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Perspectives: Dr. Carlos Schenck discusses REM-sleep behavior disorder
Carlos H Schenck MD
Raymond P Roos MD
Subsequent history of RBD and the close link with alpha-synucleinopathies and narcolepsy
RBD and narcolepsy
Parasomnia overlap disorder: RBD and NREM parasomnias
RBD in children, adolescents, and adults younger than 50 years of age
As a medical student, resident and later on as a psychiatrist, how did you become interested in Sleep Medicine?
It was known since antiquity that some individuals act out their dreams (for instance Don Quixote), but despite Jouvet's experiments in the cat in the 1960's, the medical establishment failed to pay notice until your and your colleagues' description in the medical literature 30 years later. In your book Paradox Lost you describe dramatically the discovery in 1982 of RBD in conjunction with Mark Mahowald and Andrea Patterson. Please tell us about the book.
Would you comment on the neurological nature of RBD?
Would you comment on parasomnia overlap disorder?
You are also interested in narcolepsy, a disabling condition that is more prevalent than multiple sclerosis. What is the association with RBD?
What is the current consensus on the clinical significance of RBD and future research?
These important developments should be known not only to neurologists but to all physicians who care for patients, yes?
Personal question: When you go to Barcelona, do you lecture in English or Spanish?
The discovery of RBD and its strong association with alpha-synuclein neurodegenerative disorders and narcolepsy-cataplexy
Rapid eye movement sleep behavior disorder is a parasomnia that consists of abnormal behavioral release during REM sleep, emerging with loss of the mammalian skeletal muscle paralysis of REM sleep, "REM-atonia" (01). REM sleep behavior disorder (RBD) is the only parasomnia that requires objective polysomnographic confirmation. The polysomnographic hallmark of RBD is the electromyographic abnormality "REM without atonia," with increased muscle tone or increased phasic muscle twitching. RBD represents how one of the defining features of mammalian REM sleep, ie, REM-atonia, can become impaired, permitting abnormal behavioral release during REM sleep. A person with RBD moves with eyes closed while attending to the inner dream environment and being completely unaware of the actual bedside surroundings, a highly vulnerable state that poses a risk for serious and even potentially lethal injury (22). The enacted dreams usually involve confrontations with unfamiliar people and animals, and the dreamer is rarely the primary aggressor but, rather, is usually defending himself or his parnter. The reported dream action closely matches the behaviors observed by the spouse and, during video-polysomnography evaluation, a phenomenon called "isomorphism." The recurrent, disruptive, and aggressive sleep behaviors are what usually prompt clinical evaluation and treatment (23).
The traditional clinical profile of RBD involves predominantly middle-aged and older men with aggressive, dream-enacting behaviors, with more than 80% of them eventually developing an overt alpha-synucleinopathy (23). This profile now needs to be modified, given a recent population-based study of middle-aged to older adults with polysomnography-confirmed RBD that found a 1.06% prevalence of RBD--and with gender parity (08). Because women generally have less aggressive and injurious RBD, they present for medical attention much less frequently than men. Therefore, the traditional RBD profile has reflected a clinical referral bias on account of more aggressive and injurious RBD behaviors in men compared to women. However, because both male and female middle-aged and older patients with RBD are equally at risk for eventually developing alpha-synucleinopathies, once a promising neuroprotective (disease-modifying) agent becomes available, a concerted effort must be initiated to find the women with RBD who had not sought medical attention (along with men having mild RBD); it is the presence of REM without atonia or RBD, and not its severity, that carries the strong risk for future parkinsonism.
The first description of REM sleep behavior disorder was the fictional account written by Cervantes in Don Quixote:
"…he was thrusting his sword in all directions, speaking out loud as if he were actually fighting a giant. And the strange thing was that he did not have his eyes open, because he was asleep and dreaming that he was battling the giant…He had stabbed the wine skins so many times, believing that he was stabbing the giant, that the entire room was filled with wine…"
Don Quijote de la Mancha, I, Cap. XXXV ("Aventura De Los Cueros De Vino") [1605]
The first clinical description of REM sleep behavior disorder was provided by James Parkinson in An Essay on the Shaking Palsy (1817), the treatise on the disease that bears his name. Case VI:
"His attendants observed, that of late the trembling would sometimes begin in his sleep, and increase until it awakened him: when he always was in a state of agitation and alarm…when exhausted nature seizures a small portion of sleep, the motion becomes so violent as not only to shake the bed-hangings, but even the floor and sashes of the room…" [underlining added]
(Credit herein is given to Michael J Howell MD, my former sleep medicine fellow, and now my colleague at the University of Minnesota, for finding James Parkinson's description of RBD. Dr. Howell is currently Associate Editor of the sleep disorders section of Medlink Neurology.)
The first experimental animal (cat) model of RBD, which closely resembles human RBD, was developed in 1965 by Michel Jouvet and colleagues in Lyon, France (23). This model involved bilateral dorsolateral pontine lesions during unequivocal paradoxical sleep (the basic science term for REM sleep, with the paradox being generalized skeletal muscle atonia during an otherwise highly activated brain state). Subsequent experimental animal models of RBD have been developed in mice and rats.
In humans, various polysomnographic and clinical aspects of chronic and acute RBD were described from 1966 to 1985 by investigators from Japan, Europe, and North America, almost exclusively in the settings of neurologic disorders and acute drug intoxication or withdrawal states (23). However, RBD was not formally identified as a distinct clinical disorder emerging from unequivocal REM sleep until 1986, when our group at the Minnesota Regional Sleep Disorders Center published a series of five cases in Sleep, and the next year we expanded our series to 10 cases and named rapid eye movement sleep behavior disorder in JAMA (18; 21; 19). Our initial series of 10 cases included five cases with idiopathic RBD. After increasing our series and following our first 29 patients with idiopathic RBD, we eventually found a 38% conversion rate from idiopathic RBD to an overt synucleinopathy in 1996 (20); with further follow-up, we found an 81% conversion rate in 2013 (16). The Barcelona group found a virtually identical 82% conversion rate from idiopathic RBD to overt synucleinopathy (11). Parkinson disease and dementia with Lewy bodies were equally represented, with multiple system atrophy comprising a much smaller group. The mean interval from idiopathic RBD onset to overt synucleinopathy in the two series was 11.5 years and 14.2 years, respectively (range, 5 to 29 years). These findings set off a major international clinical and basic science research effort on RBD and alpha-synucleinopathies, to be described below.
I was primed for discovering RBD by a memorable experience during my neurophysiology class as a first-year medical student in 1973 at the State University of New York at Buffalo. As I wrote in my book about the discovery of RBD (pages 15 to 17):
Emeritus Professor Sir John Carew Eccles delivered a special lecture… The general opinion was that Dr. Eccles would summarize the research for which he was awarded the Nobel Prize in Physiology or Medicine in 1963 [for identifying the electrochemical transformations across the synaptic cleft]. As it turned out, the lean Australian [from Melbourne—where my daughter now practices medicine] stood in front of our class…and launched into a declaration that the brain is very active during sleep…Dr. Eccles turned on an audio cassette player, and we heard amplified recordings of cat brain electrical activity during REM sleep. It sounded like relentless machine-gun fire or the bursting of metallic popcorn. Dr. Eccles emphasized that there is not one instance of the brain shutting down during sleep…The brain does not hibernate while we sleep; the brain directs our sleep as we sleep…Dr. Eccles' message had a lasting impact for at least one medical student in attendance (14).
I subsequently wrote to Professor Eccles about our discovery of RBD and my clear memory of his lecture, and he responded by hand on December 8, 1987 from his home in Contra, Ticino, Switzerland, with this letter later being scanned into my book. He finished his letter by stating that "I still go on working after 12 years of retirement and have just completed another book—my 8th in retirement—on the evolution of the human brain with, of course, the coming-to-be of self-consciousness."
So that early medical school experience with the Eccles lecture and the fascinating revelation about the dynamic neurophysiology of sleep was tucked in my memory bank when I had just become a member of the Minnesota Regional Sleep Disorders Center, 1 year after completing my psychiatry residency at the University of Minnesota in 1981. At one of our psychiatry staff meetings at the Hennepin County Medical Center in Minneapolis, my Chief of Psychiatry asked if anyone was interested in joining the recently formed sleep center run by the Deptartment of Neurology that was establishing a multidisciplinary sleep center. I was the only volunteer.
On my first day at the sleep clinic, September 11, 1982, the second patient on my schedule was a 67-year-old married man who complained of "physical moving dreams" and "violent moving nightmares." As described by Michael Long at the start of his story in the December 1987 issue of National Geographic magazine ("What Is This Thing Called Sleep?"):
The crowd roared as running back Donald Dorff, age 67, took the pitch from his quarterback and accelerated smoothly across the artificial turf. As Dorff braked and pivoted to cut back over tackle, a huge defensive lineman loomed in his path. One hundred twenty pounds of pluck, Dorff did not hesitate. But let the retired grocery merchandiser from Golden Valley, Minnesota, tell it: "There was a 280-pound tackle waiting for me, so I decided to give him my shoulder. When I came to, I was on the floor in my bedroom. I had smashed into the dresser and knocked everything off it and broke the mirror and just made one heck of a mess. It was 1:30 a.m."
Five nights later, Mr. Dorff was studied in our sleep laboratory, where I spent the night in observation, and he demonstrated REM without atonia along with prominent limb jerking and twitching and a variety of complex behaviors during REM sleep. I initiated therapy with a tricyclic antidepressant, hoping to suppress enough REM sleep to minimize his RBD episodes, but the anticholinergic side effects were prohibitive. So I then turned to clonazepam, as he also had periodic limb movements throughout sleep, and at that time the neurology literature contained reported cases on the benefit of clonazepam for "nocturnal myoclonus" (the original term for periodic limb movements in sleep). Lo and behold, clonazepam (0.5 mg before bed) exerted immediate and sustained nightly benefit—both for the abnormal behaviors and the abnormal dreams of RBD. The subsequent literature has documented 80% to 90% efficacy of clonazepam in RBD, and the American Academy of Sleep Medicine, in its Best Practice Guidelines published in 2010, identifies clonazepam as first-line therapy of RBD, along with medium-high dose melatonin.
So my career with RBD began the same day as my career in sleep medicine. And, of course, I had much more than a little help from my friends, beginning with my esteemed longstanding colleague and friend, the sleep neurologist Mark W Mahowald MD, who was cofounder of our sleep center. His stellar career was summarized in the obituary I wrote, together with his daughter Carrie and the noted basic sleep researcher J Allan Hobson, after his demise in 2019 (24).
Two key linked brainstem nuclei responsible for generating REM-atonia have been identified from elegant basic science studies in rats by the P-H Luppi group in Lyon: (1) the glutamate sublateral dorsal nucleus in the pontine tegmentum and (2) the GABA-ergic and glycine-ergic ventromedial medulla inhibitory neurons. Genetic inactivation of these nuclei produced RBD in the rats (15). These nuclei and their connecting pathways are now known to be the early targets for attack by alpha-synuclein in the evolution of parkinsonian degeneration (Parkinson disease, dementia with Lewy bodies, multiple system atrophy). In fact, the Movement Disorder Society research criteria for prodromal Parkinson disease declared that idiopathic or isolated REM sleep behavior disorder has a likelihood ratio (LR) of 130 for Parkinson disease conversion, along with a predictive value greater than 10x higher than any other clinical marker (eg, LR=4 for olfactory dysfunction and LR=10 for abnormal motor examination) and a predictive value greater than 3x higher than any biomarker (LR=40 for abnormal dopaminergic PET/SPECT findings) (04). Therefore, idiopathic RBD is the earliest and strongest predictor of future overt Parkinson disease, dementia with Lewy bodies, and multiple system atrophy. Furthermore, the risk of neurodegeneration with idiopathic RBD is extraordinarily high, as found in a recent meta-analysis of longitudinal studies, with conversion rates being 33%, 82%, and 97% at 5-year, 10.5-year, and 14-year follow-ups, respectively (07). Conversely, the RBD prevalence in Parkinson disease is almost 50%, and the presence of RBD in Parkinson disease is associated with widespread increased Parkinson disease morbidity across multiple domains. Also, RBD is present in 90% of reported cases of multiple system atrophy and in 75% of reported cases of dementia with Lewy bodies. Consequently, the 2017 updated dementia with Lewy bodies Diagnostic Criteria published by the DLB Consortium, listed RBD as one of the core features of clinically probable dementia with Lewy bodies (definite dementia with Lewy bodies requires autopsy confirmation) (12).
On account of idiopathic RBD being considered prodromal parkinsonism, the International RBD Study Group (IRBD-SG) was formed in 2007, and I was the founding president. To date, there have been 15 annual international symposia involving more than 150 RBD clinical researchers and basic scientists from more than 20 countries and five continents. More than 20 peer-reviewed journal articles have been published to date by the IRBD-SG. A major focus of the research effort has been to identify the predictors of imminent phenoconversion from idiopathic RBD to parkinsonism within several years, for inclusion of these patients in studies testing promising neuroprotective agents. The eight working groups include: biomarkers, imaging, neurophysiology, genetics, basic science, clinical, treatment and trials, and epidemiology. A recent article by the IRBD-SG published in The Lancet Neurology identified that the level of quantitated REM without atonia is the strongest biomarker for predicting imminent phenoconversion from idiopathic RBD to overt parkinsonism (13). Many clinical and basic science members of the IRBD-SG contributed chapters to the first textbook on RBD that was published in 2018 by Springer (Schenck CH, Hogl B, Videnovic A, editors). RBD has been included in the second (2005) and third (2014) editions of the International Classification of Sleep Disorders (01).
The NIH-funded North American Prodromal Synucleinopathy (NAPS) Consortium for RBD was formed in 2018 (and NAPS2 in 2021), involving nine research centers, including the University of Minnesota (NIH R34AG056639 and U19AG071754) NAPS (2018) and NAPS2 (2021). The primary purpose involves neuroprotective treatment trial planning in RBD, recognizing that idiopathic RBD is a prodromal synucleinopathy. This preparation involves establishing a registry of patients with RBD (300+), developing and performing quantitative biological and functional measures of synucleinopathy burden, and establishing a formal process to evaluate candidate neuroprotective agents. The comprehensive effort includes clinical assessments; clinician diagnosis; fluid biomarkers; quantitative REM without atonia measurements; functional assessments (cognitive, visuospatial, motor, sensory, sleep, pareidolia, psychiatric or neuropsychiatric, and autonomic). With NAPS2, there will be the opportunity to address unmet educational needs in the community by involving the general public, physicians, nurses, and other health care providers.
Our group first identified the association of RBD with narcolepsy in 1992 (23), and now RBD is known to be present in up to 60% of patients with narcolepsy type 1 (hypocretin-deficient) and represents a distinct phenotype of RBD, with gender parity, earlier age of onset than with idiopathic REM sleep behavior disorder, lower frequency of RBD episodes, less complex movements during REM sleep, less aggressive and violent RBD behaviors, and more even distribution of RBD episodes across all REM epochs compared to idiopathic RBD (03). However, it is premature to conclude that RBD is an intrinsic feature of narcolepsy because a complete understanding of the RBD-narcolepsy phenotype is still lacking, with some patients having normal CSF HCRT levels; also, RBD may be found in patients with narcolepsy type 2 (without cataplexy) (03). Therefore, other factors probably play a role that needs future identification. Furthermore, optimal therapy of RBD in narcolepsy has not been sufficiently studied, and there is no evidence indicating that patients with RBD-narcolepsy are at increased risk for future neurodegeneration. A recent biomarker study comparing 17 patients with narcolepsy type 1 RBD and 30 with idiopathic RBD found that 87% of patients with idiopathic RBD had positive skin biopsies for phosphorylated alpha-synuclein deposits, whereas 0% of patients with narcolepsy type 1-RBD had positive skin biopsies (02). Therefore, clinicians managing patients with RBD-narcolepsy can be confident about the lack of apparent risk for these patients to develop future neurodegeneration.
RBD can emerge as an isolated parasomnia, or it can emerge with an NREM parasomnia, designated as "parasomnia overlap disorder" with generalized motor dyscontrol across REM and NREM sleep. Parasomnia overlap disorder was formally described and named by our sleep center in 1997 with a series of 33 cases that emerged idiopathically or symptomatically with neurologic and other disorders (17). The mean age at presentation was 34 years, and the mean age of parasomnia onset was 15 years (range 1 to 66 yars); 70% were males. An idiopathic subgroup (n=22) had a significantly earlier mean age of parasomnia onset (9 years) than a symptomatic subgroup (n=11) (27 years). Since 1997, the literature on parasomnia overlap disorder has grown considerably and has expanded to include appetitive NREM sleep parasomnias (sleep-related eating disorder; sexsomnia or sleepsex), rhythmic movement disorder, and additional types and CNS locations of symptomatic cases. More than 150 cases of parasomnia overlap disorder have been published to date, with more than half being idiopathic parasomnia overlap disorder cases (15). The risk for future neurodegeneration remains unknown in patients with idiopathic parasomnia overlap disorder who are under age 50 years, just as with idiopathic RBD in the younger adult age group. Additionally, the late-life onset of sleepwalking is now known to be associated with Parkinson disease, and when there is also coexisting RBD, parasomnia overlap disorder is present in Parkinson disease (06).
The phenotype of RBD in patients under 50 years of age has now been recognized to differ from the traditional RBD phenotype of middle-aged or older men with aggressive RBD behaviors. Younger patients with RBD have greater gender parity, less severe RBD, greater association with narcolepsy-cataplexy, greater association with psychiatric disorders and with antidepressant use, greater association with the parasomnia overlap disorder, and, perhaps, also greater association with autoimmune diseases. RBD in children and adolescents, although rare, is usually associated with narcolepsy-cataplexy, parasomnia overlap disorder, brainstem tumors, and antidepressants as therapy for depression and cataplexy. Most antidepressant medications (especially selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants) can trigger or aggravate RBD, but bupropion, a dopaminergic-noradrenergic agent, does not.
Acute RBD typically emerges in the context of acute toxic-metabolic disturbances and acute drug withdrawal states, along with a variety of other emergent conditions. A review article on RBD covers the topics in this section, along with a discussion of the broad range of neurologic and other disorders that can disturb normal REM-atonia with emergence of RBD (15). Three other pertinent review articles on RBD are recommended (05; 10; 09).
In conclusion, RBD is a rapidly expanding clinical and research field, and my career has participated in and witnessed these developments from the time of reporting on our initial series of five patients in 1986 (18; 19).
American Academy of Sleep Medicine. International Classification Of Sleep Disorders. 3rd ed. Darien, Illinois, 2014.
Antelmi E, Pizza F, Donadio V, et al. Biomarkers for REM sleep behavior disorder in idiopathic and narcoleptic patients. Ann Clin Transl Neurol 2019;6(9):1872-76. PMID 31386270
Antelmi E, Pizza F, Franceschini C, Ferri R, Plazzi G. REM sleep behavior disorder in narcolepsy: a secondary form or an intrinsic feature? Sleep Med Rev 2020;50:101254. PMID 31931470
Berg D, Postuma RB, Adler CH, et al. MDS research criteria for prodromal Parkinson's disease. Mov Disord 2015;30(12):1600-11. PMID 26474317
Dauvilliers Y, Schenck CH, Postuma RB, et al. REM sleep behaviour disorder. Nat Rev Dis Primers 2018;4(1):19. PMID 30166532
Di Fabio N, Poryazova R, Oberholzer M, Baumann CR, Bassetti CL. Sleepwalking, REM sleep behaviour disorder and overlap parasomnia in patients with Parkinson's disease. Eur Neurol 2013;70(5-6):297-303. PMID 24061434
Galbiati A, Verga L, Giora E, Zucconi M, Ferini-Strambi L. The risk of neurodegeneration in REM sleep behavior disorder: a systematic review and meta-analysis of longitudinal studies. Sleep Med Rev 2019;43:37-46. PMID 30503716
Haba-Rubio J, Frauscher B, Marques-Vidal P, et al. Prevalence and determinants of rapid eye movement sleep behavior disorder in the general population. Sleep 2018;41(2):zsx197. PMID 29216391
Hogl B, Arnulf I, Bergmann M, et al. Rapid eye movement sleep behaviour disorder: Past, present, and future. J Sleep Res 2022:e13612. PMID 35470494
Hogl B, Stefani A, Videnovic A. Idiopathic REM sleep behaviour disorder and neurodegeneration - an update. Nat Rev Neurol 2018;14(1):40-55. PMID 29170501
Iranzo A, Tolosa E, Gelpi E, et al. Neurodegenerative disease status and post-mortem pathology in idiopathic rapid-eye-movement sleep behaviour disorder: an observational cohort study. Lancet Neurol 2013;12(5):443-53. PMID 23562390
McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB Consortium. Neurology 2017;89(1):88-100. PMID 28592453
Miglis MG, Adler CH, Antelmi E, et al. Biomarkers of conversion to α-synucleinopathy in isolated rapid-eye-movement sleep behaviour disorder. Lancet Neurol 2021;20(8):671-84. PMID 34302789
Schenck CH. Paradox Lost: Midnight in the Battleground Of Sleep And Dreams. Extreme-Nights, LLC: Minneapolis, 2005.
Schenck CH. REM sleep behavior disorder as a complex condition with heterogeneous underlying disorders: clinical management and prognostic implications [Commentary]. Epub ahead of print. Sleep Breath 2022. PMID 35239134
Schenck CH, Boeve BF, Mahowald MW. Delayed emergence of a parkinsonian disorder or dementia in 81% of older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder: a 16-year update on a previously reported series. Sleep Med 2013;14(8):744-8. PMID 23347909
Schenck CH, Boyd JL, Mahowald MW. A parasomnia overlap disorder involving sleepwalking, sleep terrors, and REM sleep behavior disorder in 33 polysomnographically confirmed cases. Sleep 1997;20(11):972-81. PMID 9456462
Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW. Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 1986;9(2):293-308. PMID 3505730
Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW. Chronic behavioral disorders of human REM sleep: a new category of parasomnia. 1986 [Classical article republished in the SLEEP: PAST, PRESENT AND FUTURE" section of the Silver Anniversary Issue]. Sleep 2002;25(2):293-308. PMID 11902435
Schenck CH, Bundlie SR, Mahowald MW. Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder. Neurology 1996;46(2):388-93. PMID 8614500
Schenck CH, Bundlie SR, Patterson AL, Mahowald MW. Rapid eye movement sleep behavior disorder. A treatable parasomnia affecting older adults. JAMA 1987;257(13):1786-9. PMID 3820495
Schenck CH, Lee SA, Bornemann MA, Mahowald MW. Potentially lethal behaviors associated with rapid eye movement sleep behavior disorder: review of the literature and forensic implications. J Forensic Sci 2009;54(6):1475-84. PMID 19788703
Schenck CH, Mahowald MW. REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep 2002;25(2):120-38. PMID 11902423
Schenck CH, Mahowald CM, Hobson JA. In Memoriam: Mark W Mahowald MD. 1943-2020. Sleep Med 2020;70:125-7.
Dr. Schenck of the University of Minnesota Medical School received a lecturer honorarium from Eisai, Inc.
Dr. Roos is a shareholder in Amgen, Ionis, Merck, and Pfizer.
Autonomic dysfunction in sleep disorders
Neuroimaging of sleep disorders
Parasomnia overlap disorder and status dissociatus
Rapid eye movement sleep behavior disorder
REM parasomnias
Book: Paradox Lost: Midnight in the Battleground of Sleep and Dreams
Book: Rapid-Eye-Movement Sleep Behavior Disorder
NAPS Consortium for REM Sleep Behavior Disorder
In memoriam: Mark W. Mahowald MD (1943–2020)
North American Prodromal Synucleinopathy Consortium (NAPS)
Perspectives: Dr. Christopher Walsh and genetic mechanisms underlying the developing and aging brain
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For over a decade, I've been helping clients create websites and build social media presence.
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Web Design: Wiring the right side of the ENIAC with a new program, in the "pre- von Neumann" days. Standing: Marlyn Wescoff Crouching: Ruth Lichterman —U.S. Army Photo from the archives of the ARL Technical Library.
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First Fifteen
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New Nintendo 2DS XL (Hardware) Review – Best 3DS Yet
Jesse Cabral
Score: 8 / 10
The Nintendo 3DS has been my faithful companion since I first got one back in 2011. I have fond memories of getting together with my friends and playing Super Street Fighter IV 3D Edition or more recently, Super Smash Bros..
Throughout the years, I've replaced and upgraded my 3DS as needed. One thing I never considered picking up was the Nintendo 2DS when it first launched. The wedge-shaped design never appealed to me and I didn't feel like it was a necessary iteration for the handheld. However, Nintendo has released an update to their 2DS line with the addition of the New Nintendo 2DS XL, and my opinion has changed.
The New Nintendo 2DS XL is a return to form for the system. Gone is the ugly wedge shaped design and in place is the classic the clamshell design. Our review model featured a black and turquoise colour scheme that gives it a sleek modern look, but there is also a white and orange version available. Featuring a clean profile, it sits well alongside other modern day devices. The screens themselves are the same size as its cousin the New Nintendo 3DS XL. The textured back of the top screen meant that it never slipped out of my hands and the buttons are in the right spot so nothing felt like a stretch to reach. Everything you would expect to be included in a New 3DS is here: the NFC amiibo support, AR card reading function, and the two sets of shoulder buttons. One of the best design choices is the inclusion of a cover for the game cartridge slot and the SD card slot beside it.
Even with all this, the device itself is still surprisingly light. Compared to my standard New Nintendo 3DS, the New Nintendo 2DS XL was not much heavier and in my opinion, was better balanced. Since there isn't any 3D technology in the top screen, all of the console's main components have been moved into the bottom of the console. The console felt sturdy in my hands and didn't cramp even during longer play sessions. The face buttons have a satisfying click to them and overall the console's design is top notch. Of course, the C-stick that Nintendo has added to its New line of consoles still feels uncomfortable to use, but that is more a design flaw with the accessory and less with the console.
The only major complaint I have about the console's design is the length of the included stylus. This is probably the smallest stylus offered to date and rivals the size of the original 3DS's telescopic stylus in its un-stretched form. This meant that extended play with any stylus based games, such as Hey! Pikmin, was difficult as cramping was a very real issue. I imagine cramming all of the console's hardware into the bottom portion meant there wasn't very much space left to fit a full-length stylus.
As far as games go, the New Nintendo 2DS XL stands right alongside its 3D cousin. With the ability to play any game including the ones designed exclusively for the New console line, users won't feel restricted by choosing the 2D console. In fact, users might prefer this model as many of the latest releases for the 3DS do not use the 3D feature at all—or use it sparingly.
That's the best selling point about this console. For about $40 less than the 3D model users get more or less the exact same experience. While the glasses-free 3D is a nice feature to have, it always felt more like a novelty at best. Very few games took full advantage of the 3D feature and those that did are few and far between. Couple that with the fact that 3D on the consoles was never the most reliable feature—with such specific distance and viewing angle requirements—and you have a feature that is not necessary, even if the consoles derive their name from it.
If I was looking to get a console in the New line of systems, or if I needed a new 3DS, I would consider picking up the New Nintendo 2DS XL. The New Nintendo 2DS XL is the perfect device for someone who is looking for a new handheld or is after an upgrade to the New line. I wouldn't feel as though I was lacking a core component of the console by forgoing the 3D. Otherwise, it doesn't do anything that any of the others in the 3DS family can do. The New Nintendo 2DS XL is available now and to learn more about the console check out the website.
The best iteration of the 3DS yet, as long as you won't miss the 3D
New Nintendo 2DS XL
Manufacturer: Nintendo
Type: Console
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Pierre-Olivier heads the corporate practice of Allen & Overy Belgium. He has considerable experience in working in China and on outbound transactions for PRC clients (including leading companies like Huawei Technologies). His areas of expertise include mergers & acquisitions, private equity, corporate litigation and public take-over bids, advising both local and international clients on inbound and outbound transactions. Pierre-Olivier is regularly quoted in leading international league tables. "Among the best and most effective deal lawyers who we have worked with worldwide." Chambers Europe. "Very charming man. His personal flair and personality were a part of the solution to bring the deal to a close." Chambers Europe. He is fluent in French, English, Dutch and Spanish and has a basic knowledge of Mandarin.


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MMA News
Jason Estrada defeats Alex Gonzales
PROVIDENCE (June 29, 2012) – In his continuing effort to get back to the top of the American heavyweight scene, 2008 U.S. Olympian Jason "Big Six" Estrada won a workmanlike eight-round decision over Puerto Rican-invader Alex Gonzales in the main event on tonight's "Takeover" card, presented by Big Six Entertainment, at the Rhode Island Convention Center in Providence.
In a toe-to-toe battle between quick-handed Estrada (19-4, 5 KOs) and cagey southpaw Gonzales (20-7, 10 KOs), Providence heavyweight Estrada consistently beat Gonzales, a former world title challenger and 1992 Puerto Rican Olympian, to the punch.
Estrada won all eight rounds on each of the three judges' scorecards by scores of 80-72.
"I thought it was a good performance," Estrada said after the fight. "The dude can take a shot. Once I realized that he wouldn't go, I boxed his head off. I hurt my thumb a little in the second round, so I boxed and used my jab.
"Next? If (Tony) Grano wants to fight, let's go. I've been trying to get him in the ring for a long time."
The comeback of former USBA and NABO middleweight champion Brian "The Bull" Barbosa (31-6, 23 KOs), now fighting out of Providence, continued on a high note in the co-feature. Barbosa decked light heavyweight John "Rusty" Johnson (13-3, 11 KOs) twice en route his fifth-round TKO victory.
Pawtucket (RI) junior welterweight Diego Pereira (7-0-1, 3 KOs) kept his unbeaten record intact, destroying dangerous William "Chino" Correa (9-6, KOs) by way of a second-round technical knockout.
The long awaited pro debut of junior lightweight Toka Khan-Clary was a monumental success. Liberian-native Kahn-Clary, fighting out of Pawtucket (RI), dropped a game Jonathan Caban with a body shot in the opening round. The young southpaw dropped Caban again in the second and pounded the New Yorker until the referee halted the action later in the same round.
Unbeaten junior welterweight Jair Ramos (3-0, 2 KOs) stopped an overmatched Joel Alarcon in the third round.
Providence junior middleweight Kali Reiss improved her record to 5-1-1, taking a four-round decision from Lyneisha Jefferson in an action-packed fight.
Jesus Cintron (1-1-1) recorded his first win as a professional with a four-round decision over Rameil Shelton.
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PRAYER, MARRIAGE AND THE LEADERSHIP ROLES OF THE HUSBAND AND WIFE
Title: PRAYER, MARRIAGE AND THE LEADERSHIP ROLES OF THE HUSBAND AND WIFE
Author: Bishop Ken Giles & Pastor Sheila Giles
Genre: Christian Living
Marriage is an institution established by God. God ordains a man and a woman to be husband and wife to fulfill his purpose of expanding His likeness and kingdom through their rule and dominion over His creation. Within the institution of marriage, the man is responsible for carrying out and communicating God's vision. The woman enables, strengthens and encourages her husband to carry out God's vision for himself, the marriage and family. The husband and wife become one flesh. No other human relationship, including that of parents and children, is to have priority or greater importance than that of the husband and wife to one another. The Leadership roles of the husband and wife are paramount to God's plan of blessings in the marriage, family, generations and broader society. Therefore, obedience to God and His word establishes God's order and facilitates the proper working and functioning of the marriage and family. Thus, establishing the peace, joy and increase the Lord has purposed in and through the marriage and family.
ORDER YOUR COPY:
Bishop Ken Giles began full-time ministry in 1993 as an inner-city Missions Leader in Dallas, Texas, while at Oak Cliff Bible Fellowship under Dr. Tony Evans. He later served there as Assistant Executive Director of their nonprofit corporation. In 1998, he returned to his hometown of Beaumont, Texas, and served as Pastor of Outreach at Cathedral of Faith Baptist Church and Executive Director of their nonprofit corporation. In 2000, Lincoln Bible Church was planted in the Beaumont/Port Arthur area and is now located in the Greater Houston Texas area where Bishop Ken Giles and his wife, Pastor Sheila Giles provide servant leadership. Bishop Giles has a Master of Education Administration from PrairieView A&M University and a Master of Theology from Southeast Texas Theological Seminary.
Their latest book is PRAYER, MARRIAGE AND THE LEADERSHIP ROLES OF THE HUSBAND AND WIFE.
WEBSITE & SOCIAL LINKS:
PRAYER, MARRIAGE AND THE LEADERSHIP ROLES OF THE HUSBAND AND WIFE was in my mind a very sexist book as it stated that the role of the woman was to support her husband in following God's vision. I personally see no reason why a woman should not be allowed to follow God's vision for herself. I also did not like the implication that the most important relationship had to me that of man and wife as other relationships can be just as important if not more important like that of a parent and their child. The author was well spoken, but I did not agree with his beliefs towards marriage. That aside I would give this book four out of five stars because while I personally disagree with it due to my own feelings, that does not make it a bad book.
Scene of the Crime
Title: SCENE OF THE CRIME
Author: Jennifer Chase
Publisher: JEC Press
Genre: Mystery Suspense
A calculating cold-blooded predator closes in…
When a community has barely recovered from a ruthless serial killer six months earlier; now two more horrifying murders hit the radar again. It leaves police burdened with two of the most shockingly contaminated crime scenes ever documented in California's law enforcement history. The Slayer works behind the scenes as a sinister puppet master, precisely pulling the strings, taunting the police without leaving any viable evidence, and orchestrating his killer hit squads.
The sheriff and district attorney bring in the best investigators. Reunited again, Dr. Chip Palmer, a reclusive forensic expert, joins DA Inspector Kate Rawlins to sort through the crime scene aftermath in search of the truth—all without a probable suspect or a solid motive. Complicating the investigation—sparks reignite between the two.
Ratcheting up the suspense, Chip suffers a nasty fall hitting his head, impairing his perception and giving him a mind-blowing ability for specific detailed recall. Palmer and Rawlins assemble an unusual team including a rookie detective, a forensic supervisor, and an ex-military operative turned bodyguard. After one of their own is kidnapped and the investigation is taken over by the FBI, the now rogue team must pull together their own resources—alone—with a killer waiting to take each one of them out. Scene of the Crime takes no prisoners and leaves everyone fighting to stay alive.
Jennifer Chase is a multi award-winning and best-selling crime fiction author, as well as a consulting criminologist. Jennifer holds a bachelor degree in police forensics and a master's degree in criminology & criminal justice. These academic pursuits developed out of her curiosity about the criminal mind as well as from her own experience with a violent sociopath, providing Jennifer with deep personal investment in every story she tells. In addition, she holds certifications in serial crime and criminal profiling. She is an affiliate member of the International Association of Forensic Criminologists, and member of the International Thriller Writers.
I personally found Scene of the Crime to be both an enjoyable and well written book that made for a great read. I always love crime and murder mystery books and this one was just amazing. It had plot twists that kept me guessing and characters with awesome personalities that gave the book a realist feel to it!
Love Beneath the Mighty Dome: Volume 1 by Ronald J. Wichers
Book Title: Love Beneath the Mighty Dome: Volume 1 by Ronald J. Wichers
Category: Adut Fiction, 332 pages
Genre: Literary Fiction, Mystery and Suspense
Publisher: Outskirts Press
Content Rating: PG-13
Book Description:
What if you felt that Almighty God had called you personally to devote your life exclusively to His service only to discover that those in charge of your training were people not worthy of your respect? Would you stubbornly stick to your path? Would you rebel and try to change the institution from within? Would you begin to doubt yourself and your own integrity? Or would you question whether the institution itself was actually what its founder, Jesus of Nazareth, had intended so many hundreds of generations before you?
Turn the pages of Love Beneath the Mighty Dome and discover what happens to those confronted by just this dilemma, how it affects their lives, their ability to function, their ability to love.
Amazon ~ Barnes & Noble ~ Jet
Watch the book trailer:
Ronald J. Wichers was born in Lake Ronkonkoma New York in 1947. He attended Catholic School until 1965, studied History and literature at the University of Nevada at Las Vegas until being drafted into the United States Army in 1970. He was assigned to a rifle company in the 25th Infantry Division in Vietnam and, after sustaining severe wounds in a gun battle, including the loss of his left am, was awarded the Purple Heart Medal, the Army Commendation Medal for Heroism and the Bronze Star Medal.
He later studied theology full time at the Graduate Theological Union in Berkeley California. He has published several short stories about the Vietnam war. The Fear of Being Eaten/A Biography of the Heart is his fifth novel.
Connect with the author: Website ~ Twitter ~ Facebook ~ Pinterest ~ Instagram
Boy on the Beach by R.D. Maddux
Book Title: Boy on the Beach by R.D. Maddux
Category: Adult Fiction; 304 pages
Genre: Mystery / Thriller
Publisher: Ezekiel 12 Publications
Format available for review: print & ebook (mobi file, PDF, gifted Kindle copy)
Tour dates: July 9 to August 17, 2018
Content Rating: PG-13 + M (There are implied sex scenes but no graphic descriptions of love making. There is one scene with some violence.)
Andrew Foster is a developer with aspirations of making it big in the San Diego real estate market, but he can't seem to shake the ghosts of his past. He starts to wonder if he's destined to be just another has-been when an investor offers to finance his dream project. Everything seems to be falling into place for Andrew in business, life, and even love, when he starts dating the beautiful and business-savvy Nicole. As their relationship deepens, Andrew opens up to Nicole about the many loves and adventures that have taken him from the crazy days of sex, drugs, and rock and roll to success in business. Her wise insights help him face the character flaws that have caused him to fail in his past relationships.
Rounding out his social life is his once-a-week task of assisting his sister with her nanny job watching a young boy named Chandler. They build sand castles on the beach and enjoy the beauty of nature together. But then the ominous weekly appearance of a strange car at the beach awakens Andrew's fears. Is the boy in danger? Or worse, has an enemy from Andrew's past come seeking revenge and now Chandler's caught in the middle?
A strange twist of events threatens to destroy Andrew's dreams, but as he searches for answers, a sudden revelation offers hope of a future he never imagined.
Amazon ~ Autographed copy
Watch the book trailer:
R.D. Maddux has story telling in his blood. Since he was young he's always loved a good tale. He's been writing seriously since he was in high school and college. His novels range from Mystery and Intrigue to Sci-fi/fantasy. With Boy On The Beach he's set the story in modern America, to be exact, on the West Coast of California. He's a native of the golden state and has been a resident of San Diego since 1987. Before that he grew up in northern California and lived in the Sacramento Valley and Bay Area with sojourns in some of the beautiful parts of our state.
Living in California for over 60 years he couldn't help but watch the way things have changed in our culture and the impact this coast makes on the rest of America and the world. So even though Boy On The Beach is fiction, like most serious novels, it is not without a context and comment on issues we all face in our changing world. It takes place in real locations that are very familiar to him and its characters, which are fictional, no doubt have their counterparts in the real world. Boy On The Beach is a story of intrigue, suspense, revenge, love and redemption with flashbacks to the era when sex, drugs and rock and roll set our culture on it's inevitable journey to our present day. This idea has been rattling around in his heart and mind for a decade and it's finally coming to the page.
Boy on the Beach by R.D. Maddux was a well written book that just felt so real. I knew it was fiction, but it really felt like non-fiction. I loved Andrew Foster's interactions with Chandler and how the two really seemed to have a bond that had Andrew worried about Chandler. Overall, I greatly enjoyed reading this book!
The Adventures of AR Achnid
BOOK SPOTLIGHT TOUR: The New Adventures of A.R. Achnid (Revised Edition) by Sandi Smith
Book Title: The New Adventures of A.R. Achnid (Revised Edition)
Author: Sandi Smith
Illustrator: Kathy Lee
Category: Children's Fiction, 126 pages
Genre: Children's Chapter Book, Animals, Bugs & Spiders
Publisher: Mindstir Media
Tour dates: June 18 to July 13, 2018
Content Rating: G
Harold! There goes that spider! See, he is running on the floor! That spider has to go. He cannot live here anymore!!! Oh, no! Beth looks very, very angry. What has A.R. Achnid done now? Well, before A.R. got into big trouble with Beth, he had a lot of wonderful adventures.
There are ten different adventures in this book. There is the time he went to the circus and rode on a balloon, and then had some shoo fly pie. Another day, A.R. and Rex (a Great Dane, who is A.R.'s best friend) decided to walk all the way into town, and they had such a wonderful time. Then, A.R. and his family went to New York City for the biggest craft fair ever (which was for spiders only), plus many, many other adventures.
Unfortunately, in the tenth story, A.R.'s current living situation is going to need an adjustment. Something changes in the lives of Harold and Beth (the humans) that will make things very difficult for A.R. Come along with A.R. for some fun, and find out what small bundle will cause problems for A.R. and his family.
As A.R. says, "Spiders rule!"
Amazon ~ Barnes & Noble
Watch the book trailer:
Sandi Smith spent her time as a young girl combing the shelves of the public library. She has always enjoyed the magic that books have to offer and was inspired by her high school English teacher, Mr. Coolidge to embrace the arts. The author found her calling as a writer early one morning as her first story came to her in the form of a poem. Since then she has written more than 15 children's books, with her most popular series about the adventures of an adorable spider in the A.R. Achnid series.
Sandi is happily married to her inspiration and husband of 40 years, John. She continues to write for her two precious grandchildren. When she's not penning a new story, Sandi and John like to camp, kayak and to enjoy the simple life in their home in Pembroke, NH.
Connect with the author: Website ~ Twitter ~ Facebook ~ Pinterest
Liberty Landing by Gail Vida Hamburg
Book Title: Liberty Landing by Gail Vida Hamburg
Genre: Literary Fiction
Publisher: Mirare Press
Content Rating: PG-13 + M (My book has love scenes, one explicit love scene, and some profanity)
Liberty Landing -- a 2016 Finalist for the PEN/Bellwether Prize for Socially Engaged Fiction -- narrates the American Experience of the 21st century through the lives of a polycultural cast of natives, immigrants, and refugees in Azyl Park--a town in the Midwest.
After Angeline Lalande, a journalist and historian, unearths the real meaning of the name, "Azyl," conferred on the town in the 1800s by immigrant-hating politicians, the town elders begin the act of renaming it. During the course of the renaming, we meet the intriguing denizens of the town--survivors, strugglers, and strivers of every race and nationality, see the intersection of their lives, and the ways they find home, heaven, and haven in each other. We learn about the singular journeys that brought them to Azyl Park--a place that both transforms them and is transformed by them.
The larger story of the American Experiment is told through the personal story of Alexander Hamilton, the essential immigrant among the Founding Fathers, as Angeline writes a book about him. By the end of the novel, after Azyl Park is renamed, each of the characters has lost or found something essential.
Liberty Landing is about the personal and the political, family and loss, memory and migration, finding new love and a new home, and about history and the American Experiment. Seminal moments of the American Experience figure in this literary and historical fiction. Inspired by John Dos Passos' USA Trilogy about early 20th century Americans, Liberty Landing is a sweeping, lush, layered saga, set in a vibrant community, with a cast of Americans marked by neuroses, flaws, secrets, unspeakable pasts, humor, warmth, vulnerability, and humanity.
Liberty Landing is Gail Vida Hamburg's love letter to the American Experiment--the first in a trilogy.
Amazon ~ Barnes & Noble ~ Audible
Gail Vida Hamburg is an award-winning American journalist, author, and museum storyist. She is the author of The Edge of the World (Mirare Press, 2007), a novel about the impact of American foreign policy on individual lives. A nominee for the 2008 James Fenimore Cooper Prize, it is a frequent text in undergraduate post- colonial studies, war studies, and creative writing programs. Born in Malaysia, she spent her teens and twenties in England before migrating to the United States. She holds a Master of Fine Arts in Literature and Creative Writing from Bennington Writers Seminars at Bennington College, Vermont. Liberty Landing, the first volume in her trilogy about the American Experience, is her love letter to the great American Experiment.
She lives in Chicago—the setting for Liberty Landing, a finalist for the 2016 PEN/Bellwether Prize for Socially Engaged Fiction.
Connect with the author: Website ~ Twitter ~ Facebook
LIBERTY LANDING
I want to spotlight this book
Join us for this tour from July 2 to 20, 2018!
Tour dates: July 2 to 20, 2018
LALA FEELS BLAH-LA
Title: LALA FEELS BLAH-LA
Author: Tela Kayne
Publisher: The Virtue Agency
Genre: Children's Picture Book
Welcome to LaLa's World: Where kids learn how to be the change!
In this newly released children's book, "LaLa Feels Blah-La," a young girl and her stuffed bear wake up feeling blah for no apparent reason. LaLa's mom teaches her to be mindful of her feelings and turn her mood around with the flip of a coin. Perfect for young readers, LaLa Feels Blah-La , teaches children to be more mindful of their feelings and manage their mood swings.
Amazon | Barnes & Noble
As the daughter of a librarian, Tela Kayne grew up reading countless literary works of all genres in quiet corners of the local library. She developed the love of writing at an early age, penning theatrical productions that were performed in the family living room for an audience of loved ones. She officially began her creative career as a young actress in Atlanta, having appeared on stage in a variety of roles including Puck of Midsummer Night's Dream and Alice in Alice in Wonderland.
After graduating college Summa Cum Laude from the University of Georgia with a Bachelor of Arts degree in Psychology and working a short stint in the "real world," she moved to Los Angeles to pursue a career in film. After securing her Screen Actor's Guild membership through appearances on television shows like G vs E, The Parkers and Get Real as well as films like Down to You, Almost Famous, and Disney's The Kid, she decided to garner more behind-the-camera experience. She secured internships at Scott Rudin Productions, one of Hollywood's most prolific and demanding producers and Mostow Lieberman Productions (U-571) at Universal Studios. She soon accepted a paid position with executive producer Chris Sievernich and discovered her love of screenplay development, running the coverage department for Kinowelt USA and assisting in the development of projects like Nurse Betty, The Wedding Planner and Welcome to Collinwood. After several years of working in Hollywood, she returned home to Atlanta in 2001 to focus on a career in strategic marketing.
As president and founder of The Virtue Agency, an integrated content development and marketing agency, Tela has spent the last fifteen years writing content and maximizing brand exposure and engagement for clients. She has authored articles that appear on MarketWatch (WSJ), Yahoo! Finance, MNN.com, EWG.org, and HealthyChild.org. She is also entering into the literary world with the release of LaLa Feels Blah-La, Book 1 of her debut children's series, LaLa's World.
LALA FEELS BLAH-LA is a very cute children's book that is great for helping young children to not only understand their feelings, but also in changing their moods from negative to positive! This is a great book for young children to read or for their parents to read to them. The pictures are very age appropriate.
On the Fault by Ronald J. Wichers
Book Title: On the Fault by Ronald J. Wichers
Genre: Fictionalized biography
"The heart of the planet is broken and the world is bleeding. We come out of the broken-hearted earth and try to mend it."
True grit mixes with true wit in this tragic, yet strangely triumphant tale of how much one man can lose. Following the Vietnam War, life proves bittersweet as Joe Hearns learns that sometimes finding happiness means changing the definition.
For Joe Hearns the horrors of combat give way to those of daily life upon return to the States; a life burdened by an odd curse that seems to hover over the heads of anyone who fought in that otherwise magical land. He discovers that courage takes on a whole new meaning when coping with a world moving at a different pace – the pace of friendship and love. But, in the end, this proves the way out from under the curse of the war no one wanted.
When it comes to this soldier's story the word fearless comes to mind.
Watch the book trailer:
Meet the Author:
He later studied theology full time at the Graduate Theological Union in Berkeley California. He has published several short stories about the Vietnam war. The Fear of Being Eaten: A Biography of the Heart is his fifth novel.
THROUGH A BROKEN HEART
Book Title: Through a Broken Heart: Finding Hope and Healing After a Breakup
Author: Colleen Meissner
Category: Adult Non-Fiction, 144 pages
Genre: Christian non-fiction, self-help, devotional
Publisher: A Book's Mind
Dear Broken Heart ~
You must be hurting deeply. Perhaps you're also feeling overwhelmed and completely alone in this place of emptiness and grief. I've been where you are and my heart aches with yours. I want you to know there is someone who sees and someone who cares. His name is Jesus. The journey right now is dark and painful, but if you will travel with me using God's word as our guide, it will eventually lead to a place of hope and restoration. A destination where God's love ushers you into wholeness. Where His healing hand won't just repair your shattered soul, but will establish you in the truth that you are deeply loved and understood. In contrast to your current sorrow, this may seem too good to be true. I get that, I've been there. At this point, I'm only asking you to trust that He is able. I invite you to spend these next six weeks at the feet of Jesus and allow Him to enter into your wounded heart through this very place of brokenness. Will you give Him permission to transform you in a way that far exceeds your own expectations?
~ Colleen Meissner Married for the first time at 42. Colleen knows firsthand the pain of heartbreak, being single longer than expected, and the battle against fear and insecurity. She holds a Master's Degree in Clinical Psychology and has spent over 10 years sharing her own experience and knowledge as a coach and mentor. She now has a vision to share the wisdom she's been given with you.
I earned a Master's in Clinical Psychology from Azusa Pacific University in 2010 and have been mentoring women for over a decade. The most common area of counsel I provide is to single women not ashamed to admit they want to be married and have someone to share their life with. These women often without realizing it, are battling soul wounds (emotional and heart wounds) from their past that are preventing them from fulfilling this deeply held desire of marriage and family.
I consider there to be no greater privilege than to have women trust me with their deepest struggles and fears and to travel along side of them on their journey from a place of being held in bondage by lies ("I am fat, ugly, a loser, unlovable…") to a place of freedom and victory. I know this journey well, I have traveled it; it is hard and it is long, and you cannot do it alone. There are seemingly impossible hills to climb, valleys to crawl out of and side-roads leading to nowhere. Perhaps more than a mentor, I am a tour-guide, leading you as you navigate your way to healing and overcoming those things that have kept you from embracing the fullness of life that the Lord came to give you (John 10:10).
Title: BRIMSTONE
Author: John Allen
Publisher: Allen & Allen Semiotics Inc.
Genre: Historical Fiction/Women Sleuths/Mystery/Suspense/Thriller
Author John Allen has a theory about the creator of Sherlock Holmes:
Sir Arthur Conan Doyle did not create Holmes. It was Doyle's wife, Louise Hawkins Conan Doyle, who gave birth to the beloved sleuth.
Allen has put his beliefs to the test, writing and publishing the first of a projected 12-novel series of Holmes mysteries titled BRIMSTONE. His detective is Louise Hawkins Conan Doyle, and Allen names her as the author of the tale he presents, set in 1879 Bristol, England.
In a previous book, SHADOW WOMAN, Allen set out to prove that Louise was the true creator of Sherlock Holmes. The inspiration for his startling and controversial theory of authorship was a 1980s essay by Martin Gardner called "The Irrelevance of Arthur Conan Doyle." Gardner claimed that Arthur was "too gullible and to easily duped to have created Sherlock Holmes."
Allen determined that Gardner was correct, but Gardner identified no alternative author. Allen continues, "So I decided to give it a try. I came to suspect Louise as the actual author, but I lacked the knowledge and tools to make a solid case."
Then the Internet came along, giving Allen a valuable research tool. He became convinced that Louise did in fact create Sherlock Holmes. Allen presented his case in SHADOW WOMAN, which was published in 2017. To further advance Louise as Holmes's creator, to give her the credit he believes she is due, he is now featuring her in a series of mystery novels, the first of which is BRIMSTONE.
As if Allen hadn't set the bar too high already, he has added a subtext to BRIMSTONE that explores contemporary wrongful convictions through his Victorian thrillers.
BRIMSTONE brims with appeal to multiple audiences, from lovers of detective stories to those interested in justice for the wrongfully convicted. Sherlock Holmes would be proud.
John Allen was born in Long Beach, CA. An engineer "by education, training, and experience," he describes himself as "a recovering engineer." He left engineering to become the junior partner in Allen & Allen Semiotics Inc., a corporation that his wife, Lynn, launched for their diversified home business. Their projects include designing databases for mid-sized companies. John Allen holds a BS from the United States Air Force Academy, an MS from the University of Southern California, and an MA from the University of California, Riverside.
You can visit his website at http://louiseconandoyle.com/.
BRIMSTONE was a well written book that featured Louise Hawkins Conan Doyle. I have always been a big fan of Sherlock Holmes in books, movies, and TV shows. This book really had an authentic Sherlock Holmes feel to it without being a Sherlock Holmes book. I found the story to be well thought out and it kept me on the edge of my seat as I kept trying to guess what would happen next!
PRAYER, MARRIAGE AND THE LEADERSHIP ROLES OF THE H...
Love Beneath the Mighty Dome: Volume 1 by Ronald J...
The Freedom Club
THE HEARTFULNESS WAY
WHAT DOES GOD SOUND LIKE?
THE PUMPKIN PATCH
SIGNS IN THE REARVIEW MIRROR


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redpajama_set_name: RedPajamaGithub


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Ferrovial and Macquarie fund acquire UK regional airports
A 50:50 partnership between Ferrovial, through its subsidiary Ferrovial Aeropuertos, and Macquarie European Infrastructure Fund 4 (MEIF4) has today signed an agreement with Heathrow Airport Holdings Limited for the purchase of Aberdeen, Glasgow and Southampton Airports.
The transaction is expected to complete no later than January 2015, and has an enterprise value of GBP1,048 million (US$1,678 million).
Iñigo Meirás, CEO, Ferrovial said:
"As a long standing investor in the UK, we are aware of the importance of these airports for the population in their surrounding areas. The transaction proves how valuable these assets are for Ferrovial. We are committed to improve these facilities and their services looking to a better passenger experience and in order to grant access to further domestic and international destinations."
Edward Beckley, European Head of Macquarie Infrastructure and Real Assets, the manager of MEIF4, said:
"As the world's leading infrastructure asset manager, Macquarie has a long and successful track record of investing in and developing airports around the world. We look forward to working with these airports over the long term to support route growth and enhance the passenger experience for the communities they serve."
The three airports will continue to be managed locally to meet the needs of their local communities, with the added benefit of being supported by the joint ownership of Ferrovial and Macquarie. Sir Peter Mason, Chairman of Thames Water and former CEO of AMEC plc, will be appointed as Chair of the group on completion.
The airports will continue to operate under the ownership of Heathrow Airport Holdings Limited until the transaction completes. This is expected by no later than January 2015 and is subject to regulatory clearances and processes.
The three airports collectively handled about 13m passengers a year, from Heathrow Airport Holdings (HAH).
- Southampton Airport is located 6.5 km north north-east of Southampton, in the Borough of Eastleigh within Hampshire, England. The airport handled 1,722,758 passengers during 2013, a 1.7% increase compared with 2012, making it the 18th busiest airport in the UK.
- Glasgow Abbotsinch Airport, is an international airport in Scotland, located 11 km west of Glasgow city centre. In 2013 the airport handled nearly 7.4 million passengers, a 2.9% annual increase, making it the second busiest in Scotland, after Edinburgh Airport, and the eighth busiest airport in the United Kingdom.
- Aberdeen International Airport is located at Dyce, a suburb of Aberdeen, Scotland, approximately 9.3 km northwest of Aberdeen city centre. A total of 3.44 million passengers used the airport in 2013, an increase of 3.3% compared with 2012 and a record annual total for the airport.
▶Heathrow Airport Holdings to sell Southampton, Glasgow and Aberdeen airports
▶Macquarie European Infrastructure Fund 4
▶Cintra - Ferrovial
▶Macquarie Capital - Macquarie Group
▶Macquarie Infrastructure and Real Assets (MIRA)
▶UK (United Kingdom)


text:
Q: Automatically Adjust Sampling Rate Based On File I have an Apple Lossless audio file recorded at 96 kHz but the light from my DAC is signaling that its a 44.1 kHz file when I play it.
When I go into the Audio MIDI Setup and change it to 96 kHz the light turns to green signaling its a higher sampling rate.
I have a lot of tracks at 44.1 kHz which I don't want to upsample but still want the HiRes files played at their maximum sampling rate for the best audio quality.
Is there anyway the format setting can be automatically adjusted without manually changing it by hand?

A: Just set the output to 96kHz.
Anything actually lower than that will either be transmitted at their own bit-rate & your DAC will auto-select or at worst will just be filled with empty bits. it won't make any practical difference; they're basically noise-floor bits anyway.

redpajama_set_name: RedPajamaStackExchange


The modern industry and innovation collection covers the period from 1936 to the present day. The date 1936 was chosen as the "start date" for this topic as this was the year that the first Industrial Estate was opened in Wales. It was the Treforest Industrial Estate and its creation marked a change in direction to the way we work. A move away from the traditional heavy industries to lighter industry and factory work. This event is generally regarded as the as the first step along the road to the creation of the industrially diverse economy that Wales enjoys today.
The collection itself is very diverse as it reflects the rationale of being either Welsh produced or having a strong Welsh connection such as the inventor or designer.
Examples, photographs and documents relating to factories such as Hoover and Lego.
Examples, photographs and documents relating to the animation, tourism and nuclear power industries.
Representative collection of toys manufactured in Wales, including firms like Oxford Diecast that evolved out of Mettoy.
The latest innovations in Wales, including electronics, computers, the first breathalyser and even Kevlar underpants made in Cardiff which protect soldiers from land mines.
Lately recycling and environmental industries have come to the fore with Welsh firms leading the way in recycling various waste materials, such as plastic farm baling bags into park benches or decking, and another firm recycling disposable nappies into insulation and fibreboard for construction.
The Museum also collects 'memories' in the form of video testimony from people who worked in the factories, power stations, studios and tourist resorts. These 'public histories' are added to the National Collection so that the children of tomorrow can find out first-hand how we lived.


text:
CMS eliminates retroactive DIR fees
CMS issued a final rule that eliminates PBMs' retroactive application of direct and indirect remuneration (DIR) fees, beginning in 2024, requiring that they be reflected in the negotiated price the patient pays at the pharmacy counter. This creates greater transparency for patients and pharmacies.
DIR fees are price concessions negotiated between PBMs and pharmacies participating in Medicare Part D networks. Retroactive DIR fees are assessed weeks, or even months, after Part D beneficiaries' prescriptions are filled, resulting in pharmacies realizing only long after the prescription was filled that they did not recoup their costs. Between 2010 and 2020, CMS reported that retroactive DIR fees increased by a staggering 107,400%. These fees also result in patients paying more at the pharmacy counter for their prescription drugs.
The final rule merely moves the fees to the point-of-sale negotiated price. It does not eliminate these fees.
CMS also eliminated in the final rule a proposal that would have left it up to the health plans and PBMs to decide how much, if any, of the pharmacy price concessions, they would pass through to patients at the point of sale during the coverage gap in the Medicare Part D program. This creates consistency for patients and pharmacies.
Although the entire pharmacy community has been pushing to eliminate retroactive DIR fees, how the final rule is implemented could still create some uncertainty and financial impacts on pharmacies. There is more that must be done to address the harmful and anticompetitive business practices by PBMs.
What's in CMS' final rule?
CMS' final rule includes all price concessions (including all DIR fees) in the "negotiated price," at the pharmacy counter, beginning on January 1, 2024 (contract year 2024). This will increase consistency for Part D plans and transparency for patients as well as help pharmacies better determine whether they can afford to stay open.
CMS also addresses Part D plans' and PBMs' use of "network access fees," "administrative fees," "technical fees," and "service fees" for pharmacies to participate in Part D plans' networks. If these "fees" are deducted from payments made to pharmacies for purchases of Part D drugs, CMS treats these costs as "price concessions," and they must also be reflected in the "negotiated price" at the point of sale. CMS also states that it may provide further clarification of "pharmacy administrative service fees" in a future rulemaking if PBMs use these "fees" in attempts to retain additional profits.
CMS' proposal sets a floor for pharmacy payment as the "lowest possible reimbursement" and allows for bonus payments for improved performance. Applying all pharmacy price concessions to the "negotiated price" at the point of sale will provide pharmacies with more information on the reimbursement they will receive for achieving/not achieving performance metrics.
Who benefits and why?
Patients will have reduced out-of-pocket costs.The final rule moves all pharmacy price concessions, including retroactive DIR fees, to the point of sale to benefit patients with lower cost sharing.
Pharmacists will have increased predictability.Effectively eliminating PBMs' use of retroactive DIR fees increases predictability for pharmacies and addresses a regulatory loophole CMS opened in 2014 that allowed PBMs to have unlimited license to apply retroactive DIR fees.
What's not in CMS' final rule?
CMS does not eliminate PBMs' use of DIR fees.Under the final rule, PBMs will still be able to use DIR fees to extract arbitrary fees, moving them to the point of sale (i.e., utilizing a bonus payment model), in addition to extracting other unreasonable concessions from pharmacies.
CMS acknowledges, but does not address, the impact on pharmacy cash flow.The final rule acknowledges the "possibility that changes in cash flow may cause some already struggling pharmacies to decrease services or medication availability, and/or be unable to remain in business, which may impact pharmacy networks." However, CMS fails to address the transition period for pharmacies from calendar year (CY) 2023 to (CY) 2024. Under the final rule, pharmacies will receive the "lowest possible reimbursement" in 2024 while PBMs continue to collect pharmacy DIR fees from 2023, which could create significant cash flow issues for pharmacies during the transition. While CMS "encourages Part D plans to consider options, such as payment plans or alternate payment arrangements, to minimize impacts to vulnerable pharmacies and the patients they serve," there is no requirement for Part D plans to address these cash flow concerns at the beginning of 2024.
CMS does not close other PBM loopholes.PBMs are still able to continue other harmful business practices such as negative reimbursements (through which the PBM reimburses the pharmacy less than it costs to acquire the drug) and "patient steering" for brand, generic, and specialty drugs to PBM-affiliated pharmacies.
Example of how Part D plans and PBMs will report costs/DIR under the final rule:
Example: Assuming a Part D plan and a network pharmacy have a performance-based payment arrangement to: 1) recoup 5% of its total Part D-related payments to the pharmacy for the pharmacy's failure to meet performance standards, 2) recoup no payments for average performance, or 3) provide a bonus equal to 1% of total payments to the pharmacy for high performance.
For a drug that the Part D plan has agreed to pay the pharmacy $100 at the point of sale, the pharmacy's final reimbursement under this arrangement would be: 1) $95 for poor performance, 2) $100 for average performance, or 3) $101 for high performance.
The "negotiated price" reported to CMS on the prescription drug event record at the point of sale for this drug would be $95, or the "lowest possible reimbursement" under the arrangement.
Thus, if a Part D plan were required to pay 25% coinsurance for this drug, then the patient's costs under this scenario would be 25% of $95, or $23.75, which is less than the $25 the enrollee would pay today (when the negotiated price is likely to be reported as $100).
Any difference between the reported negotiated price and the pharmacy's final reimbursement for this drug would be reported as DIR. Under this requirement, the Part D plan would report $0 as DIR under the poor performance scenario ($95 minus $95), -$5 as DIR under the average performance scenario ($95 minus $100), and -$6 as DIR under the high-performance scenario ($95 minus $101) for every covered claim for this drug purchased at this pharmacy.
Thank You APhA Members!
APhA extends our gratitude to the hundreds of members from across the country who contacted CMS and made their voices heard. When CMS issued a proposed rule aimed at lowering patients' out-of-pocket costs at the pharmacy counter and eliminating PBMs' harmful use of retroactive direct and indirect remuneration (DIR) fees, you stood up alongside APhA for yourself, your fellow pharmacists, and your patients as well as made a difference.
When CMS issued a final rule eliminating retroactive DIR, we covered this exciting development with members during an open forum featuring an expert breakdown of the rule, what it is and isn't, and future implications. The recording can be accessed below for members only.


Customers can supply files from most PC or Apple Mac applications. All files should be created and use pictures that have been converted to CMYK. We would prefer that files are saved as PDF, PostScript, JPEG or EPS files.
Azimuth Print provide template PDF files to help you create your artwork. If you can't find the template you need or you need a bespoke size, please feel free to call us on 0117 332 0055 or e-mail to sales@azimuthprint.co.uk and we will create your ideal template while you wait. All for FREE!
Once you have completed your order online, you will be given a link to upload your artwork on the last page of the order process.
Files can be sent as attachments to an e-mail, or saved and posted to us on CD, DVD or Pen-drive. Alternatively try a free file transfer service such as WeTransfer or MegaFileUpload. If you are posting your files to us please include a printed hard copy if possible.
You can create your own design if you use Azimuth Print's FREE Online Design Studio. Simply select an existing template or create your own artwork from scratch. The Online Design Studio is easy to use and it is FREE!


Precision jump rings for chainmail jewelers.
Please join me in welcoming rubber rings to the Spiderchain family. These are the rubber rings developed by Blue Buddha Boutique, and now that B3 is closing? The rubber rings needed a new home. I hope they'll feel very welcome here!
These brightly colored rings give a fun twist to chainmail. You can make stretchy jewelry that requires no clasp. You can fold and squish rubber rings in a way that metal would never tolerate. You can also use them purely for the splash of playful color!
Rubber rings come in six sizes and a wide array of colors. Please note, however, that it will be a long time (months!) before all the sizes are available in all the colors. Once the dust settles from the transition, I'll put together a chart with my best guesses for when certain size/color combinations are likely to be available.


text:
package org.elasticsearch.common.settings;

import org.elasticsearch.cluster.routing.allocation.decider.FilterAllocationDecider;
import org.elasticsearch.cluster.routing.allocation.decider.ShardsLimitAllocationDecider;
import org.elasticsearch.test.ESTestCase;
import org.elasticsearch.transport.TransportService;

import java.io.IOException;
import java.util.Arrays;
import java.util.Collections;
import java.util.HashSet;
import java.util.List;
import java.util.concurrent.atomic.AtomicInteger;
import java.util.concurrent.atomic.AtomicReference;

public class ScopedSettingsTests extends ESTestCase {

    public void testAddConsumer() {
        Setting<Integer> testSetting = Setting.intSetting("foo.bar", 1, true, Setting.Scope.CLUSTER);
        Setting<Integer> testSetting2 = Setting.intSetting("foo.bar.baz", 1, true, Setting.Scope.CLUSTER);
        AbstractScopedSettings service = new ClusterSettings(Settings.EMPTY, Collections.singleton(testSetting));

        AtomicInteger consumer = new AtomicInteger();
        service.addSettingsUpdateConsumer(testSetting, consumer::set);
        AtomicInteger consumer2 = new AtomicInteger();
        try {
            service.addSettingsUpdateConsumer(testSetting2, consumer2::set);
            fail("setting not registered");
        } catch (IllegalArgumentException ex) {
            assertEquals("Setting is not registered for key [foo.bar.baz]", ex.getMessage());
        }

        try {
            service.addSettingsUpdateConsumer(testSetting, testSetting2, (a, b) -> {consumer.set(a); consumer2.set(b);});
            fail("setting not registered");
        } catch (IllegalArgumentException ex) {
            assertEquals("Setting is not registered for key [foo.bar.baz]", ex.getMessage());
        }
        assertEquals(0, consumer.get());
        assertEquals(0, consumer2.get());
        service.applySettings(Settings.builder().put("foo.bar", 2).put("foo.bar.baz", 15).build());
        assertEquals(2, consumer.get());
        assertEquals(0, consumer2.get());
    }

    public void testApply() {
        Setting<Integer> testSetting = Setting.intSetting("foo.bar", 1, true, Setting.Scope.CLUSTER);
        Setting<Integer> testSetting2 = Setting.intSetting("foo.bar.baz", 1, true, Setting.Scope.CLUSTER);
        AbstractScopedSettings service = new ClusterSettings(Settings.EMPTY, new HashSet<>(Arrays.asList(testSetting, testSetting2)));

        AtomicInteger consumer = new AtomicInteger();
        service.addSettingsUpdateConsumer(testSetting, consumer::set);
        AtomicInteger consumer2 = new AtomicInteger();
        service.addSettingsUpdateConsumer(testSetting2, consumer2::set, (s) -> assertTrue(s > 0));

        AtomicInteger aC = new AtomicInteger();
        AtomicInteger bC = new AtomicInteger();
        service.addSettingsUpdateConsumer(testSetting, testSetting2, (a, b) -> {aC.set(a); bC.set(b);});

        assertEquals(0, consumer.get());
        assertEquals(0, consumer2.get());
        assertEquals(0, aC.get());
        assertEquals(0, bC.get());
        try {
            service.applySettings(Settings.builder().put("foo.bar", 2).put("foo.bar.baz", -15).build());
            fail("invalid value");
        } catch (IllegalArgumentException ex) {
            assertEquals("illegal value can't update [foo.bar.baz] from [1] to [-15]", ex.getMessage());
        }
        assertEquals(0, consumer.get());
        assertEquals(0, consumer2.get());
        assertEquals(0, aC.get());
        assertEquals(0, bC.get());
        try {
            service.dryRun(Settings.builder().put("foo.bar", 2).put("foo.bar.baz", -15).build());
            fail("invalid value");
        } catch (IllegalArgumentException ex) {
            assertEquals("illegal value can't update [foo.bar.baz] from [1] to [-15]", ex.getMessage());
        }

        assertEquals(0, consumer.get());
        assertEquals(0, consumer2.get());
        assertEquals(0, aC.get());
        assertEquals(0, bC.get());
        service.dryRun(Settings.builder().put("foo.bar", 2).put("foo.bar.baz", 15).build());
        assertEquals(0, consumer.get());
        assertEquals(0, consumer2.get());
        assertEquals(0, aC.get());
        assertEquals(0, bC.get());

        service.applySettings(Settings.builder().put("foo.bar", 2).put("foo.bar.baz", 15).build());
        assertEquals(2, consumer.get());
        assertEquals(15, consumer2.get());
        assertEquals(2, aC.get());
        assertEquals(15, bC.get());
    }

    public void testGet() {
        ClusterSettings settings = new ClusterSettings(Settings.EMPTY, ClusterSettings.BUILT_IN_CLUSTER_SETTINGS);

        // group setting - complex matcher
        Setting setting = settings.get("cluster.routing.allocation.require.value");
        assertEquals(setting, FilterAllocationDecider.CLUSTER_ROUTING_REQUIRE_GROUP_SETTING);

        setting = settings.get("cluster.routing.allocation.total_shards_per_node");
        assertEquals(setting, ShardsLimitAllocationDecider.CLUSTER_TOTAL_SHARDS_PER_NODE_SETTING);

        // array settings - complex matcher
        assertNotNull(settings.get("transport.tracer.include." + randomIntBetween(1, 100)));
        assertSame(TransportService.TRACE_LOG_INCLUDE_SETTING, settings.get("transport.tracer.include." + randomIntBetween(1, 100)));

        // array settings - complex matcher - only accepts numbers
        assertNull(settings.get("transport.tracer.include.FOO"));
    }

    public void testIsDynamic(){
        ClusterSettings settings = new ClusterSettings(Settings.EMPTY, new HashSet<>(Arrays.asList(Setting.intSetting("foo.bar", 1, true, Setting.Scope.CLUSTER), Setting.intSetting("foo.bar.baz", 1, false, Setting.Scope.CLUSTER))));
        assertFalse(settings.hasDynamicSetting("foo.bar.baz"));
        assertTrue(settings.hasDynamicSetting("foo.bar"));
        assertNotNull(settings.get("foo.bar.baz"));
        settings = new ClusterSettings(Settings.EMPTY, ClusterSettings.BUILT_IN_CLUSTER_SETTINGS);
        assertTrue(settings.hasDynamicSetting("transport.tracer.include." + randomIntBetween(1, 100)));
        assertFalse(settings.hasDynamicSetting("transport.tracer.include.BOOM"));
        assertTrue(settings.hasDynamicSetting("cluster.routing.allocation.require.value"));
    }

    public void testDiff() throws IOException {
        Setting<Integer> foobarbaz = Setting.intSetting("foo.bar.baz", 1, false, Setting.Scope.CLUSTER);
        Setting<Integer> foobar = Setting.intSetting("foo.bar", 1, true, Setting.Scope.CLUSTER);
        ClusterSettings settings = new ClusterSettings(Settings.EMPTY, new HashSet<>(Arrays.asList(foobar, foobarbaz)));
        Settings diff = settings.diff(Settings.builder().put("foo.bar", 5).build(), Settings.EMPTY);
        assertEquals(diff.getAsMap().size(), 1);
        assertEquals(diff.getAsInt("foo.bar.baz", null), Integer.valueOf(1));

        diff = settings.diff(Settings.builder().put("foo.bar", 5).build(), Settings.builder().put("foo.bar.baz", 17).build());
        assertEquals(diff.getAsMap().size(), 1);
        assertEquals(diff.getAsInt("foo.bar.baz", null), Integer.valueOf(17));
    }

    public void testUpdateTracer() {
        ClusterSettings settings = new ClusterSettings(Settings.EMPTY, ClusterSettings.BUILT_IN_CLUSTER_SETTINGS);
        AtomicReference<List<String>> ref = new AtomicReference<>();
        settings.addSettingsUpdateConsumer(TransportService.TRACE_LOG_INCLUDE_SETTING, ref::set);
        settings.applySettings(Settings.builder().putArray("transport.tracer.include", "internal:index/shard/recovery/*", "internal:gateway/local*").build());
        assertNotNull(ref.get().size());
        assertEquals(ref.get().size(), 2);
        assertTrue(ref.get().contains("internal:index/shard/recovery/*"));
        assertTrue(ref.get().contains("internal:gateway/local*"));
    }
}


The housing situation in Skagafjörður is quite good – meaning strong demand but rather short supply, despite over 100 flats having been built there in recent years and others being in various stages of construction. The table displays the number of residential unit sales in Skagafjörður during recent years.
Lots for 150 residential units are for sale, or will soon be if needed. In the coming years, lots for an additional 360 residential units will be available if necessary.


With the Leadville 100 races on the horizon, we thought we'd give our Tailwind community some pointers for high altitude fueling. "The Race Across the Sky" pushes the body to the extreme for 100 grueling miles at 9,100 – 12,600 feet. To put this in perspective, the highest mountain passes at the UTMB and Tour de France just barely hit 8,000-9,000 feet above sea level. At this high elevation, three things need to be taken into consideration: lack of oxygen, hydration, and digestive issues. In this unforgiving environment, issues in any of these three areas can quickly lead to problems for an athlete so we need to be prepared.
There is a common misperception that there is less oxygen at high altitude. This is not technically true. The same 21% percent of oxygen is in the air at the 12,000 foot summit of Columbine Mine (Leadville 100) as at sea level; what is different is the barometric pressure (PB). The PB at sea level is 760 mmHg and at 10,000 feet it is 534 mmHg – so there is 21% of a smaller number as one goes higher. Put another way, when pressure decreases gas molecules expand and take up more space within a given area. The result is that for a given volume of air there are less total oxygen molecules present.
In addition, the reduced atmospheric pressure at altitude reduces the driving pressure for oxygen to enter the lungs. Oxygen enters the body and the cells through partial pressure gradients. The lower partial pressure exerted at altitude makes it harder for the body to consume and use oxygen. This produces hypoxia, where our blood carries a lower level of oxygen than normal. The body compensates by increasing our heart and breathing rates to try and absorb more oxygen and deliver it to our muscles. Plus, hormonal changes occur, like the pumping of adrenaline to help with oxygen transportation and delivery.
The only cure for these dramatic changes is time. We need time to let our body adjust, or acclimate, and increase the number of oxygen-carrying red blood cells that improve our ability to deliver oxygen to the brain and working muscles. Most adaptations occur within two days to two weeks of exposure to altitude. During this time the amount of oxygen that the body can consume and utilize is reduced and endurance performance may be impaired. So aim to get to the race location a week in advance and stay active — which accelerates the acclimation process. Don't, however, workout at your full intensity. Instead, take the first day or two off, and if you aren't experiencing symptoms of acute mountain sickness, gradually start training.
High altitude presents the perfect storm for dehydration. The air at high elevation is very dry, so sweat evaporates quickly and we experience increased evaporative losses from our lungs. High altitude also causes an increase in urination. As if that wasn't bad enough, we lose the sensation of thirst at higher elevations since lower temperatures suppress thirst even when the body needs fluids.
The obvious conclusion is that proper hydration is of the utmost importance while training or racing at high altitude. Athletes can lose as much as 12 liters of sweat in a 100-mile race! It is equally important, however, to get adequate electrolytes and glucose in our fuel to ensure the proper absorption of liquid. Tailwind does just that. It keeps you hydrated and provides the optimum ratio of sodium and glucose to keep our inner hydration pumps working at their peak.
Your digestive tract gets compromised at altitude. Period. Symptoms like nausea and vomiting are common signs of altitude sickness and are seen in 81.4% of short-term visitors. At high elevations, the body is working on overdrive so it suppresses the digestive system in favor of increasing its cardiopulmonary reserves. In other words, the heart beats faster and non-essential bodily functions are repressed, resulting in a decline in food digestion efficiency. Tailwind's use of glucose as its primary fuel source makes it easy to absorb since it doesn't need digestion to get transported into our blood. By literally bypassing the need for digestion, Tailwind is the fuel that is easiest on the GI tract.
Stay hydrated with a target of 20-24 ounces of water per hour. Most GI problems stem from the fact that you get dehydrated. If you are taking gels, don't forget to drink – this is a fairly common problem since gels are somewhat viscous.
Carbs, like glucose, are the body's fuel of choice at high altitude because carbs can supply 15 percent more energy for the same amount of oxygen in comparison to fats.
Don't overload the gut with too many calories. Aim for 200-300 calories/hour.
Have your crew monitor your intake of calories and fluids.
Avoid drinks or foods that are high in protein. Although protein is important for recovery and as part of your overall diet, it is too hard on the digestive tract during a high altitude race.
Don't go too hard. At altitude where your GI system is already compromised working too hard can just stress it more. Instead, strive to maintain a nice achievable pace.