

“Good.”

Maki was back in control of her voice at least. “Just ask at reception. We’ll be in the family suite.”

The Family Suite. Sometimes Eli forgot exactly how privileged the Nishikinos were. They had what was basically a two bedroom apartment tucked into the hospital for their private use.

“All right, Maki. Just be careful.”

No reply as Maki ended the call.

Eli put the phone down, her forehead against the wall, until Nozomi’s arms wrapped around her waist, Eli turning to meet worried turquoise eyes.

“Apparently, be gay and do crime now means violate medical consent and privacy laws.” Eli couldn’t filter the snark. She liked rules. Rules prevented situations like this.

Nozomi winced. Eli just sounded so stretched. “What’s happening, Elichi? Maki sounded panicky.”

“Maki’s got Nico in a car, passed out, with a maybe concussion.” Eli sighed, “I think it’s more likely exhaustion and dehydration and worry caught up to Nico, but that’s not good either.”

“No.” Nozomi shook her head, “And Teddy was coughing when she came home from school.”

“Fever?”

“Not enough to notice.”

“Vik have any symptoms?” Eli ran a hand through her messy hair, considering a diagnosis and treatment plan for Nico.

“They were kinda quiet, no bragging about Nico or planning for Tokyo.”

“Flu cases have been surging. Better keep both home today.” Eli raised a hand to Nozomi’s cheek, reveling in the softness, “I hate to leave. You’re…”

Nozomi giggled, breaking the moment. “Help Maki and we get our guest room back.”

Eli frowned, “You’re shameless. This is all your fault. I haven’t forgotten.”

“I know.” Nozomi dropped her head, more of an admission of responsibility and guilt than Eli had expected, “We’ll fix this. But first go fix Nico.”

“Yeah.” Eli tilted Nozomi’s head up, making sure Nozomi could see the love in her eyes, “I am sorry to go.”

“Just come back to me.”

“Always.”

From the first kiss to this one, Eli had never been anything but certain Nozomi had been meant to be by her side. 1000 platinum records and screaming sell out crowds wouldn’t have matched even the first clumsy thrill or this avalanche of content and chemistry.

###

For this late an hour, a surprising number of nurses, aides, clerks, security, and doctors were scurrying everywhere when Eli reached the main desk in the Emergency Department. Eli recognized the mood. Maki was in a temper.

“Dr. Ayase!” Amaya Robinson, one of the Emergency Department Managers, hurried up to Eli, “What is going on?”

“Where is Dr. Nishikino?” Had Maki signed Nico in in any way? Or just rushed her somewhere. “And the patient?’”

Robinson moved to let a clerk use the nearest computer, “Dr. Maki Nishikino rushed into the Emergency Department, ignoring triage protocols and the admission clerks, diverted resources in a questionable manner, and has refused to fill out any forms or provide any information about the woman she commandeered a bed for. She referred all questions to you, upon arrival. I can assure you the Board will have many more questions than I do.”

Damn it, Maki, Eli thought. Then she spoke in her best concerned colleague voice, “Amaya, I know this is irregular. Maki called me in at the last minute.” Eli debated how much to share, but if Ms. Robinson had any human sympathy at all, Eli was going to summon it, “She was in a panic. I know I can trust your discretion, but the patient is,” Eli lowered her voice, obviously checking to see if there were eavesdroppers, “Nico Ni. So it’s important we keep this as quiet as possible.”

“Tell Dr. Nishikino that.” No sympathy. Maki’s brusque independence had left her few friends among upper management.

“Have you called either of her parents?”

Amaya shook her head, “I want to be able to sum it all up in one message.”

That could take hours, if Maki kept up a rampage. Time for Eli to get some fluids in Nico and find some way to calm Maki down. “Where is Maki raging now?”

Amaya almost laughed, “Private suite. You remember where that is?”

Eli nodded. After Dia’s birth, Maki had been moved there. “Have there been any tests run?”

“Basic blood work. X ray. Have you contacted next of kin?”

Nico’s mom was so not going to be on board with Maki’s plan to be in charge without being in charge. Eli gritted her teeth and punted, “I’m sure Maki’s done something about that.”

“Good. Dr. Nishikino needs to be a lot less visible and audible on this case.”

Eli nodded, briskly stepping around Amaya, “I’ll take over.”

“I’ll exert some diplomacy in the ER.”

“Thanks. I’m sure Maki wouldn’t have upset her coworkers if she weren’t so worried.” Eli stopped, frowning, “Although that’s no excuse, I know.”

Robinson grimaced, not thrilled at how long this night was going to linger on her to deal with list. “Please, just don’t let this turn into a bigger problem, Dr. Ayase”

That was Eli’s plan. And Maki was a wrecking ball pointed at it. Eli nodded and speedwalked to the elevator.

###

Where was Eli? Maki paced, almost frantic, stopping to make sure Nico was still breathing. Rationally, she knew Eli was right and she wouldn’t have missed anything major, but here, now, in this room, Nico was unconscious in bed, with an IV line, looking so frail. And tiny. Maki couldn’t process how drained Nico looked, how breakable, how…“Nico?”

No response. Where was Eli?

Maki forced herself to breathe. Eli would be here. Eli was making things happen so Nico would be okay. Nico was important to Eli. Maki had had enough faith in Eli to trust her through her fertility trials and pregnancy. Maki remembered when Dia decided to be delivered early, how calm Eli was. Breathe. Trust Eli. Nico would be all right. She was just tired. Maki was tired too. Go sit on the bed in the other half of the suite, take a moment, text Rin about what was going on, find out how Dia’s afternoon had been. Nico wasn’t going anywhere. Walking slowly to the other bed, sitting awkwardly, still watching Nico. Surprised at how heavy she felt, Maki thought maybe she would just lay down for a minute, just until Eli got there. A yawn. Just for a minute. That was better than staring at Nico hard enough to wake her up.

###

Nico heard someone walking. Why was she asleep? Wasn’t Maki talking to her? Maki’s car had been too comfortable, Nico must have fallen asleep. She opened her eyes and jumped to see Eli's face too close, blue eyes worried.

“What the hell, Eli?” Nico shouted, but she didn’t get the volume she expected.

Eli raised a finger to her lips and pointed to an open archway, “Maki’s asleep in there. She’s had a long day.”

“Maki’s had a long day? Nico’s had a long day.” Nico had never been in this room before. Eli had scrubs on. Had Maki taken Nico to the hospital? After the…

“This is ridiculous, Eli. Nico’s fine.” Nico sat up, swinging her legs to the side of the bed, but Eli’s arm blocked her.

“You’re not going anywhere until I see your X-Rays, Nico. And maybe a CAT scan. Your pulse rate is too fast, you’re dehydrated and running a fever, you are not fine.”

“Maki just wanted to kidnap Nico.” Nico pouted, not wanting to admit how that motion had left her.

“Maki...” Eli glanced over her shoulder, “was terrified.”

Nico coughed. It hurt. If Maki was here... “Where’s Dia?”

“Rin and Hanayo.”

“Good.” Nico relaxed just slightly, “I’m not staying Eli. If it’s a concussion, it’s minor, and this hospital is just full of people wanting to stalk Nico and stare.”

“I know, I called your Mom. After we get some fluids and meds in you, I think home is the best place for you. But you need to talk to Maki, Nico. And you need to take it easy.”

Nico shook her head, wincing, “Nico has to finish the video. And then the mini tour starts.”

Eli pushed her glasses up, blue eyes flaring with stubborn, “Nico, your insurance will cover a postponement for medical reasons. If you’ve got the flu that’s been going around the twins’ school, you’re going to feel worse tomorrow. And if you don’t rest, there’s pneumonia to worry about. Your blood work worries me. You need to take better care of yourself.”

“Nico?” Maki’s voice, soft, worried. She was standing in the archway, staring at Nico and Eli.

Eli’s voice was soft, but too serious for Nico to ignore. “Don’t move much. And talk to Maki, Nico. I’m going to go wait for your Mom downstairs.”

Nico nodded at Eli, settling back against the pillows as another wave of tired hit.

Eli gave Maki an encouraging smile and exited the room.

Nico turned to Maki, not happy to be having this conversation here. “You called Eli? Aren’t you a doctor?”

Maki shook her head, suddenly shy, “Not yours.”

“Nico is confused.” But then a rush of adrenaline surged and Nico sat up, hand out, “But not concussion confused.”

Maki sat on the end of Nico’s bed, “I’m your...girlfriend, not your doctor. I don’t want to be your doctor. Doctors don’t date patients.”

“But you kidnapped Nico.”

“You passed out in my car, Nico.” Maki leaned forward, fingers tugging through hair. "I didn't know what to do." She sounded so young.

"You could come closer.” Nico wanted to smooth the strands back into place, soothing Maki.

Maki shook her head, not raising it.

“Maki?” No reply. “I’m glad you didn’t go to the party.”

“Wanted to get OUT but wanted to see you more…” A sigh, “Watching Dia alone was exhausting. And lonely. Since I got pregnant, everybody just treats me like a mom, not a....person. All they talk about is Dia.” Maki glanced up, a smile starting, “You didn’t.”

Nico managed to slide down the bed, hip to hip with Maki. Attraction had heady, hella pull. “Nico wants to know more about Maki.”

The air got heavy, Maki decided to risk the hard question, turning to face Nico,“But what about Dia? Eli says…”

Nico took Maki’s hand, “Maki and Dia are a package deal. Nico wants both.”

Maki let herself just sit there, meeting Nico’s gaze, feeling her worries fade, becoming fascinated by the swirls of sparkling love in the deep ruby crimson. Nico was leaning forward....

A knock...Nico’s eyes closed and frustration edged her voice, “Go away, Eli.”

But the door opened and Maki’s mother stepped through, still in her coat. “Here you are, Maki. I want to talk to you.”

“Mama, not now.”

“Yes, now, Maki…you didn’t tell me you were coming back into town, I had to find out from security you’d smuggled...Yazawa in here, I want to know what’s going on. And where’s Dia?”

Was everyone going to ask Maki that? Like she'd forget her child somewhere.

“Rin’s.”

“Good. There’s no need for her to be any further involved with Yazawa and her fans.” Maki’s mother turned on Nico, who was processing the family resemblances, “Please keep my family out of your...harem.”

Maki hissed. Nico nearly jumped off the bed, the IV stand rattling with her movement.

“You’re embarrassing me, Mama.”

Dr. Nishikino shrugged, “This isn’t the first fleeting celebrity crush anybody’s ever had. Easily forgotten in a week.”

“I’m not a teenager with a crush.”

Nico winced at how sullen Maki sounded. She was not dealing with this well, not making eye contact with anyone. Nico reached out a hand, laying it on top of Maki’s, willing reassurance into the contact. They could do this together.

“Nico!!!” Nico’s mother barrelled into the room, no Eli in sight. “Are you all right?” Mrs. Yazawa rushed to her daughter’s bedside, pushing aside Maki's mother, her hand raising Nico’s chin so she could get a good look at her daughter’s face, “Eli is right. You are exhausted. You should stay here.”

“I’m going home, Mama.” Nico said quietly.

“Nico…” Maki started, to be interrupted by her own mother.

“I agree with Yazawa, the hospital is far too public. I want the Nico Ni social media circus far away from my daughter and granddaughter.”

Nico’s mother switched her attention to Maki, her questions sharp, her eyes suspicious. “Where’s Dia? With your nanny?”

“Mama…” Nico whined. Maki might have smiled at Nico’s pouty cuteness but the tension in the room was near exploding.

“It is none of anyone’s business where my granddaughter is…”

“Family belongs with family...”

“Mama.” Nico grabbed her mother’s arm, “let Nico handle this.”

Maki was rocking, chewing on her lip, finally raising her head to glare at her mother, “None of this concerns you, Mama.”

“Maki, you are obviously…”

“Obviously what?” Maki had snapped, “Responsible for my own life and child? Not wanting interference from anyone? Tired of being told what to do for the Nishikino brand?”

And then there was Eli, clapping her hands, the loud noise startling the room into silence, “That’s enough. Nishikinos out. Now.” Eli held the door open, her determination stilling the room.

“Your intervention is not appreciated, Dr. Ayase.” Dr. Nishikino the elder frowned. “I will remember this.”

“Nico is my patient. You have no rights here.” Eli’s smile was icily polite.

“Nico…” Maki had Nico’s hand again.

“It’s okay, Maki. Mama’s going to take me home and you’re going to check on Dia. And then,” Nico deliberately held the very hostile gaze of Maki’s mother, “You’re going to come stay at Nico’s house for as long as you want. I’ll text you the security code.”

"Really?" Hope surged as Nico looked at Maki.

"If it's what you want." Nico tugged Maki forward, leaning up for a quick, awkward kiss, fingers sweeping Maki’s cheek. They smiled at each other, a moment anchored in their growing bond, a calm in this crazy day. “See you soon.”

Maki nodded, then rushed by Eli, not looking at Nico’s mother. When she got to hers, she stopped, hand on her mother’s elbow “C’mon Mama. Let Nico rest.”

“We’re not done discussing this, Maki.”

“I know.” And Maki steered her mother out of the room.

Mrs. Yazawa closed the door after the Nishikinos, frowning. “Is that really wise, Nico? Inviting her to stay with you?”

“Mama, just let Eli unlock and unplug Nico and we’ll go home. You can list what Nico should have done on the way.”

Arms crossed, Mrs. Yazawa’s foot kept a brisk pace tapping the floor. “Trust me, I will.”

“Just remember,” Nico flopped back, groaning and wincing dramatically, “Nico’s not well.”

“Well enough to flirt.”

Nico grinned, “Nico’s Dr. Charm, not Dr. Harmed.”

Mrs. Yazawa rolled her eyes at her eldest. Eli giggled.

A/N: Stay safe out there.

[rayarmat]

A Guide to Outpatient COVID Treatment: Step-By-Step Doctors’ Plan That Could Save Your Life

Recently, Dr. Peter McCullough, MD, of Baylor University Medical Center in Dallas testified to Texas Senate HHS Committee  about how mass media and even some government agencies are silencing clinical outpatient evidence for effective treatment of COVID19 and instead push vaccines only (video shown below).

Treatments like those mentioned by Dr. McCullough can be found in sites like https://c19early.com/ but specifically, McCullough refers to the following Appendix to a document published by Association of American Physicians and Surgeons (AAPSonline.org) as an educational resource. It is based on a paper published in American Journal of Medicine (link), by Dr. Peter McCullough and 22 other clinicians (MDs) and researchers (PhDs).

“Seek early treatment and be your own advocate. All of the physicians contributing to this booklet are  on the frontlines treating outpatients at the first signs of COVID illness. Studies in the US and many other  countries clearly show that patients who are treated within the first 5 days of symptoms have better  outcomes using the combination of medications in the algorithm below.”

COVID-19 hospitalizations and death can be reduced with outpatient treatment.

Principles of COVID-19 outpatient care include: 1) reduction of reinoculation, 2) combination antiviral therapy, 3) immunomodulation, 4) antiplatelet/antithrombotic therapy 5) administration of oxygen, monitoring, and telemedicine.

“For the ambulatory patient with recognized early signs and symptoms of COVID-19, often with nasal real-time reverse transcription or oral antigen testing pending, the following 4 principles could be deployed in a layered and escalating manner depending on clinical manifestations of COVID-19-like illness and confirmed infection: 1) reduction of reinoculation, 2) combination antiviral therapy, 3) immunomodulation, and 4) antiplatelet/antithrombotic therapy. Because the results of testing could take up to a week to return, treatment can be started before the results are known. For patients with cardinal features of the syndrome (ie, fever, body aches, nasal congestion, loss of taste and smell, etc.) and suspected false-negative testing, treatment can be the same as those with confirmed COVID-19. Future randomized trials are expected to confirm, reject, refine, and expand these principles. In this article, they are set forth in emergency response to the growing pandemic as shown in Figure 1 .

Treatment algorithm for COVID-19-like and confirmed COVID-19 illness in ambulatory patients at home in self-quarantine. BMI = body mass index; CKD = chronic kidney disease; CVD = cardiovascular disease; DM = diabetes mellitus; Dz = disease; HCQ = hydroxychloroquine; Mgt = management; O2 = oxygen; Ox = oximetry; Yr = year.

The basic groups of prescription medicines and other therapies used in COVID-19: 

▪ Combination anti-viral medicines started as soon as symptoms occur ▪ Medicines to decrease inflammation, such as corticosteroids (called  immunomodulators) 

▪ Anticoagulant therapy to prevent blood-clots that can cause strokes, heart attacks,  kidney shut-down, and death. 

▪ Non-prescription supportive treatments with zinc, vitamin D, vitamin C, electrolyte  drinks such as Pedialyte, and others. 

▪ Home-based oxygen support, such as with an oxygen concentrator. These machines  are available by physician prescription from home health medical supply businesses and are covered on most medical insurance plans. 

I. Antiviral Agents:  

These must be started quickly at STAGE I (Days 1-5):  

Symptoms include sore throat, nasal stuffiness, fatigue, headaches, body aches, loss of  taste and/or smell, loss of appetite, nausea, diarrhea, fever.  

These medicines stop the virus from (1) entering the cells and (2) from multiplying once  inside the cells, and they reduce bacterial invasion in the sinuses and lung: 

▪ *Hydroxychloroquine (HCQ) with azithromycin (AZM) or doxycycline 

OR 

▪ Ivermectin with azithromycin (AZM) or doxycycline 

Either combination above must also include zinc sulfate or gluconate, plus supplemental vitamin D, and vitamin C. Some doctors also recommend adding a B complex vitamin. 

Zinc is critical. It helps block the virus from multiplying.  

Hydroxychloroquine is the carrier taking zinc INTO the cells to do its job.

An educational resource from The Association of American Physicians and Surgeons (AAPSonline.org) 16 

II. Anti-inflammatory Agents - Corticosteroids (“steroids”): Oral and Nebulized. 

These are started at STAGE II (Days 3-14) to reduce inflammation, the cause of added  damage to the lungs and critical organs. Symptoms include worsening cough, difficulty  breathing, chest heaviness/tightness or chest pain.  

As inflammation damages the airways interfering with normal oxygen-carbon dioxide  exchange, blood oxygen levels drop and people experience loss of focus, drowsiness, confusion, difficulty concentrating, low energy and severe fatigue.  

The exaggerated Inflammation response in COVID further increases the risk of blood clots. 

Prescription medicines and other support added now to Stage I medicines are: ▪ nebulized budesonide to help penetrate the lungs and reduce inflammation ▪ oral prednisone, methylprednisolone, dexamethasone 

▪ colchicine – may also be added to reduce inflammation 

▪ full strength adult aspirin 325 mg to reduce inflammation and risk of blood clots ▪ home oxygen concentrator may be needed to improve oxygen levels (requires  physician prescription) 

III. Prescription Anticoagulants (“blood thinners”):

STAGE III (Day 7 and beyond): Symptoms seen in Stage II intensify. Difficulty breathing becomes extreme, oxygen levels  drop sharply, risk of heart attack or stroke increases. At this point, people are critically ill.  

The medicines to be added to Stage I and II medicines now include: 

▪ Aspirin 325 mg unless told not to take by your doctors 

▪ And/or low molecular weight heparin injections (e.g. enoxaparin [Lovenox]) OR 

▪ apixaban (Eliquis), or rivaroxaban (Xarelto), or dabigatran (Pradaxa) or 

edoxaban (Savaysa) in standard doses for 5 to 30 days 

If these added steps do not lead to improvement, or the patient becomes unstable, a 911  call is warranted for ER evaluation and hospital admission so that more aggressive IV  medications (such as remdesivir, Regeneron, and others) may be considered, and more  intensive ventilation regimens are possible in ICU settings. 

IV. Vitamins, Supplements, and Oxygen.  

▪ Zinc sulfate, gluconate or citrate. These forms are available in pharmacies, health  food stores, and sold online. Zinc sulfate 220 mg provides 50 mg elemental zinc, the  recommended anti-viral dose. Zinc in the form of zinc picolinate form is not  recommended following reports of liver damage and tumors from studies about 20  years ago. Following these reports, the German Commission E that regulates  supplements used in medical practice in Germany banned this form of zinc. 

An educational resource from The Association of American Physicians and Surgeons (AAPSonline.org) 17 

▪ Vitamin D3, preferable in oil in capsules for better absorption. Recommended doses  for anti-viral benefit vary from 5000 IU or more for 5-30 days 

▪ Vitamin C with bioflavonoids for antioxidant, anti-inflammatory effects. Dose  

recommendations from our contributors vary from 1000 mg (1 gram) once or twice  a day up to 4 or more times a day. 

▪ A word about quercetin. Some physicians are recommending this supplement to  reduce viral illnesses because quercetin acts as a zinc ionophore to improve zinc  

uptake into cells. It is much less potent than HCQ as a zinc transporter, and it does  

not reach high concentrations in lung cells that HCQ does. Quercetin may help  

reduce risk of viral illness if you are basically healthy. But it is not potent enough to  replace HCQ for treatment of COVID once you have symptoms, and it does not  

adequately get into lung tissue unless you take massive doses (3-5 grams a day),  

which cause significant GI side effects such as diarrhea.

Control of Contagion

A major goal of self-quarantine is the control of contagion. Many sources of information suggest the main place of viral transmission occurs in the home. Facial covering for all contacts within the home as well as frequent use of hand sanitizer and hand washing is mandatory. Sterilizing surfaces such as countertops, door handles, phones, and other devices is advised. When possible, other close contacts can move out of the domicile and temporarily stay with others not ill with SARS-CoV-2. Findings from multiple studies indicate that policies concerning control of the spread of SARS-CoV-2 are effective and extension into the home as the most frequent site of viral transfer is paramount.

Reduction of Self-Reinoculation

It is well-recognized that COVID-19 exists outside the human body in a bioaerosol of airborne particles and droplets. Because exhaled air in an infected person is considered to be “loaded” with inoculum, each exhalation and inhalation is effectively reinoculation. In patients who are hospitalized, negative pressure is applied to the room air largely to reduce spread outside of the room. We propose that fresh air could reduce reinoculation and potentially reduce the severity of illness and possibly reduce household spread during quarantine. This calls for open windows, fans for aeration, or spending long periods of time outdoors away from others with no face covering to disperse and not reinhale the viral bioaerosol.

Combination Antiviral Therapy

Rapid and amplified viral replication is the hallmark of most acute viral infections. By reducing the rate, quantity, or duration of viral replication, the degree of direct viral injury to the respiratory epithelium, vasculature, and organs may be lessened. Additionally, secondary processes that depend on viral stimulation, including the activation of inflammatory cells, cytokines, and coagulation, could potentially be lessened if viral replication is attenuated. Because no form of readily available medication has been designed specifically to inhibit SARS-CoV-2 replication, 2 or more of the nonspecific agents listed here can be entertained. None of the approaches listed have specific regulatory approved advertising labels for their manufacturers; thus all would be appropriately considered acceptable “off-label” use.

Zinc Lozenges and Zinc Sulfate

Zinc is a known inhibitor of coronavirus replication. Clinical trials of zinc lozenges in the common cold have demonstrated modest reductions in the duration and or severity of symptoms. By extension, this readily available nontoxic therapy could be deployed at the first signs of COVID-19. Zinc lozenges can be administered 5 times a day for up to 5 days and extended if needed if symptoms persist. The amount of elemental zinc lozenges is <25% of that in a single 220-mg zinc sulfate daily tablet. This dose of zinc sulfate has been effectively used in combination with antimalarials in early treatment of high-risk outpatients with COVID-19.

Antimalarials

Hydroxychloroquine (HCQ) is an antimalarial/anti-inflammatory drug that impairs endosomal transfer of virions within human cells. HCQ is also a zinc ionophore that conveys zinc intracellularly to block the SARS-CoV-2 RNA-dependent RNA polymerase, which is the core enzyme of the virus replication. The currently completed retrospective studies and randomized trials have generally shown these findings: 1) when started late in the hospital course and for short durations of time, antimalarials appear to be ineffective, 2) when started earlier in the hospital course, for progressively longer durations and in outpatients, antimalarials may reduce the progression of disease, prevent hospitalization, and are associated with reduced mortality. In a retrospective inpatient study of 2541 patients hospitalized with COVID-19, therapy associated with an adjusted reduction in mortality was HCQ alone (hazard ratio [HR] = 0.34, 95% confidence interval [CI] 0.25-0.46, P <0.001) and HCQ with azithromycin (HR = 0.29, 95% CI 0.22-0.40, P <0.001). HCQ was approved by the US Food and Drug Administration in 1955, has been used by hundreds of millions of people worldwide since then, is sold over the counter in many countries, and has a well-characterized safety profile that should not raise undue alarm. Although asymptomatic QT prolongation is a well-recognized and infrequent (<1%) complication of HCQ, it is possible that in the setting of acute illness symptomatic arrhythmias could develop. Data safety and monitoring boards have not declared safety concerns in any clinical trial published to date. Rare patients with a personal or family history of prolonged QT syndrome and those on additional QT prolonging, contraindicated drugs (eg, dofetilide, sotalol) should be treated with caution and a plan to monitor the QTc in the ambulatory setting. A typical HCQ regimen is 200 mg bid for 5 days and extended to 30 days for continued symptoms. A minimal sufficient dose of HCQ should be used, because in excessive doses the drug can interfere with early immune response to the virus.

Azithromycin

Azithromycin is a commonly used macrolide antibiotic that has antiviral properties mainly attributed to reduced endosomal transfer of virions as well as established anti-inflammatory effects. It has been commonly used in COVID-19 studies initially based on French reports demonstrating markedly reduced durations of viral shedding, fewer hospitalizations, and reduced mortality combination with HCQ as compared to those untreated. In the large inpatient study (n = 2451) discussed previously, those who received azithromycin alone had an adjusted HR for mortality of 1.05, 95% CI 0.68-1.62, and P = 0.83.23 The combination of HCQ and azithromycin has been used as standard of care in other contexts as a standard of care in more than 300,000 older adults with multiple comorbidities. This agent is well-tolerated and like HCQ can prolong the QTc in <1% of patients. The same safety precautions for HCQ listed previously could be extended to azithromycin with or without HCQ. Azithromycin provides additional coverage of bacterial upper respiratory pathogens that could potentially play a role in concurrent or secondary infection. Thus, this agent can serve as a safety net for patients with COVID-19 against clinical failure of the bacterial component of community-acquired pneumonia. The same safety precautions for HCQ could be extended to azithromycin with or without HCQ. Because both HCQ and azithromycin have small but potentially additive risks of QTc prolongation, patients with known or suspected arrhythmias or taking contraindicated medications or should have more thorough workup (eg, review of baseline electrocardiogram, imaging studies, etc.) before receiving these 2 together. One of many dosing schemes is 250 mg po bid for 5 days and may extend to 30 days for persistent symptoms or evidence of bacterial superinfection.

Doxycycline

Doxycycline is another common antibiotic with multiple intracellular effects that may reduce viral replication, cellular damage, and expression of inflammatory factors. This drug has no effect on cardiac conduction and has the main caveat of gastrointestinal upset and esophagitis. As with azithromycin, doxycycline has the advantage of offering antibacterial coverage for superimposed bacterial infection in the upper respiratory tract. Doxycycline has a high degree of activity against many common respiratory pathogens including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, anaerobes such as Bacteroides and anaerobic/microaerophilic streptococci and atypical agents like Legionella, Mycoplasma pneumoniae, and Chlamydia pneumoniae. One of many dosing schemes is 200 mg po followed by 100 mg po bid for 5 days and may extend to 30 days for persistent symptoms or evidence of bacterial superinfection. Doxycycline may be useful with HCQ for patients in whom the HCQ-azithromycin combination is not desired.

Favipiravir

Favipiravir, an oral selective inhibitor of RNA-dependent RNA polymerase, is approved for ambulatory use in COVID-19 in Russia, India, and other countries outside of the United States.35 It has been previously used for treatment of some life-threatening infections such as Ebola virus, Lassa virus, and rabies. Its therapeutic efficacy has been proven in these diseases. Like, the antimalarials and antibiotics, favipiravir has no large-scale randomized trials completed at this time, given the short time frame of the pandemic. A dose administration could be 1600 mg po bid on day 1, following by 600 mg po bid for 14 days.

Immunomodulators

The manifestations of COVID-19 that prompt hospitalization and that may well lead to multiorgan system failure are attributed to a cytokine storm. The characteristic profile of a patient acutely ill with COVID-19 includes leukocytosis with a relative neutropenia. These patients have higher serum level of cytokines (ie, TNF-α, IFN-γ, IL-1β, IL-2, IL-4, IL-6, and IL-10) and C-reactive protein than control individuals. Among patients with COVID-19, serum IL-6 and IL-10 levels appear even more elevated in the critically ill. As with any acute inflammatory state, early treatment with immunomodulators is expected to impart greater benefit. In COVID-19, some of the first respiratory findings are nasal congestion, cough, and wheezing. These features are due to excess inflammation and cytokine activation. Early use of corticosteroids is a rational intervention for patients with COVID-19 with these features as they would be in acute asthma or reactive airways disease. The RECOVERY trial randomized 6425 hospitalized patients with COVID-19 in a 2:1 ratio to dexamethasone 6 mg po/IV daily for up to 10 days and found dexamethasone reduced mortality (HR = 0.65, 95% CI 0.51-0.82, P <0.001). One potential dosing scheme for outpatients starting on day 5 or the onset of respiratory symptoms is prednisone 1 mg/kg given daily for 5 days with or without a subsequent taper.

Colchicine

Colchicine is a nonsteroidal antimitotic drug that blocks metaphase by binding to the ends of microtubules to prevent the elongation of the microtubule polymer. This agent has proven useful in gout and idiopathic recurrent pericarditis. The GRECCO-19 randomized open-label trial in 105 hospitalized patients with COVID-19 found that colchicine was associated with a reduction in D-dimer levels and improved clinical outcomes. The clinical primary end point (2-point change in World Health Organization ordinal scale) occurred in 14.0% in the control group (7 of 50 patients) and 1.8% in the colchicine group (1 of 55 patients) (odds ratio, 0.11; 95% CI, 0.01-0.96; P = 0.02). Because the short-term safety profile is well understood, it is reasonable to consider this agent along with corticosteroids in an attempt to reduce the effects of cytokine storm. A dosing scheme of 1.2 mg po, followed by 0.6 mg po bid for 3 weeks can be considered.

Antiplatelet Agents and Antithrombotics

Multiple studies have described increased rates of pathological macro- and micro-thrombosis. Patients with COVID-19 have described chest heaviness associated with desaturation that suggests the possibility of pulmonary thrombosis. Multiple reports have described elevated D-dimer levels in acutely ill patients with COVID-19, which has been consistently associated with increased risk of deep venous thrombosis and pulmonary embolism. Necropsy studies have described pulmonary microthrombosis in COVID-19. These observations support the notion that endothelial injury and thrombosis play a role oxygen desaturation, a cardinal reason for hospitalization and supportive care. Based on this pathophysiologic rationale, aspirin 81 mg daily can be administered as an initial antiplatelet and anti-inflammatory agent. Ambulatory patients can be additionally treated with subcutaneous low-molecular-weight heparin or with short-acting novel anticoagulant drugs in dosing schemes similar to those use in outpatient thromboprophylaxis. In a retrospective study of 2773 inpatients with COVID-19, 28% received anticoagulant therapy within 2 days of admission, and despite being used in more severe cases, anticoagulant administration was associated with a reduction in mortality (HR = 0.86 per day of therapy, 95% CI: 0.82-0.89; P <0.001). Additional supportive data on the use anticoagulants reducing mortality has been reported in hospitalized patients with elevated D-dimer levels and higher comorbidity scores.53 Many acutely ill outpatients also have general indications for venous thromboembolism prophylaxis applicable to COVID-19.

Delivery of Oxygen and Monitoring

Because ambulatory centers and clinics have been reticent to have face-to-face visits with patients with COVID-19, telemedicine is a reasonable platform for monitoring. Clinical impressions can be gained with audio and video interviews by the physician with the patient. Supplemental information, including vital signs and symptoms, will be important to guide the physician. A significant component of safe outpatient management is maintenance of arterial oxygen saturation on room air or prescribed home oxygen under direct supervision by daily telemedicine with escalation to hospitalization for assisted ventilation if needed. Self-proning could be entertained for confident patients with good at-home monitoring.

Many of the measures discussed in this article could be extended to seniors in COVID-19 treatment units in nursing homes and other nonhospital settings. This would leave the purposes of hospitalization to the administration of intravenous fluid and parenteral medication, assisted pressure or mechanical ventilation, and advanced mechanical circulatory support.”

This is the group’s statement on vaccines:

“Vaccines in Development: 

Several vaccine models are being investigated for SARS-CoV-2 (COVID-19) including DNA and RNA  vaccines. These vaccines take genetic information from other sources that is introduced into the cells. This  information includes instructions to produce a SARS2-like viral antigen itself, and the immune system then  reacts to it to develop immunity to the virus.  

The most important consideration before approving a vaccine for human use is to make sure that the  vaccine is safe and effective. Developing safe and controlled infection models for humans normally takes many  years of phased testing in the lab and then in humans. Many physicians and scientists have been concerned  that vaccine manufacturers, with government support, are speeding up this process in ways that are not  allowing adequate time for the usual phased testing leading up to human clinical trials. Two vaccine  manufacturers already have voluntarily paused their clinical trials in people due to serious adverse events. 

Currently, there are no RNA-based vaccines approved for human use so it would seem prudent to take  the time needed to ensure safety. Vaccines for RNA viruses are notoriously challenging and difficult to  develop. We still, after all these years since AIDS emerged in the 1980s, do not have a vaccine for the AIDS  virus, or the SARS-1 coronavirus that emerged in 2002-2003, and both are RNA viruses.  

Several attempts have been made to create vaccines for coronavirus and other respiratory viruses but  none of the vaccines have survived the testing phases. The vaccine trials for SARS-1 from 2003, for example,  was shut down because it produced autoimmune hypersensitivity reactions when exposed to the natural virus  after immunization in animal studies.  

Another problem is that the SARS-2 virus has already shown many mutations. Viruses adapt to the  environment to survive. Like the flu virus, it is difficult to predict what mutations will occur and circulate  around the world each season. A new vaccine must be reformulated to adjust to the changing genetic makeup  of the SARS-2 virus.  

Even the best vaccines for flu are only about 30-60% effective. Compare that with an effectiveness for  improvement ranging from 64% to more than 90% in more than 100 new studies showing early, outpatient  treatment with our existing medications described in chapters.  

As research on the vaccine continues, safety and effectiveness are of primary concern. The good news  is there are very safe and effective early treatments already available as we described in Chapter 3. Clearly,  early, home-based treatment has now been so successful and offers so much hope, there is less urgency to  have a vaccine.”

You can sign up to receive the full protocol here: https://aapsonline.org/covidpatientguide/  or find the research paper here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410805/

[uk-news-talking-politics]

Assisted suicide ‘is the abandonment of care’

By Scott Benton MP 

Recent calls for a parliamentary review of assisted suicide prematurely presume that the winds of political and social change are blowing in favour of legalisation. Through heavy focus on hard cases and hardly any coverage of the life-giving merits of palliative care, some proponents of change in Parliament have grandly overstated the problems with the status quo and grossly overestimated the successes of assisted suicide legislation elsewhere. As the most recent government response to a parliamentary urgent question on foreign travel for assisted suicide demonstrates, their demands are far from measured in their misleading comparisons and claims. And as the most recent government reply to a written question on a future review of the law around assisted suicide suggests, those advocating for assisted suicide have far from full support in Westminster and Whitehall. Addressing the secretary of state for health and social care Matt Hancock, Andrew Mitchell suggested that the ‘suffering that the blanket ban on assisted dying is causing dying people and their families […] [and] the challenges that the current law is creating for healthcare professionals, police officers and other public servants...’ would be alleviated by a ‘very tight reform’, effectively resembling the system of assisted suicide available in the American state of Oregon, with the addition of ‘suicide courts’ to pass judgement on who should live or die. Assisted suicide advocates place the Pacific Northwestern state on a pedestal, claiming it has robust regulation and successful safeguards that prove assisted suicide laws work. Yet they conveniently ignore the ways in which the Oregon Death with Dignity Act has been bent and broken since 1997. The rate has skyrocketed by over 1000% from 1998 to 2019, and while almost half of all patients in that period have cited concern about being or becoming a burden on family, friends, and caregivers among their end-of-life worries, only around a quarter were concerned by inadequate pain control. As in the handful of other jurisdictions that have legalised assisted suicide, less than six per cent of countries worldwide, access continues to expand. In Oregon, it is now possible to have your life ended on the basis of ‘terminal’ conditions such as arthritis, diabetes, and complications following a fall. Any proposal that the UK can engineer an Oregon-plus system of assisted suicide with even tighter safeguards ignores that only four per cent of Oregon patients since 1998 have been referred for psychiatric evaluation and almost the same number have suffered complications. Furthermore, complications are only reported when the physician or alternate health care provider is present at the time of death, which has not been the case for 60.5% of deaths since 1998. Most strikingly, the Oregon Health Authority is concerned by the growing number of suicides across all age groups yet unconcerned by the vast increase in assisted suicides over the past two decades. Indeed, a study of suicide rates across the American states that have legalised assisted suicide illustrates that legalisation is associated with an increase in the total suicide rate. While advocacy for assisted suicide claims strong public support, as Christine Jardine suggested during the latest debate, the polling of public support for assisted suicide is hindered by simplistic questions. When more precise issues are presented to the public, the results are more complicated. This was certainly the case in a February 2019 survey when 51% responded that they would be concerned that the legalisation of assisted suicide might cause some people to feel pressurised into accepting lethal medication to avoid burdening others. Other arguments for legalising assisted suicide centre on the present danger of prosecution. Though these claims summon strong emotions around perceived injustice, they misrepresent the reality. Only three cases of possible assistance or encouragement of suicide in England and Wales have resulted in prosecutions since 2009. Prosecution is rare, and serves as an essential safeguard against abuse and exploitation of some of the most vulnerable in our society. The merits of palliative care seldom feature in petitions for assisted suicide legislation. As Danny Kruger highlighted in his contribution during the recent debate, modern medicine can effectively alleviate distressing symptoms associated with the dying process. Rather than sidelining such services as a separate issue, proponents of assisted suicide should instead demand universal access to high-quality palliative care. Notably, 90% of palliative care specialists opposed legalising assisted suicide in the form of the 2015 Marris assisted suicide bill. A recent British Medical Association members’ survey found that 76% of palliative care specialists - those who have the most expertise and experience in caring for the terminally ill at the end of life - oppose any legalisation of assisted suicide, and the same percentage declared that they would be unwilling to participate in any such activity. The terminally ill deserve the best palliative care available. Vulnerable patients who experience suicidal ideation should receive high-quality physical and psychological care that reaffirms their inherent dignity, rather than medical confirmation, here or abroad, of their diminished view of their own life. Matt Hancock himself stated that ‘[t]he global devastation of the coronavirus pandemic has brought to the fore the importance of high-quality palliative care’. Indeed, as the Department of Health and Social Care continues to battle the Covid-19 crisis, it is my hope that investment in hospice care remains high on the agenda. Certainly, the government must respond to the recent survey from Hospice UK which shows an overwhelming 93% of hospice leaders were concerned that their patients with end of life and palliative care needs could miss essential treatment because of stretched resources.

As Fiona Bruce powerfully argued in the Chamber, ‘when the whole country is making huge sacrifices to protect life, at a time of exceptionally high levels of physical and mental stress, and when many people may feel very vulnerable [...] it would be completely inappropriate—indeed, insensitive—of this Parliament to go anywhere near considering making access to any form of suicide easier’. Far too many of our citizens have experienced unprecedented loneliness, uncertainty, and change during this often paralysing pandemic, and introducing assisted suicide would be far too rash a response. Thankfully, the government has resisted the latest round of pressure from assisted suicide advocates. They are not alone in standing firm against an unnecessary and unsafe proposal: Perhaps tellingly, not a single doctors group or major disability rights organisation in the UK supports changing the law, including the British Medical Association, the Royal College of General Practitioners, the Royal College of Physicians, the British Geriatric Society, the Association for Palliative Medicine, Disability Rights UK, SCOPE, United Kingdom’s Disabled People’s Council, and others. Laws send social messages. An assisted dying law, however well intended, would alter society’s attitude towards the elderly, seriously ill, and disabled, suggesting that assisted dying is an option they ‘ought’ to consider.

[bagbear8]

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[maximelebled]

My quick review of the ASUS XG27UQ monitor (4K, HDR, 120Hz)

I originally wanted to tweet this series of bullet points out but it was getting way too long, so here goes! I got this to replace a PG278Q, which was starting to develop odd white stains, and never had good color reproduction in the first place (TN film drawbacks, very low gamma resulting in excessively bright shadows, under-saturated shadows, etc.)

The hardware aesthetic is alright! The bezels may feel a bit large to some people, but I don’t mind them at all. If you’re a fan of the no-bezel look, you’ll probably hate it. There is a glowing logo on the back that you can customize (Static Cyan is my recommendation), but it isn’t bright enough to be used as bias lighting, which would’ve been nice.

The built-in stand is decent; it comes with a tacky and distracting light projection feature at the bottom. It felt quite stable, though I don’t care about it because it got instantly replaced by an Ergotron LX arm. (I have two now, I really recommend them in spite of their price.) 

The coating is a little grainy and this is noticeable on pure colors! You can kinda see the texture come through, a bit more than I’d like. Not a huge deal though.

The rest of the review will be under the cut.

The default color preset (”racing mode”), which the monitor is calibrated against, is very vivid and saturated. It looks great! But it’s inherently inaccurate, which bothers me, so I don’t like it. It looks like as if sRGB got stretched into the expanded gamut of the monitor.

sRGB “emulation” looks very similar to my Dell U2717D, whose sRGB mode is factory-calibrated. However, the XG27UQ’s sRGB mode has lower gamma (brighter shadows), so while the colors are accurate, the gamma is not. It feels 1.8-ish. Unless you were in a bright room, it would be inappropriate for work that needs to have accurate shadows. This mode also locks other controls, so it’s not the most useful, but the brightness is set well on it, so it is usable!

The “User Mode” settings use the calibrated racing mode as a starting point, which is a big relief. So it’s possible to tweak the color temperature and the saturation from there! I checked pure white against my Dell monitor and my smartphone (S9+) and tried to reach a reasonable 3-way compromise between them, knowing that the Dell is most likely the most accurate, and that Samsung also allegedly calibrates their high-end smartphones well. My configuration ended up being R:90/G:95/B:100 + SAT:42. This matches the saturation of the U2717D sRGB mode fairly closely. You also get to choose between 1.8, 2.2, and 2.5 gamma too, which is not too granular, but great to have. It kinda feels like my ideal match is between 2.2 and 2.5, but 2.2 is fine.

The color gamma according to lagom.nl looked fine, but I had to open the picture in Paint, otherwise it was DPI-scaled in the browser, and that messed with the way it works!! (That website is an amazing resource for quick monitor checks.)

Colors are however somewhat inaccurate in this mode. It’s easy to see by comparing the tweaked User Mode vs. sRGB emulation. There are some rather sizeable hue shifts in certain cases. I believe part of this is caused by the saturation tweak not operating properly.

Here’s a photo of what the Photoshop color picker looks like when Saturation is set to 0 on the monitor, vs. what a proper grayscale conversion should be. It’s definitely not using the right coefficients. 

So in practice, when using the Racing & User modes, compared to the U2717D sRGB, here’s a few examples of what I see:

Reds are colder (towards the purple side) & oversaturated

Bright yellow (255,215,90) is undersaturated

Bright green (120,200,130) is undersaturated

Dark green (0,105,60) is fine

Magenta (220,13,128) is oversaturated

Dark reds & brown (150,20,20 to 90,15,10) is oversaturated

Cyan (0,180,240) is fine 

Pink (230,115,170) is fine

Some shades of bright saturated blue (58,48,220) have the biggest shifts.

The TF2 skin tone becomes slightly desaturated and a bit colder

It’s not inaccurate to the point of being distracting, and you always have the  sRGB mode (with flawed gamma?) to check things with, but it’s definitely not ideal, and some of these shifts go far enough that I wouldn’t recommend this monitor for color work that needs to be very accurate.

I’ve went back and forth, User vs sRGB, several times, on my most recent work (True Sight 2019 sequences). I’ve found the differences were acceptable for the most part; they bothered me the most during the Chronosphere sequence, in which the hazy sunset atmosphere turned a bit into to a rose gold tint, which wasn’t unpleasant at all — and looked quite pretty! — but it wasn’t what I did.

I’m coming from the point of view of a “prosumer” who cares about color accuracy, but who ultimately recognizes that this quest is impossible in the face of so many devices out there being inaccurate or misconfigured one way or the other. In the end, my position is more pragmatic, and I feel that you gotta be able to see how your stuff’s gonna look on the devices where it’ll actually be watched. So while I’ve done color grading on a decent-enough sRGB-calibrated monitor, I’ve always checked it against the inaccurate PG278Q, and I’ve done a little bit of compromising to keep my color work looking alright even once gamma shifted. And so, now, I’ll also be getting to see what my colors look like on a monitor that doesn’t quite restrain itself to sRGB gamut properly.

Well, at least, all of that stuff is out of the box, but...

TFTCentral (one of the most trustworthy monitor review websites, in my opinion) has found suspiciously similar shifts. But after calbration, their unit passed with flying colors (pun intended), so if you really care about this sort of stuff and happen to have a colorimeter... you should give it a try!

I hope one day we’ll be able to load and apply an ICC/ICM profile computer-wide, instead of only being able to load a simple gamma curve on the GPU with third-party tools like DisplayCAL. Even if it had to squeeze the gamut a bit...

Also, there are dynamic dimming / auto contrast ratio features which could potentially be useful in limited scenarios if you don’t care about color accuracy and want to maximize brightness. I believe they are forced on for HDR. But you will probably not care at all.

IPS glow is not very present on my unit; less than on my U2717D. However, when it starts to show up (more than a 30°-ish angle away), it shows up more. UPDATED: after some more time with the monitor, I wanna say that, in fact, IPS glow isit's slightly stronger, and shows up sooner (as in, from broader angles). It requires me to sit a greater distance from the monitor in order to not have it show up and impede dark scenes. It is worse than on my U2717D.

Backlight bleed, on the other hand, is there, and a little bit noticeable. On my unit, there’s a little bit of blue-ish bleed on the lower left corner, and some dark-grey-orange bleed for a good third of the upper-left. However, in practice, and to my eyes, it doesn’t bother me, even when I look for it. It ain’t perfect, but I’ve definitely seen worse, especially from ASUS. The photo above was taken at 100% brightness, and I’ve tried to make it just a tad brighter than what my eyes see, so hopefully it’s a decent sample.

Dead pixels: on my unit, I have 5 stuck dead green subpixels overall. There are 4 in a diamond pattern somewhat down and right to the center of the screen, and another one, a bit to the right of that spot. All of them kinda “shimmer” a little bit, in the sense that they become stronger or weaker based on my angle of view. They’re a bummer but I haven’t found them to be a hindrance. Took me a few days to even notice them for the first time, after all.

HDR is just about meaningless and uses some global dimming techniques, as well as stuff that feels like... you know that Intel HD driver feature that brightens the content on the screen, while lowering the panel backlight power in tandem, to save power, but it kinda flattens (and sometimes clips) highlights? It kinda looks like that sometimes. Without local dimming, HDR is just about meaningless.

Unfortunately, the really nice HDR support in computer monitors is still looking like it’s going to be at the very least a year out, and even longer for sub-1000 price ranges. (I was holding out for the PG27UQX at first, but it still has no word on availability, a whole year after being announced, and will probably cost over two grand, so no thanks.)

G-Sync (variable refresh rate) support is... not there yet?! The latest driver does not recognize the monitor as being compatible with the feature. And it turns out that the product page says that G-Sync support is currently being applied for. Huh. I thought they had special chips in those monitors solely for the feature, but it’s possible this one does it another way? (The same way that Freesync monitors do it?)

DSC (Display Stream Compression) enables 4K 120Hz to work through a single DisplayPort cable, without chroma subsampling. And it’s working for me, which came as a surprise, as I was under the impression this feature required a 2000-series Turing GPUs. (I have a 1080 Ti.) I was wrong about this, it’s 144 Hz that requires DSC. And I don’t have it on this Pascal card. But I don’t really care since I prefer to run this monitor at 120 Hz, as it’s a multiple of the 60 Hz monitor next to it.

Windows DPI scaling support is okay now. Apps that are DPI-aware, and the vast majority of them are now, scale back and forth between 150% and 100% really well as they get dragged between the monitors! The only program I’ve had issues with is good old Winamp, which acted as if it was 100% on the XG27UQ... and shrinked down on another monitor. So I asked it to override DPI scaling behaviour (”scaling performed by: application”), which keeps the player skin at 100% on every monitor, but any call to system fonts and UI (Bento skin’s playlist + Settings panel) are still at 150%. So I had to set the playlist font size to 7 for it to look OK on the non-scaled monitor!

A few apps misbehave in interesting ways; TeamSpeak, for example, seen above, scales everything back from 150% to 100%, and there is no blurriness, but the “larger layout” (spacing, etc.) sticks.

Games look great with 4K in 27 inches. Well, I’ve only really tried Dota 2 so far, but man does it get sharp, especially with the game’s FXAA disabled. It was already a toss-up at 1440p, but at 4K I would argue you might as well keep it disabled. However, going from 2560x1440 to 3840x2160 requires some serious horsepower. It may look like a +50% upgrade in pixels, but it’s actually a +125% increase! (3.68 to 8.29 million pixels.) For a 1080 Ti, maxed-out Dota 2 at 1440p 120hz is really trivial, but once you go to 4K, not anymore...  you could always lower resolution scale though! (Not an elegant solution if you like to use sharpening filters though, looking at you RDR2.)

Overall, the XG27UQ is a good monitor, and I’m satisfied with my purchase, although slightly disappointed by the strong IPS glow and the few dead subpixels. 7/10

[onlinemarketinghelp]

Finding Recession-Resistant Investments In The Face Of The Coronavirus https://ift.tt/2w14Ney

The coronavirus has presented investors with unprecedented uncertainty.

The global financial markets are still reeling from what WHO has called a pandemic, and the White House has declared a national emergency. Last month, the Dow Jones dropped 10 percent in one day, its largest one-day fall since 1987. The Federal Reserve Bank has even stepped in, injecting $1.5 trillion into the economy. In one month alone, the stock market lost well over 20%.

In light of these events, we thought it was interesting to see impact of the coronavirus on the fine wine market with a great deep-dive with our partners Vinovest. With more people looking for alternative investments, especially recession-resistant investments, let's look into this relatively unknown asset.

If you want to skip the details and learn more, check out Vinovest and see how you can invest in fine wine >>

Quick Navigation

How Does The Coronavirus Affect Fine Wine?

What Makes Fine Wine A Recession-Resistant Investment?

The Economics Of Fine Wine

Fine Wine vs. Gold In Recessions

Long-Term Appreciation In The Face Of Panic

Historical Performance Of Fine Wine

What To Expect From Here

How Does The Coronavirus Affect Fine Wine?

It is natural to wonder how the coronavirus will affect the value of fine wine. After all, equities are cratering under recent financial pressure. With that in mind, it's important to know that fine wine has almost no correlation with the stock market. Even in the most turbulent economic periods, fine wine manages to march on unscathed. Take the Great Recession in 2008. Stock prices plummeted 52 percent as people created a run on the money market funds. The price of fine wine, though? It had a single digit dip of nine percent.

What Makes Fine Wine A Recession-Resistant Investment?

Fine wine is not susceptible to the same market forces as traditional investments, like stocks, bonds, and mutual funds. While supply and demand impact both assets, the similarities disappear quickly after that. The separate sphere of influence is the key to the recession-resistance.

Factors That Influence The Price Of Wine:

Annual Harvest Yield

Consumer Tastes

Reputation

Tariffs

Vintage

Weather

Factors That Influence The Price Of Equities:

Company Earnings

Corporate Management

Dividends

Interest Rates

Political Climate

Barring a cataclysmic natural disaster or shift in consumer tastes, fine wine will remain a reliable investment. Outside factors, like the coronavirus or stock prices, are highly unlikely to influence whether or not someone wants to buy and consume wine. In an interview with Forbes, Silicon Valley Bank Wine Division founder Rob McMillian articulated the sentiment best, saying:

“We have to start the conversation by recognizing that people enjoy wine in good times and stressful times. Wine is not recession-proof, but it is recession-resistant. In the same way, it might not be virus-proof, but it will prove virus-resistant from an economic perspective. There is no chance we will see sweeping abstinence as a consequence of the virus.

Since the Great Recession, there have been several corrections in the stock market, the most recent being the coronavirus. While stock prices fluctuate during these times, the fine wine market tends to stay the same. Fine wine may experience a small decline. That said, there are precedents for price increases. We understand the coronavirus is creating a lot of concern. The cause for concern shouldn��t extend into investment-grade wine, though. It’s why fine wine is one of the few recession-resistant assets that can safeguard investors from the economic storm.

The Economics Of Fine Wine

Again, fine wine does not play by the same rules as traditional equities. For starters, wine has a fixed supply. Once the harvest is over, that is it. A winery cannot produce more wine for that vintage, even if it's a smashing success. 

That supply will only decrease with time because investors will drink the wine. Even if the demand remains constant, the scarcity will drive up the price, barring a significant change in one of the factors mentioned above. The growth is buoyed by increasing interest in fine wine consumption from emerging markets, like India and China. 

As Rob McMillian suggested, the coronavirus will not diminish people’s interest in wine. While the outbreak is far from ideal, people should not expect to see a meaningful change in consumption habits. The same cannot be said of the stock market. 

The coronavirus has created a domino effect through fear, panic, and uncertainty, all things that investors want to avoid. As a result, many people are selling their stocks to minimize their losses or get their money into "safer" investments. As a result, American investors have lost roughly $3 trillion in wealth. 

Fine Wine vs. Gold In Recessions

It's worth taking a moment to talk about gold. The odds are that when investors think of "safer" physical assets, they think of gold. That inclination is not without merit. Gold handily outperformed the S&P 500 from December 2007 to June 2009.

Historically, gold has had an inverse relation with the equity market during times of crisis. That correlation, though, is not stagnant. Gold’s recent performance suggests a positive correlation with the stocks, thus weakening its reputation as a risk-hedging investment. 

The coronavirus-induced recession is a perfect example. The United States saw the first COVID-19 death on February 29. In the following days, Florida and California declared states of emergency, public and privates closed, and major corporations-imposed travel restrictions on employees. Gold, which had traded at $1,697 per ounce on March 2, fell 11 percent in a week.

There are other examples of gold’s increasing correlation with the stock market. During the 2018 US-China trade war, gold showed a 0.69 correlation, which means almost 50 percent of the variance between two is correlated. Mathematicians would call this value statistically significant. Fine wine, however, had a negative correlation, coming in at -0.55.

Gold is losing its luster as a portfolio diversifier. Its increasing correlation with the equity market fails to protect investors, despite its “safe haven” reputation. Additionally, the price of gold has more than quadrupled since 2000, far outpacing the reasonable demand for the physical product. 

Long-Term Appreciation In The Face Of Panic

It is unclear how long the coronavirus will last. China is returning to its new normal after roughly 50 days. All countries, though, are not as well-equipped or proactive when it comes to treating COVID-19.

While the immediate financial world is in upheaval, fine wine is a long-term investment. It is not something people day trade, like stocks, to make marginal capital gains. Investors do not have the pressure of time when selling wine. 

That is, in part, because wine gets better with age. All grapes have a compound called tannins. The organic substance is in the seeds, skin, roots, and leaves of the grape. While the quantity of tannins varies based on the grape varietal, they are present in every wine, to some extent. 

Tannins have a bitter and astringent taste. Over time, though, they break down, which makes a wine smoother and more balanced. It is one of the reasons why wine producers put so much emphasis on proper and extended aging. To reap the benefits of aging, investors will likely need enough patience to outlast the 2020 flu season.

Historical Performance Of Fine Wine

Predictions are challenging, and the coronavirus only adds more uncertainty to the equation. The best way to understand what the future holds is to look at the past. From 2008 to 2010, in the throes of the global recession, the Liv-ex 1000, which tracks 1,000 wines from across the world, returned a little less than zero. 

The same recession-resistant applied abroad. The March Gestion Vini Catana fund, which started in December 2009, invests in wine production and vineyards. Within a year after opening, it was up nine percent compared to a 3.7 percent decline for the FTSE 100.  Meanwhile, the average hedge fund at this time was down 0.2 percent. 

The question here is, why? During economic struggles, investor’s preferences do not change in a meaningful way when it comes to fine wine. It is one of the reasons why annual wine consumption has grown for the past 20 years. By the same token, people who purchase investment-grade wine can often afford to hold on to their collections during recessions, mitigating the risk of fire sales.

Wine Business Monthly published a study about which wineries performed the best during the recession in 2008. One of its conclusions was that large wineries had the resources to deal with the downturn. They have well-established consumer bases and can leverage economies of scale. 

The second conclusion was that wineries that owned the means of production thrived. Translation: wineries like Château Lafite Rothschild, Screaming Eagle, and many more are in good shape. These estates control their land, grapes, and production, all the way through to distribution. Therefore, they do not have the same concerns as boutique producers that rely on purchasing grapes.

Unsurprisingly, sub-indices, like the Bordeaux 500 and Burgundy 150, performed well during the Great Recession. The former saw a 50 percent increase in value from 2009 to 2011. As for the Burgundy 150, its growth was closer to 60 percent. 

The best case for fine wine’s recession-resistant is its history. While it is not impervious, it has stood up against the Great Depression, Dot Com bubble, and more. Researchers found the long-term investment performance of young-maturing wines from high-quality vintages provided the strongest financial return. Not only did it demonstrate remarkable recession-resistance, but it has also outpaced competitors, like fine stamps, arts, and bills, during the same time.

What To Expect From Here

As Managing Director of Cult Wines Ltd. Tom Gearing put it, “fine wine can act as a defensive asset class in times of economic crisis but also benefit from periods of economic growth.” It is why many people use fine wine as a way to round out their long-term investment strategy. The investment reduces overall risk while adding diversification and stability.  

While clouds are darkening over Wall St, fine wine is a silver lining. The short-term volatility resistant and long-term appreciation will counteract the chaotic snapshot of the world today. 

If you have any additional questions about wine investment, check out Vinovest today. 

The post Finding Recession-Resistant Investments In The Face Of The Coronavirus appeared first on The College Investor.

from The College Investor

The coronavirus has presented investors with unprecedented uncertainty.

The global financial markets are still reeling from what WHO has called a pandemic, and the White House has declared a national emergency. Last month, the Dow Jones dropped 10 percent in one day, its largest one-day fall since 1987. The Federal Reserve Bank has even stepped in, injecting $1.5 trillion into the economy. In one month alone, the stock market lost well over 20%.

In light of these events, we thought it was interesting to see impact of the coronavirus on the fine wine market with a great deep-dive with our partners Vinovest. With more people looking for alternative investments, especially recession-resistant investments, let's look into this relatively unknown asset.

If you want to skip the details and learn more, check out Vinovest and see how you can invest in fine wine >>

Quick Navigation

How Does The Coronavirus Affect Fine Wine?

What Makes Fine Wine A Recession-Resistant Investment?

The Economics Of Fine Wine

Fine Wine vs. Gold In Recessions

Long-Term Appreciation In The Face Of Panic

Historical Performance Of Fine Wine

What To Expect From Here

How Does The Coronavirus Affect Fine Wine?

It is natural to wonder how the coronavirus will affect the value of fine wine. After all, equities are cratering under recent financial pressure. With that in mind, it's important to know that fine wine has almost no correlation with the stock market. Even in the most turbulent economic periods, fine wine manages to march on unscathed. Take the Great Recession in 2008. Stock prices plummeted 52 percent as people created a run on the money market funds. The price of fine wine, though? It had a single digit dip of nine percent.

What Makes Fine Wine A Recession-Resistant Investment?

Fine wine is not susceptible to the same market forces as traditional investments, like stocks, bonds, and mutual funds. While supply and demand impact both assets, the similarities disappear quickly after that. The separate sphere of influence is the key to the recession-resistance.

Factors That Influence The Price Of Wine:

Annual Harvest Yield

Consumer Tastes

Reputation

Tariffs

Vintage

Weather

Factors That Influence The Price Of Equities:

Company Earnings

Corporate Management

Dividends

Interest Rates

Political Climate

Barring a cataclysmic natural disaster or shift in consumer tastes, fine wine will remain a reliable investment. Outside factors, like the coronavirus or stock prices, are highly unlikely to influence whether or not someone wants to buy and consume wine. In an interview with Forbes, Silicon Valley Bank Wine Division founder Rob McMillian articulated the sentiment best, saying:

“We have to start the conversation by recognizing that people enjoy wine in good times and stressful times. Wine is not recession-proof, but it is recession-resistant. In the same way, it might not be virus-proof, but it will prove virus-resistant from an economic perspective. There is no chance we will see sweeping abstinence as a consequence of the virus.

Since the Great Recession, there have been several corrections in the stock market, the most recent being the coronavirus. While stock prices fluctuate during these times, the fine wine market tends to stay the same. Fine wine may experience a small decline. That said, there are precedents for price increases. We understand the coronavirus is creating a lot of concern. The cause for concern shouldn’t extend into investment-grade wine, though. It’s why fine wine is one of the few recession-resistant assets that can safeguard investors from the economic storm.

The Economics Of Fine Wine

Again, fine wine does not play by the same rules as traditional equities. For starters, wine has a fixed supply. Once the harvest is over, that is it. A winery cannot produce more wine for that vintage, even if it's a smashing success. 

That supply will only decrease with time because investors will drink the wine. Even if the demand remains constant, the scarcity will drive up the price, barring a significant change in one of the factors mentioned above. The growth is buoyed by increasing interest in fine wine consumption from emerging markets, like India and China. 

As Rob McMillian suggested, the coronavirus will not diminish people’s interest in wine. While the outbreak is far from ideal, people should not expect to see a meaningful change in consumption habits. The same cannot be said of the stock market. 

The coronavirus has created a domino effect through fear, panic, and uncertainty, all things that investors want to avoid. As a result, many people are selling their stocks to minimize their losses or get their money into "safer" investments. As a result, American investors have lost roughly $3 trillion in wealth. 

Fine Wine vs. Gold In Recessions

It's worth taking a moment to talk about gold. The odds are that when investors think of "safer" physical assets, they think of gold. That inclination is not without merit. Gold handily outperformed the S&P 500 from December 2007 to June 2009.

Historically, gold has had an inverse relation with the equity market during times of crisis. That correlation, though, is not stagnant. Gold’s recent performance suggests a positive correlation with the stocks, thus weakening its reputation as a risk-hedging investment. 

The coronavirus-induced recession is a perfect example. The United States saw the first COVID-19 death on February 29. In the following days, Florida and California declared states of emergency, public and privates closed, and major corporations-imposed travel restrictions on employees. Gold, which had traded at $1,697 per ounce on March 2, fell 11 percent in a week.

There are other examples of gold’s increasing correlation with the stock market. During the 2018 US-China trade war, gold showed a 0.69 correlation, which means almost 50 percent of the variance between two is correlated. Mathematicians would call this value statistically significant. Fine wine, however, had a negative correlation, coming in at -0.55.

Gold is losing its luster as a portfolio diversifier. Its increasing correlation with the equity market fails to protect investors, despite its “safe haven” reputation. Additionally, the price of gold has more than quadrupled since 2000, far outpacing the reasonable demand for the physical product. 

Long-Term Appreciation In The Face Of Panic

It is unclear how long the coronavirus will last. China is returning to its new normal after roughly 50 days. All countries, though, are not as well-equipped or proactive when it comes to treating COVID-19.

While the immediate financial world is in upheaval, fine wine is a long-term investment. It is not something people day trade, like stocks, to make marginal capital gains. Investors do not have the pressure of time when selling wine. 

That is, in part, because wine gets better with age. All grapes have a compound called tannins. The organic substance is in the seeds, skin, roots, and leaves of the grape. While the quantity of tannins varies based on the grape varietal, they are present in every wine, to some extent. 

Tannins have a bitter and astringent taste. Over time, though, they break down, which makes a wine smoother and more balanced. It is one of the reasons why wine producers put so much emphasis on proper and extended aging. To reap the benefits of aging, investors will likely need enough patience to outlast the 2020 flu season.

Historical Performance Of Fine Wine

Predictions are challenging, and the coronavirus only adds more uncertainty to the equation. The best way to understand what the future holds is to look at the past. From 2008 to 2010, in the throes of the global recession, the Liv-ex 1000, which tracks 1,000 wines from across the world, returned a little less than zero. 

The same recession-resistant applied abroad. The March Gestion Vini Catana fund, which started in December 2009, invests in wine production and vineyards. Within a year after opening, it was up nine percent compared to a 3.7 percent decline for the FTSE 100.  Meanwhile, the average hedge fund at this time was down 0.2 percent. 

The question here is, why? During economic struggles, investor’s preferences do not change in a meaningful way when it comes to fine wine. It is one of the reasons why annual wine consumption has grown for the past 20 years. By the same token, people who purchase investment-grade wine can often afford to hold on to their collections during recessions, mitigating the risk of fire sales.

Wine Business Monthly published a study about which wineries performed the best during the recession in 2008. One of its conclusions was that large wineries had the resources to deal with the downturn. They have well-established consumer bases and can leverage economies of scale. 

The second conclusion was that wineries that owned the means of production thrived. Translation: wineries like Château Lafite Rothschild, Screaming Eagle, and many more are in good shape. These estates control their land, grapes, and production, all the way through to distribution. Therefore, they do not have the same concerns as boutique producers that rely on purchasing grapes.

Unsurprisingly, sub-indices, like the Bordeaux 500 and Burgundy 150, performed well during the Great Recession. The former saw a 50 percent increase in value from 2009 to 2011. As for the Burgundy 150, its growth was closer to 60 percent. 

The best case for fine wine’s recession-resistant is its history. While it is not impervious, it has stood up against the Great Depression, Dot Com bubble, and more. Researchers found the long-term investment performance of young-maturing wines from high-quality vintages provided the strongest financial return. Not only did it demonstrate remarkable recession-resistance, but it has also outpaced competitors, like fine stamps, arts, and bills, during the same time.

What To Expect From Here

As Managing Director of Cult Wines Ltd. Tom Gearing put it, “fine wine can act as a defensive asset class in times of economic crisis but also benefit from periods of economic growth.” It is why many people use fine wine as a way to round out their long-term investment strategy. The investment reduces overall risk while adding diversification and stability.  

While clouds are darkening over Wall St, fine wine is a silver lining. The short-term volatility resistant and long-term appreciation will counteract the chaotic snapshot of the world today. 

If you have any additional questions about wine investment, check out Vinovest today. 

The post Finding Recession-Resistant Investments In The Face Of The Coronavirus appeared first on The College Investor.

https://ift.tt/39s5Ku4 April 01, 2020 at 10:15AM https://ift.tt/39uZORf

[the-phelan63-blog]

Pick the Best Gaming PC for your Needs

PC game headway is a rapidly creating field. To the degree both mechanical social gathering and programming, affiliations are perseveringly endeavoring to develop the cutoff centers and increment execution. As the erraticism of individual games increases, notwithstanding, it gets key to pick a PC gaming structure that will best oblige your particular needs. Horrifyingly, there is no inadequacy of gaming PCs open accessible. How, by then, do you select the best gaming system? By paying extraordinary character to a couple of offers concerning your gaming and budgetary needs, you can perceive which bearing to go like a genuine gaming structure ESPrecision Acquires battletitans .

What Kinds of Games do you Play?

The specific sorts of games that you will with everything considered play will help pick which hardware plans will best address your issues. All games are not made proportionate, and depending on the class organizers will give an incessantly prominent level of their significance to different bits of the title. Thinking and reenactment games, for example, will with everything considered be less graphically-guaranteed than various sorts of games and right at present be run on a less unfathomable gaming structure. As a point of reference, the choices for Civilization IV, a rich and least need structure game, are as shown by the going with:

- 1.8GHz Intel or AMD processor

- 512MB RAM

- 128MB video card

Stood segregated from a groundbreaking store of the more present day gaming PCs open today, the referencing for running Civilization IV are not high. So also proportionately in like manner with various structure and development games, a dependably clear weight is put on AI and game considers denied to charts, and grungy contraption power ends up being less major to run the title reasonably.

Verifiably, first-single shooters (FPS) and progress titles will everything considered depend all around more vivaciously on outlines and material science to cause the best to feel and condition. In that by and large crazy, the structure necessities for these sorts of games are routinely essentially higher than various sorts. Titles like Half-Life 2 and Quake 4 catch the player with graphically approved scenes, and the material assessment of the game are indeed made charts to make the most sensible conditions possible. As opposed to the terminations recorded over, the proposed structure approach for F.E.A.R., one of the further made FPS titles correspondingly as plans limit, are as appeared by the going with:

- 3.0 Pentium 4 or all around that genuinely matters cloud processor

- 1GB RAM

- 256MB video card

Notwithstanding the way that F.E.A.R. in like manner, Civilization IV released at customarily a proportionate time a year sooner, the grasped structure necessities for the past are about twofold those of the last referenced. This is continually the condition with FPS titles; since producers, as it's been communicated, imagine that these games should be "walk" bits of a particular movement or affiliations engine, an unmitigated unequivocally overpowering gaming PC is usually required to run them in their full graphical mass. The watching rendering takes enough resources, yet when you figure in the necessities for certain driving material science estimations, these get pound up a lot further. As should act normally clear, the sorts of PC games that you play ceaselessly impact the mechanical assembly that you should purchase.

Must you have the Best Graphics?

Outline alone isn't the sole focal factor in seeing which gaming PC to purchase, in any case. Various titles, including such show pieces as Half-Life 2 and Doom 3, give the player the decision of decreasing the graphical effects in order to run the game sensibly on a less-character blowing structure. While FPS and various games a magnificent piece of the time require a behemoth of a structure to run with each and every graphical effect turned on, they will all around run enough on adroitly settled contraptions. If you can live without such upsetting effects as atom veiling and edge rates in the hundreds, chances are that you can spend less on a gaming PC and still have the decision to play the latest games.

In like manner, as a last resort game facilitators and players will discover ways to deal with oversee control direct make a game run all around more enough and perseveringly not long after it releases. It is for the most part predicted that, in the race to hit the business focus, various games are less "finished"; endlessly end, the code behind them could stay to be reestablished incredibly more. Right now, and distributers will all around releases fixes or reestablishes in order to fix certain specific issues. By morals of F.E.A.R., various players uncovered not long after its release that the edge rate would dependably drop down to unplayable levels mid-game, chugging along even on shocking gaming structures. Suitably when the game was fixed, by some chance occasion, this need was, allegorically, changed. So moreover, vivacious players or people from a gaming structure will routinely find ways to deal with oversee manage direct improve a game's bit in package through hacks or changes. Right when this happens, their disclosures are regularly released online quickly, and a game that may have made your gaming PC past its capacities may exceptionally get playable. Again, it's not resolutely fundamental to have the most magnificently shocking contraption to play the latest games.

What complete do you Plan on Spending?

Continually, the whole of this improvement blends some focal poundings. As the idiom goes, you have to pay to play. Everybody attempts to one day guarantee a heavenly gaming PC; the central focuses are dumbfounding, and there is no nonappearance of affiliations offering creature gaming rigs. Regardless, the cost of owning one of these machines is routinely prohibitive. Review that the freshest and most prevailing video cards will if all else fails hit the market at the $500 respect point. Additionally, the most preparing processors can be respected at $1000 or more. Right when you plan a structure around these top-level parts - a system that can take the latest game releases, gobble them up, and let them out- - you can anticipate that the cost of it should take off. It's not hard to see submitted gaming PCs surveyed at $4000 or more for the apex emblematically.

Completely, the secured two plans sway the third a great deal. If you don't play some graphically-believable games, or in case you are glad to live with barely undermined in-game outlines, it is in a general sense not fundamental to spend that kind of money on a gaming structure. There are a colossal measure of PC affiliations that have in their lineups midrange frameworks that are flawlessly created having an immense impact of games accessible today- - and at an on a wonderfully essential level put held down expense. Make the basic advances not to give up if you can't hold up under the expense of the latest and most winning PC improvement; while money related methods may be the most inevitable of each and every basic factor, it won't everything considered square you from playing the games that you need.

[sandovalenst1000]

The phone’s ringing... it’s Earth!

The environmental studies program at Fordham is not only interdisciplinary, but allows students to have a concentration in one of various fields of study, from sustainable business to food security and organic farming. The major and minor programs’ course selections are built from the pressing changes to our earth and the need to address the Earth’s environmental problems that society has caused. The environmental studies program allows students to understand the causes and effects of current and developing environmental problems through studying the humanities and physical & social sciences, in addition to exploring solutions for societal and physical impacts on the Earth through various disciplines. While scientists have been trying to make society more aware of our environmental impacts, it has not proved to be enough to motivate most people, creating a need for an interdisciplinary environmental studies program to educate the current generation and aligning with the current surge for environmental activism.

Without scientific fields of study such as biology and chemistry, we would not even begin to understand the environment, allowing environmental science to be the foundation for environmental studies. Environmental science is the study of “how the earth works…, how humans interact with the environment, and how we can live more sustainably” (Miller, 2018, p. 5), allowing individuals to answer the call to understand environmental problems. The physical science aspect of environmental studies provides the background to understand sustainability, “the capacity of the earth’s natural systems...to survive or adapt to changing environmental conditions” (Miller, 2018, p. 4). The six main principles of sustainability applying to the environment, which allow humans to understand and attempt to create a more sustainable future, include the following: dependence on solar energy, biodiversity, nutrient cycling, full cost pricing, win-win solutions, and responsibility to future generations.

All energy comes from the sun and provides continuous energy to cycle nutrients throughout an ecosystem. The sun additionally provides the energy for biodiversity, which is “the variety of genes, species, ecosystems, and ecosystem processes” (Miller, 2018, p. 5). Full-cost pricing, rooted in economic principles, is encouraged by environmentally-conscious economists, who propose to include the health and environmental costs of production and usage of products in the market pricing of services and goods rather than companies taking advantage of the environment for larger profit margins. Win-win solutions, rooted in political science, incorporate compromise and collaboration to find the greatest benefit for both the environment and people. Lastly, the responsibility to future generations to preserve the environment incorporates ethics to provide morality towards what humans do to affect the Earth. A comprehensive assessment on the environmental cost of animal source foods by the Ecological Society of America notes unbalanced regulation when comparing marine and terrestrial sources and suggests policy action to avoid high-impact farming, aquaculture, and fisheries (Banobi, 2018), exhibiting the interdisciplinary suggestions necessary to help the environment and limit society’s impacts.

With various facets of the environment suffering due to exploitation of nature, such as ozone depletion and toxic coastal soil from farming, scientists continue to reach out to society to strike the feeling of responsibility to future generations and the Earth, using the ethical approach. In the 1992 Warning to Humanity letter by the Union of Concerned Scientists, it cites irreversible damage to the Earth as of almost three decades ago, which is considerably worse in 2020 with little change to policy. The letter recommends collaboration, policy change for better management of resources, and population stabilization to help halt the degradation of resources and the overall health of the Earth. Most recently in the 2017 Warning of Climate Emergency from the Alliance of World Scientists, scientists still use the ethical and moral approach to try and motivate others to help save the Earth. Both the 1992 and 2017 letters from scientists have similar messages, with each urging people to contribute to helping the environment. The Alliance of World Scientists urges leaders to adapt approaches to governing and policy making in relation to environmental management, and the materials used to manufacture products. Both letters identify developed nations, such as the United States, as the largest contributors to environmental decline and also as the most influential in saving the environment.

With many calls from the United Nations to help motivate nations to contribute to saving the environment, one of the most comprehensive calls is the UN Millennium Ecosystem Assessment, collecting data from 2001 to 2005 to analyze the consequences of ecosystem changes on the Earth and on human beings and focuses on various ecosystem services. Ecosystem services include provisioning, regulating, habitat and support, and cultural services that benefit human beings and maintain the environment to a certain extent. Provisioning services include “material outputs from ecosystems” (2005), such as food and water, raw materials, and medicinal benefits. Regulating services regulate the quality of air and soil, in addition to providing flood and disease control in ecosystems. Habitat and supporting services include providing habitats for species and maintaining genetic diversity among breeds of organisms. Lastly, cultural services include the non-material benefits humans receive from nature, such as tourism and recreational experiences. With about 60% of the ecosystem services that were studied being degraded or used unsustainably, usage shifts the consequences further into the future for future generations (2005). While usage of ecosystem services benefit humans now, in the future they will not as shifts in regional climates continue, affecting not only production of goods but humans as well due to loss of assets. While developed countries continue to impact the environment the most, degradation of ecosystem services affect impoverished populations the most (2005), due to large centralized impoverished populations being in third-world countries. The Ecosystem Assessment highlights that changes require influential policy changes and without it, impacts will become permanent and compounded, such as projected future species loss to increase ten-fold to approximately 80 to 110 extinctions per 1000 species (2005).

Reflecting on the larger impacts of society on the environment, I took the Ecological Footprint quiz to see what my individual environmental impact is, considering that I live in dorm housing on campus in New York City. Unsurprisingly, the largest consumption result is my housing, considering that I live in a dorm with approximately 800 other students, with mobility coming in second, which I based off of my driving habits at home. Despite some of my less environmentally friendly habits, I still have about half of the ecological footprint of the average American. Overall solutions proposed by the Ecological Footprint results include green urban planning, considering 70-80% of the world’s population is projected to live in cities by 2050, renewable energy sources, reduced food waste, controlled population size, and actively protecting ecosystems. Solutions proposed by almost all materials read, specifically the Ecosystem Assessments and Warning letters, include interdisciplinary approaches to responding to environmental disarray, stemming from environmental science and environmental studies.

Word Count: 1132/1100 words

Question: Considering the cutthroat business market, are there any successful full-cost pricing models used by companies today? If so, how do those companies differentiate their product from cheaper models in the same market?

Bibliography

“1992 World Scientists' Warning to Humanity.” July 16, 1992. https://www.ucsusa.org/resources/1992-world-scientists-warning-humanity.

“Ecosystems and Human Well-Being: Synthesis.” Millenium Ecosystem Assessment, 2005.

“Environmental Studies.” Fordham University. Accessed January 27, 2020. https://www.fordham.edu/es.

Hilborn, Ray, Jeannette Banobi, Stephen J Hall, Teresa Pucylowski, and Timothy E Walsworth. “The Environmental Cost of Animal Source Foods.” Frontiers in Ecology and the Environment, June 12, 2018. https://doi.org/https://doi.org/10.1002/fee.1822.

Ripple, William J, Christopher Wolf, Thomas M Newsome, Phoebe Barnard, and William R Moomaw. “World Scientists' Warning of a Climate Emergency.” Alliance of World Scientists, November 5, 2019. https://academic.oup.com/bioscience/article/70/1/8/5610806.

[hachama]

Second Democratic Debate Analysis, pt. 1

Like last time, I’ve (finally) read the transcripts.  I read the fact-checkers’ analysis.  I have ranked them. 

Also like last time, due to the size of the field, I’ll be splitting my analysis into four groups.  This first one will be the Please Do Not Make Me Vote For Them group: 

Good news!  Due to candidates dropping out, it’s a shorter list!

Biden, Williamson, Delaney, Ryan, and Bullock

Under the break, I’ll be analyzing their debate performance, how effectively they represented themselves on the issues, and how much I hate them, in reverse order of preference. Let’s begin.

17) Bullock

Governor Steve Bullock did not make an appearance in the first set of debates, and now I know why. He is the Shirley Exception made flesh. “Surely no one would actually use our laws to hurt someone.  Surely if someone is really a good person they won’t face terrible abuses.  Surely not…” Stevie, these are things that are currently happening.  These are facts.  

Those who read my analysis of the first debates should know that I do not accept any luke-warm “healthcare choice” arguments, and Steve is full of those, too.

He’s very worried about other candidates campaign promises being unrealistic, and says that it’s important to listen to “real Americans,” as if democratic socialists and the majority of Americans who support universal healthcare aren’t “real” enough for him.

As if that weren’t enough, he also argues in favor of some of the abuses of immigrants, as a deterrent to immigration.

To his credit, he supports treating gun violence as a public health issue, including research by the CDC into causes, which could inform actually useful gun control policies.  He wants to see Citizens United overturned, which is also good.  But not good enough.

16) Ryan

Representative Tim Ryan has the distinction of being one of the candidates I hated entirely in this debate. I agreed with none of his points, and most of my notes contain profanity.  He introduced himself as New and Fresh, playing on his youth (he’s 45. The average age of the democratic candidates is 54.  There are 4 people running who are younger than Tim) without offering much substance.

He opposes decriminalizing the border.  On healthcare he seems to think we can’t make healthcare better for everyone because then unions won’t have anything going for them which is just… He thinks letting businesses “buy in to medicare” is a good idea, and all I can hear is “privatize the social safety net and let companies decide whose grandma actually deserves to have proper care when she breaks her hip.”  

I’m not saying Tim is evil. I’m saying he’s spineless and would let bad things happen because it’s too much work to stop them.

15) Delaney

Representative John Delaney joins Tim Ryan in the dubious category of “I hate you and everything you stand for.”  The only reason he ranks slightly higher than Tim is because someone had to.  Their scores were the same level of shrieking profanity.

John thinks that reminding everyone that he was the youngest CEO in the history of the New York Stock Exchange is a good thing, showing that he has absolutely no idea what democrats are looking for in a candidate.  Surely, we should trust him!  He sold his soul early and has abided by the contract for so long!

He is another candidate decrying “unrealistic” campaign promises.  He reiterated his concern that Medicare for All would underfund the healthcare industry in America, he considers it an “extreme” policy proposal, and called it an “anti-private sector strategy.”  Yes, John, because the private sector’s profit motive has been working so well, let’s all continue dying so that small groups of people can make lots of money off of the price of insulin.  Fuck you.

14) Williamson

Marianne Williamson’s contributions were blessedly brief and infrequent.  She supports public campaign funding, which is great, but she also spent an entire minute on “I have concerns” without once proposing a solution, referred to the American healthcare system as a “sickness care system,” which for me evokes concerns about chemtrails and chemikillz, and her opening statement evoked American Exceptionalism.  

I’m so tired of Marianne Williamson.

13) Biden

Former Vice President, Former Senator Joe Biden was invited to comment on everything.  As a result, I have over a page of notes just for him. The moderators’ bold strategy of checking in with Uncle Joe every time anyone said anything gave him opportunities to say a few things I agreed with, but ultimately was not enough to get him out of my lowest ranked category.

As he said in the last debate, Joe supports rejoining the Paris Climate Accord.  This time, he said we need to “increase” the standard, apparently recognizing that solutions negotiated several years ago will not be sufficient now, and he wants to see an end to fossil fuel subsidies.  These are good things I can agree with.

Joe is concerned by the treatment of immigrants seeking asylum, and the excessive wait times for their cases to be heard and the refugees either released or returned to their country of origin.  His solution is to “flood the zone,” spend more resources to make decisions faster. This guarantees nothing except a reduction in detainees which, while generally positive, is less than half a solution.

The thing Joe said that I liked best was about the treatment of former-inmates after the completion of their prison sentences.  Joe said that former-inmates should have access to public programs and benefits upon release.  This would be a significant change from the current system, which continues to punish people long after their sentence is served.  He also said that drug crimes should result in rehab, not prison.

Joe continued to use his association with Obama as a shield against criticism, which was worn thin before the first debate started.  He evaded questions about Eric Garner, refused to answer questions about Obama-era deportations (with the added bonus of “what I said was said in confidence, you’d share it, but not me”), invoked American Exceptionalism in his opening statement, interrupted Cory Booker at one point, blamed all of our current political and social dysfunction on Trump, and thinks we should renegotiate the Trans Pacific Partnership.  

The cherry on top of this shit sundae?  He said the phrase “I have the only plan that (…)” I haven’t talked about this much, because it’s a little hard to express in text, but I have a very, very negative response to any claim to being the only person who can solve a problem.  It’s bad when Trump does it, it’s bad when Biden does it, it’s an abuser’s tactic.  “I’m the only one who loves you, I’m the only one who can help you, I’m the only one” is always a) a lie, and b) a red flag.

Granted, I was so far behind that some of Biden’s comments formed parallels I might not have seen when he initially said them, but some of the things he said about immigration were symptomatic of the same thought process that gave us that abominable rewrite of Emma Lazarus’s New Colossus.  Biden, when trying to make a point about the strength of America being in our diversity, said that “we’ve been able to cherry pick from the best of every culture,” and followed it up with “anybody that crosses the stage with a PhD, you should get a green card for seven years. We should keep them here.” Not everyone who immigrates to the U.S. is going to have an advanced degree. Not everyone who immigrates to the U.S. is going to be “the best and brightest.”  And that’s a good thing.  There is a limit to the number of doctors and lawyers a society needs. Some immigrants are going to be nurse’s assistants and cab drivers, and we need them here, too.

Even with all of that, the worst of what Joe had to say was about healthcare.  Joe thinks that limiting co-pays to $1000 per person is part of making healthcare accessible to everyone.  He thinks your health insurance premium should be no more than 8.5% of your annual income.  I did some math.  For minimum wage, that’s almost $2500 for insurance, out of pocket, before anyone sees any benefit.  After taxes, that leaves about $10k for a minimum wage worker to live on for a year. At $15/hour, $20k to live on.  These are not reasonable numbers in most of the country.

[coolpyoda-blog]

Factors associated with increased  or decrease treatment use in with Major Depression

A.     The dataset used is National Epidemiologic Survey of Drug Use and Health.

B.     My topics of interest is “Factors associated with increased  or decrease treatment use in with Major Depression”

C.     A literature search on PubMed is conducted using terms: “Major Depression”, “Factor”, “Success”, “treatment”

D.     Seven relevant articles are identified:

1: Kraus C, Kadriu B, Lanzenberger R, Zarate CA Jr, Kasper S. Prognosis and

improved outcomes in major depression: a review. Transl Psychiatry. 2019 Apr

3;9(1):127. doi: 10.1038/s41398-019-0460-3. Review. PubMed PMID: 30944309; PubMed

Central PMCID: PMC6447556.

2: Kelley ME, Dunlop BW, Nemeroff CB, Lori A, Carrillo-Roa T, Binder EB, Kutner

MH, Rivera VA, Craighead WE, Mayberg HS. Response rate profiles for major

depressive disorder: Characterizing early response and longitudinal nonresponse.

Depress Anxiety. 2018 Oct;35(10):992-1000. doi: 10.1002/da.22832. Epub 2018 Sep

7. PubMed PMID: 30260539.

3: Heinz AJ, Meffert BN, Halvorson MA, Blonigen D, Timko C, Cronkite R.

Employment characteristics, work environment, and the course of depression over

23 years: Does employment help foster resilience? Depress Anxiety. 2018

Sep;35(9):861-867. doi: 10.1002/da.22782. Epub 2018 Jun 7. PubMed PMID: 29878482;

PubMed Central PMCID: PMC6123281.

4: Agabio R, Trogu E, Pani PP. Antidepressants for the treatment of people with

co-occurring depression and alcohol dependence. Cochrane Database Syst Rev. 2018

Apr 24;4:CD008581. doi: 10.1002/14651858.CD008581.pub2. Review. PubMed PMID:

29688573; PubMed Central PMCID: PMC6494437.

5: Dunlop BW, Kelley ME, Aponte-Rivera V, Mletzko-Crowe T, Kinkead B, Ritchie JC,

Nemeroff CB, Craighead WE, Mayberg HS; PReDICT Team. Effects of Patient

Preferences on Outcomes in the Predictors of Remission in Depression to

Individual and Combined Treatments (PReDICT) Study. Am J Psychiatry. 2017 Jun

1;174(6):546-556. doi: 10.1176/appi.ajp.2016.16050517. Epub 2017 Mar 24. PubMed

PMID: 28335624.

6: Hall CA, Reynolds-Iii CF. Late-life depression in the primary care setting:

challenges, collaborative care, and prevention. Maturitas. 2014 Oct;79(2):147-52.

doi: 10.1016/j.maturitas.2014.05.026. Epub 2014 Jun 7. Review. PubMed PMID:

24996484; PubMed Central PMCID: PMC4169311.

7: Marshall M, Crowther R, Almaraz-Serrano A, Creed F, Sledge W, Kluiter H,

Roberts C, Hill E, Wiersma D, Bond GR, Huxley P, Tyrer P. Systematic reviews of

the effectiveness of day care for people with severe mental disorders: (1) acute

day hospital versus admission; (2) vocational rehabilitation; (3) day hospital

versus outpatient care. Health Technol Assess. 2001;5(21):1-75. Review. PubMed

PMID: 11532238.

E.      Abstracts and full articles are obtained. The abstracts are enclosed:

Transl Psychiatry. 2019 Apr 3;9(1):127. doi: 10.1038/s41398-019-0460-3.

Prognosis and improved outcomes in major depression: a review.

Kraus C1,2, Kadriu B2, Lanzenberger R1, Zarate CA Jr2, Kasper S3.

Author information

Abstract

Treatment outcomes for major depressive disorder (MDD) need to be improved. Presently, no clinically relevant tools have been established for stratifying subgroups or predicting outcomes. This literature review sought to investigate factors closely linked to outcome and summarize existing and novel strategies for improvement. The results show that early recognition and treatment are crucial, as duration of untreated depression correlates with worse outcomes. Early improvement is associated with response and remission, while comorbidities prolong course of illness. Potential biomarkers have been explored, including hippocampal volumes, neuronal activity of the anterior cingulate cortex, and levels of brain-derived neurotrophic factor (BDNF) and central and peripheral inflammatory markers (e.g., translocator protein (TSPO), interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor alpha (TNFα)). However, their integration into routine clinical care has not yet been fully elucidated, and more research is needed in this regard. Genetic findings suggest that testing for CYP450 isoenzyme activity may improve treatment outcomes. Strategies such as managing risk factors, improving clinical trial methodology, and designing structured step-by-step treatments are also beneficial. Finally, drawing on existing guidelines, we outline a sequential treatment optimization paradigm for selecting first-, second-, and third-line treatments for acute and chronically ill patients. Well-established treatments such as electroconvulsive therapy (ECT) are clinically relevant for treatment-resistant populations, and novel transcranial stimulation methods such as theta-burst stimulation (TBS) and magnetic seizure therapy (MST) have shown promising results. Novel rapid-acting antidepressants, such as ketamine, may also constitute a paradigm shift in treatment optimization for MDD.

PMID: 30944309 PMCID: PMC6447556 DOI: 10.1038/s41398-019-0460-3

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2.

Depress Anxiety. 2018 Oct;35(10):992-1000. doi: 10.1002/da.22832. Epub 2018 Sep 7.

Response rate profiles for major depressive disorder: Characterizing early response and longitudinal nonresponse.

Kelley ME1, Dunlop BW2, Nemeroff CB3, Lori A2, Carrillo-Roa T4, Binder EB2,4, Kutner MH1, Rivera VA5, Craighead WE2,6, Mayberg HS1,7.

Author information

Abstract

BACKGROUND:

Definition of response is critical when seeking to establish valid predictors of treatment success. However, response at the end of study or endpoint only provides one view of the overall clinical picture that is relevant in testing for predictors. The current study employed a classification technique designed to group subjects based on their rate of change over time, while simultaneously addressing the issue of controlling for baseline severity.

METHODS:

A set of latent class trajectory analyses, incorporating baseline level of symptoms, were performed on a sample of 344 depressed patients from a clinical trial evaluating the efficacy of cognitive behavior therapy and two antidepressant medications (escitalopram and duloxetine) in patients with major depressive disorder.

RESULTS:

Although very few demographic and illness-related features were associated with response rate profiles, the aggregated effect of candidate genetic variants previously identified in large pharmacogenetic studies and meta-analyses showed a significant association with early remission as well as nonresponse. These same genetic scores showed a less compelling relationship with endpoint response categories. In addition, consistent nonresponse throughout the study treatment period was shown to occur in different subjects than endpoint nonresponse, which was verified by follow-up augmentation treatment outcomes.

CONCLUSIONS:

When defining groups based on the rate of change, controlling for baseline depression severity may help to identify the clinically relevant distinctions of early response on one end and consistent nonresponse on the other.

© 2018 Wiley Periodicals, Inc.

KEYWORDS:

CBT/cognitive behavior therapy; antidepressants; depression; genetics; treatment

PMID: 30260539 DOI: 10.1002/da.22832

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3.

Depress Anxiety. 2018 Sep;35(9):861-867. doi: 10.1002/da.22782. Epub 2018 Jun 7.

Employment characteristics, work environment, and the course of depression over 23 years: Does employment help foster resilience?

Heinz AJ1,2, Meffert BN1, Halvorson MA3, Blonigen D2,4, Timko C2,4, Cronkite R2,5,6.

Author information

Abstract

BACKGROUND:

Depression is the leading cause of disability and represents a significant challenge to stable employment and professional success. Importantly, employment may also operate as a protective factor against more chronic courses of depression as it can function as a form of behavioral activation and scaffold recovery by facilitating community integration. The current study examined work-related characteristics as protective or risk factors for subsequent long-term depression trajectories.

METHODS:

Relations between employment characteristics and lifetime course of depression were examined among 424 adults in the community who entered treatment for depression. The sample was followed for 23 years with assessments at 1, 4, 10, and 23 years post baseline. At baseline, participants were asked about employment history and status along with work-related events and aspects of their work environments. Depression was measured at each assessment, and three different life course trajectories of depression were identified.

RESULTS:

Employment at baseline was associated with lower levels of depression at baseline and less severe life courses of depression. Among employed participants, higher occupational prestige, a more supportive work environment (greater involvement, cohesion, and perceived support), and lower work stress (less pressure and more control, role clarity, and autonomy) may protect against more severe, intractable depression over time and may have bolstered functioning.

CONCLUSIONS:

Findings have potential to be harnessed for clinical translation to better inform vocational rehabilitation counseling and human resources programs. Specifically, clinician assessment of work setting can guide patient decision making about how to reduce vulnerability to depression and foster resilience via employment.

© 2018 Wiley Periodicals, Inc.

KEYWORDS:

depression; employment; occupational prestige; resilience; work environment

PMID: 29878482 PMCID: PMC6123281 DOI: 10.1002/da.22782

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4.

Cochrane Database Syst Rev. 2018 Apr 24;4:CD008581. doi: 10.1002/14651858.CD008581.pub2.

Antidepressants for the treatment of people with co-occurring depression and alcohol dependence.

Agabio R1, Trogu E, Pani PP.

Author information

Abstract

BACKGROUND:

Alcohol dependence is a major public health problem characterized by recidivism, and medical and psychosocial complications. The co-occurrence of major depression in people entering treatment for alcohol dependence is common, and represents a risk factor for morbidity and mortality, which negatively influences treatment outcomes.

OBJECTIVES:

To assess the benefits and risks of antidepressants for the treatment of people with co-occurring depression and alcohol dependence.

SEARCH METHODS:

We searched the Cochrane Drugs and Alcohol Group Specialised Register (via CRSLive), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from inception to July 2017. We also searched for ongoing and unpublished studies via ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (apps.who.int/trialsearch/).All searches included non-English language literature. We handsearched references of topic-related systematic reviews and the included studies.

SELECTION CRITERIA:

Randomized controlled trials and controlled clinical trials comparing antidepressants alone or in association with other drugs or psychosocial interventions (or both) versus placebo, no treatment, and other pharmacological or psychosocial interventions.

DATA COLLECTION AND ANALYSIS:

We used standard methodological procedures as expected by Cochrane.

MAIN RESULTS:

We included 33 studies in the review (2242 participants). Antidepressants were compared to placebo (22 studies), psychotherapy (two studies), other medications (four studies), or other antidepressants (five studies). The mean duration of the trials was 9.9 weeks (range 3 to 26 weeks). Eighteen studies took place in the USA, 12 in Europe, two in Turkey, and one in Australia. The antidepressant included in most of the trials was sertraline; other medications were amitriptyline, citalopram, desipramine, doxepin, escitalopram, fluoxetine, fluvoxamine, imipramine, mianserin, mirtazepine, nefazodone, paroxetine, tianeptine, venlafaxine, and viloxazine. Eighteen studies were conducted in an outpatient setting, nine in an inpatient setting, and six in both settings. Psychosocial treatment was provided in 18 studies. There was high heterogeneity in the selection of outcomes and the rating systems used for diagnosis and outcome assessment.Comparing antidepressants to placebo, low-quality evidence suggested that antidepressants reduced the severity of depression evaluated with interviewer-rated scales at the end of trial (14 studies, 1074 participants, standardized mean difference (SMD) -0.27, 95% confidence interval (CI) -0.49 to -0.04). However, the difference became non-significant after the exclusion of studies with a high risk of bias (SMD -0.17, 95% CI -0.39 to 0.04). In addition, very low-quality evidence supported the efficacy of antidepressants in increasing the response to the treatment (10 studies, 805 participants, risk ratio (RR) 1.40, 95% Cl 1.08 to 1.82). This result became non-significant after the exclusion of studies at high risk of bias (RR 1.27, 95% CI 0.96 to 1.68). There was no difference for other relevant outcomes such as the difference between baseline and final score, evaluated using interviewer-rated scales (5 studies, 447 participants, SMD 0.15, 95% CI -0.12 to 0.42).Moderate-quality evidence found that antidepressants increased the number of participants abstinent from alcohol during the trial (7 studies, 424 participants, RR 1.71, 95% Cl 1.22 to 2.39) and reduced the number of drinks per drinking days (7 studies, 451 participants, mean difference (MD) -1.13 drinks per drinking days, 95% Cl -1.79 to -0.46). After the exclusion of studies with high risk of bias, the number of abstinent remained higher (RR 1.69, 95% CI 1.18 to 2.43) and the number of drinks per drinking days lower (MD -1.21 number of drinks per drinking days, 95% CI -1.91 to -0.51) among participants who received antidepressants compared to those who received placebo. However, other outcomes such as the rate of abstinent days did not differ between antidepressants and placebo (9 studies, 821 participants, MD 1.34, 95% Cl -1.66 to 4.34; low-quality evidence).Low-quality evidence suggested no differences between antidepressants and placebo in the number of dropouts (17 studies, 1159 participants, RR 0.98, 95% Cl 0.79 to 1.22) and adverse events as withdrawal for medical reasons (10 studies, 947 participants, RR 1.15, 95% Cl 0.65 to 2.04).There were few studies comparing one antidepressant versus another antidepressant or antidepressants versus other interventions, and these had a small sample size and were heterogeneous in terms of the types of interventions that were compared, yielding results that were not informative.

AUTHORS' CONCLUSIONS:

We found low-quality evidence supporting the clinical use of antidepressants in the treatment of people with co-occurring depression and alcohol dependence. Antidepressants had positive effects on certain relevant outcomes related to depression and alcohol use but not on other relevant outcomes. Moreover, most of these positive effects were no longer significant when studies with high risk of bias were excluded. Results were limited by the large number of studies showing high or unclear risk of bias and the low number of studies comparing one antidepressant to another or antidepressants to other medication. In people with co-occurring depression and alcohol dependence, the risk of developing adverse effects appeared to be minimal, especially for the newer classes of antidepressants (such as selective serotonin reuptake inhibitors). According to these results, in people with co-occurring depression and alcohol dependence, antidepressants may be useful for the treatment of depression, alcohol dependence, or both, although the clinical relevance may be modest.

PMID: 29688573 PMCID: PMC6494437 DOI: 10.1002/14651858.CD008581.pub2

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5.

Am J Psychiatry. 2017 Jun 1;174(6):546-556. doi: 10.1176/appi.ajp.2016.16050517. Epub 2017 Mar 24.

Effects of Patient Preferences on Outcomes in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) Study.

Dunlop BW1, Kelley ME1, Aponte-Rivera V1, Mletzko-Crowe T1, Kinkead B1, Ritchie JC1, Nemeroff CB1, Craighead WE1, Mayberg HS1; PReDICT Team1.

Author information

Abstract

OBJECTIVE:

The Predictors of Remission in Depression to Individual and Combined Treatments [PReDICT] study aimed to identify clinical and biological factors predictive of treatment outcomes in major depressive disorder among treatment-naive adults. The authors evaluated the efficacy of cognitive-behavioral therapy (CBT) and two antidepressant medications (escitalopram and duloxetine) in patients with major depression and examined the moderating effect of patients' treatment preferences on outcomes.

METHOD:

Adults aged 18-65 with treatment-naive major depression were randomly assigned with equal likelihood to 12 weeks of treatment with escitalopram (10-20 mg/day), duloxetine (30-60 mg/day), or CBT (16 50-minute sessions). Prior to randomization, patients indicated whether they preferred medication or CBT or had no preference. The primary outcome was change in the 17-item Hamilton Depression Rating Scale (HAM-D), administered by raters blinded to treatment.

RESULTS:

A total of 344 patients were randomly assigned, with a mean baseline HAM-D score of 19.8 (SD=3.8). The mean estimated overall decreases in HAM-D score did not significantly differ between treatments (CBT: 10.2, escitalopram: 11.1, duloxetine: 11.2). Last observation carried forward remission rates did not significantly differ between treatments (CBT: 41.9%, escitalopram: 46.7%, duloxetine: 54.7%). Patients matched to their preferred treatment were more likely to complete the trial but not more likely to achieve remission.

CONCLUSIONS:

Treatment guidelines that recommend either an evidence-based psychotherapy or antidepressant medication for nonpsychotic major depression can be extended to treatment-naive patients. Treatment preferences among patients without prior treatment exposure do not significantly moderate symptomatic outcomes.

KEYWORDS:

Antidepressants; Cognitive Therapy; Mood Disorders-Unipolar; Outcome Studies

Comment in

Engaging Depressed Patients: An Essential Step in Optimizing Care. [Am J Psychiatry. 2017]

PMID: 28335624 DOI: 10.1176/appi.ajp.2016.16050517

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6.

Maturitas. 2014 Oct;79(2):147-52. doi: 10.1016/j.maturitas.2014.05.026. Epub 2014 Jun 7.

Late-life depression in the primary care setting: challenges, collaborative care, and prevention.

Hall CA1, Reynolds-Iii CF2.

Author information

Abstract

Late-life depression is highly prevalent worldwide. In addition to being a debilitating illness, it is a risk factor for excess morbidity and mortality. Older adults with depression are at risk for dementia, coronary heart disease, stroke, cancer and suicide. Individuals with late-life depression often have significant medical comorbidity and, poor treatment adherence. Furthermore, psychosocial considerations such as gender, ethnicity, stigma and bereavement are necessary to understand the full context of late-life depression. The fact that most older adults seek treatment for depression in primary care settings led to the development of collaborative care interventions for depression. These interventions have consistently demonstrated clinically meaningful effectiveness in the treatment of late-life depression. We describe three pivotal studies detailing the management of depression in primary care settings in both high and low-income countries. Beyond effectively treating depression, collaborative care models address additional challenges associated with late-life depression. Although depression treatment interventions are effective compared to usual care, they exhibit relatively low remission rates and small to medium effect sizes. Several studies have demonstrated that depression prevention is possible and most effective in at-risk older adults. Given the relatively modest effects of treatment in averting years lived with disability, preventing late-life depression at the primary care level should be highly prioritized as a matter of health policy.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS:

Collaborative care; Depression prevention; Late-life depression; Primary care; Treatment of depression

PMID: 24996484 PMCID: PMC4169311 DOI: 10.1016/j.maturitas.2014.05.026

[Indexed for MEDLINE] Free PMC Article

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7.

Health Technol Assess. 2001;5(21):1-75.

Systematic reviews of the effectiveness of day care for people with severe mental disorders: (1) acute day hospital versus admission; (2) vocational rehabilitation; (3) day hospital versus outpatient care.

Marshall M1, Crowther R, Almaraz-Serrano A, Creed F, Sledge W, Kluiter H, Roberts C, Hill E, Wiersma D, Bond GR, Huxley P, Tyrer P.

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Abstract

***ACUTE DAY HOSPITAL VERSUS ADMISSION FOR ACUTE PSYCHIATRIC DISORDERS***

BACKGROUND:

Inpatient treatment is an expensive way of caring for people with acute psychiatric disorders. It has been proposed that many of those currently treated as inpatients could be cared for in acute psychiatric day hospitals.

OBJECTIVE:

The aim of this review was to assess the effectiveness and feasibility of day hospital versus inpatient care for people with acute psychiatric disorders.

METHODS - STUDY SELECTION:

Eligible studies were randomised controlled trials of day hospital versus inpatient care for people with acute psychiatric disorders. Studies were excluded if they were primarily concerned with elderly people, children, or patients with a diagnosis of organic brain disease or substance abuse. METHODS - DATA SOURCES: We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, PsycLIT, and the reference lists of articles. Researchers were approached to identify unpublished studies. Trialists were asked to provide individual patient data. METHODS - DATA EXTRACTION: Data were extracted independently by two reviewers and cross-checked. METHODS - DATA SYNTHESIS: Relative risk (RR) and 95% confidence intervals (CIs) were calculated for dichotomous data. Weighted or standardised means were calculated for continuous data. Day hospital trials tend to present similar outcomes in slightly different formats, making it difficult to synthesise the data. Individual patient data were therefore sought so that outcomes could be re-analysed using a common format.

RESULTS:

Nine trials met the inclusion criteria (involving 1568 randomised patients and 2268 assessed for suitability of day hospital treatment). Individual patient data were obtained for four trials (involving 594 people). A sensitivity analysis of combined data suggested that day hospital treatment was feasible for at worst 23.2% (n = 2268; 95% CI, 21.2 to 25.2) and at best 37.5% (n = 1768; 95% CI, 35.2 to 39.8) of those currently admitted to inpatient care. Individual patient data from three trials showed no difference in the number of days in hospital (combining day hospital days and inpatient days) between day hospital patients and controls (n = 465; weighted mean difference (WMD) = -0.38 days/ month; 95% CI, -1.32 to 0.55). However, compared with controls, patients randomised to day hospital care spent significantly more days in day hospital care (n = 265; WMD = 2.34 days/month; 95% CI, 1.97 to 2.70) and significantly fewer days in inpatient care (n = 265; WMD = -2.75 days/month; 95% CI, -3.63 to -1.87). There was no difference between readmission rates for day hospital and control patients (n = 667; RR = 0.91; 95% CI, 0.72 to 1.15). Individual patient data from three trials showed a significant time-treatment interaction, indicating a more rapid improvement in mental state (n = 407; c2 = 9.66; p = 0.002), but not social functioning (n = 295; c2 = 0.006; p = 0.941) amongst day hospital patients. Four of five trials demonstrated that day hospital care was cheaper than inpatient care (with overall cost reductions ranging from 20.9% to 36.9%).

CONCLUSIONS:

Acute day hospitals are an attractive option in situations where demand for inpatient care is high and facilities exist that are suitable for conversion. They are a less attractive option when demand for inpatient care is low and where effective alternatives already exist. The interpretation of day hospital research would be enhanced if future trials made use of the common set of outcome measures used in this review. It is important to examine how acute day hospital care can be most effectively integrated into a modern community-based psychiatric service. ***VOCATIONAL REHABILITATION FOR PEOPLE WITH SEVERE MENTAL DISORDERS***

BACKGROUND:

People who are disabled by severe mental disorders experience high rates of unemployment, but most want to work. Prevocational training (PVT) is the traditional approach to helping such people to return to work. PVT assumes that a period of preparation is required before those with a severe mental disorder can enter into competitive employment. Supported Employment (SEm) is a new approach that places clients in competitive employment without extended preparation. Both PVT and SEm are widely practised, but it is unclear which is the most effective.

OBJECTIVES:

The overall objective of this review was to assess the effectiveness of PVT and SEm relative to each other and to standard care (in hospital or the community) for people with severe mental disorders. In addition, the review examined the effectiveness of: (1) special types of PVT ("clubhouse" model) and SEm (individual placement and support model); and (2) modifications for enhancing PVT (e.g. payment or psychological interventions).

METHODS - STUDY SELECTION:

Eligible studies were randomised controlled trials (RCTs) examining the effectiveness of vocational rehabilitation approaches (PVT and SEm or modifications) for people of working age and suffering from a severe mental disorder. METHODS - DATA SOURCES: Relevant trials were identified from searches of the Cochrane Schizophrenia Group's specialised register, MEDLINE, EMBASE, CINAHL and PsycLIT, and the reference lists of all identified studies and review articles. Researchers who were active in the field were approached in order to identify unpublished studies. METHODS - DATA EXTRACTION: All data were extracted independently by two reviewers and cross-checked. Continuous data were excluded if they were collected by using an unpublished scale or were based on a subset of items from a scale. METHODS - DATA SYNTHESIS: For all comparisons, the primary outcome was the number of clients who were in competitive employment at various time points. Secondary outcomes were: other employment outcomes, clinical outcome and costs. The relative risk (RR) and number-needed-to-treat (NNT) were calculated for the relevant categorical outcomes. Continuous data were either presented as in the original trial reports or, where possible, combined across trials as a standardised mean difference score.

RESULTS:

Eighteen RCTs of reasonable quality were identified: PVT versus hospital controls, three RCTs, n = 172; PVT versus community controls, five RCTs, n = 1204; modified PVT, four RCTs, n = 423; SEm versus community controls, one RCT, n = 256; and SEm versus PVT, five RCTs, n = 491). The main finding was that, on the primary outcome (number in competitive employment), SEm was significantly more effective than PVT at all time points (e.g. at 12 months, SEm 34% employed, PVT 12% employed; RR of not being in competitive employment = 0.76, 95% confidence interval 0.69 to 0.84, NNT = 4.5). Clients in SEm also earned more and worked more hours per month than those in PVT.

CONCLUSIONS:

The main finding was that SEm was more effective than PVT for patients suffering from a severe mental disorder who wanted to work. There was no evidence that PVT was more effective than standard community care or hospital care. The implication of these findings is that people suffering from mental disorders who want to work should be offered the option of SEm. Commissioning agencies would be justified in encouraging vocational rehabilitation (VR) providers to develop more SEm schemes. From a research perspective, the cost-effectiveness of SEm should be examined in larger multicentre trials, both within and outside the USA. There is a case for countries outside the USA to survey their existing VR services to determine the extent to which the most effective interventions are being offered. ***DAY HOSPITAL VERSUS OUTPATIENT CARE FOR PATIENTS WITH PSYCHIATRIC DISORDERS***

BACKGROUND:

This review considers the use of day hospitals as an alternative to outpatient care. Two typesof day hospital provision are covered: "day treatment programmes" and "day care centres". Day treatment programmes are day hospitals that are used to enhance the treatment of patients with anxiety or depressive disorders who have failed to respond to outpatient care. Day care centres are day hospitals that offer structured support to patients with long-term severe mental disorders who would otherwise be treated in an outpatient clinic.

OBJECTIVES:

There were two objectives: first, to assess the effectiveness of day treatment programmes versus outpatient care for people with non-psychotic disorders; and, secondly, to assess the effectiveness of day care centres versus outpatient care for people with severe long-term disorders.

METHODS - STUDY SELECTION:

Eligible studies were randomised controlled trials comparing day hospital care (either a day treatment programme or a day care centre) with outpatient care. Studies were ineligible if they were largely restricted to patients who were aged under 18 or over 65 years or who had a primary diagnosis of substance abuse or organic brain disorder. METHODS - DATA SOURCES: Relevant trials were identified from searches of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, PsycLIT, and the reference lists of all identified studies and review articles. Researchers were approached to identify unpublished studies. Trialists were asked to provide individual patient data. METHODS - DATA EXTRACTION: All data were extracted independently by two reviewers and cross-checked. METHODS - DATA SYNTHESIS: Relative risks and 95% confidence intervals were calculated for dichotomous data. Standardised mean differences were calculated for continuous data.

RESULTS:

There was evidence from two of the five trials identified suggesting that day treatment programmes were superior to continuing outpatient care in terms of improving psychiatric symptoms. There was no evidence to suggest that day treatment programmes were better or worse than outpatient care on any other clinical or social outcome variable or on costs. (ABSTRACT TRUNCATED)

[i-kill-boys]

Four Breathtaking Details About Ebike 2019

Bicycles are a wonderful means of transport that assists protect the environment: it lowers air contamination, ecological footprints, carbon emissions, is healthy and really economical! Up up until World War II, bicycles were the most common methods of transportation in cities. Nevertheless, except for nations such as Holland or Belgium, they have ended up being merely another leisure activity. However, the current crisis and increase in the price of oil has actually contributed to a small increase in making use of cheaper, more eco-friendly ways of transportation, such as the electrical bicycle. The electric bike kit or e-bike is a standard bicycle equipped with an electric motor to assist with pedaling. We can buy one straight or adapt a conventional bicycle. Do you understand how it works and the advantages it has over other means of transport? How does an electrical bicycle work? It consists of numerous parts: biking system (part of the standard bicycle), battery, controller (sends power to the motor), electric motor and pedaling sensor. The motor is supplied with power from the battery, which is recharged in the electrical grid, although a solar panel can also be used. Particular modern motors can be charged while riding down hill. When the sensor spots pedaling, it begins the motor, which helps on high hills and cross countries. When the rider stops pedaling or brakes, the motor stops. Complete electrical bicycle: these electrical bicycles are bought currently geared up but might have issues of compatibility for broken parts. Electrical roadway bikes cost 800 euros or more and electrical mtb cost 1000 euros or more. Standard bicycle to set up a kit on: some are easy to transform and the kit can be installed in really little time. The advantage over a serial electrical bike is that you do not have to buy a brand-new bike if you currently have a traditional one, thus conserving a fair bit of money. Packages can be purchased for 400 euros or more. Collapsible format: designed to be saved in cars, homes or on arrival at the office. More economical than fuel-powered cars and bikes, and less expensive than buying an electrical car for the city.

You can adapt your conventional bike using a package, and you can do it yourself in a few minutes, so you don't need to purchase a brand-new one. No contamination, forget about CO2 emissions! Depending on the person's physical condition, the kind of terrain or the distance, the electrical bike can be more comfy since it permits the rider to cover more distance or climb hills when more moderate workout is required. The bicycle does not do the riding for you, it offers a small impulse when you begin or ride uphill with a smooth, fluid motion. Even individuals who are otherwise pro e-bike frequently balk at the concept of e-biking as workout. Now, a new study reveals that if you're currently unconditioned, have a couple of pounds to lose, and/or simply starting, it not just "counts," however also it can improve your cardiovascular fitness just as well as riding a conventional bike. In the research study, Swiss scientists hired 32 sedentary and inexperienced volunteers to begin commuting to work by bike. Half of the group pedaled e-bikes, while the other half rode conventional bikes. The only stipulation was that they ride a minimum of 6 kilometers (3.7 miles) a day, a minimum of three days a week for 4 weeks. At the end of the month, the volunteers who e-biked improved their VO2 peak-- just how much oxygen your body can utilize during exertion-- just as much, if not even a bit more, than those who were commuting on conventional best electric bikes. Both groups likewise experienced an enhancement in heart function. Though the e-bike riders obviously had support, they used it to go quicker and to acquire more daily elevation than their peers on regular bikes, according to the researchers. "This shows that the ebike can increase inspiration and assist obese and older people to keep physical fitness training on a regular basis," study author Arno Schmidt-Trucksäss, MD, professor of sports medication at the University of Basel stated in a University of Basel press release. " Those who utilize e-bikes regularly benefit completely, not just in regards to their fitness, but also in terms of other aspects such as high blood pressure, fat metabolism, and their mental wellness," Schmidt-Trucksäss concluded. We're living in the future! In all elements, technology has improved our lives, whether that be through breakthrough medicines, renewable resource or new sporting ideas to keep us active (and living) longer ... one of these modifications is an electric bike. You may have currently seen among these zipping through your streets. The question is, is it worth all the buzz, especially for our fellow cyclists? Nicknamed 'E-bike' (likewise called power bike or booster bike), it might be the biggest adoption of green transport of the decade. 'cycling is already green' you might say, but it's more than that. Consider them in place of small gas scooters instead of typical bicycles. E-bikes utilize rechargeable batteries that can travel as much as 25 to 45 km/h, much faster than the majority of people would cycle, getting you to your location quicker and in better shape. In a nutshell they provide low cost, energy efficient, and emission-free transportation which likewise has physical and health benefits. However, why precisely is this such an excellent concept? Here are some benefits that will eliminate all your doubts and make you consider buying an E-bike ... get ready for the very best trip of your life! 1. Helped biking E-bikes have what they call battery-powered "pedal assist." Technically, this is a machine incorporated within the bike to offer your pedalling an increase. This can lower tension and impact on your knees and thighs. Bid farewell to sweaty trips. There are E-bikes that have specific boosting technology that can assist you to conquer hills and inclines, so you don't need to worry about any challenging terrain. People of any ages and health can ride perfectly and for much longer with an E-bike. Longer trips indicate more views and more possibilities for lunch stops! 2. Quick and flexible The innovation gives you the additional zest you need to cover miles of range with little effort. You can likewise still make the most of the multi-purpose cycle lane and courses that are traffic free, dazzling if you're residing in a city to slash your commute time. These are getting a growing number of popular in cities as governments and councils advise people to give up their car. The bikes have been developed over the years and now look almost like a regular bike frame, with just the subtle 'hum' giving them away. Benefit from the lithe form and toughness of an E-bike without anyone being the smarter!

 3. Improve physical fitness According to a study of scientists at Switzerland's University of Basel, riding an E-bike is just as excellent as regular bikes at enhancing fitness. Although cycling with an folding electric bike is pedal helped, it's still an exercise after all and therefore great for your health, both psychologically and physically. If you are more into physical fitness, there are customisable ones appropriate for exercise, try looking at and comparing these prior to purchasing.

4. Cut back costs If you utilize the E-bike instead of a motor vehicle it will conserve you loan in the long run. Petrol and diesel are pricey in a lot of countries, and periodic cost surges can really influence on your budget. While with E-bikes, you can purchase budget-friendly batteries which can last you 18-50 miles after a complete charge depending on the level of assistance you utilize. 5. They're the future of transportation We have actually all seen it in sci-fi movies. Sleek and attractive vehicles, none of which look old, bulky or have jets of smoke coming out the back, un-futuristic transport is no longer being made. The electric bike is on its way to being up there with its smart counterparts. Thinking about that this innovation will improve continually over time, what we have now might be the prototype of this promising transportation. Lots of countries in Southeast Asia took the lead in using E-bikes as sustainable mode of transportation, and with the constant increase of urban air pollution, there is a huge future for E-bikes. 6. Nature-friendly Climate change and worldwide warming are serious problems and we all need to play our part. We might be facing our last stand to conserve our dying earth, and we can all add to this. E-bikes emit lower pollution per kilometre than motorcycles and cars and trucks. You can assist by using an E-bike instead of a petrol or diesel automobile. They utilize energy with an average rate of 100 to 150 watts compared to 15,000 or so for a car. As a result, this can assist to enhance air quality. 7. Wide array of designs With technology, everything is practically possible, and as the marketability of best electric bikes increases, companies produce a variety of designs that can accommodate your requirements. If there isn't the best one out there right now, you can be quite sure there will be soon. 8. Easy to get one (in some nations). In some countries' laws, E-bikes are still considered as a bicycle, so if you don't like the procedure of registration or getting licence plates or insurance coverage, getting an E-bike can be a excellent option. You can pop into your regional Halfords or cycle shop and purchase one today, additionally you can buy them from Amazon and other online suppliers ... simple peasy! Electric cycling helps people cycle their method to health, physical fitness and more good days. It can help reduce the risk of a variety of health problems, from cardiovascular disease to breast cancer. In addition, electric biking gets individuals encouraged to get outside and pedal, which is great for the mind and body. Even with the electric motor, cyclists do most of the pedaling themselves and utilize the throttle to dominate hills or make headwinds a breeze. Numerous riders report that they seem like a kid again. The health advantages of electric biking consist of:. Decrease Tension-- According to the Stress Management Society (August 15, 2014), biking decreases stress and promotes relaxation. In fact, research studies have actually shown that routine workout helps reduce mild depression and anxiety. Increase Your Immunity-- Regular biking improves a body's defenses by approximately 50 percent (Appalachian State University Research Study, 2010). You're not just biking; you're riding far from germs. Reduce Danger of Illness-- Cycling can help reduce your high blood pressure and cholesterol and can even help battle cancer, diabetes and cardiovascular disease. In fact, studies suggest that riding 20 miles per week might decrease the risk of heart disease by up to half (Health Benefits of Biking, AboutBicying.com). Raise Your State of mind. Studies like one in the Journal of Cardiopulmonary Rehabilitation & Prevention (Nov/Dec, 2007) reveal that regular exercise assists reduce mild depression and stress and anxiety. Riding an folding electric bike assists release endorphins, which develop feelings of joy and ecstasy. There's no better method to increase the benefit than with a healthy dose of fun. Look ten years Younger-- Research studies have actually revealed that regular cyclists delight in the general health of somebody roughly 10 years younger (Start Biking and Look ten years Younger, 2013). Reduce Weight and Get Fit-- Cycling can burn 500 calories per hour, helping bicyclists lose or control their weight while enhancing their fitness ( The length of time & Quick Do I Need to Bike to Lose 500 Calories, 2015). Move Ahead of the Pack-- Commuting by electric bicycle is among the easiest methods to fit workout into your daily regimen because it doubles as transport while still allowing you to reach work fresh and sweat-free-- plus, it's green. And fun! In the Tour de France, equipping your bike with a small electric motor is called mechanical doping, and is thought about unfaithful. But for the rest people, an electric hybrid bike might be a method to make workout both tolerable and practical, according to an encouraging brand-new research study of bicycle commuting. Workout is essential in our lives, as we all know by now. People who are physically active are much less likely than inactive individuals to establish heart disease, diabetes, cancer, stroke, depression, impairments in old age, or to pass away prematurely. But stats show that, regardless of its advantages, a majority people never ever exercise. When researchers ask why, the majority of people use the very same two excuses-- they don't have time to fit workout into their lives or they aren't fit enough to carry out workout. Potentially, electric bicycles might deal with those concerns. Their motors support your pedaling as required-- or, with some electric bikes, do the pedaling for you-- making climbing up hills or riding for fars away less taxing and intimidating than the same ride on a standard bicycle. In the process, they could make biking a tasty alternative to commuting by car, allowing individuals with jammed daily schedules to exercise while getting to work.

But the worth of best electric bicycles has so far been primarily notional. Few people have seen, not to mention ridden, an electric bike and there is little scientific evidence supporting-- or refuting-- the prospective health benefits of using the machines. So for the brand-new experiment, which was published last month in the European Journal of Applied Physiology, scientists at the University of Colorado, Stone, chose to see what would happen if they provided a group of out-of-shape men and women zippy electric bikes and recommended that they begin riding to work. Significantly, the scientists only studied motorized bikes that help the rider instead of doing all the work for them, like a moped. They utilized electric bikes that need the rider to pedal in order to receive help from the motor. The scientists wanted to determine whether these bikes-- even with the added support of a motor-- would offer a meaningful workout for people who previously had actually not been working out much. They likewise wished to see whether such bikes were fundamentally safe, given that they enable even novice riders to achieve speeds of 20 miles per hour or higher. (The Stone city government partially funded the study as part of an assessment of whether to enable electric bikes on local bike courses. Additional funding originated from regional bike shops and Skratch Labs, a sports nutrition company in Stone.).

The scientists initially brought their 20 sedentary volunteers into the lab to examine their body structure, physical fitness, blood sugar control, high blood pressure and cholesterol profiles. Then they provided each with an electric bicycle, heart rate screen, GPS device, directions on using all of this equipment, and asked each volunteer to wear the screens and ride his/her new ebike to and from work at least 3 times a week for the next month, costs a minimum of 40 minutes in the saddle on those days. The volunteers were directed to pick whatever speed and effort felt comfy for them. Then the researchers loosed the beginner riders onto Boulder's roads and bike courses. A month later on, the volunteers went back to the lab to repeat the original tests and turn over heart rate and GPS information. All of them had actually ridden a minimum of the recommended minimum of 40 minutes three times per week and in fact, according to their display data, a lot of had ridden more than required, a number of about 50 percent more. The riders likewise had actually ridden with some intensity. Their heart rates averaged about 75 percent of each person's optimum, suggesting that even with the motor help, they were getting a moderate workout, comparable to brisk walking or a simple jog. But fortunately none had crashed and injured themselves (or anybody else). In fact, "we discovered that participants rode at a reasonable typical speed of about 12 miles per hour," said James Peterman, a college student at U.C. Boulder who led the study. Possibly most important, the riders were much healthier and more fit now, with considerably greater physical fitness, much better blood glucose control, and, as a group, a pattern toward less body fat. They also reported discovering the riding to "be a blast," stated William Byrnes, the study's senior author and director of the university's Applied Workout Science Lab. "It's exercise that is enjoyable.". Numerous individuals have actually purchased electric bikes given that the research study ended, he said. He likewise rides an electric bike to and from school. Electric bikes are not likely to be a solution for everybody who is pressed for time or hesitant to exercise, however. The best electric bicycles are pricey, generally retailing for thousands of dollars. They also offer less of an exercise than non-motorized bicycles. Mr. Peterman, an accomplished bike racer who positioned 5th in the time trial at the United States National Cycling Championships last week admits that motorized bicycles are not likely to goose the physical fitness of trained athletes. But for the many other people who presently do not exercise or have actually never considered electric bike kit commuting, there is much to be said for knowing that, if needed, you can get a little assistance pedaling up that next hill.

[enchantment1385]

INQUISITOR AS A COMPANION

I was tagged by the lovely @ironbullsmissingeye thanks sweetie! 

Inquisitor’s Name: Faeron Tamlin Lavellan & Nico Ashara Lavellan

Race / Class / Specialization: Elf 

Mage/ Rift mage/ Dreamer 

Warrior / Reaver 

Gender Identity: Faeron ~ Male - Nico ~ Female

Varric’s Nickname for them?: Faeron - Dreamy - Nico - Firecracker

Short bio: The twins are the only children of Thalion Lavellan, keeper of their clan. Thalion’s clan has freely traded with humans for sometime. However, after the chantry was destroyed in Kirkwall, tension had been slowly building before the inevitable war spilled out over Thedas, involving them by proxy. It’s decided that the twins should go to look into the situation, gather information, and offer help if it is needed. Faeron and Nico are were both brought up believing in the elven gods, and with a strict set of discipline.  Faeron was gifted with magic early in his life, and is a highly skilled mage, however his abilities as a dreamer have left some in his clan distrustful of a magic they do not fully understand.  Nico was an angry child when she developed no signs of magical talent. Her high stealth and ability to adapt quickly in any situation left her parents encouraging her to take up a bow... However, Nico had little patience and quickly took the sword instead. After many years she is now known as the clan’s strongest warrior.     Where one goes, the other will always follow. So, if you love Faeron, better get used to having Nico around, and vice versa!

Initial Card: The twins first card has the same image for both. The card would be black at the bottom fading into green at the top. There would be one of those trees, (sorry i honestly had no idea how to classify it without the picture! Elfy metal tree from the crossroads or old temples?!?)

in gold, and the twins silhouettes in a purple (Twins clan colour).  

Loyalty: After the twins loyalty mission, depending on the actions taken, the twins will either; Receive their own individual companion cards.  Or  Leave the inquisition for good.  In this case, the image will change slightly, the scene will appear darker, with all the leaves being stripped from the tree, and the branches alit with veilfire. Faeron’s silhouette would be kneeling in distress, while Nico will have her sword drawn with her other hand on her brother’s shoulder. The cards will be grayed out, and unable to be selected.  

Faeron ~ Faeron’s card would show him close-up so you could only see from his torso to his nose, he would be hanging upside down with his legs wrapped around a tree branch with a huge smile on his face. A few strands of his hair would be trailing  up his face and he would be glowing a soft silvery colour.

Nico ~ Nico would be hunched over a map laid out on a table, her sword would also be on the table, covering the far off areas (we don’t get to visit) she would be ever so slightly smirking as she pushed her brother’s face out of the scene.

Romanced: Faeron ~ What is it they say? A picture is worth a 1000 words? Well, this is exactly what his romance card would be- just done in the tarot style!

Nico ~ Nico would be looking over her shoulder, with a bare back except for some material (in purple of course!) gathered around her waist (like she just woke up and sat up in bed),  she would be smiling (YES! It does happen!) as the inquisitors marked hand stroked her hair to one side of the neck. 

Recruitment mission: Double trouble ~ On your return to Haven after your first visit to the storm coast, a cutscene will trigger in which you will meet the twins. If inquisitor is an elf ~ Nico will demand to see her clansmen is ‘safe’ with her own eyes. Faeron will be uncomfortably trying to make the situation less tense and calm his sister’s temper. If inquisitor is any other race ~ The twins will approach the party before reaching the gates, if Cassandra or Blackwall are in the party they will warn the inquisitor to be wary which will trigger a small, somewhat hilarious argument between Nico and said companion, where you can earn friendship points if the inquisitor picks either the heart option or the pleased (thumbs up option). Even if this option is not picked the twins will offer their help in the efforts to fix the hole in the sky.  

Where they would be in Skyhold / Haven: Faeron can be found sat by the fire by Varric in Haven and in the kitchen cooking once you reach skyhold. Nico can be found opposite her brother at Haven and in main hall on a table covered in maps and papers once you reach skyhold.

Personal quests: Twins mission ~ The Halla and the hound War table, ‘We have received word from the twins father, asking for assistance with a local lord who is causing… Trouble’   Advisor Options Leliana ~ I can spare a few of my best scouts. They can move quickly and fully assess the situation. They can also think on their feet if the need arise. Josephine ~ Ah yes. Lord Bran Perrin. He is young and… Disliked by many due to his attitude. Perhaps I can speak with a neighbouring lady I know, who holds a personal grudge? She could threaten a scandal if he does not ‘back off’? Cullen: Sneaking around and noble bickering won’t solve the real problem! Send in a small group to stand guard for a few weeks let this ‘Lord’ 👀 the clan is under inquisition protection! Any action taken against the clan will also be seen as a move against the inquisition and will be treated as such. Whichever action taken you will receive a letter from the lord requesting a meeting. The young arrogant git… I mean lord, offers you a cut of the newly imparted taxes he is now levying and says ‘If they can not provide coin we will have to find more... creative ways of receiving ‘payment.’ The inquisitor can; Side with the twins: Which leads to Nico headbutting the lord and Faeron sending a small lightning bolt shocking the him before the inquisitor forcibly recruits him *Bran can be found shoveling dung at the stables if this option is chosen.  Faeron and Nico both Greatly Approve. Side with Lord Bran: Which ends with Nico telling the inquisitor exactly what he can do with the 💰. Faeron will turn and walk away sadly. Faeron and Nico both Greatly Disapprove This will also have further consequences on returning to Skyhold.   Kill Lord Bran: This option does not have any lasting consequences nor does it offer any boons. Faeron Slightly Approves ~ Nico Approves   The twins personal missions will not trigger unless one is romanced. 

Faeron ~ Chasing the dream(er) If the inquisitor is pursuing a romance with Faeron after a certain point has been met, through banter and mission progression, will appear to become quite withdrawn from the inquisitor and will not be found with Nico, or in his usual spot in skyhold. As such the inquisitor will have to search the grounds and ask the companions if they have seen Faeron. After talking to all the companions and advisers, Faeron can be found in the undercroft sitting alone at the edge overlooking the waterfall, and in some distress. After approaching a cutscene will trigger with Faeron explaining about a mistake made long ago, a mistake that still haunts him (quite literally) to this day, a mistake that almost cost Faeron, Nico and their clan their lives. Faeron was almost killed in this experience and lost control of his magic, killing several men. Faeron still relives the experience in his darkest nightmares, and is terrified that the inquisitor may be drawn into one of these nightmares and think less of him or worse be hurt in the process.  The inquisitor has the choice of - Ending the relationship OR   Kiss Faeron telling him wherever life takes them, it’s now together. 

Nico ~ Loves a Bitch  The inquisitor if pursuing a relationship with Nico has had to sleep with her once before this mission will trigger.  Once the inquisitor has slept with Nico she can be found in the courtyard sparing with Bull. At the end of the sparing the two will briefly flirt.  Nico will appear happy enough but will not bring up the encounter, when asked she will simply reply something along the lines of ‘I assumed that was out of our system, and we simply move on now.’  The inquisitor can leave things as they are OR Can press for more than a one night stand.  If this option is chosen Nico will laugh and say words of ‘love’ are meaningless, if you really want more, you have to best her in combat.  The inquisitor will be forced to ask for help from the others in terms of strategy. (Faeron’s advice is priceless!) One the inquisitor has spoken to all the companions, a rather awesome or hilarious (depending which choice the inquisitor chooses) ‘Battle’ will ensue.  

Approval / Disapproval:

Faeron is pro people, any decision that will benefit an innocent will gain friendship points from him. He is somewhat pro mages but not anti templar. He approves of kind and friendly Inquisitors. Faeron is sweet and flirty. He disapproves of evil inquisitors. Nico is pro inquisition, any decision made that strengthens your army. Recruiting any new companion, gaining resources, or upgrade made on skyhold will gain friendship from her.  Nico is somewhat neutral when it comes to the mages/templars, but does believe in greater freedom for the mages. Nico can be blunt if she dislikes the inquisitor and will appear as somewhat cold until you reach skyhold. She disapproves of evil inquisitors. 

Break down Approval Ratings for Major Missions:

                                  Faeron  ~   Nico If sided with the mages:

-Conscripted mages: Greatly disapproves ~ Disapproves

-Free mages: Greatly Approves ~  Approves

If sided with the Templars:

-Disband the Templars: Disapproves ~ Disapproves

-Ally with the Templars: Slightly Approves ~ Approves

In Wicked Eyes and Wicked Hearts:

-Celene lives: Greatly Approves ~ Approves

-Celene dies: Greatly Disapproves ~ Disapproves

In Here lies the Abyss

-Grey Wardens join the Inquisition: Approves ~ Greatly Approves

-Grey Wardens banished: Greatly Disapproves ~ Greatly Disapproves

Other (Optional):

-Cole joins:  Approves ~ Slightly Disapproves

-Cole is not allowed to stay: Disapproves ~ Slightly Approves

-Saves the chargers: Greatly Approves ~  Approves -Saves the dreadnought: Greatly Disapproves ~ Disapproves - Drink from the Well: Inquisitor Drinks: Approves ~ Slightly Approves  Romanced Inquisitor Drinks: Slightly Disapproves ~ Approves

Morrigan Drinks: Greatly Disapproves ~  Slightly Disapproves

Are they romanceable? Yes. Both twins are both romanceable by any male inquisitor.  Faeron’s friendship route with a female inquisitor is very much like Dorian’s. Many of the flirt options will still be open.

Can you have sex with them?  Does a bear shit in the woods?  Faeron only if romanced Nico can be a one night stand with no negative consequences or be pursued further into a romance. 

Are they open to polyamory?: Probably not. Faeron is too insecure and Nico is too territorial to share. 

Relationship with the other characters?

                  Faeron   ~     Nico

*Cassandra: Neutral  ~  Friendly  

*Varric: Friendly ~  Neutral

*Solas: Averse/ wary ~ Friendly

*Dorian: Friendly ~ Neutral

*Vivienne: Neutral  ~  Neutral

*Blackwall: Friendly ~  Neutral

*Iron Bull: Friendly ~  Friendly

*Sera: Friendly ~ Averse

*Cole: Friendly ~  Neutral / wary

Others: (optional)

*Leliana: Neutral  ~  Friendly  

*Josephine: Friendly ~  Neutral

*Cullen: Neutral  ~  Friendly  

*Morrigan: Averse ~  Neutral

Side Missions:  Faeron ~ A feast like no other! Faeron is a great cook and has been dying to make use of skyhold’s impressive kitchens since your arrival. And how better than by preparing a feast! However, to make the feast ‘like no other’ you’re going to need to go shopping for some... Odd ingredients. 

Nico ~ Training day There a certain places where one should not tread... At least if you hope to keep all your blood on the inside anyway! Nico has asked to visit some of the more... ‘Perilous’ places to put herself through some serious training! And she’s kindly invited you to come along too... Great.

Special Events: Imprisoned at Redcliffe: How is your Inquisitor holding up in Redcliffe, being slowly infected with red lyrium over the course of a year?

Faeron would be a lot darker than before. Almost as if the darkness inside him he kept locked away with light and laughter, would be breaking through. He would physically shake his head a lot to try and remember himself, and make small quips about how green was never his colour. He would gladly give up his life if it meant saving the inquisitor, and resetting time. 

Nico would just be angry and looking for revenge on those who infected her. A pissed powerhouse of anger. 

At the Winter Palace: Does your Inquisitor enjoy the party, any special events with them at the Palace? Faeron would be enraptured by it all! The pretty-ness of everything. The food and wine! And Dancing OH! He LOVES to dance! His big eyes would be twice the size and shining brightly. He would complain about his suit though, and how daft he feel he looks in it!

Nico would be scheming. Listening, annnnnd probably threatening anyone who mistook her or Faeron as servants. She’d find the whole thing crass.

Both would have a dance scene if romanced. 

In the Fade: Your Inquisitor’s reaction upon entering the Fade? Archdemon’s taunt, and Inquisitor’s response? Epitaph on their grave?

Faeron Upon entering ~ Oh... Balls. And things were going SO well too! Well, apart from the murious wardens thing... and the big dragon..

Archdemon taunt   Shall we let Nicolas out to play Lavellan? He always was much more fun than you. (Evil laugh)   Inquisitor’s response? Alas, you’re not his type. The melting face thing isn’t a good look.

Epitaph on their grave? Faeron died screaming in his sleep.

Nico Upon entering If Faeron is NOT present - I wish Faeron was here... If Faeron is present - This is your stomping ground isn’t it? Gods, you are way more messed up and I realised...    

Archdemon taunt You’ll never be able to protect him forever Nico... Faeron will die, and you will be powerless. Inquisitor’s response? I’d like to see you make those threats again once I smash all your teeth down your throat...

Epitaph on their grave? Nico a weak feeble knifear.    

Other Major Events: Any other major events that happen with them over the course of the main game? Banter: (If Faeron is in a romance with the inquisitor) Nico ~ Faeron, wha… What are you doing? Faeron ~ I think the proper term is ‘Fawning’. *Sighhhhh* Inquisitor ~ What have I told you about being adorable in public, 😍? Faeron ~ *Giggle* Nico ~ I’m going to be 😷… (If Nico is in a romance with the inquisitor) Faeron ~ *Cute noises* Nico ~ Wha-? Heh- What was that noise for?! Faeron ~ I’m just.. I’m so -. You two, It’s just so-.. *snuff snuff* Nico ~ … Faeron? Are… You 😭? Faeron ~ … *Sob*. Nooo…. Maybe. Cole (if present) ~ He is happy. He likes 👀 you both 😁. It makes him 😁 too. Sera (if present) ~ *laughs* You soppy tit! Dorian (if present) ~ Now that is precious. Varric (if present) *chuckling* Come here dreamy! There there. You are way too soft for this 💩. 

Okay... That.. that was a LOT! (Sorry!)  Tagging @heraldofwho @keeperscompanionsdai @dreadhobo @kagetsukai @john-cousland @gugle1980  @dinah-myles @tessa1972 No pressure as always guys!!

[lowryjacobs7-blog]

Chapter 3.

If you're not sure whether you're an excellent prospect for a bust lift, take into consideration some of the most typical reasons why females are having this procedure done. Below alright, currently exactly what I'm going to do is I'm going to lift my heels up alright, I'm gon na lift my legs up till my body forms a straight line right here utilizing my lower back and my glutes. As they docked at the pier, the skipper again lifted her bag before nicely assisting her down onto the wood jetty. It's the system that power business intervenors standing for some 10 percent of U.S. generation, joined by amicus Preeminence Resources, have actually stepped in to safeguard right here. Checks out the globe of a boxing health club in Austin, Texas, home on the technique of training as people from all profession desire reach their personal ideal. 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When you fight in a gym you're never really dealing with one more gamer: the defending Pokémon are managed by an AI, as are yours later, when they're resident in the gym and defending. This is a listing of publications, ideas, and also authors stated in The Power of Fifty Bits, which could be useful for future analysis. The court action was brought by the Workplace of Fair Trading versus Ashbourne Management Provider, which prepares arrangements and also gathers payments from gyms with an overall of more than 500,000 participants. Power Tattoo ® suggest une toute nouvelle façon de jouer et permet aux 7-12 ans de s' affronter n'importe où, n'importe quand. Members of the gym teams are currently able to terminate their contracts early need to their circumstances alter in such a way that makes presence at the gym hard or expensive. The Turtles were transformed bad and teleported from New York by Astronema to infiltrate the Astro Megaship as well as take control of it to destroy the Power Rangers. Yet the most unpleasant aspect of the power mystery is that even if an individual increases to power by counter-Machiavellian means-- kindness, kindness, concern with the usual excellent-- power itself will eventually warp her priorities and make her much less kind, less generous, much less concerned with the typical good, which will certainly in turn erode her power as her reputation for these counter-qualities grows. studiosante of this kind are smaller sized and also lighter compared to systems with weight stacks. As an individual thinker and also one to examine sacred as well as old facts, I use this statement: that power is damaging to autonomy, that it has the propensity to neglect the rate of interests of the people, as it grows the people pass away, as it recedes the flower of freedom flowers. 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When selecting a gym or gym, it could be best to visit the extra costly areas. Great no rubbish suggestions and also workouts for any individual that doesn't prefer to go to the health club or workout with weights. The oppositions next case is that EPA is totally prevented from restricting nuclear power plant' harmful carbon pollution because EPA has currently made use of another part of the regulation-- Area 112-- to curb the very same plants' emissions of mercury and various other hazardous air contaminants. Citizens Recommendations highlighted a common problem that individuals joining health clubs can fail to understand that they were authorizing a credit report arrangement. Most of the pain associated with DOMS occurs when you lower a raised weight and subject your muscles to a type of tightening called an eccentric tightening. We obtain a capacity making a distinction in the world by improving the lives of others, yet the very experience of having power and also advantage leads us to behave, in our worst moments, like spontaneous, out-of-control lunatics. There is an alternative now to select 6x2 chassis or 6x2 chassis with lift-able axles (raised axles stay clear of unnecessary tire wear when the weight circulation stays within lawful limitations). This exercise tools is frequently gone along with by a display screen that tracks the heart rate,. in addition to various other details like the variety of miles run or calories shed. Il est vrai que j' y consacre a peu prés 4 heures par semaine chez moi en musique et je peu vous dire que je ne rate aucune séance tant je me sens bien après mon heure de power plate. There are other basic attributes of veranda PL-P mobile mobility device lift are as complies with. The High court currently chose that question also in American Electric Power v. Connecticut, in 2011. Both gyms have actually walked around the central city location of Sparkhill as well as cater for a largely Muslim clients. The Lumo Lift expenses ₤ 80 in black, grey as well as white with black as well as silver magnets. To the teacher's surprise, just what need to emerge from the subsequent chain reaction but 3 little women: bright and also useful Bloom (voice of Cathy Cavadini), pleasant as well as sunny Bubbles (voice of Tara Solid), as well as tomboyish Buttercup (voice of Elizabeth Daily). Right as blade cuts hung the broken strings of the unused internet, threaded here and there with wheels of silken webs. It took a little convincing, but the Rangers established Auric right, and now he gets on their side. Today, I'm midway via The Power and must say that it is a combination of points I needed to be advised of and afterwards some things I really did not fairly understand. You can obtain a complete body workout in about 20 minutes with the Bowflex Sporting activity house health club if you use it right.

[jgkoomey]

Talking Sense About Bitcoin Electricity Use

There’s been a lot written over the past couple of years about the electricity used to mine Bitcoin, the most prominent of many cryptocurrencies. I can best summarize the credibility and tone of that coverage with the following headline from Newsweek:

Bitcoin Mining On Track To Consume All Of The World’s Energy By 2020

This kind of headline makes me cringe, because it’s

1) an invalid extrapolation of oversimplified calculations that are no better than guesses that may mislead investors into taking rash actions; and (less importantly)

2) Bitcoin mining uses electricity, not (usually) other forms of energy.

I’ve been studying the electricity used by computing equipment for more than two decades, so I have some things to say about this latest outbreak of people taking leave of their critical faculties.

I’m also the author of an award winning book on critical thinking skills (among many other books and articles), recently out in its 3rd edition (Turning Numbers into Knowledge: Mastering the Art of Problem Solving, October 1, 2017).

In this post, I lay out my thoughts about how sensible people can avoid being misled by the hype machine on Bitcoin electricity use. I created a blog page that lists the recent links I’ve been able to find on this topic, which you can find here.

I’m making no judgment here about whether Bitcoin is something that society shouldbe doing, just focusing on the narrow question of what we know about the estimates of electricity used by Bitcoin currently making the rounds.

PRELIMINARIES

Bitcoin is what’s called a “cryptocurrency”, which is a digital medium of exchange and a store of value under decentralized control (unlike traditional currencies that are created and regulated by governments). The technology underlying Bitcoin and other cryptocurrencies is what’s called “block chain”, which is a decentralized way to establish and maintain trust among people interacting with each other.

Bitcoin is a public, permissionless block chain that uses what’s called “proof of work” to establish this trust. There are other types of block chains, and in some cases these can be designed to be less computationally and energy intensive than Bitcoin. I’ll explore the implications of this fact below.

There are at least a couple of credible academic studies of Bitcoin electricity use (O’Dwyer and Malone 2014 and Vrankan 2017), but things change so fast in this field that estimates become outdated in weeks or months.

BRANDOLINI’S LAW GOVERNS

In 2014, and Italian software developer named Alberto Brandolini made the following trenchant observation, which has come to be known as Brandolini’s law, or the BS asymmetry principle (where BS stands for bull manure in polite company):  

The amount of energy needed to refute BS is an order of magnitude bigger than to produce it.

This “law” encapsulates one important reality of living in the digital age: it’s easier to create ostensibly accurate but incorrect numbers than it is to demonstrate why such numbers are invalid. That is the nature of careful analysis, but people have come to expect instant answers on new topics, even when there isn’t any real data or research. That’s the case for Bitcoin electricity use, which has emerged as a topic of wide public interest only in the past couple of years.

My corollary to Brandolini’s law is that

In fast changing fields, like information technology, BS refutations lag BS production more strongly than in fields with less rapid change.

This corollary places special obligations on media producers and consumers (Koomey 2014).

KNOW YOUR HISTORY

Information technology changes at a much more rapid pace than many other technologies (Nordhaus 2007, Koomey et al. 2011, Koomey et al. 2013, Koomey and Naffziger 2016). Unfortunately, innumerate observers love to mindlessly extrapolate rapid exponential growth rates to create “clickbait” headlines like the one in Newsweek I cited above. There’s also a tendency to assume that because information technology is economically important that it also must use a lot of electricity, but that’s just not the case.

Here are a couple of historical examples.

In 2003, writing in IEEE Spectrum, I cited an anecdote from Andrew Odlyzko, formerly at AT&T, now at the University of Minnesota (Koomey 2003). Odlyzko documented the genesis of a familiar “factoid” from the mid-1990s (“the Internet doubles every 100 days”) that led to a substantial overinvestment in the fiber optic network. This misconception

was based on data reported by UUNet, the first commercial Internet service provider, in the mid-1990s. In those days, at least for a brief time, such growth rates actually prevailed. But for almost all the rest of the 1990s, data flows were doubling only every year or so, as documented by Kerry Coffman and Andrew Odlyzko of AT&T Corp. and reported by The Wall Street Journal in 2002.

The difference between the two growth rates is huge: because of the magic of compounding, a doubling of traffic every 100 days translates into growth of about 1000 percent a year, rather than the 100 percent-a-year growth represented by an annual doubling.

During the dot-com boom, industry leaders, investment analysts, and the popular press repeated that gross overestimate of the growth of Internet data flow. The bogus figures helped justify dubious investments in network infrastructure and contributed greatly to overcapacity in the telecommunications and networking industries. Only a tiny fraction of this network capacity is now [circa 2003] being used, and billions of dollars [were] squandered because of blind acceptance of flawed conventional wisdom.

Misleading factoids about information technology electricity use emerged from coal-industry funded studies around the year 2000, at the time of the first dot com bubble and the California electricity crisis. They popped up again, from the same authors and funders, in 2005and 2013. The claims were reported in every major newspaper, cited by investment banking reports and politicians of both political parties, and avidly promoted by people and companies who should have known better.

The authors claimed that the Internet used 8% of US electricity in 2000, that all computers (including the Internet) used 13%, and that the total would grow to 50% of US electricity in 10 years. The authors also claimed that a wireless Palm VII used as much electricity as a refrigerator (later updated to an iPhone using as much electricity as TWO refrigerators) for the networking to support its data flows.

All of these claims turned out to be bunk, but it took years of creating peer reviewed research to prove it. We found that the Internet (defined as those authors defined it) used only 1% of US electricity in 2000, all computers used 3%, the total would never grow to half of all electricity use, and that the factoid about the wireless Palm VII overestimated networking electricity by a factor of 2000. In virtually every case, we found that those authors had overestimated electricity used by computing equipment. For a summary of these claims and a review of their effects on investors, see the Epilogue to the 3rd Edition of Turning Numbers into Knowledge.

These examples came to mind when I first heard about recent claims about Bitcoin electricity use, but the Bitcoin issue has some unique features.

BEWARE OF HAND WAVING ESTIMATES

The web site Digiconomist is the source for many media estimates of Bitcoin electricity use. The site is the creation of Alex de Vries, an economist in the Netherlands, and he summarizes his estimates in the form of his “Bitcoin consumption index”. Figure 1 is a screen shot of that index for roughly the past 16 months, showing TWh (terawatt-hours or billion kWh) on the Y-axis and time on the X-axis:

One important feature of cryptocurrency electricity use is that you need to specify the exact day to which your estimate applies. That’s because Bitcoin mining is increasing rapidly over time, so generating a monthly or annual average isn’t accurate enough. Such growth makes estimates from only a couple of years back less useful for estimating current day Bitcoin electricity use than you might expect.

De Vries recently published a commentary article in the journal Joule, in which he summarized the method for generating the Bitcoin consumption index. De Vries is able to create a time series day by day because he generates the index using following data:

1) the price of bitcoin over some time period (it was about $6300 as of today, October 29, 2018);

2) the number of Bitcoins mined over that same time period;

3) an assumption about the percentage of the bitcoin price that is electricity (60%), which would include both direct electrcity use for bitcoin mining rigs and the supporting infrastructure electricity(cooling, fans, pumps, power conversion, etc); and

4) an assumption about the price of electricity (5¢ US/kWh)

Figure 1: Digiconomist Bitcoin Energy Consumption Index

The price of bitcoin over some time period times the number of Bitcoins mined in that period (plus transaction fees) gives total revenues, which are multiplied by 60% to get electricity expenditures. Those expenditures are divided by the assumed electricity price to get electricity consumption of the network in TWh.

The calculation has the advantage of being tractable using available data, but it relies on assumptions about economic parameters and Bitcoin miner behavior (e.g., optimal allocation of mining resources) to estimate physical characteristics of a technological system.

Calculations like these set off alarm bells for me. Economic parameters (like Bitcoin prices) are volatile, and are at best imperfectly correlated with electricity use. In real economic systems, there may be a tendency towards optimality, but they often don’t get close because of transaction costs, cognitive failures, and other imperfections in people and institutions. In addition, the assumptions used by Digiconomist are so simplistic as to make any credible analyst wary.

DOING IT RIGHT

The more direct way to estimate electricity used by equipment is to understand the characteristics of the underlying computing, cooling, and power distribution equipment using field data (as we did for our most recent data center report). Unfortunately, aside from a few anecdotes in the trade and popular press, there’s little information on Bitcoin mining operations.

The servers used for Bitcoin mining are nowadays customized for just that application, and they bear little resemblance to standard server hardware installed in corporate or hyperscale data centers. Because these custom servers have not been tracked by the big data providers (like IDC and Gartner), we have only guesses/estimates as to how many are being built. We know almost nothing about where they’re being installed. And our knowledge of the power systems and cooling equipment in these facilities is virtually nil.

These data issues make it hard to create accurate estimates of electricity used by Bitcoin mining in the aggregate. This is probably why de Vries used his simplified economic approach to generate his index, but that doesn’t mean this method is a reliable indicator of Bitcoin electricity use.

Marc Bevand, an “analyst and crypto[currency] entrepreneur”, critiqued the Digiconomist estimates on February 1, 2017. Most importantly, he expressed concern over the arbitrary choice of 60% of revenues being electricity, and showed a range in his data (based on real equipment) of between 6.3% and 38.6%. Using a more refined approach and more detailed information about the characteristics of Bitcoin mining rigs over time, he estimated Bitcoin electricity use for February 26, 2017, July 28, 2017, and January 11, 2018. Figure 2 compares the Bevand and Digiconomist estimates for those three days.

Bevand did not generate day by day estimates for the intervening periods as Digiconomist does, but these three data points are enough to teach some important lessons. Both sources show growth of about fourfold between February 26, 2017 and January 11th, 2018. That’s rapid growth compared to conventional end-uses, so it’s not surprising that Bitcoin is getting more attention. The big difference is in the absolute electricity consumption. Bevand’s estimates are less than half of the Digiconomist estimates. They also are far more technically detailed and less dependent on high level arbitrary assumptions, which makes them more trustworthy, in my view.

Another important finding from this graph is the relative scale. The world used 21,200 TWh/year in 2016, the latest year for which I could find historical data, and this number increases by only a few percent a year, if history is any guide. This means that on January 11, 2018, Bitcoin accounted for about 0.1% of global electricity if Bevand’s numbers are correct.

Figure 2: Comparison of Digiconomist and Bevand Estimates of Bitcoin Electricity Use

IT’S NOT A CRISIS, BUT MORE RESEARCH IS NEEDED

According to the International Energy Agency, data centers and global networking equipment each accounted for about 1% of global electricity use in 2014, for a total of 2% (IEA 2017). In addition, growth in electricity use for data centers appears to have slowed substantially in recent years, as is also true for the US (Shehabi et al. 2016). Because of inefficiencies in current corporate data centers, little if any growth is expected for electricity use of data centers as a whole over the next couple of years.

Mining Bitcoin accounts for about 0.1% of global electricity use if Bevand’s estimates are correct, implying that total data center electricity use is about 5% bigger than what IEA estimates (Bitcoin isn’t included in those figures). Without better data, it’s hard to be any more precise than that.

Recent growth rates for Bitcoin mining are substantial, and if that growth continues at anywhere near current rates, Bitcoin electricity use will become more important soon. Continued growth in Bitcoin mining electricity use depends on the price of bitcoin, the difficulty of mining Bitcoin (which goes up as mining speed goes up), and the rate of efficency improvements in Bitcoin mining rigs. It also depends on electricity prices, the cost of mining equipment, and the continued laissez-faire attitude many governments have about Bitcoin (which could change quickly, but no one can predict if or when that might happen).

One thing we should NOT do is recklessly extrapolate recent growth rates for Bitcoin into the future, as the Nature Climate Change article coming out today appears to do (Mora et al. 2018). I cannot emphasize enough how dangerous, irresponsible, and misleading such extrapolations can be, and no credible analyst should ever extrapolate in this manner, nor should readers of reports on this topic fall for this well-known mistake.

Another big uncertainty is that we know even less about other cryptocurrencies than about Bitcoin, so more research is clearly needed there. The electricity use for non-Bitcoin cryptocurrencies should be tallied, both because the total is important and because these other cryptocurrencies (which can be MUCH more energy efficient than Bitcoin) may represent competition to Bitcoin if the electricity demands of Bitcoin become unmanageable.

We urgently need measured data about Bitcoin mining facilities in the field, including characteristics of Bitcoin mining rigs and the power and cooling infrastructure needed to support them. The Digiconomist estimate uses very high level assumptions and data to estimate electricity use, while Bevand creates a more detailed technical estimate, but neither includes much if any field data on actual equipment in real facilities. If we’re to get a better handle on Bitcoin electricity use, such field studies and data are vital.

A colleague (Professor Eric Masanet) and I have secured a small amount of funding to investigate the implications of block chains for electricity use, and that project begins in November 2018. To do such analyses properly (as we did in 2007, 2008, 2011, 2013, and again in 2016 for US data center electricity use) takes teams of scientists and hundreds of thousands of dollars, so it’s no surprise this emergent issue hasn’t yet been carefully studied (EPA 2007, Koomey 2008, Masanet et al. 2011, Masanet et al. 2013, Shehabi et al. 2016). Policy makers naturally want answers quickly, but until more research is funded, there’s not a whole lot more we can say about this issue.

OTHER LESSONS

While I encourage everyone in the electricity sector to track Bitcoin as a potential source of new load growth, please use caution and avoid being misled by the hype. Breathless media coverage papers over the uncertainties in the underlying data, and makes it seem like Bitcoin is taking over the world, but in fact it’s likely only 0.1% of global electricity consumption, and it is unlikely to continue growing at recent historical rates.

Because the rate of change in Bitcoin electricity use can be rapid, it is critically important that no estimates of electricity use be cited or reported unless the day to which that estimate applies is also reported. It is not sufficient to report the year in which an estimate applies, because things change so fast.

If there are many mining facilities proposed in a utility service territory, I suggest that they be charged the full cost of transmission and distribution infrastructure investments up front. Bitcoin mining can disappear just as fast as it rose to prominence, and you don’t want ratepayers to be left holding the bag. I’m not predicting that outcome, just pointing it out as a possibility with real risks to utility ratepayers.

If Bitcoin electricity use becomes more important, we’re likely to face questions about whether to allocate limited zero emissions generation resources to power it. If we use it for Bitcoin, we can’t use it elsewhere, so we’ll have to choose. This concern should factor into the needed societal conversation about whether cryptocurrencies are something we should as a society encourage.

The method for ascertaining trust for Bitcoin is needlessly computationally intensive, and other cryptocurrencies have taken a different tack. Resource intensity can be reduced substantially (i.e., by orders of magnitude) with software and protocol redesign, so it’s not just a question of hardware efficiency. As use cases for cryptocurrencies emerge, we’ll need to confront the possibility that more efficient cryptocurrency designs may be a better fit than Bitcoin for a low emissions world.

CONCLUSIONS

It’s still early days for cryptocurrency and the data on its electricity use are still too poor to derive firm conclusions. The issue bears watching, but caution is indicated, particularly when large investments are involved (like for transmission lines and distribution transformers for new bitcoin mining facilities). Media observers should beware of mindless extrapolations of recent trends, as such simpleminded methods can lead to consequential mistakes. At this point (as of January 11, 2018), Bitcoin mining accounts for about 0.1% of global electricity use, but recent growth has been rapid. What happens next is up to us.

ACKNOWLEDGMENTS

Professor Harald Vrankan of the Open University of the Netherlands and Jens Malmodin of Ericsson gave comments on an earlier version of this blog post. The author is responsible for the blog post itself and any errors contained herein.

REFERENCES

IEA. 2017. Digitalization and Energy. Paris, France: International Energy Agency.  [https://www.iea.org/digital/]

Koomey, Jonathan. 2003. "Sorry, Wrong Number:  Separating Fact from Fiction in the Information Age." In IEEE Spectrum. June. pp. 11-12. [http://ieeexplore.ieee.org/xpls/abs_all.jsp?arnumber=1203076&tag=1]

Koomey, Jonathan. 2008. "Worldwide electricity used in data centers."  Environmental Research Letters.  vol. 3, no. 034008. September 23. [http://stacks.iop.org/1748-9326/3/034008]

Koomey, Jonathan G., Stephen Berard, Marla Sanchez, and Henry Wong. 2011. "Implications of Historical Trends in The Electrical Efficiency of Computing."  IEEE Annals of the History of Computing. vol. 33, no. 3. July-September. pp. 46-54. [http://doi.ieeecomputersociety.org/10.1109/MAHC.2010.28]

Koomey, Jonathan G., H. Scott Matthews, and Eric Williams. 2013. "Smart Everything:  Will Intelligent Systems Reduce Resource Use?" The Annual Review of Environment and Resources.  vol. 38, October. pp. 311-343. [http://arjournals.annualreviews.org/eprint/wjniAGGzj2i9X7i3kqWx/full/10.1146/annurev-environ-021512-110549]

Koomey, Jonathan. 2014. "Separating Fact from Fiction: A Challenge For The Media." In IEEE Consumer Electronics Magazine. January. pp. 9-11. [http://ieeexplore.ieee.org/xpl/articleDetails.jsp?arnumber=6685864]

Koomey, Jonathan, and Samuel Naffziger. 2016. "Energy efficiency of computing:  What's next?" In Electronic Design. November 28. [http://electronicdesign.com/microprocessors/energy-efficiency-computing-what-s-next]

Masanet, Eric R., Richard E. Brown, Arman Shehabi, Jonathan G. Koomey, and Bruce Nordman. 2011. "Estimating the Energy Use and Efficiency Potential of U.S. Data Centers."  Proceedings of the IEEE.  vol. 99, no. 8. August. [https://eta.lbl.gov/sites/all/files/publications/lbnl_version_procieee_embargoed-1-1.pdf]

Masanet, Eric, Arman Shehabi, and Jonathan Koomey. 2013. "Characteristics of Low-Carbon Data Centers."  Nature Climate Change.  vol. 3, no. 7. July. pp. 627-630. [http://dx.doi.org/10.1038/nclimate1786]

Mora, Camilo, Randi Rollins, Katie Taladay, Michael B. Kantar, Mason K. Chock, Mio Shimada, and Erik C. Franklin. 2018. "Bitcoin emissions alone could push global warming above 2°C." Nature Climate Change. October 29. [https://doi.org/10.1038/s41558-018-0321-8]

Nordhaus, William D. 2007. "Two Centuries of Productivity Growth in Computing." The Journal of Economic History. vol. 67, no. 1. March. pp. 128-159. [http://www.econ.yale.edu/~nordhaus/homepage/homepage/nordhaus_computers_jeh_2007.pdf]

O’Dwyer, Karl J., and David Malone. 2014. Bitcoin Mining and its Energy Footprint. Proceedings of the ISSC 2014/CIICT 2014 Conference. Limerick, Ireland: June 26-27. [http://eprints.maynoothuniversity.ie/6009/1/DM-Bitcoin.pdf]

Shehabi, Arman, Sarah Josephine Smith, Dale A. Sartor, Richard E. Brown, Magnus Herrlin, Jonathan G. Koomey, Eric R. Masanet, Nathaniel Horner, Inês Lima Azevedo, and William Lintner. 2016. United States Data Center Energy Usage Report. Berkeley, CA: Lawrence Berkeley National Laboratory. LBNL-1005775.  June. [https://eta.lbl.gov/publications/united-states-data-center-energy]

US EPA. 2007. Report to Congress on Server and Data Center Energy Efficiency, Public Law 109-431. Prepared for the U.S. Environmental Protection Agency, ENERGY STAR Program, by Lawrence Berkeley National Laboratory. LBNL-363E.  August 2. [http://www.energystar.gov/datacenters]

Vranken, Harald. 2017. "Sustainability of bitcoin and blockchains."  Current Opinion in Environmental Sustainability.  vol. 28, no. Supplement C. 2017/10/01/. pp. 1-9. [http://www.sciencedirect.com/science/article/pii/S1877343517300015]

[veronicasanders]

Mental Health Resources

Hey everyone! This is a reminder that your mental health is incredibly important, and if you are going through something or suffering from a mental illness, seeking out help is an incredibly brave, responsible move and the best way possible to love yourself.

Please remember that there is always help to be had. Take care of yourselves. You are worth it. (And feel free to add to the list or send in suggestions!)

The Trevor Project - crisis intervention and suicide hotline for LGBTQ+ youth. The Trevor Project has a phone number to call, [866-488-7386] or a feature where you can text them from your phone, and even a chat system that works best from a computer. For the texting and chat features, click here.

More resources after the jump. (Please keep in mind that the majority of these services are U.S. based. If you’re outside the U.S. and know of other resources, please feel free to add to the list. Also, we encourage you to do more research and ask questions if you are feeling lost.)

Love, Veronica and Cunt

CC: @theofficialcunt

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Hotlines - This link has many hotlines for a range of crisis issues, along with chat services.

Warmlines - these are numbers to call if you are not in crisis, but just need someone to talk to. They are mostly peer-run services staffed by people in recovery for whatever they specialize in, whether that be mental illness, substance abuse, etc. Master List by state.

Depression Checklist - If you are planning to seek out formal therapy and counseling - which we would always recommend if you think something might be wrong, but you feel a little lost about where to begin, one of the things you could start with is a depression checklist. This is meant to help you and your therapist assess whether you are depressed, and how severe it is - and what other physical or emotional factors are involved. It also can help give you an idea of some symptoms that they check for which might not be related to depression in your mind. (Thing like forgetfulness, restlessness, impatience, etc.) There is a great interactive one at BeyondBlue.org.au - which is an Australian website that can also give you local resources if you are in Australia, and there’s another checklist at YourLifeCounts.org that describes symptoms health care providers will be looking for.

General Depression Info - More information about depression and some additional hotlines.

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Paid Services/Apps:

·       Brightside: app/website that connects you to a therapist or psychiatrist remotely. This is pretty reputable but not terribly cheap.

·       Talkspace: On-demand therapy (and couples’ therapy) sessions via video chat or text within 24 hours, as cheap as $25/session.

·       BetterHelp: There are a variety of plans starting from $35 a week, but the idea is that you have a virtual “room” where you record your thoughts and then the licensed counselor checks into the room to give you feedback, insight, and ask questions.

·       Huddle: Basically online group therapy - a safe space to talk to peers going through the same issues as you. I believe it’s free once you pay for the app.

·       Moodnotes: This app uses the principles of Cognitive Behavioral Therapy (CBT), using actions to help correct the faulty or negative thinking patterns that lead to negative behavioral patterns. It is sort of a cross between therapy and journaling. It’s less than $5 so it’s a great way to cheaply dip your toe in the waters without breaking the bank - and the bonus is that you can do it as much as you like.

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LGBTQI+ Resources

·       Pride Counseling: Online counseling specifically for all members of the LGBTQI+ community. 1000+ licensed therapists include many LGBT individuals and others who specialize in helping individuals work through questions of gender, sexuality and identity. (From the makers of BetterHelp)

·       7 Cups: FREE. A friendly and supportive online LGBTQ community that is free and easy to access. Talk to someone in a 1-1 chat, or join our LGBT chat room to chat with others who understand what you're going through. You can get support with exploring your sexuality, gender identity or coming out. They have many people across the LGBTQ spectrum. Do you identify with any of the following labels? Lesbian, gay, bisexual, transexual, transgender, pansexual, gender neutral, queer, asexual, or any others. Offers free, 24/7 support today.

·       Verena: The app helps users locate police stations, hospitals, shelters, and other safe havens during emergencies and times of need. Users can also designate a list of contacts for Verena to alert in an emergency. As a developer and LGBTQ ally, Southworth is conscious that some members of the LGBT community aren’t out or open about their identity. To accommodate people who desire privacy, Verena contains clever UI/UX features which users can engage to conceal Verena’s real purpose from intolerant and/or nosy friends or family members.

·       GLBT National Help Center: A great resource for folks identifying across all ends of the LGBTQ spectrum, the GLBT National Help Center includes information on everything from mental health support resources to educational materials and community organizing. One of the center’s best resources is its online volunteer-run chat room. All chats are confidential (read: no transcripts or recordings are saved).

·       QSPACES: QSPACES, helps to connect people to LGBTQ-friendly healthcare providers. Founders Nic Anthony and Catherine Hofman started the company after discovering that many of their friends and community members were predominantly using social media outlets to share details about LGBTQ-friendly healthcare providers. On QSPACES, users can find, rate, and review healthcare providers on their level of LGBTQ-friendliness, competency, and overall care. If you’re looking for an affordable LGBT-friendly mental health resource, the platform will help you find a nearby licensed psychiatrist, psychologist, therapist, or other mental health professional.

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Free Apps/Resources

·       Vent: Vent helps you connect to a supportive, positive, and understanding community, making it easy to share your feelings with people around the world.

·       Podcasts by Lavendaire: These podcasts cover a variety of subjects such as: healing from depression, how to stop feeling like shit, understanding and balancing your mind, and even some self guided meditation.

·       Lavendaire on Youtube: Same girl from the podcasts, she has a plethora of self guided videos on vision boards, finding your ideal career path, organization, how to be more positive and much more.

·       Pacifica: An app that provides tools for managing depressed moods, anxiety and stress that are built upon principles of Cognitive Behavioral Therapy (CBT), mindfulness, relaxation and health as well as mood tracking.

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Other Apps/Tools:

·       Pause: A guided meditation that feels more like a game, drawing upon “ancient Tai Chi and mindfulness practices.” It’s under $5 - Veronica uses it and says that it’s awesome.

·       Breathing Zone: Guided breathing exercises for when you are having anxiety.

·       Panic Attack Apps: this article rates 5 apps designed to help you cope with panic attacks

·       Ways to Cope With Stress: We all have stress in our lives, and this article gives some ideas for things we can do to manage ourselves and feel more control.

·       Pema Chödrön: What To Do When the Going Gets Rough: This Buddhist nun has written several books and many articles. Here’s an intro.