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Gerson Therapy (PDQ®): Integrative, alternative, and complementary therapies – Health Professional Information [NCI]
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
NOTE: The information in this summary is no longer being updated and is provided for reference purposes only.
This cancer information summary provides an overview of the Gerson therapy as a treatment for people with cancer. The summary includes a brief history of the development of the Gerson therapy; a review of laboratory, animal, and human studies; and possible side effects associated with the use of this treatment.
This summary contains the following key information:
- The Gerson therapy is advocated by its supporters as a method of treating cancer patients based on changes in diet and nutrient intake.
- An organic vegetarian diet plus nutritional and biological supplements, pancreatic enzymes, and coffee or other types of enemas are the main features of the Gerson therapy.
- The regimen is intended to "detoxify" the body while building up the immune system and raising the level of potassium in cells.
- The regimen is empirically based on observations made by Max Gerson, M.D., in his clinical practice and on his knowledge of research in cell biology at the time (1930s–1950s).
- No results of laboratory or animal studies are reported in the scientific literature contained in the Medical Literature Analysis and Retrieval System Online database.
- Few clinical studies of the Gerson therapy are found in the medical literature.
Many of the medical and scientific terms used in this summary are hypertext linked (at first use in each section) to the NCI Dictionary of Cancer Terms, which is oriented toward nonexperts. When a linked term is clicked, a definition will appear in a separate window.
Reference citations in some PDQ cancer information summaries may include links to external websites that are operated by individuals or organizations for the purpose of marketing or advocating the use of specific treatments or products. These reference citations are included for informational purposes only. Their inclusion should not be viewed as an endorsement of the content of websites, or of any treatment or product, by the PDQ Integrative, Alternative, and Complementary Therapies Editorial Board or the National Cancer Institute.
General Information
The Gerson therapy is a complex regimen advocated by its supporters to treat cancer and other degenerative diseases. It consists of a specialized diet to "detoxify" the body and rebuild the immune system, adding vitamin and mineral supplements to help in these processes. Coffee enemas are an essential part of the regimen. The therapy is named for its developer, Max Gerson, a German physician who emigrated to the United States and started a medical practice in New York City in 1938.[1,2]
The Gerson therapy is rooted in the belief that cancer is a disease of the whole organism, the tumor being only a symptom of a diseased body. Gerson considered cancer to be an accumulation of several damaging factors that combine to cause the deterioration of the entire metabolic system. The goal of the Gerson therapy is to bring the body back to its normal metabolic state, or as near to this state as possible, and to keep the metabolism in natural equilibrium.[1,2]
Gerson observed that cancer patients exhibited markedly degenerated organs, especially the liver, presumably caused by the clearing of toxic materials of an unknown type that the disease produced. He also noted that the situation became worse after chemotherapy, probably because of more toxic products entering the bloodstream. Gerson's regimen focused on helping the liver rid the body of toxic substances while restoring and maintaining healthy liver function.[1,2]
According to Gerson, during the detoxification process that results from the Gerson diet, the liver becomes progressively overburdened as the body rids itself of toxic substances formed by the breakdown of cancer cells. Coffee enemas, pancreatic enzymes, and crude liver extract are used to help the liver deal with the burden of removing toxic substances.[1,2,3,4,5]
Total control of everything that enters and leaves the body is the governing principle of the Gerson regimen. Its three main components are strict diet, nutritional supplements, and regular enemas.
The diet is strictly vegetarian for at least 6 weeks and consists of specific fruits and vegetables, eaten either raw or stewed in their own juices. No animal protein is allowed. Some whole grains such as oatmeal are included. Flaxseed oil is allowed only because it aids in the body's use of vitamin A.[2] No other fat such as cooking oil and no salt or spices of any kind are allowed. A glass of freshly prepared juice from vegetables and fruits must be consumed every hour for 13 hours throughout the day. The vegetables and fruits used on the diet are very high in potassium and very low in sodium.
Food preparation is also controlled. Food may be prepared only in cast-iron pots and pans; no aluminum cookware is allowed. Juices must be prepared using a specific type of juicer that crushes the fruit or vegetable rather than grinding it into pulp. Gerson advocated organically produced food, with all fruits, vegetables, and grains grown and raised in soil free of pesticides and contaminants and enriched only with natural fertilizers.[2]
The protein and dairy restriction may be lifted to include buttermilk; however, this restriction may continue through the entire course of the therapy, depending on the individual patient. Some changes in the original diet have occurred over time, but the initiation phase of the diet has always been a vegetarian diet.[2]
Taking specific vitamin and mineral supplements plus pancreatic enzymes is the second component of the regimen. Although there have been additions and substitutions to the basic list of supplements, there have been few changes since the 1940s. The typical range of supplements includes the following:
- Potassium solution
- Lugol's solution (potassium iodide, iodine, water)
- Injectable crude liver extract (no longer used) with vitamin B12 (substitution: coenzyme Q10 and vitamin B12)
- Vitamins A, C, and B3 (niacin)
- Flaxseed oil
- Pancreatic enzymes
- Pepsin
The potassium solution (potassium dissolved in water) is to help increase the ratio of potassium to sodium in the cells. Lugol's solution, which consists of 5 g of iodine and 10 g of potassium iodide dissolved in water, is given to increase the body's metabolic rate. The potassium solution and Lugol's solution are both added to the hourly juice intake.[1,2,3,4,5]
Originally, Gerson thought that using crude liver extract and juice (made by processing fresh calf and veal livers) would help maintain liver function. The extract and juice were given to patients via injection with the vitamin B12. In 1989, the use of injectable crude liver extract was banned by the U.S. Food and Drug Administration because it was found to be contaminated with Campylobacter.[1,2] Desiccated liver capsules replaced the crude extract, but this has now been replaced by coenzyme Q10.[2] As mentioned above, flaxseed oil is used to help the body utilize vitamin A. Pancreatic enzymes are given to assist in the digestion and the elimination of the breakdown products in the colon.
Coffee (or chamomile) enemas are the third component of the Gerson therapy. Coffee enemas supposedly dilate the bile duct in the liver, thereby allowing the liver to release the breakdown products more easily and speed their removal to the intestine. At the beginning of therapy, a patient may take four or more coffee enemas per day. Literature suggests that coffee enemas help relieve the pain associated with gastrointestinal cancers; however, there is only anecdotal evidence to suggest that the enemas actually dilate the bile ducts.[6,7]
Central to the therapy is an abundance of potassium and the lack of sodium. Gerson had observed that as soon as his cancer patients started on the diet regimen, they released large amounts of sodium in their urine. He noticed that cells in the patients' bodies that had been bloated with fluid started to shrink as the fluid was released.[1] After studying the research in cancer cell biology available to him at the time and noting the ratio of potassium to sodium in cancer cells versus healthy cells, he deduced that the reason for this sodium excretion was that the diet regimen was correcting generalized tissue damage caused by excess sodium. Healthy cells had a high ratio of potassium to sodium; diseased cells had a low ratio of potassium to sodium or an abundance of sodium.[1]
The implications of this observation led Gerson to believe that part of the process of recovery from cancer was the replacement of excess sodium by potassium in damaged tissues.[8] This belief is the theoretical basis for Gerson's choice of high-potassium, low-sodium fruits and vegetables in his prescribed diet: a high intake of potassium was needed to restore a normal ratio of potassium to sodium in the cell.
The Gerson therapy is the basis for other CAM therapies that include cleansing enemas or special diets as part of their regimens, most notably the Gonzalez regimen. (Refer to the PDQ summary on the Gonzalez Regimen for more information.)
- Gerson M: A Cancer Therapy: Results of Fifty Cases and The Cure of Advanced Cancer by Diet Therapy. San Diego, Calif: The Gerson Institute, 2002.
- Gerson C, Walker M: The Gerson Therapy: The Amazing Nutritional Program for Cancer and Other Illnesses. New York, NY: Kensington Publishing Corp, 2001.
- Gerson M: Effects of a combined dietary regime on patients with malignant tumors. Exp Med Surg 7 (4): 299-317, illust, 1949.
- Gerson M: Dietary considerations in malignant neoplastic disease: preliminary report. Rev Gastroenterol 12: 419-25, 1945. Also available online. Last accessed April 11, 2016.
- Gerson M: The cure of advanced cancer by diet therapy: a summary of 30 years of clinical experimentation. Physiol Chem Phys 10 (5): 449-64, 1978.
- Green S: A critique of the rationale for cancer treatment with coffee enemas and diet. JAMA 268 (22): 3224-7, 1992.
- Brown BT: Treating cancer with coffee enemas and diet. JAMA 269 (13): 1635-6, 1993.
- Cope FW: A medical application of the Ling association-induction hypothesis: the high potassium, low sodium diet of the Gerson cancer therapy. Physiol Chem Phys 10 (5): 465-8, 1978.
Max Gerson immigrated to the United States from Germany. In 1938, after passing the New York state medical board examinations, he started a practice in New York City. While in Germany, Gerson had suffered from severe migraine headaches and developed a vegetarian diet as a way to cure his migraines. The diet was based on his study of the history of medicine and his respect for the writings of Paracelsus (1490–1541), who said that diet must be the basis of medical therapy; however, Gerson noted that diet is only one part of a treatment regimen.[1] The special diet cured his migraines, and after seeing its success in one of his patients suffering from lupus vulgaris, he prescribed the diet for others suffering from the same disease. He conducted a successful clinical trial in Germany using the vegetarian diet.[1] His most noted patient was the wife of Albert Schweitzer, M.D., whom he reported curing. The accolades he received from Dr. Schweitzer may have persuaded the medical community to seriously consider the Gerson therapy and perhaps led to Gerson's 1946 appearance with five of his patients before a congressional committee considering a bill to increase funding for cancer research.[2]
When Gerson began prescribing his regimen for patients, he did not consider his therapy a cure for cancer. At that time he wrote that there was no conclusive evidence from his work that cancer was influenced by diet; however, he did think that diet was a useful supportive measure.[3] In 1958, after treating patients with his regimen for more than 15 years, Gerson published his complete theory, including the results of 50 cases. He started referring to his regimen as an "effective treatment for cancer, even in advanced cases."[1,4]
The practice of changing diet or fasting to cure or ameliorate the effects of disease has a long history, as does the practice of giving enemas to flush the body, thus keeping the body clear of toxins.[5] There are no reported results of clinical trials examining the efficacy of either of these practices in the treatment of cancer or how these practices would affect a treatment. Evolving evidence supports the idea that a plant-based diet plays a role in cancer prevention.
Gerson theorized that the use of pancreatic enzymes would reduce demands on the liver and pancreas, already in a weakened state, to manufacture the enzymes necessary to convert food into usable nutrients; this would help stabilize the nutritional needs of the body while it undergoes the detoxification process.[1,6] Gerson's therapy was widely considered impossible because it was thought that pancreatic enzymes were reduced to their components in the intestinal tract. However, it has been reported that these enzymes are not broken down but are released into the bloodstream and used again in the digestive process.[7,8]
Controversy about the efficacy of the Gerson therapy continued throughout Gerson's life. In 1946 and 1949, two articles in the Journal of the American Medical Association concluded that the treatment was of no value.[9,10] The National Cancer Institute (NCI) reviewed Gerson's data from ten case histories in 1947 and 50 case histories in 1959. NCI concluded that in most cases, basic criteria for evaluating clinical benefit were not met. NCI concluded that the data demonstrated no benefit.[2] In 1972, the American Cancer Society (ACS) published a statement summarizing the negative assessments of Gerson's treatment.[11] Another statement published by ACS in 1991 concerned various "metabolic therapies" (defined as treatments that depend on changing metabolism through diet, enemas, and supplements given at clinics in Tijuana, Mexico) and reemphasized the lack of scientific evidence on the efficacy of the Gerson regimen.[12]
Gerson died in 1959, leaving behind no systematic way to continue offering his treatment. His malpractice insurance had been canceled in 1953, and in 1958 he was suspended for 2 years from the New York County Medical Society.[11] In 1977, his daughter, Charlotte Gerson Straus, who had continued to lecture widely about the Gerson therapy, cofounded the Gerson Institute with Norman Fritz. Located in San Diego, the Gerson Institute does not own or operate treatment facilities but maintains a licensing program for treatment centers such as the Centro Hospitalario Internacional Pacifico and Mexico's Center for Integrative Medicine and the Gerson Hospital (CHIPSA) in Baja California, Mexico. CHIPSA refers to Max Gerson as the founder of "immunonutrition," their term for Gerson's idea of cleansing the body while building up the immune system through diet and supplementation.
- Gerson M: A Cancer Therapy: Results of Fifty Cases and The Cure of Advanced Cancer by Diet Therapy. San Diego, Calif: The Gerson Institute, 2002.
- US Congress, Office of Technology Assessment: Unconventional Cancer Treatments. Washington, DC: U.S. Government Printing Office, 1990. OTA-H-405.
- Gerson M: Dietary considerations in malignant neoplastic disease: preliminary report. Rev Gastroenterol 12: 419-25, 1945. Also available online. Last accessed April 11, 2016.
- Gerson M: The cure of advanced cancer by diet therapy: a summary of 30 years of clinical experimentation. Physiol Chem Phys 10 (5): 449-64, 1978.
- Ernst E: Colonic irrigation and the theory of autointoxication: a triumph of ignorance over science. J Clin Gastroenterol 24 (4): 196-8, 1997.
- Gerson C, Walker M: The Gerson Therapy: The Amazing Nutritional Program for Cancer and Other Illnesses. New York, NY: Kensington Publishing Corp, 2001.
- Rothman S, Liebow C, Isenman L: Conservation of digestive enzymes. Physiol Rev 82 (1): 1-18, 2002.
- Isenman L, Liebow C, Rothman S: Transport of proteins across membranes–a paradigm in transition. Biochim Biophys Acta 1241 (3): 341-70, 1995.
- Gerson's cancer treatment. JAMA 132 (11): 645-6, 1946.
- Council on Pharmacy and Chemistry: Report of the council: cancer and the need for facts. JAMA 139 (2): 93-8, 1949.
- Unproven methods of cancer management. Gerson method of treatment for cancer. CA Cancer J Clin 23 (5): 314-7, 1973 Sep-Oct.
- Questionable cancer practices in Tijuana and other Mexican border clinics. CA Cancer J Clin 41 (5): 310-9, 1991 Sep-Oct.
Laboratory / Animal / Preclinical Studies
There are noin vivo studies in animal models of the Gerson diet in the scientific literature.
Human / Clinical Studies
Gerson's book [1] and articles in English [2,3,4] are primarily reports of the details of the Gerson regimen, supplemented with case reports of patients seen in his clinical practice. His book presents an extended discourse on the empirical and scientific foundation for his treatment regimen and an expansive description of the treatment and diet followed by 50 patients selected from 30 years of clinical practice. Gerson's published cases encompass a variety of cancer types. The reports are extended case notes, with occasional x-rays of the patients over time. Although some attempt at follow-up is made, it is not systematic and consists chiefly of anecdotal reports and conversations with patients by mail or phone.
A preliminary study conducted between 1983 and 1984 attempted to collect any available retrospective data on three nonallopathic treatments offered in clinics in Tijuana, Mexico: Gerson, Hoxsey, and Contreras.[5] The authors did not have access to medical records and relied on patient interviews for all information. The self-reporting was incomplete and inconsistent, lacking precise information in areas such as how far the disease had advanced. In the Gerson segment, only 18 of the 38 patients stayed in the study for 5 years or until they died; their mean survival was 9 months from the beginning of the study. The other 20 patients were lost to follow-up. At 5 years, 17 of the 18 had died, and one patient with advanced non-Hodgkin lymphoma was alive but not disease free. Overall, this study did not offer meaningful data to support the clinical efficacy of the approaches studied.
A 1990 noncontrolled, self-selected, matched-pairs study conducted in Austria used a diet regimen based on the Gerson therapy to evaluate diet as an adjuvant to surgery. This diet was ovolactovegetarian.[6] The Gerson regimen is basically strictly vegetarian (no eggs or milk) and does not introduce food other than buttermilk until 6 or 8 weeks into the regimen, if at all, depending on the patient.
Two groups of patients who had undergone surgery—18 patients with colorectal cancer with metastases to the liver and 38 with breast cancer —were treated. Each of the two groups was divided into a diet group and a nondiet group. All patients continued with whatever prescribed conventional regimen was required after their surgery. Results in the matched pairs with colorectal cancer showed an increased survival time in three of the nine patients in the diet group (28.6 months) as compared with four of the nine patients (16.2 months) in the nondiet group. In the breast cancer matched pairs, side effects of chemotherapy and pain and pleural effusion were lower in the diet group. No statistically significant information was generated in this small number of patients; however, the authors stated that the diet regimen appeared to have beneficial effects that required further study.[6]
The Gerson Research Organization published a retrospective survival analysis of their melanoma patients treated with the Gerson approach, which was compared with published survival data according to stage. The analysis showed a survival advantage for melanoma patients with stage IIIA disease and stage IV disease with no visceral metastases, who were treated with the Gerson approach.[7] However, there has been no report of a prospective clinical trial confirming the findings of this retrospective analysis.
The study looked at records of 153 patients with stage I–IV melanoma treated with the Gerson diet. Of the 14 stage I–II patients, all were disease-free at 17 years posttreatment; however, this number was too small for a statistical comparison with other cohorts. For stage III patients, the 5-year survival rate was 71% compared with rates of 27% to 42% reported in the literature. The stage IV patients had the largest survival advantage. The 5-year survival rate for these 18 patients was 39%, compared with 6% in the published literature. The analysis did not include 53 patients who were lost to follow-up, which could have influenced the survival comparisons.[7]
A small best-case series [8] suggests that the evidence presented supports the development and conduct of a more definite clinical study on the Gerson regimen.
No conclusions about the effectiveness of the Gerson therapy, either as an adjuvant to other cancer therapies or as a cure, can be drawn from any of the studies reported above.
- Gerson M: A Cancer Therapy: Results of Fifty Cases and The Cure of Advanced Cancer by Diet Therapy. San Diego, Calif: The Gerson Institute, 2002.
- Gerson M: Effects of a combined dietary regime on patients with malignant tumors. Exp Med Surg 7 (4): 299-317, illust, 1949.
- Gerson M: Dietary considerations in malignant neoplastic disease: preliminary report. Rev Gastroenterol 12: 419-25, 1945. Also available online. Last accessed April 11, 2016.
- Gerson M: The cure of advanced cancer by diet therapy: a summary of 30 years of clinical experimentation. Physiol Chem Phys 10 (5): 449-64, 1978.
- Austin S, Dale EB, DeKadt S: Long term follow-up of cancer patients using Contreras, Hoxsey and Gerson therapies. J Naturopathic Med 5 (1): 74-6, 1994.
- Lechner P, Kroneberger L Jr: Experiences with the use of diet therapy in surgical oncology. Aktuel Ernahrungsmed 2 (15): 72-8, 1990.
- Hildenbrand GL, Hildenbrand LC, Bradford K, et al.: Five-year survival rates of melanoma patients treated by diet therapy after the manner of Gerson: a retrospective review. Altern Ther Health Med 1 (4): 29-37, 1995.
- Molassiotis A, Peat P: Surviving against all odds: analysis of 6 case studies of patients with cancer who followed the Gerson therapy. Integr Cancer Ther 6 (1): 80-8, 2007.
Adverse Effects
Case reports of adverse events associated with coffee enemas raise concern about their use. Three deaths that seem related to coffee enemas have been reported in the literature. Salmonella enteridis group D and Campylobacter fetus intestinalis were cultured from stool and blood of one patient who died shortly after treatment at the Gerson Institute clinic. This death could not be directly linked to the practice of coffee enemas because more tests could not be performed.[1]
Case reports of two more deaths following treatment at the Gerson Institute were both attributed to electrolyte imbalance after autopsies were performed showing no active inflammation of the colon.[2]
A third case report of electrolyte imbalance that did not result in death describes a patient who developed hyperkalemia while undergoing Gerson therapy.[3] No other reports of adverse effects have been identified.
- Margolin KA, Green MR: Polymicrobial enteric septicemia from coffee enemas. West J Med 140 (3): 460, 1984.
- Eisele JW, Reay DT: Deaths related to coffee enemas. JAMA 244 (14): 1608-9, 1980.
- Nagasaki A, Takamine W, Takasu N: Severe hyperkalemia associated with "alternative" nutritional cancer therapy. Clin Nutr 24 (5): 864-5, 2005.
Summary of the Evidence for Gerson Therapy
To assist readers in evaluating the results of human studies of integrative, alternative, and complementary therapies for cancer, the strength of the evidence (i.e., the "levels of evidence") associated with each type of treatment is provided whenever possible. To qualify for a level of evidence analysis, a study must:
- Be published in a peer-reviewed scientific journal.
- Report on a therapeutic outcome or outcomes, such as tumor response, improvement in survival, or measured improvement in quality of life.
- Describe clinical findings in sufficient detail that a meaningful evaluation can be made.
Evidence from studies that do not meet these requirements is considered extremely weak. In addition to scoring individual studies, an overall level of evidence assessment is usually made.
Because no prospective, controlled study of the use of the Gerson therapy in cancer patients has been reported in a peer-reviewed scientific journal, no level of evidence analysis is possible for this approach. The data that are available are not sufficient to warrant claims that the Gerson therapy is effective as an adjuvant to other cancer therapies or as a cure. At this time, the use of the Gerson therapy in the treatment of cancer patients cannot be recommended outside the context of well-designed clinical trials.
Separate levels of evidence scores are assigned to qualifying human studies on the basis of statistical strength of the study design and scientific strength of the treatment outcomes (i.e., endpoints) measured. The resulting two scores are then combined to produce an overall score. For additional information about levels of evidence analysis, refer to Levels of Evidence for Human Studies of Integrative, Alternative, and Complementary Therapies.
Changes to This Summary (04 / 11 / 2015)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
This summary is written and maintained by the PDQ Integrative, Alternative, and Complementary Therapies Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® – NCI's Comprehensive Cancer Database pages.
About This PDQ Summary
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the use of Gerson therapy in the treatment of people with cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Integrative, Alternative, and Complementary Therapies Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
- be discussed at a meeting,
- be cited with text, or
- replace or update an existing article that is already cited.
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewer for Gerson Therapy is:
- Patrick J. Mansky, MD (FMH Regional Cancer Therapy Center)
Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's Email Us. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Integrative, Alternative, and Complementary Therapies Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
PDQ® Integrative, Alternative, and Complementary Therapies Editorial Board. PDQ Gerson Therapy. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/treatment/cam/hp/gerson-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389464]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
The information in these summaries should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
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More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website's Email Us.
Last Revised: 2016-04-11
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Wedding bands used to be produced in sets to celebrate a relationship. However, there are no longer any restrictions stating that your wedding bands must match. Some folks choose a wedding ring that isn't the same colour as their engagement ring. When it comes down to it, your jewellery selections should reflect your preferred style.
Men's Wedding Rings in Rh - https://www.weddingringsdirect.org.uk/mens/powys/rh
Wedding Rings for Women in Rh - https://www.weddingringsdirect.org.uk/womens/powys/rh
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With the number of unique options available to choose from, you will be sure to find the ideal products for you and your partner. So make contact today for our advice. Fill in the contact form provided, and we will get back to you with more information on wedding rings direct in Rh SY22 6 as well as a free quotation if required.
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Online Tutorials
From Library Success: A Best Practices Wiki
Success Stories
Links to Great Online Tutorials
- Atlantic Community College
- Central Michigan University
- ANTS: ANimated Tutorial Sharing project by COPPULThis project was designed to enable librarians to share in the development of point-of-need animated tutorials for a multitude of e-products. The project makes use of new Collaborative Information Technology (CIT) via an Open Source Institutional Repository (DSpace), a Wiki, RSS Feeds and Web Pages. This enables participants to (1) identify tutorials for development and (2) keep others up to date on their work. Initially only COPPUL librarians could add content to the Repository; but as of October 2006, any librarian can add content as well as download open source tutorials. It should also be noted that as its list of e-resources for tutorial development is on a Wiki, the list is considered to be a starting point for development. Anyone can add new e-products to the list of tutorials for development. Similarly, other types of library tutorials are welcome. One need only indicate that it exists on the wiki and ensure that the source code for the tutorial is uploaded into DSpace.
- Dalhousie University LibCasts
- University of Oklahoma
- University of Minnesota
- Binghamton University
Tips for Developing Online Tutorials & Other Tricks
- Resources: Consider what type of software best meets the needs of your library and your tutorial.
- Budget: Determine your budget for software and staffing for the project. Often an online tutorial project can be funded with grant money from a parent institution.
- Technical Support: Secure some form of ongoing technical support for your tutorials. Tech support can come from your library systems department or a campus Information Technology department.
- Planning: Many people find "storyboarding" and graphic outlines to be useful tools for planning tutorials.
- Content: Carefully consider your audience when designing tutorials. Tailor tutorials to meet the needs of your audience. Tutorials can be course-related or stand alone. The objectives of the tutorial should be clearly stated for users. The most effective online tutorials allow for interaction and "active learning." Graphics add to the learning experience, but studies have found that adding sound to a tutorial doesn't work. Be sure and provide contact information for librarians who can help tutorial users with the tasks covered in the tutorial. Many tutorials contain email links.
- Currency: Keep tutorials current. Update as information and resources change and evolve.
- Feedback: Have a novice user review your tutorial to ensure ease of use and to ensure all tasks/steps are clearly defined in the tutorial.
Software We Like
Whopper List of Every Screencasting Tool on the Planet
- CamStudio (GPL)
- Adobe Captivate (formerly Macromedia Captivate)
- TechSmith Camtasia
- Qarbon ViewletBuilder 5
- Wink (Freeware)
- Freescreencast.com (Free - Windows Only - includes free hosting)
- Jing (Free - OSX and Windows - includes free hosting)
- TipCam from Utipu.com
- Windows 10 troubleshooting guide
- Camtasia:mac
- iShowU
- Snapz Pro X
- ScreenFlow (Leopard Only)
- Jing (Free - OSX and Windows - includes free hosting)
- Qarbon ViewletBuilder 4
- Qarbon ViewletBuilder 4
- Wink (Freeware)
- xvidcap
- Tux Radar Group test: screencasting apps
Web-based (Platform Independent)
- Screencast-O-Matic (Free)
- ScreenToaster (Free)
- Screenr
- ScreenCastle
- Screenjelly
Blogs/Websites to Watch
- Distant Librarian
- Jon Udell's Weblog
- CORIL A small but growing Canadian repository of online learning objects sponsored by the Ontario Council of University Libraries
- PRIMO A database of links to "peer-reviewed instructional materials created by librarians to teach people about discovering, accessing and evaluating information in networked environments". Produced by the Instruction Section of the ALA/ACRL.
- Library Instruction Wiki - Sharing resources section
- Rich Hoeg's eContent Blog - knowledge management from the corporate perspective
- LibCasting
- Scrast.net
Specific Blog Posts/Articles to Check Out
- Captivate vs. Camtasia - It's Anybody's Game by Steadfast Librarian
- Screencasting to Help Your Mom by Digital Inspiration
- Camtasia vs. Captivate by Information Wants to be Free
- Macromedia Captivate vs. Qarbon ViewletBuilder by Distant Librarian
- Creating Interactive Learning Tutorials for Software by Robin Good
- Demo services for Software products by Mervyn
- Movies of Software by Jon Udell
- Our Reference Wiki and Online Tutorials by Stephen Francoeur
- Web 2.0 Screencast Tutorials by Rich Hoeg
- Google Co-Op Search Engines & Tutorial by Rich Hoeg
- That's Infotainment School Library Journal article by Ellyssa Kroski
- How to Make 720p High Definition Screencast Videos for YouTube by Digital Inspiration
- "More Than Words" screencasting as a reference tool by Allison Carr & Pearl Ly Reference Services Review 2009, 37(4) p. 408-420. DOI: 10.1108/00907320911007010


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Having a mate is supposed to be good for your mental health.
But if that mate is critical or can't be counted on when the going gets tough, that's worse than having no mate at all, researchers say.
"The quality of your relationships matters more than quantity when it comes to depression," says Dr. Alan Teo, a psychiatrist at the University of Michigan who led the study.
And quality counts the most with a spouse or partner, Teo and his colleagues found. People with unsupportive, critical spouses were much more likely to suffer major depression, while people without a mate saw no higher risk.
So much for the depressed singleton stereotype.
The quality of relationships with other family members also influenced depression risk, though not as much as a spouse did.
And friendships weren't a factor at all. That's unlike earlier studies that found that having a broad social network makes for a longer life.
But this study seems plausible, especially since it covers an unusually large number of people for a mental health study, over a long period of time. It asked 4,642 people about their mental health and relationships in the 1990s, and again 10 years later. Their ages ranged from the mid 20s to the mid 70s. It was published in the online journal PLOS ONE.
To scope out the quality of a relationship, the researchers asked questions like: "How much does your spouse or partner really understand the way you feel about things?" and "How much can you rely on him or her for help if you have a serious problem?"
Strain in the relationship matters, too, the researchers found. They identified strains by asking questions like: "How often does he or she criticize you?" and "How often does he or she get on your nerves?"
People with the most negative relationships were more than twice as likely to suffer depression as the people with the most positive relationships.
Clinical depression is a serious medical issue in the United States, with almost 20 percent of the population suffering depression at least once in their lives. Depression take a big toll on work and family, and increases the risk for heart disease, stroke and cancer.
People can improve the quality of their relationships, Teo says. Interpersonal therapy and couples therapy can help identify communication problems and come up with practical improvements.
And doctors need to ask not just about if a person is married, but about the quality of family relationships. "You have to ask, do you feel like your wife is supportive of you? Do you feel like you can open up to her if something's worrying you?" Teo says.
"Relationships have these two dimensions," he adds. "There's the social support, and there's also the strain from being criticized and someone getting on your nerves. You can have both in the same relationship."
The study was funded by the the Robert Wood Johnson Foundation, which also supports NPR.
Copyright 2021 NPR. To see more, visit https://www.npr.org.


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There's something so meaningful about the circular design of a wreath for honoring a love that will live on forever. Our large tribute wreath is a truly impressive arrangement of rich red and pristine white blooms. It's uniquely designed with a cluster of fresh, pink lilies at the top that are beautifully accented with a bow and trailing ribbons. It's a tribute that will leave a loving, lasting impression. Large standing wreath arrangement of Red roses, white carnations, Stargazer Lilies and assorted greenery; white bow with trailing ribbon Arrangement measures 35"H x 26" W (without stand) Arrives with standing easel; measures 66" H A grand display appropriate for the funeral or memorial service Our florists use only the freshest flowers available, so colors and varieties may vary due to local availability
Order by 5:30 PM PST for same day pickup or delivery!
* Fee charged in addition to the Standard Delivery Fee
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The Western Tribes. 1These are the portions which the Israelites received as heritage in the land of Canaan.a Eleazar the priest, Joshua, son of Nun, and the heads of families in the tribes of the Israelites determined 2their heritage by lot, as the LORD had commanded through Moses concerning the remaining nine and a half tribes.b 3To two and a half tribes Moses had already given a heritage beyond the Jordan; to the Levites he had given no heritage among them:c 4the descendants of Joseph formed two tribes, Manasseh and Ephraim. But the Levites were given no share of the land except cities to live in, with their pasture lands for the herds and flocks.d
5As the LORD had commanded Moses, so the Israelites did: they apportioned the land.
Caleb's Portion. 6e When the Judahites approached Joshua in Gilgal, the Kenizzite Caleb, son of Jephunneh, said to him: "You know the word the LORD spoke to Moses, the man of God, concerning you and concerning me in Kadesh-barnea. 7f I was forty years old when Moses, the servant of the LORD, sent me from Kadesh-barnea to reconnoiter the land; and I brought back to him a frank report. 8g My fellow scouts who went up with me made the people's confidence melt away, but I was completely loyal to the LORD, my God. 9On that occasion Moses swore this oath, 'The land where you have set foot shall become your heritage and that of your descendants forever, because you have been completely loyal to the LORD, my God.' 10Now, as he promised, the LORD has preserved me these forty-five years since the LORD spoke thus to Moses while Israel journeyed in the wilderness; and now I am eighty-five years old,h 11but I am still as strong today as I was the day Moses sent me forth, with no less vigor whether it be for war or for any other tasks.* i 12Now give me this mountain region which the LORD promised me that day, as you yourself heard. True, the Anakim are there, with large fortified cities, but if the LORD is with me I shall be able to dispossess them, as the LORD promised."j 13Joshua blessed Caleb, son of Jephunneh, and gave him Hebron as his heritage.k 14Therefore Hebron remains the heritage of the Kenizzite Caleb, son of Jephunneh, to the present day, because he was completely loyal to the LORD, the God of Israel. 15Hebron was formerly called Kiriath-arba, for Arba, the greatest among the Anakim.l And the land had rest from war.
* [14:11] War…other tasks: lit., "to go forth and to come in," i.e., to conduct military expeditions and to return after victory; cf. 1 Sm 18:16; 2 Sm 5:2.
a. [14:1] Jos 17:4; 21:1; Nm 27:19–22; 34:17–18.
b. [14:2] Nm 26:55; 33:54; 34:13.
d. [14:4] Jos 21:3–40; Gn 48:5.
e. [14:6] Nm 14:24, 30; 32:12; Dt 1:36, 38.
g. [14:8] Nm 13:31–33; 14:24; 32:12; Dt 1:36.
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Only the finest ingredients and purest fragrances are used to create the Sara Miller Home Fragrance collection which is alcohol free and made in the UK.
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Most shipments are next day delivery unless your order is multi location partial picking.
FREE Delivery for orders over £75 and it takes 1-3 working days.
Click & Collect is Free Of Charge and will be available from the store . You will be notified when you order is ready to pick up. We aim to prepare orders within 24 hours ( 2-4 days in Forest Hill Branch) however, if you are in hurry please contact your choice of pick up location and we will try our best to help. Please note: Local Pick up is not available for (Apple Pay, Google Pay and Paypal) Please use Shop Pay.
Local Delivery is free over £30 within 3km radius for Beckenham and 2km radius for Forest Hill. We aim to deliver 4 days a week locally. If you have any special requirements please add a note to your order or call your closest store for arrangements.
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Odyssey Dumpster Rental is recognized as a leader in delivering high quality dumpster rental services to customers throughout the Greater Barrington Area. We are well-known for our clean and quality dumpsters as well as our strong customer service team. Our mission is to deliver dependable, quality and professional services and competitive rates. Odyssey Dumpster Rental is renowned for our unmatched customer service and competitive prices. Complete customer satisfaction is, and always has been, our top priority, and it comes as no surprise that Odyssey Dumpster Rental has an unblemished reputation for not only offering the finest level of services, but for forming lasting relationships with our customers. As a result, whenever Barrington, State customers need dumpster rental services, Odyssey Dumpster Rental is the only name they need to know!
Barrington Dumpster Rental
Serving the Barrington area, Odyssey Dumpster Rental is committed to providing white glove service in a blue collar industry. We offer fast roll-off dumpster delivery and pick up and have a vast assortment of residential, commercial and industrial dumpsters, ranging from 10-yard dumpsters to 40-yard dumpsters. Give us a call today at 630-320-2540 to learn more, or fill out our online quote form.
Odyssey Dumpster Rental
Headquartered in Downers Grove, Illinois, Odyssey Dumpster Rental offers fast roll-off dumpster delivery and pick up and have a many kinds of residential, commercial and industrial dumpsters – ranging from 10-yard dumpsters to 40-yard dumpsters. We offer prompt pickup and delivery services for your convenience. With Odyssey, you'll always receive fast and dependable services with upfront pricing. We are licensed, bonded and insured. Call us today at 630-320-2540!
Dumpster Rental | Free Estimate
Whether you are a resident or a contractor, Odyssey Dumpster Rental will provide you with roll-off dumpsters at affordable rates. If you want to know how much our dumpster services are going to cost you, give us a call. Our service professionals at Odyssey Dumpster Rental will provide you with an instant and honest estimate for free – no strings attached.
Residential Dumpster Rental – Barrington
If you are looking for a dumpster rental company in Barrington, look no further than Odyssey Dumpster Rental. We know that finding a dumpster company can be challenging work – and we try to make it as easy as possible. If you are a resident in Barrington, we offer dumpsters for all kinds of material, including:
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Whether you're a small or large contractor undertaking a minor or major project, Odyssey Dumpster Rental offers Roll-Off dumpsters with a capacity ranging from 10 to 30 yards. Our equipment is always clean and we are licensed and insured for your protection. Additionally, we make ourselves available to you with emergency delivery services.


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Processing time
3-4 weeks
Customs and import taxes
Buyers are responsible for any customs and import taxes that may apply. I'm not responsible for delays due to customs.
Model SOGN01
This wedding flower package is made with natural Sola flowers, Blush (light peach) and Ivory Roses, Mini Roses, Green Beli Flowers, Dried Baby's breath and faux Lamb ears leave. The handle is decorated with Blush ribbon and lace. Other pieces match bride's bouquet. Bride's bouquet's shown is the 10" size.
For a 15 piece package including:
1x10" Bride's round bouquet
5x 7" Bridesmaids bouquets
1x5" Toss bouquet
2 WRIST corsages
1 Groom boutonnière
5 Others boutonnières
3-4 weeks
Buyers are responsible for any customs and import taxes that may apply. I'm not responsible for delays due to customs.
Just contact me within: 3 days of delivery
Ship items back to me within: 7 days of delivery
Buyers are responsible for return shipping costs. If the item is not returned in its original condition, the buyer is responsible for any loss in value.
This Privacy Policy describes how and when I collect, use, and share information when you purchase an item from me, contact me, or otherwise use my services through Etsy.com or its related sites and services.
This Privacy Policy does not apply to the practices of third parties that I do not own or control, including Etsy or any third party services you access through Etsy. You can reference the Etsy Privacy Policy to learn more about its privacy practices. Nathan should then go on to include information on the following:
Information I Collect
To fulfil your order, you must provide me with certain information (which you authorized Etsy to provide to me), such as your name, email address, postal address, payment information, and the details of the product that you're ordering. You may also choose to provide me with additional personal information (for a custom order of jewelry, for example), if you contact me directly.
Why I Need Your Information and How I Use It
I rely on a number of legal bases to collect, use, and share your information, including:
■ As needed to provide my services, such as when I use your information to fulfil your order, to settle disputes, or to provide customer support;
■ When you have provided your affirmative consent, which you may revoke at any time, such as by signing up for my mailing list;
■ If necessary to comply with a legal obligation or court order or in connection with a legal claim, such as retaining information about your purchases if required by tax law; and
■ As necessary for the purpose of my legitimate interests, if those legitimate interests are not overridden by your rights or interests, such as:
1) Providing and improving my services. I use your information to provide the services you requested and in my legitimate interest to improve my services; and:
2) Compliance with the Etsy Seller Policy and Terms of Use. I use your information as necessary to comply with my obligations under the Etsy Seller Policy and Terms of Use.
Information Sharing and Disclosure
Information about my customers is important to my business. I share your personal information for very limited reasons and in limited circumstances, as follows:
■ Etsy. I share information with Etsy as necessary to provide you my services and comply with my obligations under both the Etsy Seller Policy and Etsy Terms of Use.
■ Service providers. I engage certain trusted third parties to perform functions and provide services to my shop, such as delivery companies. I will share your personal information with these third parties, but only to the extent necessary to perform these services.
■ Business transfers. If I sell or merge my business, I may disclose your information as part of that transaction, only to the extent permitted by law.
■ Compliance with laws. I may collect, use, retain, and share your information if I have a good faith belief that it is reasonably necessary to: (a) respond to legal process or to government requests; (b) enforce my agreements, terms and policies; (c) prevent, investigate, and address fraud and other illegal activity, security, or technical issues; or (d) protect the rights, property, and safety of my customers, or others.
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I retain your personal information only for as long as necessary to provide you with my services and as described in my Privacy Policy. However, I may also be required to retain this information to comply with my legal and regulatory obligations, to resolve disputes, and to enforce my agreements. I generally keep your data for the following time period: 7 years.
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I may store and process your information through third-party hosting services in the US and other jurisdictions. As a result, I may transfer your personal information to a jurisdiction with different data protection and government surveillance laws than your jurisdiction. If I am deemed to transfer information about you outside of the EU, I rely on Privacy Shield as the legal basis for the transfer, as Google Cloud is Privacy Shield certified.
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If you reside in certain territories, including the EU, you have a number of rights in relation to your personal information. While some of these rights apply generally, certain rights apply only in certain limited cases. I describe these rights below:
■ Access. You may have the right to access and receive a copy of the personal information I hold about you by contacting me using the contact information below.
■ Change, restrict, delete. You may also have rights to change, restrict my use of, or delete your personal information. Absent exceptional circumstances (like where I am required to store data for legal reasons) I will generally delete your personal information upon request.
■ Object. You can object to (i) my processing of some of your information based on my legitimate interests and (ii) receiving marketing messages from me after providing your express consent to receive them. In such cases, I will delete your personal information unless I have compelling and legitimate grounds to continue using that information or if it is needed for legal reasons.
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For purposes of EU data protection law, I, Mehdi Sahrai, am the data controller of your personal information. If you have any questions or concerns, you may contact me at email@example.com.
Alternately, you may mail me at:
Lily of Angeles, Inc.
23192 Alcalde Dr
Suite F
Laguna Hills, CA 92653
Q- I don't need 9 pieces can I change quantities?
A- Yes, please email us your quantities and we will reply with a quote.
Q- I need to customize my set?
A- You may fully customize your bouquets, you just need to take a look at all our models and find the ones that have your colors/flowers. Then let us know the model number and what you like in there. For example: "RED LILIES" in model "X", "WHITE ROSE" in model "Y" and "BLUE" ribbon in model "Z".
Here is the link to our store:
Q- How does the customization work and how do I order it since it is different from the original listing?
A- You give us all information about your customization. We will reply with a quote. After we finalize all details, we will create a special listing describing all pieces with your specifications and send you the link to place your order.
Q- Can I send you a photo to duplicate for me?
A- No, we prefer not to duplicate someone else's design.
Q- Can you make a sample of my customized order and send me a photo before I place my order?
A- No, unfortunately we cannot start making a custom set before the order is placed.
Q- Do you have any ready to ship bouquets?
A- No, all our products are made to order and we do not have any ready to ship product.
Q- Can you make a larger bouquet for me?
A- Technically we have no problem to make larger bouquets however we do not suggest doing it. We have made several size bouquets 11" up to 15" but to be honest, they lose their elegance and a few of the buyers were not happy to have done this.
Q- Can I order additional pieces in a later date?
A- As long as we still have your flowers in our inventory we have no problem to make additional matching pieces for you.
Q- Do I get a tracking number?
A- Yes, as soon as we ship your package the tracking info will be emailed to you.
Q- Do you ship internationally?
A- Yes, we ship worldwide and use extra heavy duty boxes (double wall).
Q- What is the shipping method for international shipments?
A- USPS Priority Mail; usually takes 6 to 10 business days.
Q- I am not in the US, do I have to pay taxes or duty fees?
A- We are not aware of all countries tax and custom/duty regulations, please inform yourself through your local authorities before placing your order.
Q- How do you pack your products?
A- Each piece is individually wrapped in tissue paper and packed in large enough boxes to avoid getting squeezed during the shipment.
Q- Is any assembly required after we receive your products?
A- No, all our products are complete and you can use them as soon as they are out of the box.
Q- Can I call you on the phone to place my order?
A- We prefer to communicate via emails since this is the best way to keep track of our communications and avoid mistakes
Q- I need my order earlier, do you do rush orders?
A- Please let us know when you need them and we will tell you if it is possible and also the additional rush charge, if any. Please contact us before buying if you need to rush your order. We do not offer rush processing for all models.


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If your Toshiba Excite 7 won't hold a charge, the problem could be a broken charger port. Bring it in for a free diagnostic and we'll repair it for you right in the store.
Our low price guarantee ensures that we always offer the best price to our customers. Just bring in any local competitor's published price for the same repair, and we will happily match and beat their price by $5.
The repair price must be a regularly published price. This offer does not apply to competitor's specials, coupons or other discounts.


text:
Graphic novel of short story Peeling
- UQFL164-Series J-Item 11
- Item
- 1993?
Part of Peter Carey Papers
Photocopy of graphic novel of the short story Peeling by Peter Carey, first published in 1972 in Meanjin Quarterly. Creator unidentified but 'ERTL '93' appears faintly at the bottom of each page. 24 pages (including cover and back pages).
Olds, Sharon.


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The curtain of aluminum-glazed windows falling from the curved steel roofline that frames the Lewis Library is a reflection of the architect's homage to the beauty of the lines and curves he sees in everyday life.
Sheer glass walls of two rising wings play with spatial boundaries that typically would separate the interior and exterior of the building. The windows allow the eye to travel in one glance from the inside of one part of the building, to the outside, to the inside, and to the outside.
"The designs are inspired by the visual world that surrounds us and by art," design architect Frank Gehry said, explaining his inspiration. "Many times we refer to painting and sculpture. Sometimes it's more about how an artist sees and interprets a subject or how an artist uses a shape or a material.
"Sometimes we are inspired by everyday objects that have beautiful shapes," he added. "Sometimes we are inspired by the energy and life of the cities in which we work."
The Gehry-designed Lewis Library officially opened with the start of Princeton's academic year Thursday, Sept. 11. After almost four years of construction, the library brings together science libraries from across campus in a research and study space that is, according to the architect, intended to reflect the character of the people who will use it.
Supported by a $60 million gift from class of 1955 alumnus Peter B. Lewis, a University trustee and chairman of the board of Progressive Corp., the Lewis Library houses the collections for astrophysics, biology, chemistry, geosciences, mathematics, physics and statistics. Also in the building are student classrooms and seminar rooms; the University's map collection; the digital map and geospatial information center; the Office of Information Technology's (OIT's) Education Technologies Center and its New Media Center; a new Broadcast Center operated by OIT and the Princeton Institute for Computational Science and Engineering; and OIT's computational science and engineering support group.
The bold lines of the library should serve as inspiration for these groups, Gehry said.
"The design of the interior of the Walt Disney Concert Hall was intended to provide a visual environment to be seen while listening to music," explained Gehry, who also designed that structure in Los Angeles. "The curving lines lead the eye around the room and create an abstract visual landscape that would enhance the experience of the music.
"It may be true that a similar experience may happen in the Lewis Library. Scientists who are focused on complex issues may find that the abstract landscape of the building will stimulate their imagination and perhaps lead them to thinking outside the box."
Standing in the main library's highest level, for example, there are alternating glimpses of color outside every window -- shades of green, purple and orange.
"It's great to be in the main lobby space at different times of the day and to see how the light changes as it casts shadows from the mullions of the skylights onto the colored walls," Gehry said. "As the light shifts, the colors reflect onto the glass and walls. The colors move from one surface to another in ever-changing patterns. Some of the walls take on the color of walls on the other side of the lobby.
"The reading rooms in the library tower face to the north, and the quality of indirect sunlight in these spaces creates an ambient effect that is quite beautiful."
Considerations in the design process
Moving beyond the building itself, Gehry said it also was important that the Lewis Library be "a good neighbor" to the buildings surrounding it.
There are many design styles on campus, but rather than attempt to fit into a particular aesthetic, one primary goal was to help create a visual context for neighboring Fine Tower. The academic building for the mathematics department had previously been a very tall, but solitary, physical statement.
"The massing of the building is developed into an architectural expression which is a response to the material, colors and textures of the context buildings," Gehry said of his design process for the library. "A sculptural body-language develops out of these responses and evolves with development of the design. This is how we work."
The 88,000 pounds of embossed stainless steel and 620 tons of clay brick that were combined with the glass, steel and stucco for the Lewis Library were selected as materials because they were reflected in the buildings nearby.
"We have matched the scale and texture of these neighbors," Gehry said. "We have also tried to make a better relationship between the smaller buildings on Ivy Lane and the Fine Tower by placing smaller building elements on the lane and placing the library tower closer to Fine. This stair-stepped design makes more of a family of the buildings on the site."
Mark Burstein, Princeton's executive vice president, said the cohesive nature of Gehry's design is one of its greatest benefits.
"Lewis Library provides an excellent anchor on the Ivy Lane/Western Way corridor for development," Burstein said of the roadway along the eastern area of campus, where the library now abuts Washington Road. "With Peyton (Hall) -- the home of our astrophysics department -- as a neighbor, the new science library sets the context for academic development eastward."
A 10-year Campus Plan completed by the University this spring establishes a framework for future campus development, and presents the Ivy Lane area as a pivot point for the campus. The plan proposes a new academic neighborhood in this location over the next 20, 30 or 40 years that would combine the natural and applied sciences.
Burstein said the Lewis Library is a "linchpin" that pulls both areas together.
"What better way to do that than with the science library?" he said. "And what better match than one of the modern masters with our natural sciences endeavor? The connection between the building's program -- an integrated science library and the University's science and engineering research computing effort -- with the architecture makes the building an excellent contribution to the campus. Gehry has also designed a building that takes full advantage of the marvelous campus vistas from the inside looking out."
Peter Lewis, for whom the library is named, said the building makes a powerful statement about Princeton's commitment to excellence in the sciences.
"It also brings together two things that are very close to my heart -- Princeton University and the architecture of Frank Gehry," said Lewis, a longtime friend of the architect. "The building represents the kind of inspired risk-taking that is necessary for education and progress, and I am thrilled that Princeton has embraced Gehry's unique architecture on its campus."
While the Lewis Library design itself differs significantly from other architectural styles currently represented on campus, that difference in a way is typical of Princeton, Burstein said.
A departure in Princeton's architectural landscape
Burstein explained that Princeton's architectural history has been marked by departures in style that helped build the rich tapestry of architecture that today distinguishes the campus.
"Quite frankly, at the time our first Collegiate Gothic structure was built, it was a departure," Burstein said of the late 19th- and early 20th-century architecture of many of the University's dorms and academic buildings that today is often referred to as traditional Princeton. "Before that, the campus was a collection of buildings designed in the colonial and Victorian styles."
The modern style of Robertson Hall, designed by Minoru Yamasaki in 1966, was considered an architectural departure when it became the home of the Woodrow Wilson School of Public and International Affairs; the post-modern Wu Hall, designed by class of 1947 alumnus Robert Venturi, was seen as a "radical" design when it was erected to serve as a dining hall for the Butler College undergraduate student residential complex in the 1980s; and today, some may say the same about the Lewis Library.
"One of the important strengths of our physical campus is architectural diversity harmonized with landscape and architects' efforts to design within context," Burstein said. "Lewis Library is an excellent addition to this composition of buildings."
While the Lewis Library catches the eye because of its sculpted steel curves and bold colors, it helps exemplify the way in which the architecture on Princeton's campus is coming to reflect a new direction in using technology in design.
"Although we have used technology for modeling and design on many campus projects, including the new chemistry building designed by Michael Hopkins, the Lewis Library project pushed our use significantly," Burstein said.
What distinguished the Lewis Library from the other buildings is that the development of the library's complex structure of curved steel, sloping glass walls and concrete and stucco towers relied at a basic level on technological intervention from concept to completion.
"The technical solutions to construction are an integral part of our design process," Gehry said. "They develop right along with the architecture and inform the creation of shapes. Many times we need to invent a new way of putting things together to get the shapes we are after. We have a very creative technical staff, and we use computer models to fully explore design methods before we get the projects under construction."
The technology evolution in campus design
The library was constructed using a trademark computer modeling process never before used in Princeton's construction history.
Project manager Henry Thomas of the University's Office of Design and Construction explained that the project was made possible by "Digital Project" software engineered and marketed by Gehry's firm Gehry Technology to operate on a computer platform known as CATIA.
Short for Computer-Aided Three-Dimensional Interactive Application, CATIA is a programming platform on which software was developed originally in the 1970s and early 1980s to build aircraft. The platform was later adapted for use with software to build submarines and automobiles, and Gehry Technology adapted it further for Gehry's postmodern building design.
"The CATIA model provides a way of controlling all dimensions of the project. It eliminates the ambiguity," Thomas said.
Rather than go to a printout of an architectural drawing of the library, project managers and contractors routinely consulted a computerized three-dimensional model. The model was built using software that digitized the block form masses that Gehry Partners typically uses to represent Gehry's design. The software cut planes through the digitized version of the block model to generate two-dimensional drawings that were then fed into a design platform known as AUTO-CAD, which is the industry standard for building design.
The architectural plans do not have dimensions written on them, as more traditional plans would. Rather, the builder can extrapolate dimensions and x, y, z coordinates from the digital model.
The contractors were able to use the software to determine every possible element related to dimensions and materials, including such elements as the volume of concrete they would need, how many square feet of carpet and drywall to purchase, how many bricks they would use and how much mortar would go into the project.
"You couldn't build a building like this without the modeling software," said Greg Ondick, architectural project manager for Barr & Barr Inc. Builders, the New York-based general contractor for the project. "It tells us where to put a brick, where to erect a beam, how much glass to cut -- before I gave any kind of direction on how to proceed, I came back to look at the model."
In a demonstration of the modeling software, Ondick showed how he was able to rotate the entire building, highlight all parts of the structure made with concrete, glass, wood or any other individual building material, and zoom in on a single beam to learn its full dimensions, its distance from the edge of the room, and its elevation above sea level. This directed contractors and subcontractors on the precise placement of project elements in relation to other elements.
"The seams on the roof, for instance, are located relative to the lines of rule that dictate the geometry of the entire structure," Ondick said.
In another example, achieving the shapes and the geometry for bending the drywall for a unique star shape that frames an opening between two floors of the library in Gehry's design were difficult because drywall workers typically work with 2D drawings. But they had to do the job only once, thanks to the CATIA software.
Trademark Gehry finishing touches throughout the building also were designed with the software, including the wavy lines of the canary-yellow welcome desk -- a main attraction in the first-floor entrance to the library.
"We worked with the library staff on these elements, making full-scale mockups and having the staff test and comment on the design," Gehry said. "During one mockup review, we cut and rebuilt the mockup on the spot based on their comments. They placed their computers and other equipment on the mockup to make sure it would fit. We selected all of the loose furniture in the building also in collaboration with the librarians."
The science librarians, OIT staff, and the support staff for computational science and engineering spent the summer moving into the building while interior design work was being completed in the library.
An assortment of deep blue, green, red, yellow and black desk chairs were wheeled into the 14 group-study and seminar rooms while the registrar's office determined which classes would meet in the building during the year; angled gray tables and chairs reflecting the Gehry geometry were placed throughout reading areas and common spaces; and lights were installed to hang from a ceiling reaching almost 34 feet in the second-story "tree house," so named because the expansive, glass-enclosed room skims the tree line and looks out into neighboring tree tops.
Now that it is complete, Gehry said he hopes all who use the building find delight in its features.
"We hope that the library will be a great place to study and hang out, and that it will fulfill the needs of the community of scientists that will use it," Gehry said. "We hope that students will enjoy the experience of being in the building, of seeing the forms and color, and how the light comes down through the spaces."
For those who ask what the building will mean to the future generations of students and researchers who will use it, Gehry said its meaning derives from the University's choice to support the design.
"It means that the institution is looking to the future," he said.


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