text:
Losses incurred by the financial crisis of 2007-2009 could exceed $10 trillion, and the effects could linger for years to come, according to a just-released report by the Government Accountability Office (GAO).
The GAO says in its report that studies estimating the losses of financial crises based on lost output—value of goods and services not produced—suggest losses associated with the recent crisis could range from a few trillion dollars to more than $10 trillion.
The crisis also resulted in large declines in employment, household wealth and other economic indicators, the report says, with some studies suggesting the crisis could have "long-lasting effects." For example, "high unemployment, if persistent, could lead to skill erosion and lower future earnings for those affected."
Since the crisis began, federal, state and local governments have also faced greater fiscal challenges, the report points out, "in part because of reduced tax revenues from lower economic activity and increased spending to mitigate the impact of the recession."
The report—written at the request of Sen. Tim Johnson, D-S.D., chairman of the Senate Banking Committee, and Rep. Michael Capuano, D-Mass.—is called "Financial Regulatory Reform: Financial Crisis Losses and Potential Impacts of the Dodd-Frank Act."
Johnson said in a statement after the report's release that "nearly five years after the failure of Bear Stearns, the devastation caused by the financial crisis is still with us." The "truly staggering sum" of losses since the crisis is "a stark reminder of the need to fully implement the Wall Street Reform Act" and minimize the risk of another costly crisis, he said, noting that one of his priorities will be to "continue to work with the financial regulators to ensure that the new law is implemented to promote financial stability and protect consumers."
But GAO stated in its report that "quantifying" the Dodd-Frank Wall Street Reform and Consumer Protection Act's benefits since being passed into law in 2010 is "difficult."
While Dodd-Frank's "reforms could enhance the stability of the U.S. financial system and provide other benefits, the extent to which such benefits materialize will depend on many factors whose effects are difficult to predict," GAO said.
"According to some academics, industry representatives, and others, a number of the act's provisions could help reduce the probability or severity of a future crisis and thereby avoid or reduce the associated losses. These include subjecting large, complex financial institutions to enhanced prudential supervision, authorizing regulators to liquidate a financial firm whose failure could pose systemic risk, and regulating certain complex financial instruments."


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Alexander Scriabin short biography
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Awk, the little language loved by so many, has been around in one form or another since the days of V7 UNIX, circa 1978. Its data- and text-processing capabilities, expressed in a concise, highly expressive syntax, are the epitome of what DSLs strive for and were, in fact, the inspiration for general-purpose scripting languages, particularly Perl.
The original language has evolved considerably. In particular, the GNU version gawk is far more powerful than standard Awk. In this article, I provide some background on the development of the Awk language, focusing particularly on gawk. I also take a high-level look at the new features available in gawk 4.1, which was released in May of this year.
History of Awk
Awk was originally developed at Bell Laboratories by Al Aho, Peter Weinberger, and Brian Kernighan: It took its name from their initials. It was first exposed to the world with V7 UNIX around 1978. Awk was intended for writing very small programs (a few lines only) to perform simple data filtering and manipulation tasks. Despite this, the language offered some unique facilities, along with most of the major features needed for serious programming:
- Powerful regular expression matching
- String manipulation and numeric facilities, including a handful of the most useful mathematical functions
- Associative arrays
- Flow control:
while, and
- A built-in
printfstatement and shell-like I/O redirection
- The pattern-action paradigm for expressing what needs to be done, along with a built-in input loop that automatically reads records and splits them into fields.
It is perhaps the last item that gives Awk its expressiveness. Around 1985, based on user demand, the authors beefed up the language by adding:
- C-compatible operator precedence
- Regular-expression-based field splitting
- Multidimensional array syntax
- User-defined functions. (This is perhaps the most important addition.)
This version was released with UNIX System V Release 3.2, but due to the nature and cost of UNIX licenses, did not become widely available. In late 1987, the authors published a book on this version of Awk that, more than 25 years later, is still valuable reading.
When the book came out, I bought it because I'd been wanting to learn Awk. Having an interest in programming language design and development, and being then single (thus with lots of spare time), I looked to see if the GNU project had a version of awk that I could play with.
Indeed they did. But alas, it was a clone of the original awk, not of the new version. In addition, it was buggy and slow. So I joined forces with the main GNU awk volunteer, David Trueman, to update awk. We worked together for several years until he had to bow out. Since1994, I have been the official maintainer, working with a pleasant and pleasantly sized team of codevelopers.
Around 1991, the IEEE POSIX committee started working on a command language and utilities standard, which included Awk. Gawk complies with POSIX, except in the few cases where it does not make sense to do so, and even then an option enables full blind compatibility.
For the first ten years of my involvement with gawk, it was usually used along-side UNIX awk. Gawk offered the advantages of being generally faster and also of having fewer arbitrary limits; often, I had users who would push quantities of data through gawk that would cause UNIX awk to roll over and die. (UNIX awk has considerably improved since then, however.)
Things changed when GNU/Linux started to take off, as gawk became the only version of awk available on the system. Today, I believe that gawk is the most widely used Awk implementation. In the rest of this article, I will show what kinds of interesting things you can now do with gawk.
Gawk Features
Given the natural tendency of programmers to want to change, extend, and add features, together with the long-lived nature of this project, it is perhaps not surprising that gawk has developed a multitude of additional features not present in standard awk.
These features can be grouped into several categories:
- Support facilities:
- Statement count profiling.
- Awk-level debugging with a debugger that is similar to GDB, the GNU debugger. This first became available with gawk 4.0 (released in 2011) as a separate executable, but it is now built-in to the regular gawk executable.
- Many additional command-line options for controlling all the possibilities. All GNU-style
longoptions also have short options, for use in
#!(shebang) scripts.
- Extensibility:
- File inclusion with the
@includestatement (new in 4.0).
- Loading of extension functions written in C or C++ that can be called from Awk code with the
@loadstatement or the
-l(lower case "L") command-line option (new in 4.1).
- New built-in functions:
- String functions, such as the
gensub()generalized substitution function, the
patsplit()function to use regular expressions to define the contents to be split out, and extensions to the standard
match(), and
- Array sorting functions:
- Bit-manipulation functions:
xor(), and
- Time-stamp functions:
systime(), and
- Translation functions:
dcngettext(), and facilities for internationalization based upon GNU
- A type function:
- Language extensions:
- Regular-expression-based record splitting.
- Field splitting based on regular expressions specifying the field contents instead of the field separators.
- Two-way I/O to coprocesses and TCP/IP socket communication, using an extended I/O syntax.
- True multidimensional arrays, and control over array traversal order with
ENDFILEspecial patterns.
- The
nextfilekeyword and the
- Indirect function calls
- Indirect control of variables through the
The details on all of these features (and additional minor ones) are provided in the gawk documentation, which is available online and in printed form as a 490-page book containing 16 chapters, four appendices, a glossary, and many sample programs.
What's New in gawk 4.1
Most of the changes in the recently released gawk 4.1 relate to the internals. In particular, there is now just one executable instead of three. This considerably reduces the installation footprint" and simplifies maintenance and documentation.
The most notable change at the Awk language level is the ability to use the GNU MPFR and GMP libraries for arbitrary-precision integer and floating-point arithmetic. This requires either the
-M command-line option or setting the new variable
PREC to indicate the precision to use. If you select either option, gawk switches to using arbitrary precision for all of its numerical calculations.
The new feature in gawk 4.1 that I think is the most important is the addition of a defined and documented extension mechanism. The new mechanism defines a syntax for loading extensions (the
@load keyword and/or the
-l option) and an API for extension functions written in C or C++ to use when communicating with gawk. Extension functions act like user-defined functions callable from Awk programs, but they are written in a different language. Their reason for being is to provide access from Awk programs to external operating system facilities and libraries.
While gawk has had a minimally documented extension mechanism for many years, using it required understanding the source code data structures and some of the internal functions. It offered no compatibility from release to release, even at the source code level, much less at the binary level. I had been wanting to rewrite this mechanism for a long time. The new implementation provides the potential for Awk programs to do anything that can be done from C or C++. The simplest example is an extension that provides
chdir(), so that Awk programs can finally change their working directory!
Besides letting you write functions in C or C++, the new API provides hooks into gawk's I/O redirection so that you can provide your own filenames for input, output, and two-way I/O. You can also register functions to be called before gawk exits.
Many of the additional functions that gawk has could, in fact, be implemented using the new API. They remain built-in for backwards compatibility and to avoid the overhead of having to load them every time gawk starts up.
Gawk comes with several sample extensions. In addition, the gawkextlib project provides several more; the most notable of which is an extension that parses XML files and presents them to Awk programs in a familiar manner.
As one small example of what you might do, consider the existing
stat and
fts extensions that, when combined with multidimensional arrays, let you walk a file hierarchy and do just about anything you want with the returned information. Using these extensions, writing a simple version of the UNIX du utility could be accomplished in a few hundred lines of Awk, instead of several thousand lines of C. Furthermore, it would be portable to GNU/Linux, Windows, and Mac OS X, without any changes.
There's a lot of great stuff in gawk much more than most people realize. In particular, the profiler and debugger provide necessary tools for larger scale development. The extension mechanism opens up many new frontiers for doing things in Awk that were not possible before. If you haven't looked at Awk in a while, give it another go. I expect you just might like what you see.
Arnold Robbins has been the principal maintainer of gawk since 1994.


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Observing Strategies
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Given the complexity of the AO system, careful designing of GeMS/GSAOI observations is essential to achieve the desired performance required for the success of a science program. In this page we provide important information to guide the users with defining the observing strategies to follow with GeMS/GSAOI. The page also provides some guidelines to maximize observing efficiency and avoid some common errors. This information might be also useful to prepare a GeMS/GSAOI proposal submission (Phase I).
The users may want to take into account the following factors when designed observing sequences:
- Natural Guide stars (NGS)
- Recommended maximum exposure time for individual frames
- Read mode selection, co-adds and associated overheads
- Dithering and offset sizes
- Observing sky frames
Natural Guide stars (NGS)
As it is mentioned in Guiding Options page, the best and most uniform AO correction is achieved when the NGSs are positioned as close as possible to an equilateral triangle. The best asterisms are the ones that cover the larger portion of the field, and the more distant the stars are from each other, the lower the plate scale error will be. When the asterism is not the optimal or less than 3 NGS (2 or 1 NGS) are used, the users might expect larger variation in the delivered FHWM across the GSAOI FoV when compared to an optimal asterism selection, affecting the PSF uniformity across the field. If using only one NGS, the user can expect corrections slightly better compared to a single conjugate adaptive optics system (e.g. Altair). This is because the distribution of the 5 laser guide stars (LGS) on the sky (a 1' x 1' square) can better compensate the variation across the GSAOI FoV compared to a classical AO system with a single laser.
- The users should pay special attention to the guide star selection. By default the OT will automatically select the best asterism. Use the Automatic guide star selection mode to select the CWFS guide starrs and off-axis PWFS1 star.
- Sometimes the available optical catalogs, in particular UCAC4 and PPMX catalogs, show an inacurate R magnitude. If you have doubts about the magnitudes of the stars, always use the brighter stars available inside the Canopus patrol field. Rotating and shifting the GSAOI FoV may help with selecting a better asterism.
- Always assign the brightest guide star inside the Canopus patrol field to CWFS1 (default when the automatic guide star selection mode is used).
Recommended maximum exposure time for individual frames
For broad band filters (Z J H K Kp Ks), the maximum recommended exposure time for a single frame is 120 sec. Longer exposures are not recommended because the sky changes significantly between exposures, in particular in H, Kp, Ks and K bands, making proper sky subtraction difficult.
For narrow band filters, the maximum recommended exposure time is about 360 seconds. Make sure the exposures are long enough to be background limited. The users have to use the Faint Object or Very Faint Object read modes to observe with narrow band filters (see below).
Science programs that need separate sky frames should alternate the science observations with the sky frame observations. It is strongly recommended to observe a set of sky frames every 10 or 15 minutes (less is better), in particular for H and K filters (see below for details about sky frame observations).
Read mode selection, co-adds and associated overheads
The selection of the read mode and the number of co-adds used in any GeMS/GSAOI observation will directly impact in the overheads. It is important to balance between the read mode and the co-adds needed for your observation to minimize the associated overheads and optimize the S/N ratio of the resulting image. The overheads associated to each read mode are listed in this table. Note that in the Observing Tool GSAOI component, the read mode is automatically selected based on the filter and exposure time used. The user can select a different read mode using the OT GSAOI sequence iterator.
- If the observations are photon dominated, the Bright objects read mode may be used. If the objects in the field are too bright, then you can reduce the exposure time and add some co-adds to avoid saturation. However, the penalty will be the increase of the overheads due to the readout time associated to each co-add (see this table for details).
- The minimum exposure time with GSAOI using the Bright Object mode is 5.3sec.
- If the observations are background-limited, the Faint or Very faint object read modes may be used. The choice between the two read modes depends on the filters used and the exposure time of each frame. Note that the recommended exposure time per filters is automatically displayed in the GSAOI component. For broad band filters, it is recommended to use Faint Object read mode. For narrow band filters, it is recommended to use the Faint or Very Faint Object modes, depending on the exposure time. The readout noise can be reduced by using different read modes. For example, you can be tempted to observe with broad band filters and using the Very Faint Objects read mode to reduce as much as possible the read noise. The difference in read noise between Faint and Very Faint modes is ~3 e-. However, the penalty is an increase in the read out time by a factor of two, from 26.2 sec to 47.7 sec. Therefore, short exposure times (< 30 sec) with Very Faint Object read mode is not a very efficient combination.
Dithering and offset size
The GSAOI FOV is formed by four HAWAII-2RG 2k x 2k arrays mounted in a 2 x 2 mosaic. Note that due to the field distortion the arrays are not perfectly parallel to each other and the size of the gaps varies between 2.5" and 3.5" on the sky. Since most observations will require to dither in order to prevent any loss of information due to objects falling in the gaps, for the majority of the programs it is recommended that the dithering pattern is constructed with a minimum offset size of 4" between images.
When an observing sequence is constructed, the user has to keep in mind the following:
- Observe the same offset position multiple times is not recommended. There are some ''memory effects'' in the arrays when the same objects are observed multiple times at the same position (see section 3.4 in Schirmer et al. 2015 for details). Instead, a Random offset pattern, with a maximum offset of ~5" (or larger) is recommended.
- The CWFS NGSs must remain inside the patrol field area of Canopus in all steps defined in the GSAOI offset iterator. Note that in the case that one or more CWFS NGS move outside the Canopus patrol field area during dithering, an error message will be appear in the OT. A visual inspection of the offsets can be done using the OT Position Editor (see Visualization of Selected Asterism page for details).
- The off-axis PWFS1 star used for focus sensing must remain inside the ring between 5.8' and 6.95' in diameter from the Base Position. If the off-axis PWFS1 moves outside the ring during dithering, an error message will be appear in the OT.
- Remember, the overheads associated to dither, i.e. the time needed to open all loops, move the telescope and close all loops again, is 15 sec per dither position.
- Precise astrometry with GeMS: The complicated field distortion introduced by GeMS makes it difficult to obtain a good astrometric performance in a combined image when offsets are used. For programs that require a good astrometric accuracy, the primary recommendation is to not apply offsets between consecutive images. However, If the user needs to dither, then we suggest to use offsets no larger than 0.1- 0.2 arcsec (5 - 10 pixels). For detailed analysis of the astrometric performance with GeMS in crowded field, see B. Neichel et al. 2014, MNRAS, 445, 500 . For detailed information about GeMS commissioning an overall performance, see B. Neichel et al. 2014, MNRAS, 440, 1002.
Observing sky frames
As any near-IR imaging, GeMS/GSAOI observations require background subtraction. In the case of crowded fields, fields embedded in a large nebulosity or fields containing an extended object, sky frames have to be acquired using a blank region near the science target. In the case of sparse fields, the same science images can be used to create a master sky frame to subtract the background as long as enough dither positions are obtained to mask the objects in the individual frames.
A. General notes
When obtaining separate sky images, the dither pattern should be large enough to remove point sources in the combined sky frame (5"-10" is usually more than enough since the observations are unguided). Preferably, obtain the sky frames using the same exposure time and number of exposures as used for your science observations. Exposures shorter (or longer) than your science observations can make the sky subtraction (and your data reduction) more difficult. Avoid saturating objects in your sky frames when possible - remember, these frames are unguided, so feel free to move the center of the field around to exclude the brighter stars. Saturated objects are very difficult to remove and can affect the background subtraction. Observe sky frames every 10 - 15 minutes (less is better), particularly when using the H and K broad band filters.
B. Sparse fields
In the case of sparse fields, the science images can be used to construct a master sky frame to subtract the background. The offsets should be large enough to remove point sources and cover the gaps when making sky images. If the field contains sources that are more extended than point sources, it is recommend to construct a dither sequence with offsets slightly larger than the average size of these objects.
C. Crowded fields and fields with extended objects
For crowded fields, fields embedded in a large nebulosity or fields containing one or more extended object, sky frames have to be acquired in a blank region near the science target. In some cases (extended nebulosities, large star clusters) very large offsets are required to reach a blank field to observe the sky frame. If the offset to reach the sky frame is larger than 5 arcmin from the science position, the laser has to be shuttered and the science field will need to be re-acquired when the telescope is back from the sky, incurring in additional overheads to the program. Depending on the location of the blank field, the best observing strategy to follow is different.
C.1. Sky field located < 5 arcmin from the science target
- The sky frames can be interleaved with the science frames and included in the same observing sequence. Note that the entire sequence, including overheads, cannot be longer than 2.5 hours. A sequence longer than 2.5hrs requires an additional acquisition.
- If the science sequence includes more than one filter, the exposures are short and the sequence through all filters is not longer than 10 minutes (including overheads), then it is recommended first to observe the science target with all filters from blue to red, then move to the blank field and observe the sky frames in all filters in the reverse order. e.g. science (J) + science (H) + science (K) + sky (K) + sky (H) + sky (J). This strategy optimize the observations and minimize the overheads.
- If the science sequence includes more than one filter and the exposures are long, then it is recommended to observe one filter at time, e.g. science (J) + sky (J) + sky(H) + science (H) + science (K) + sky (K), within the same sequence. Note the use of the traditional ABBA pattern (science-sky-sky-science) in order to minimize offset overheads.
C.2. Sky field located > 5 arcmin from the science target
In this case, the laser propagation must be stopped due to Laser Clearing House restrictions. Therefore, when returning to science target, the LGSs have to be re-acquired and the CWFS NGS acquisition re-checked.
- For observations with only one filter, the best strategy is to create a sequence containing one science and a sequence containing one sky blocks, of a longer duration as scientifically useful (as noted above, it is recommended to obtain a sky block every 10 - 15 min or less of science). As many sequences as required to obtain the total time on-source should be provided. Note that it is not feasible to observe science-sky-sky-science in this case, since there can be a gap of more than 10min between the second sky block and the start of the second science block as the target (LGS+NGS) is re-acquired. Note that the sky observation must be defined in a separate sequence, and setup unguided.
- For sequences with short total time and multiple filter observations, the best strategy is to observe the science field in all filters and then move to the sky position. The sky observation must be defined in a separate sequence, and setup unguided.
- For long sequences with multiple filters observations, the best strategy is to observe the science field then move to sky for each filter. In this case, one science sequence and one sky sequence have to be created separately for each filter.


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Principal Proposed Uses
There are two main ways to use vitamins and mineral supplements: "megadose" and nutritional therapy.
The megadose approach involves taking supplements at doses far above nutritional needs in hopes of producing a specific medical benefit. This technique essentially uses nutrients as natural drugs. The individual supplement articles in this encyclopedia explain what is known about the potential risks and benefits of megadose therapy.
This article addresses the second approach: taking nutrients at the level of nutritional needs. We discuss general issues regarding such "nutritional insurance" and indicate which nutrients you should consider taking on a daily basis.
There is no doubt that it's important to get enough of all necessary nutrients. However, the process of determining proper daily intake levels for vitamins and minerals is far from an exact science and the recommendations issued by experts in various countries often disagree to a certain extent.
In general, while it is fairly easy to determine the minimum nutrient intakes that are necessary to avoid frank malnutrition, there's no straightforward way to determine optimum intake levels. Furthermore, individual needs undoubtedly vary based on numerous factors, including age, genetics, lifestyle, other foods in the diet, and many additional environmental influences; no schedule of official recommendations could possibly take all these factors into account, even if all the necessary data existed (which it doesn't).
Thus, all recommendations for daily nutrient intake must be regarded as approximate. The individual supplement articles in this encyclopedia summarize the current US recommendations.
Common Nutritional Deficiencies
Severe deficiencies of vitamins or minerals are rare in the developed world. However, evidence suggests that slight deficiencies in certain nutrients may be relatively common. These include calcium , 15,16chromium , 14folate , 13magnesium , 17 vitamin B 6 , 18-20vitamin C , 21-24 vitamin B 12 (primarily in the elderly), 25-28vitamin D , 33vitamin E , 40-42 and zinc . 16,34-37
While few people are so deficient in these nutrients to show symptoms of outright malnutrition, subtle deficiencies may increase the risk of a number of diseases. For example, insufficient intake of calcium and vitamin D may increase your chances of developing osteoporosis, and inadequate folate and vitamin B 6 may speed the development of heart disease.
Thus, taking supplements to supply these important vitamins and minerals as a form of insurance may be a good idea. For standard dosage recommendations as well as safety issues, follow the links above to the full articles.
Besides vitamins and minerals, intake of essential fatty acids may be commonly inadequate. For more information, see the articles on omega-6 and omega-3 fatty acids.
Women may develop iron deficiency, but men hardly ever do. Even in women, iron supplements are not beneficial in the absence of true deficiency. We recommend avoiding iron supplements unless tests show that you really need them.
Multivitamin/Mineral Supplements
The simplest way to support your nutrition is to take a general multivitamin and mineral supplement providing a broad range of nutrients at standard nutritional levels. However, there are a few caveats to keep in mind.
- Some supplements include very high doses of certain nutrients, such as antioxidants. As described above, when you take nutrients in this fashion, you are using them as drugs rather than nutrients; you are no longer in the world of nutritional supplementation and have passed into the riskier world of megadose treatment.
- We recommend that you use an iron-free multivitamin and mineral supplement unless you have been tested and found to be deficient in iron.
- The minerals calcium and magnesium are very bulky, and few multivitamin/mineral supplements provide the daily requirement. These minerals generally must be taken in the form of additional pills. Note: It isn't possible for your body to absorb a day's worth of calcium in a single dose. At least two doses are necessary.
- Finally, note that food may contain many nonessential substances, such as carotenoids and bioflavonoids, that nonetheless enhance health. For this reason, no nutrient supplement should be regarded as a substitute for a healthy and varied diet.
Taking Individual Supplements
One problem with multivitamin/mineral supplements is that some nutrients may interfere with the absorption of others. For this reason, there may be advantages to taking supplements separately. (The hassle factor is a strong disadvantage!) In addition, this method allows one to avoid taking vitamins and minerals one doesn't need.
If you do use this approach, keep in mind the following:
- Minerals come in many different chemical forms, technically called "salts." For example, you can purchase calcium as calcium carbonate, calcium citrate, calcium orotate, and in half a dozen or more other forms. In some cases, certain salts of minerals are known to be better absorbed than others. This is particularly the case with calcium , as described in the full article.
- When you take zinc , you should balance it with copper .
- There may be advantages to taking certain nutrients at levels a bit higher than the standard recommendations, but each nutrient presents its own issues. More is not necessarily better. See each individual nutrient article for details.
Natural vs. Synthetic Vitamins
Many people wonder whether "natural" vitamins are better than "synthetic" ones. This question, however, is a bit of a red herring. Ultimately, no vitamin or mineral supplement is "natural." Purified vitamins and minerals are refined, processed products analogous to white sugar or artificial fertilizer. It doesn't much matter whether they are extracted from foods or manufactured in a laboratory: the result is the same. For example, vitamin C made from rose hips is chemically identical to vitamin C synthesized from scratch. Both are ascorbic acid.
Rose hips themselves, however, supply many nutrients along with vitamin C. If you truly wish to get your vitamins naturally, you might consider taking them as freeze-dried or condensed whole food supplements rather than as purified vitamins. This might offer a specific advantage over purified vitamins: as we noted above, fruits and vegetables may provide substances that are not actually essential but that promote better health.
Therapeutic Uses
Under certain conditions, the need for many nutrients may increase. These include illnesses such as diabetes , Crohn's disease , HIV , and ulcerative colitis . Furthermore, individuals who smoke cigarettes or overuse alcohol may need additional nutrients. Follow the links to the individual articles for more information.
Medications may increase the need for certain nutrients; if you look up your own medications in the Drug Interaction section of this encyclopedia, you will find what is known about these so-called nutrient depletions.
Other potential uses of multivitamins generally lack strong support.
Some but not all evidence hints that multivitamin/multimineral supplements may help prevent infections in seniors or otherwise enhance immunity. 7, 8, 9, 32,38,39,43,57,63-64 However, there are strong suspicions that scientific fraud may have tainted this research, and when the potentially fraudulent studies are disregarded the evidence looks more negative than positive. 70
Similarly, some but not all studies suggest that multivitamin/multimineral supplements can enhance mental function , and here, too, there are concerns about potential fraud. 11,12,48-51,58,59, 62,71,74 In general, the best designed studies have failed to find benefit. However, it is quite possible that multivitamin/multimineral supplements are helpful for people with marked vitamin or mineral malnutrition. 71
One study found that use of a multivitamin tablet improved mood, but not cognitive function, in hospitalized acutely ill seniors. 72 Another study failed to find that a mix of multivitamin (either general, or consisting of B-complex vitamins) were more effective than placebo for treating depression in healthy young adults. 75
Incomplete, and in some cases contradictory, evidence suggests that use of multivitamin and/or multimineral supplements might reduce antisocial behavior in children and young adults (especially those who are malnourished), 40,47,52 prevent pressure ulcers (bed sores), 54 lower blood pressure , 53 improve fertility in women , 10 improve general well-being , 47,51, 65enhance sports performance , 67 enhance growth in children, 56 speed healing of minor wounds,55 reduce the pain of osteoarthritis , 46 reduce pregnancy-related nausea ("morning sickness"), 47decrease risk of numerous birth defects , 68 help control menopausal hot flashes , 69 decrease symptoms of premenstrual stress syndrome (PMS)1-4 and ordinary stress , 5,6reduce risk of prostate cancer , 66 and help prevent cataracts . 76
In a double-blind study of 40 people undergoing radiation therapy for breast cancer, use of a standard multivitamin preparation failed to reduce fatigue as compared to placebo. 73 (In fact, people in the placebo group may have done somewhat better than those given the vitamin.)
Safety Issues
Standard multivitamin/multimineral tablets contain nutrients at levels believed to be safe for the majority of healthy people, as indicated by amounts at or below the recommended daily allowance. However, even these supplements could be harmful for people with certain diseases, such as kidney or liver disease, or for people taking certain medications, such as warfarin .
There are other multivitamin/multimineral tablets that contain high levels of certain nutrients far above nutritional needs. These could conceivably present risks for healthy people, particularly if they are taken in combination with additional specific supplements. Almost any mineral can be toxic if taken to excess, and there are also risks with excessive intake of vitamins A, B 6 , and D.
One study found that use of multivitamin/mineral supplements may actually increase the infectivity of women with HIV. 61 The reasons for this are unclear.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


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Principal Proposed Use
Other Proposed Uses
Riboflavin, also known as vitamin B 2 , is an essential nutrient required for life. This vitamin works with two enzymes critical to the body's production of adenosine triphosphate (ATP)—its main energy source. Vitamin B 2 is also used to process amino acids and fats and to activate vitamin B 6 and folate.
Preliminary evidence suggests that riboflavin supplements may offer benefits for two illnesses: migraine headaches and cataracts.
The official US and Canadian recommendations for daily intake of riboflavin are as follows:
- 0-6 months: 0.3 mg
- 7-12 months: 0.4 mg
- 1-3 years: 0.5 mg
- 4-8 years: 0.6 mg
- 9-13 years: 0.9 mg
- 14 years and older: 1.3 mg
- 14-18 years: 1.0 mg
- 19 years and older: 1.1 mg
- Pregnant Women : 1.4 mg
- Nursing Women : 1.6 mg
Riboflavin is found in organ meats (such as liver, kidney, and heart) and in many vegetables, nuts, legumes, and leafy greens. The richest sources are torula (nutritional) yeast, brewer's yeast, and calf liver. Almonds, wheat germ, wild rice, and mushrooms are good sources as well.
Although serious riboflavin deficiencies are rare, slightly low levels can occur in children, the elderly, and those in poverty. 1-4 Oral contraceptives used in the 1970s and 1980s appeared to reduce levels of riboflavin. 5,6,7 But, it is not clear whether today's versions of those medications, which contain much lower levels of estrogen, would have the same effect.
Therapeutic Dosages
For migraine headaches, the typical recommended dosage of riboflavin is much higher than nutritional needs: 400 mg daily. For cataract prevention, riboflavin may be taken at the nutritional dosages described. Since the B vitamins tend to work together, many nutritional experts recommend taking B 2 with other B vitamins, perhaps in the form of a B-complex supplement.
Therapeutic Uses
Preliminary evidence suggests that riboflavin supplements taken at high dosages may reduce the frequency of migraine headaches . 8
One very large study suggests that riboflavin at nutritional doses may be helpful for cataracts , but in this study it was combined with another B vitamin—niacin ( vitamin B 3 )—so it's hard to say which vitamin was responsible for the effect. 9
Riboflavin has also been proposed as a treatment for sickle-cell anemia , 10HIV infection, 11 and as a performance enhancer for athletes, but there is no real evidence that it is effective for these uses.
What Is the Scientific Evidence for Vitamin B
Migraine Headaches
According to a 3-month, double-blind, placebo-controlled study of 55 people with migraines, riboflavin can significantly reduce the frequency and duration of migraine attacks. 12 This study found that, when given at least 2 months to work, a daily dose of riboflavin (400 mg) can produce dramatic migraine relief. The majority of the participants experienced a greater than 50% decrease in the number of migraine attacks as well as the total days with headache pain. However, a larger and longer study is needed to follow up on these results.
Riboflavin supplements may help prevent cataracts, but the evidence isn't yet clear. In a large, double-blind placebo-controlled study, 3,249 people were given either placebo or one of four nutrient combinations ( vitamin A - zinc , riboflavin- niacin , vitamin C - molybdenum , or selenium - beta-carotene - vitamin E ) for a period of 6 years. 13 Those receiving the riboflavin-niacin supplement showed a significant (44%) reduction in the incidence of cataracts. However, it is unclear whether the benefits seen in this group were due to niacin, riboflavin, or the combination of the two. Strangely, there was a small, but statistically significantly higher incidence of a special type of cataract (called a subcapsular cataract) in the niacin-riboflavin group.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


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While most people think that the salads offered at fast food restaurants are healthy, nutritious choices, the truth may be quite different. Fast food salads vary widely in the nutrition category. While some salads are reasonable choices, some fast food restaurants soup up their salads with a variety of less-healthy, fat- and sodium-laden items, such as fried chicken, creamy full-fat dressings, sour cream, and lots of cheese, bacon, fried croutons, and taco chips or shells. Less prevalent or completely absent are the nutritious, high-fiber salad items such as beans, chick peas, and a wide variety of fresh vegetables.
But with a busy work schedule, family responsibilities, and the chaos of life in general, sometimes fast food restaurants are the only option. So, what is a hungry person to do? Here is some food for thought the next time you are at the drive-thru ready to order a fast food salad:
Beware of Deceptive Information
While all of the fast food restaurants have nutritional information available on all of their menu offerings, some of the information can be a bit misleading. For example, some of the information only gives nutritional statistics on the actual salad, leaving off the information about dressing, croutons, cheese, or other packets of ingredients that are included with your salad. Make sure you read the information carefully.
Remember: An Iceberg Sank the Titanic
Choose more complex greens than plain old iceberg lettuce. Iceberg lettuce is calorie-free, but it is also nearly nutrition- and fiber-free. Worst of all, it is essentially flavor-free, leading you down the path to temptation by encouraging you to add more flavorful ingredients that increase your fat, sodium, and calorie intake.
Paint With a Broad Palette of Color
The greater the variety of colors in the vegetables in your salad, the greater the variety of nutrients. Go for a wide variety of greens, which include different types of lettuces, spinach, and peppers. Enhance the greens with oranges from carrots, and reds from tomatoes or peppers.
Skip the Meat
Try ordering your salad without meat. Or, if you really want the meat, choose to have it grilled rather than fried, and consider eating only half of what is included with your salad. Consider lean meats, such as chicken or turkey over steak. Substitute beans or legumes for meat. The added fiber will help make you feel more full.
Remember: Dynamite Comes in Small Packages
If you want to avoid exploding your healthy eating plan, say no to those little packets of Parmesan cheese, croutons, or Chinese noodles. They may look deliciously innocent, but these extras are a serious source of fat, calories, and sodium. Ask your server to leave them off of your order if possible. This will help you avoid the temptation before it gets to your table.
Do Not Douse, Dress
Ask if there is a low- or no-fat dressing available, and substitute that for the one that comes with the salad you have ordered. Use the smallest amount possible to flavor your salad. Remember, you do not want to drench your salad in dressing. Some restaurants have plain packets of vinegar or lemon juice available; consider sprinkling these on your greens instead of dressing. If packets are not available, ask for your dressing on the side. That way, you can control how much you actually use.
Inquiring Minds Want to Know
All of the major fast food restaurants have websites that detail the nutritional stats on each of their menu items. Read the available nutritional information about various fast food salads and other offerings. If you read about the choices in advance, and plan your attack, you might be more successful at making healthy choices.
- Reviewer: Michael Woods, MD, FAAP
- Review Date: 02/2017 -
- Update Date: 02/01/2017 -


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block(redirected from perineural block)
Also found in: Dictionary, Thesaurus, Medical, Financial, Encyclopedia.
Related to perineural block: perineural anesthesia
A segment of a town or city surrounded by streets and avenues on at least three sides and usually occupied by buildings, though it may be composed solely of vacant lots. The section of a city enclosed by streets that is described by a map which indicates how a portion of land will be subdivided.
blockverb arrest, avert, ban, bar, barricade, blockade, bridle, check, choke, clog, close, cohibit, constrict, cramp, curb, dam, debar, delay, encumber, estop, exclude, fend off, forbid, foreclose, frustrate, halt, hamper, hinder, hobble, intercept, interdict, interfere with, jam, leave out, limit, obstruct, occlude, oppose, parry, plug up, preclude, prevent, prohibit, proscribe, repulse, restrain, restrict, retard, shut off, shut up, snag, stall, stand in the way, stay, stem, stop, stop up, thwart, trammel, wall up
See also: arrest, balk, ban, bar, barrier, bind, blockade, bulk, censorship, check, clog, condemn, constrain, constrict, contain, damper, deadlock, debar, defeat, delay, deter, deterrence, deterrent, disadvantage, disqualify, encumber, enjoin, exclude, forbid, halt, hamper, hinder, hold up, impasse, impede, impediment, inhibit, interdict, interfere, interpose, interruption, keep, kill, land, limitation, lock, obstacle, obstruct, obstruction, obturate, occlude, oppose, parcel, parry, plot, preclude, prevent, procrastinate, prohibit, prohibition, real estate, resist, restrain, section, shut, stall, stave, stay, stem, stifle, stop, strangle, toll, vicinity, withhold, withstand


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Monday, March 30, 2020 | 2:16 pm:In order to help protect patients, family members and health care workers from the spread of COVID-19, no visitors are allowed at any of Wake Forest Baptist Health's outpatient or inpatient facilities, except in certain situations.Learn moreAt this time, Wake Forest Baptist Health is following state and national guidelines and is limiting COVID-19 testing in the outpatient setting to only patients ill enough to require admission to the hospital.
More COVID-19 Updates
High-protein diets. Low-fat diets. All-vegetable diets. No-carb diets. With all the focus on dieting, how do you figure out what's healthy and what isn't?
Lots of people feel pressured to lose weight and try different types of diets. But if you really need to lose weight, improving your eating habits and exercising will help you more than any diet.
People diet for many reasons. Some are at an unhealthy weight and need to pay closer attention to their eating and exercise habits. Some play sports and want to be in top physical condition. Others may think they would look and feel better if they lost a few pounds.
Some people may diet because they think they are supposed to look a certain way. Actors and actresses are thin, and most fashions are shown off by very thin models. But this look is unrealistic for most people — not to mention physically damaging to the models and stars who struggle to maintain it.
By the time they turn 12 or 13, most teen girls start to go through body changes that are natural and necessary: Their hips broaden, their breasts develop, and suddenly the way they look may not match girls on TV or in magazine ads. Guys develop at different rates, too. Those guys with washboard abs you see in clothing ads are usually in their twenties.
Any diet on which you eat fewer calories than you need to get through the day — like an 800-calorie-per-day diet, for instance — can be dangerous. Diets that don't allow any fat also can be bad for you. Everyone needs a certain amount of fat in their diet — about 30% of total calories — so no one should eat a completely fat-free diet.
Don't fall for diets that restrict certain food groups, either. A diet that requires you to say no to bread or pasta or allows you to eat only fruit is unhealthy. You won't get the vitamins and minerals you need. And although you may lose weight, you'll probably gain it back as soon as you start eating normally again.
Some people start dieting because they think all the problems in their lives are because of weight. Others have an area of their lives that they can't control, like an alcoholic parent, so they focus excessively on something they can control — their exercise and food intake.
People who diet may get lots of praise and compliments from friends and family when they start losing pounds, which makes them feel good. But eventually a person reaches a weight plateau — and doesn't lose as much weight as before because the body is trying to maintain a healthy weight. People in these situations eventually discover that, even if they do lose weight, they aren't any happier.
Some people may find it hard to control their eating, so they stick with an extreme diet for a little while, but then eat tons of food. Feeling guilty about the binge, they vomit or use laxatives. Eating too little to maintain a healthy weight (anorexia) or eating only to throw up the calories (bulimia) are both eating disorders, which are harmful to a person's health. Someone with an eating disorder needs medical treatment right away.
When you're a teen, dieting can be dangerous because you may not get the right kinds and amounts of nutrients, which can lead to poor growth and other health problems. But eating healthy meals and snacks combined with reasonable amounts of exercise can help you lose weight and develop properly at the same time. For a lot of people, just being more active might help them lose weight without even changing what they eat. Regular exercise also helps them feel healthier and better about themselves.
The best way to diet is to eat a wide variety of enough food to meet your body's needs. Aim to eat more fruits and veggies, cut back on meats high in fat (like burgers and hot dogs), greasy fried foods, and sweets, and drink more water instead of sugary drinks like sports drinks or sodas.
If you are concerned about your body's size or think you need to lose weight, talk with your doctor or a registered dietitian, who may reassure you that you are at a healthy weight. Or if you are overweight, he or she can sit down with you and determine the best way for you to reach a healthy weight.
If you want to change your health habits, here are some tried-and-true tips:
How do you know if your diet is out of control? Warning signs include:
If you, or someone you know, shows any of these signs, talk to a trusted adult or doctor.
Dieting and weight control can consume your life. By accepting your body and making healthy choices, you can keep your weight under control and enjoy life at the same time.
Reviewed by: Mary L. Gavin, MD
Date reviewed: May 2013
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Principal Proposed Uses:
Isoflavones are naturally occurring, hormonally active substances found in soy and other foods. Chemical modifications of isoflavones have been studied as possible alternative treatments for various conditions. One of these, ipriflavone , was developed primarily for treating osteoporosis . Methoxyisoflavone is a chemical derivative of ipriflavone, but it is marketed as a bodybuilding aid .
Methoxyisoflavone is not a nutrient and is not supplied to any meaningful extent in food. However, it is possible that, once in the body, natural isoflavones, such as daidzein, may be converted to some extent into methoxyisoflavone.
Therapeutic Dosages
A typical recommended dose of methoxyisoflavone is 200 mg to 400 mg taken twice daily.
Therapeutic Uses
Methoxyisoflavone is marketed as an anabolic steroid, said to increase muscle mass without causing androgenic (testosterone-like) effects. However, there is no meaningful evidence that it actually works.
The use of methoxyisoflavone in the US began with two US patents established in the late 1970s. 1,2 The patent applications report a few research studies performed by the Hungarian pharmaceutical company Chinoin. None of these studies were published in peer-reviewed journals; furthermore, even as described, this research is altogether inadequate to demonstrate effectiveness, consisting as it did only of animal studies and exceedingly preliminary studies on humans. Proof of effectiveness is not required to establish a patent.
One placebo-controlled human trial on methoxyisoflavone was published in abstract form in 2001. 3 Apparently, this study found that athletes who took 800 mg per day of methoxyisoflavone for 8 weeks experienced a significantly greater increase in muscle mass than those who took placebo. However, despite claims made by methoxyisoflavone retailers, this study was not published in a prestigious journal. Rather, it appeared in what is a called a "supplement" published in association with a fairly prestigious journal. Supplements are special editions printed by a journal for extra income; they explicitly lack the supervision, approval, review or imprimatur of the journal itself. For this reason, all studies published in journal supplements must be taken with a grain of salt. This is particularly so in cases like this, where only an abstract of the study was published rather than the full text of the study itself.
Another oft-repeated claim regarding methoxyisoflavone is that it is widely utilized in the livestock industry to enhance lean mass. However, if livestock breeders are in fact using methoxyisoflavone, they are keeping it quiet: an Internet search for "methoxyflavone" and "livestock" turned up numerous sites that sell supplements to humans (and make this claim to support the sales of their product), but not a single site by or for livestock breeders.
The bottom line: There is no meaningful evidence to indicate that methoxyisoflavone is useful as a sports supplement .
Methoxyflavone has not undergone comprehensive safety testing. Those who take it do so at their own risk.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


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text: Tuesday, February 26, 2013 USPSTF Releases Comprehensive Guide of Preventive Services The US Preventive Services Task Force (USPSTF) recently released its updated 2012 Guide to Clinical Preventive Services—an authoritative source that can help primary care clinicians and patients decide together what preventive services are right for a patient's needs. This edition of the guide includes the USPSTF's evidence-based recommendations on clinical preventive services from 2002 through March 2012, topics in development, and at-a-glance clinical summary tables. Go to USPSTF's A-Z Topic Guide to access recommendation statements on interventions to prevent low back pain, falls in older adults, and osteoporosis. USPSTF also makes recommendations on screening for and management of obesity in adults and children. The 2012 guide can be found on the Agency for Healthcare Research and Quality's website.


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Diagnosis often starts when someone sees their doctor for certain symptoms like painless, swollen lymph nodes in the neck, collarbone, armpit, or groin. For some, swollen lymph nodes are found incidentally during a physical exam or chest x-ray.
There are several noncancerous reasons why lymph nodes maybe swollen. Your doctor will ask about your symptoms, and family and medical history. Lymph nodes throughout the body will be carefully examined. The doctor will check other areas of the body, such as the spleen and liver, for swelling. If there are no obvious reasons for these symptoms, a blood disorder may be suspected
Diagnosis of Non-Hodgkin Lymphoma
A lymph node biopsy is the only way to confirm a diagnosis. During the biopsy, all or part of a lymph node is removed. The tissue is examined under a microscope to look for specific types of cancer cells. The presence of these cells help determine the type of lymphoma present. Types of biopsies include:
- Exisional—Most common. The entire lymph node is removed in an open procedure.
- Incisional—A small part of the node is removed during an open procedure.
- Fine needle aspiration —A thin needle is inserted into the lymph node. Lymph tissue and fluid removed with a syringe.
- Core needle—A larger, hollow needle is inserted into the lymph node. Lymph tissue and fluid are removed with a syringe.
Staging of Non-Hodgkin Lymphoma
If non-Hodgkin lymphoma is confirmed, the results from the biopsy and new tests will help determine the stage of the cancer. Staging is used to identify characteristics of the cancer. Staging as well as other information like age and overall health will help develop the prognosis and treatment plan.
Staging is determined by a number of factors. Tests will vary by individual, but may include:
- Blood tests to look for abnormal numbers of certain blood cells, proteins, indications of cancer, and abnormal cells. The tests may also show changes in kidney or liver function.
- Flow cytometry and cell marker tests to examine cells for specific characteristics, like proteins.
Imaging tests may be used to evaluate the extent of cancer and involved organs. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may depend on suspected location of cancer based on symptoms, but may include:
- Chest x-ray
- CT scan
- Abdominal ultrasound
- PET/CT scan
- Gallium scan
- Bone scan
- Biopsies of other tissues to confirm the presence of cancer in a specific location:
- Lumbar puncture to evaluate the cerebrospinal fluid that protects the brain and spinal cord
- Bone marrow
- Fluid tests from the cavities around the lungs and abdomen
- Laparotomy to explore the abdominal cavity for the presence of tumors.
- Ultrasound of the heart—electrocardiogram.
- Pulmonary function tests.
Non-Hodgkin lymphoma is staged from 0-4:
Stage 0—Cancer is INSIDE the lymphatic system in one the following places:
- One lymph node or more than one in the same lymph node cluster OR
- Lymphatic tissue in the throat (tonsils and/or adenoids) OR
- Thymus OR
- Spleen
- Stage 1E—Cancer is OUTSIDE of the lymphatic system in ONE organ or area.
- Stage 2—Cancer is in 2 or more lymph node clusters either above OR below the diaphragm (the sheet of muscle that separates the chest and abdominal cavities).
- Stage 2E—Cancer is in one or more lymph node clusters either above OR below the diaphragm AND in a nearby organ or area on the same side of the diaphragm.
- Stage 3—Cancer is in lymph node clusters above AND below the diaphragm.
- Stage 3E—Cancer is in lymph node clusters above AND below the diaphragm AND in a nearby organ or area.
- Stage 3S—Cancer is in lymph node clusters above AND below the diaphragm AND in the spleen.
- Stage 3E, S—Cancer is in lymph node clusters above AND below the diaphragm AND in a nearby organ or area AND in the spleen.
Stage 4—
- Cancer is OUTSIDE of the lymphatic system in one or more organs AND MAYBE in the lymph nodes near the affected organs OR
- Cancer is OUTSIDE of the lymphatic system in one organ AND has spread to areas or organs away from the affected organ OR
- Cancer is found in the lungs, liver, bone marrow, or cerebrospinal fluid of the brain and spinal cord. The cancer is in these areas, but has not spread there from other nearby sites.
For treatment purposes, non-Hodgkin lymphoma may also be grouped as:
- Indolent—slow-growing
- Aggressive—fast-growing
- Contiguous—the affected lymph nodes are next to one another
- Noncontiguous—the affected lymph nodes are not next to one another, but are on the same side of the diaphragm
Revision Information
- Reviewer: EBSCO Medical Review Board Mohei Abouzied, MD, FACP
- Review Date: 03/2018 -
- Update Date: 04/07/2016 -


text:
As a member of COL, you will influence and shape the future of ocean science and technology.
- Amplify your impact on federal policy and investments in ocean research and infrastructure, technology development, and ocean science education.
- Participate in COL-convened meetings and congressional events that bring our members together with elected officials, federal representatives, and other stakeholders to explore emerging research challenges and opportunities.
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- Make your congressional and federal agency visits as effective as possible by strategizing with COL's policy experts.
- Exchange experience and advice with other leaders in the ocean community.
- Guide COL member services and its research and education programs.
More specific benefits vary depending upon the member's particular interests. For example, our Associate Member category brings together smaller universities focused on undergraduate education, the IOOS Regional Associations, aquaria and marine labs. Click here to request more information on the benefits that meet the specific needs and interests of different subsets of our membership.
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text:
Which Toilets Deliver?
A version of this article appears in the May/June 2005 issue of Home Energy Magazine.
May 01, 2005
A new testing procedure gives researchers a valuable tool to evaluate the effectiveness of low-flow toilets.
When builders install new toilets in new construction or in existing homes, they need to be able to trust the stated efficiency and effectiveness of those toilets, since their reputations and businesses depend on the trust of their customers. Conventional 3.5-gallon (13-liter) toilets consume approximately 33% of all household water. More water-efficient toilets can reduce that figure to18%. So, in an effort to conserve water, many consumers are choosing water-efficient 1.6-gallon (6- liter) ultralow-flush (ULF) toilets when building or remodeling their homes. In fact, many municipalities across North America now offer financial rebates for ULF retrofits, and the United States, the Province of Ontario, and some cities in Canada mandate such toilets in all new construction. But are those toilets actually delivering the promised water savings? Virtually all the toilet models sold in North America meet both the flush volume and the performance requirements of the Canadian Standards Association (CSA) and the American National Standards Institute/American Society of Mechanical Engineers (ANSI/ASME). However, recent research in Canada and the United States has shown that some certified and commercially available models do not flush effectively, leading to customer complaints ...
To read complete online articles, you need to sign up for an Online Subscription.
Once an order has been placed there is an automatic $10 processing fee that will be deducted with any cancellation.
The Home Energy Online articles are for personal use only and may not be printed for distribution. For permission to reprint, please send an e-mail to email@example.com.


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Principal Proposed Uses
- Cancer Treatment Support (Injectable Form)
Other Proposed Uses
European mistletoe, famous during the Christmas season, is a semiparasitic plant that grows on trees in Europe and Asia. Its young leafy twigs and flowers were used as an "all-heal" or panacea, said to be helpful for virtually all diseases. The herb is also said to have played a role in Celtic religious celebrations.
Note : American mistletoe, Phoradendron leucarpum , is related to European mistletoe, but it is thought to be more toxic and has not been well studied.
What is Mistletoe Used for Today?
In the 20th century, mistletoe became popular in Germany through the advocacy of a mystic and philosopher named Rudolf Steiner. The school of medicine he founded, anthroposophical medicine, recommended injectable forms of mistletoe as a treatment for cancer. The initial basis for this use was Steiner's "clairvoyant" insight. Scientific tests were subsequently conducted with somewhat positive results, but current evidence is far from definitive.
Mistletoe extracts show anticancer effects in the test tube. 1-5 However, test-tube studies cannot show a treatment effective; only controlled clinical trials can do that. A 2003 review found 10 human trials of injected mistletoe for cancer that met at least minimal scientific standards. 6 Unfortunately, even these studies generally suffered from significant weaknesses in design. The review authors noted that the better-designed studies failed to find evidence of benefit, in terms of lengthened remission, improved quality of life, or chance of survival. Subsequent human trials have also failed to reach adequate levels of scientific rigor or clinical relevance and have, therefore, failed to clarify matters. 7-10, 21,22,24 Another review of 21 clinical trials found no convincing evidence that mistletoe was effective for cancer survival, tumor response, quality of life, psychological distress, or any other favorable outcomes. 23 However, two of the better designed studies did suggest some benefit for breast cancer patients undergoing chemotherapy. A more recent review of 49 22 studies found the addition of mistletoe to standard cancer treatment was associated with improved survival in cancer patients. An analysis restricted to randomized controlled trials, however, showed less of an overall effect. 25 In a small randomized trial of 32 patients with gastric cancer, addition of mistletoe to oral chemotherapy improved quality of life and reduced the incidence of diarrhea compared to patients who did not receive mistletoe. 26
Oral uses of mistletoe have not undergone significant study. Very weak evidence, too weak to rely upon at all, hints that constituents of mistletoe might potentially offer benefit in diabetes11-14 and colds and flus. 15,16 It is commonly stated that oral mistletoe products reduce blood pressure, but there is no scientific evidence to support this belief.
Injectable mistletoe extracts should only be used under the supervision of a physician.
Mistletoe tea can be made by soaking 10-20 g of chopped leaves in 2 cups of water for 8 hours. A typical dose is 1 to 3 cups daily.
Safety Issues
In large clinical trials, use of injected pharmaceutical-grade mistletoe products has not been associated with serious adverse effects, although pain at the injection site and mild flu-like symptoms are common. Severe allergic reactions may occur rarely. 17
Oral use of a mistletoe product has been associated with hepatitis. 18 Mistletoe berries and perhaps the leaves can cause severe toxicity, especially in children. 19 American mistletoe may be more toxic than European mistletoe. 19,20
Mistletoe is not recommended for use in young children, pregnant or nursing women, or people with severe liver or kidney disease.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -