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        <title><![CDATA[Stories by Rohitsharma on Medium]]></title>
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            <title><![CDATA[A Vaccine Has Arrived and the U.S. Is Still Screwing Up]]></title>
            <link>https://rohitsharma58984.medium.com/a-vaccine-has-arrived-and-the-u-s-is-still-screwing-up-42d7f7407492?source=rss-ac81f98174a5------2</link>
            <guid isPermaLink="false">https://medium.com/p/42d7f7407492</guid>
            <category><![CDATA[public-health]]></category>
            <category><![CDATA[coronavirus]]></category>
            <category><![CDATA[covid19]]></category>
            <category><![CDATA[united-states]]></category>
            <category><![CDATA[health]]></category>
            <dc:creator><![CDATA[Rohitsharma]]></dc:creator>
            <pubDate>Fri, 18 Dec 2020 18:53:52 GMT</pubDate>
            <atom:updated>2020-12-18T18:53:52.888Z</atom:updated>
            <content:encoded><![CDATA[<h4>Magical thinking doesn’t work to stop pandemics</h4><figure><img alt="" src="https://cdn-images-1.medium.com/max/1024/0*C9B8DGiQWKOnanCz" /><figcaption>Photo: Christian Lue/Unsplash</figcaption></figure><p>Ireally don’t know why anyone is surprised by <a href="https://www.wsj.com/articles/pfizer-slashed-its-covid-19-vaccine-rollout-target-after-facing-supply-chain-obstacles-11607027787?reflink=desktopwebshare_twitter">recent revelations</a> about Covid-19 vaccine manufacturing and distribution snafus. For nine months, our government has failed to create working supply chains for both testing and personal protective equipment (PPE). We still lack raw materials, manufacturing capability, data on need, logistics, price supports, and equitable distribution. Why would we expect vaccines to be different?</p><p><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de.html</a><br><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de1.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de1.html</a><br><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de2.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de2.html</a><br><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de3.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de3.html</a><br><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de4.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de4.html</a><br><a href="http://tn.buffalo.wi.gov/alo/end-vs-bristol-city-serias-livat-x10.html">http://tn.buffalo.wi.gov/alo/end-vs-bristol-city-serias-livat-x10.html</a><br><a href="http://tn.buffalo.wi.gov/alo/end-vs-bristol-city-serias-livat-x11.html">http://tn.buffalo.wi.gov/alo/end-vs-bristol-city-serias-livat-x11.html</a><br><a href="http://tn.buffalo.wi.gov/alo/end-vs-bristol-city-serias-livat-x12.html">http://tn.buffalo.wi.gov/alo/end-vs-bristol-city-serias-livat-x12.html</a><br><a href="http://tn.buffalo.wi.gov/alo/end-vs-bristol-city-serias-livat-x13.html">http://tn.buffalo.wi.gov/alo/end-vs-bristol-city-serias-livat-x13.html</a><br><a href="http://tn.buffalo.wi.gov/alo/end-vs-bristol-city-serias-livat-x14.html">http://tn.buffalo.wi.gov/alo/end-vs-bristol-city-serias-livat-x14.html</a><br><a href="http://tn.buffalo.wi.gov/alo/video-h-v-a20.html">http://tn.buffalo.wi.gov/alo/video-h-v-a20.html</a><br><a href="http://tn.buffalo.wi.gov/alo/video-h-v-a21.html">http://tn.buffalo.wi.gov/alo/video-h-v-a21.html</a><br><a href="http://tn.buffalo.wi.gov/alo/video-h-v-a22.html">http://tn.buffalo.wi.gov/alo/video-h-v-a22.html</a><br><a href="http://tn.buffalo.wi.gov/alo/video-h-v-a23.html">http://tn.buffalo.wi.gov/alo/video-h-v-a23.html</a><br><a 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href="https://datainventory.ed.gov/data/video-u-v-b-im-tv-01.html">https://datainventory.ed.gov/data/video-u-v-b-im-tv-01.html</a><br><a href="https://datainventory.ed.gov/data/video-u-v-b-im-tv-02.html">https://datainventory.ed.gov/data/video-u-v-b-im-tv-02.html</a><br><a href="https://datainventory.ed.gov/data/video-u-v-b-im-tv-03.html">https://datainventory.ed.gov/data/video-u-v-b-im-tv-03.html</a><br><a href="https://datainventory.ed.gov/data/video-u-v-b-im-tv-04.html">https://datainventory.ed.gov/data/video-u-v-b-im-tv-04.html</a><br><a href="https://datainventory.ed.gov/data/video-u-v-b-im-tv-05.html">https://datainventory.ed.gov/data/video-u-v-b-im-tv-05.html</a><br><a href="https://datainventory.ed.gov/data/video-u-v-b-im-tv-06.html">https://datainventory.ed.gov/data/video-u-v-b-im-tv-06.html</a><br><a href="https://datainventory.ed.gov/data/video-u-v-b-im-tv-07.html">https://datainventory.ed.gov/data/video-u-v-b-im-tv-07.html</a><br><a 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href="https://brevardalz.org/dalz/video-u-v-b-im-tv-07.html">https://brevardalz.org/dalz/video-u-v-b-im-tv-07.html</a><br><a href="https://brevardalz.org/dalz/video-u-v-b-im-tv-08.html">https://brevardalz.org/dalz/video-u-v-b-im-tv-08.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-01.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-01.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-02.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-02.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-03.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-03.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-04.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-04.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-05.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-05.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-06.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-06.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-07.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-07.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-08.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-08.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-01.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-01.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-02.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-02.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-03.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-03.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-04.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-04.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-05.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-05.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-06.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-06.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-07.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-07.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-08.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-08.html</a></p><p>Back in March, many of us called out that the health care supply chain was broken. I wrote about it with Ashish K. Jha and Valerie Griffeth in the <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2006141"><em>New England Journal of Medicine</em></a>. Nothing that we talked about or called for has been fixed. Instead, the feds developed a <a href="https://www.nytimes.com/2020/05/05/us/jared-kushner-fema-coronavirus.html">mess of a system</a> to meet our health care systems’ PPE, testing, and other supply chain needs — a “fumbling” effort by “inexperienced” people with no background in supply chain logistics, manufacturing, disaster preparedness, or health care.</p><p>We learned very early in this pandemic that our national strategy was one of bluster and photo ops — not one of doing the hard work to get supplies into the hands of those who need them.</p><blockquote><em>Alarm bells have been ringing for months about the lack of strategy for vaccine manufacturing, distribution, and messaging.</em></blockquote><p>In the face of immediate need for PPE, we set up workarounds — groups like <a href="http://getusppe.org/">Get Us PPE</a> developed <a href="https://getusppe.org/data">data networks</a> and equitable distribution strategies. For testing, the country relied on public-private partnerships, like Rhode Island’s (and other states’) partnership <a href="https://www.cnbc.com/2020/04/06/cvs-launches-drive-thru-rapid-testing-in-rhode-island-and-georgia.html">with CVS</a>.</p><p>But let’s be clear: these efforts are simply substitutes for a federal strategy.</p><p>They are in no way equivalent to a good, organized, 50-state, publicly funded effort — which brings me to vaccines. Alarm bells have been ringing for months about the lack of strategy for vaccine manufacturing, distribution, and messaging.</p><h3><a href="https://elemental.medium.com/every-covid-19-vaccine-question-youll-ever-have-answered-9a0eeb334ded">Every Covid-19 Vaccine Question You’ll Ever Have, Answered</a></h3><h3><a href="https://elemental.medium.com/every-covid-19-vaccine-question-youll-ever-have-answered-9a0eeb334ded">Clear guidance on everything you want to know about the vaccine (and then some)</a></h3><h4><a href="https://elemental.medium.com/every-covid-19-vaccine-question-youll-ever-have-answered-9a0eeb334ded">elemental.medium.com</a></h4><p>In September, Trust for America’s Health, a nonprofit, and David Lakey, vice chancellor for health affairs at the University of Texas, wrote <a href="https://www.statnews.com/2020/09/14/key-to-efficient-vaccine-distribution-start-preparing-early/">a piece for <em>STAT</em></a><em> </em>imploring “Operation Warp Speed” to come up with a plan. Simultaneously, potential breakdowns in the cold-storage distribution chain were highlighted by <a href="https://www.statnews.com/pharmalot/2020/09/08/covid19-vaccine-supply-chain-cold-chain/">Ed Silverman</a> and others.</p><p>In October, the Association of State and Territorial Health Officials <a href="https://www.astho.org/COVID-19/Vaccine-Distribution-and-Implementation-in-States-and-Territories-Brief/">sounded the alarm</a> that they still had no funds and no federal guidance on strategy. As of November, despite knowing that multiple phase 3 trials were nearing the end, and despite earlier promises to release vaccines pre-election, there was still no central repository for distribution plans, <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/states-are-getting-ready-to-distribute-covid-19-vaccines-what-do-their-plans-tell-us-so-far/">according to <em>Kaiser Health News</em></a>.</p><p>Not to mention the fact that months on, few people in positions of authority are talking about how to handle long-standing, well-founded <a href="https://twitter.com/DrBrittaniJ/status/1334594110888554499">mistrust from Black and Brown communities</a>.</p><p>Without trust, even the best supply chain is useless.</p><p>With consumer confidence in the federal government at an all-time low and <a href="https://www.cnbc.com/2020/10/31/2020-election-coronavirus-vaccine-disinformation-will-continue.html">misinformation</a> campaigns at an all-time high, even health care workers have expressed hesitancy about the vaccine.</p><p>Meanwhile, the guy who is directing Operation Warp Speed <a href="https://www.politico.com/news/2020/12/08/operation-warp-speed-trumps-vaccine-order-443574">can’t explain</a> why President Trump is making certain executive orders or why we passed on buying an extra 100 million doses of the vaccine.</p><p>Let’s be clear:</p><ul><li>More than 300,000 Americans have died.</li><li>Another 150,000 will likely die before inauguration.</li><li>A vaccine is <em>the best chance we have</em> at getting things back to normal, quickly.</li></ul><p>But what good is a vaccine if it stays on the shelves?</p><p>So, to those who expect that a miracle will be wrought and Covid-19 will simply disappear? Sorry, not gonna happen. To those who expect that herd immunity will naturally come to pass? Also not gonna happen. Just look at <a href="https://www.reuters.com/article/uk-factcheck-prageru-sweden-herd-immunit-idUSKBN28C2R7">Sweden</a> or New York City. To those who think the states will magically figure it out without funding or clear national guidance? Nope.</p><p>For the next 33 days until the inauguration, we’ll just continue to bumble along through the goodwill of philanthropy, the forethought of a few great states’ departments of health, and the hard work of health care workers, pharmacists, and techs who have already sacrificed so much.</p><p>And we’ll continue to watch our number of preventable deaths grow.</p><p>At the end of the day, despite having sunk billions of dollars into the creation of a vaccine, our feds have failed to close the last-mile gap — just as they failed with testing and with PPE.</p><p>To fix it, we need investments in manufacturing and supply chain. We need investments in data architecture and equitable distribution. We need clear public health messaging, stat. Magical thinking doesn’t work to stop pandemics.</p><img src="https://medium.com/_/stat?event=post.clientViewed&referrerSource=full_rss&postId=42d7f7407492" width="1" height="1" alt="">]]></content:encoded>
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            <title><![CDATA[Now Is the Worst Time for Covid-19 Fatigue]]></title>
            <link>https://rohitsharma58984.medium.com/now-is-the-worst-time-for-covid-19-fatigue-12eb583d3253?source=rss-ac81f98174a5------2</link>
            <guid isPermaLink="false">https://medium.com/p/12eb583d3253</guid>
            <category><![CDATA[society]]></category>
            <category><![CDATA[coronavirus]]></category>
            <category><![CDATA[health]]></category>
            <category><![CDATA[covid19]]></category>
            <category><![CDATA[culture]]></category>
            <dc:creator><![CDATA[Rohitsharma]]></dc:creator>
            <pubDate>Fri, 18 Dec 2020 18:52:15 GMT</pubDate>
            <atom:updated>2020-12-18T18:52:15.453Z</atom:updated>
            <content:encoded><![CDATA[<h4>Scientists fear an exhausted nation will let down its guard just as cooler weather raises risk of a twindemic</h4><figure><img alt="" src="https://cdn-images-1.medium.com/max/1024/0*G0WDOGRlKem8dAiE.jpeg" /><figcaption>Photo: picture alliance/Getty Images</figcaption></figure><p>“Are we there yet? Are we there yet? Are. We. There. Yet?” That’s how Andrea Taylor, PhD, describes her own growing exhaustion with the Covid-19 trip we’re all on right now, the frustrating and inconvenient detour in the journey through the longest year ever.</p><p><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de.html</a><br><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de1.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de1.html</a><br><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de2.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de2.html</a><br><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de3.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de3.html</a><br><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de4.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de4.html</a><br><a href="http://tn.buffalo.wi.gov/alo/end-vs-bristol-city-serias-livat-x10.html">http://tn.buffalo.wi.gov/alo/end-vs-bristol-city-serias-livat-x10.html</a><br><a 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href="https://datainventory.ed.gov/data/video-u-v-b-im-tv-07.html">https://datainventory.ed.gov/data/video-u-v-b-im-tv-07.html</a><br><a href="https://datainventory.ed.gov/data/video-u-v-b-im-tv-08.html">https://datainventory.ed.gov/data/video-u-v-b-im-tv-08.html</a><br><a href="https://brevardalz.org/dalz/video-u-v-b-im-tv-01.html">https://brevardalz.org/dalz/video-u-v-b-im-tv-01.html</a><br><a href="https://brevardalz.org/dalz/video-u-v-b-im-tv-02.html">https://brevardalz.org/dalz/video-u-v-b-im-tv-02.html</a><br><a href="https://brevardalz.org/dalz/video-u-v-b-im-tv-03.html">https://brevardalz.org/dalz/video-u-v-b-im-tv-03.html</a><br><a href="https://brevardalz.org/dalz/video-u-v-b-im-tv-04.html">https://brevardalz.org/dalz/video-u-v-b-im-tv-04.html</a><br><a href="https://brevardalz.org/dalz/video-u-v-b-im-tv-05.html">https://brevardalz.org/dalz/video-u-v-b-im-tv-05.html</a><br><a href="https://brevardalz.org/dalz/video-u-v-b-im-tv-06.html">https://brevardalz.org/dalz/video-u-v-b-im-tv-06.html</a><br><a href="https://brevardalz.org/dalz/video-u-v-b-im-tv-07.html">https://brevardalz.org/dalz/video-u-v-b-im-tv-07.html</a><br><a href="https://brevardalz.org/dalz/video-u-v-b-im-tv-08.html">https://brevardalz.org/dalz/video-u-v-b-im-tv-08.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-01.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-01.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-02.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-02.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-03.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-03.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-04.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-04.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-05.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-05.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-06.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-06.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-07.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-07.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-08.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-08.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-01.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-01.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-02.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-02.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-03.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-03.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-04.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-04.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-05.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-05.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-06.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-06.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-07.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-07.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-08.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-08.html</a></p><p>While the growing and horrific U.S. <a href="https://elemental.medium.com/us-covid-19-deaths-compared-to-diseases-pandemics-wars-2a7495a43280">coronavirus death toll</a> exceeds 200,000, Covid-19 fatigue is spreading even among people least affected by the pandemic, according to more than a half-dozen experts interviewed for this article.</p><p>The common sentiment: “Boy, do I really need some contact with people, and some normalcy,” says Taylor, a clinical psychologist and assistant professor at the University of Texas Health Science Center at Houston.</p><p>“A mood that ‘we’re past this’ is palpable and worrisome,” says epidemiologist Saskia Popescu, PhD, an adjunct professor of public health at the University of Arizona, who sees the fatigue turning to complacency already, in a trend of fewer people wearing masks. “After nine months and a lot of failures in response, people are tired and it’s hard to stay vigilant. Now though, it is more important than ever.”</p><p>With the <a href="https://elemental.medium.com/this-years-flu-vaccine-could-be-the-most-important-one-you-ever-get-c12bebd83203?source=user_profile---------15-----------------------">high season for viral transmission</a> looming, scientists worry Covid-19 fatigue and a resulting complacency will help the virus spread more than ever as people migrate indoors, take more risks, and otherwise let their guards down. While <a href="https://elemental.medium.com/dont-panic-over-the-new-swine-flu-you-ve-been-hearing-about-c855caed461c">scientists can’t predict</a> whether this year’s flu season will be mild or severe, concern is brewing over a “twindemic” that could overload the health care system.</p><h3>Changing view of risk</h3><p>Covid-19 fatigue is causing people to change their cost-benefit analyses, perhaps making more trips to the grocery store or planning a holiday gathering that would have been unthinkable in the spring. This is how our brains deal with risk, says Kaye Hermanson, PhD, a clinical psychologist and assistant professor at UC Davis Health. Imagine you’re in a car crash. The next time you drive, you’ll be anxious. But with each successful trip, your brain can unlearn the danger and you start to feel safer behind the wheel. This psychology works even on psychologists.</p><p>“After seven months of going to a hospital every day, I don’t really think about or worry about getting Covid-19,” Hermanson says. “I’ve gone to the grocery store and been fine. I’ve gone to work and been fine.” She still takes precautions, of course, but each time the bad thing doesn’t happen, she says, it becomes easier to discount the threat.</p><blockquote><em>But now there’s a big problem: We’re not winning this war, and that’s affecting the motivation to fight.</em></blockquote><p>How ardently people continue to fight the invisible enemy called the coronavirus will depend on each person’s view of the pandemic, says Jed Magen, DO, a psychiatrist at Michigan State University.</p><p>“If it seems that there is not a lot of risk in the community, you are likely to be less vigilant,” Magen says. “If it seems like there are a lot of cases around and/or you know someone who becomes ill, you are probably going to be a lot more likely to be careful.” It’s also vital that political leaders set good examples on prevention efforts and give an honest portrayal of the risks of Covid-19 and hopes for a vaccine, he says.</p><h3>“We can only take so much.”</h3><p>Not since WWII have Americans been asked en masse to endure so much behavioral change for the common good, psychologists say. And the majority of people have willingly adapted, polls show. Consistently across several <a href="https://covid19pulse.usc.edu/">weekly polls</a> by USC Dornsife project, more than 90% of people say they wore a mask at least once in the past week.</p><p>But now there’s a big problem: We’re not winning this war, and that’s affecting the motivation to fight.</p><p>“This has been so emotionally taxing, and we can only take so much,” says Neda Gould, PhD, a clinical psychologist and assistant professor of psychiatry at Johns Hopkins Medicine. “People are feeling exhausted and burned-out from having to do certain things a certain way, and then not do so many things.”</p><p>“A lot of people are feeling fatigued and distressed around the lack of light at the end of the tunnel,” says Arianna Galligher, a social worker and associate director of the trauma recovery center at Ohio State University Wexner Medical Center. “Folks don’t really have a sense of when this will be over.”</p><p>Amid all this fatigue, trust in government and health officials <a href="https://coronavirus.medium.com/trust-in-fauci-and-the-cdc-falls-as-partisan-gap-widens-ec2c8ae92a72">has been eroded </a>by the lack of federal leadership on the pandemic, President Trump’s <a href="https://www.nytimes.com/2020/09/16/us/politics/trump-cdc-covid-vaccine.html">repeated slap downs of health experts</a>, and pandemic rules that are wildly different from one state or city to the next.</p><blockquote><em>“This has been so emotionally taxing, and we can only take so much. People are feeling exhausted and burned-out from having to do certain things a certain way, and then not do so many things.”</em></blockquote><p>“Some people are feeling fatigued because they don’t really know what’s true,” Galligher says. “It’s hard to know what to believe and <a href="https://elemental.medium.com/50-experts-to-trust-in-a-pandemic-fe58932950e7">which experts to trust</a>.”</p><p>Meanwhile, after months of masking up and avoiding people, the social animal in all of us is begging to be uncaged. The USC polling shows the percentage of people who think it’s safe to eat at a restaurant or visit friends or relatives at their homes has been inching up.</p><p>“We need to be touched, we need to be hugged, we need social interaction,” Hermanson says. “Zoom was pretty good for a little while, but it doesn’t really meet those needs on a long-term basis.”</p><h3>Poised to rage</h3><p>Respiratory viruses like the coronavirus need human hosts to survive. Cold and flu viruses hang out in small “reservoirs” during summer — a few infections here and there, waiting for the cooler temperatures they thrive in and for people to gather more frequently in enclosed spaces. Even in past flu pandemics, infection rates fell significantly during summer, says Stephen Kissler, PhD, an expert in immunology and infectious diseases at the Harvard School of Public Health.</p><p>It’s not yet clear if SARS-CoV-2, the coronavirus that causes Covid-19, is suppressed by summer heat, but if so it’s clearly not by much, as surges across the Sunbelt showed. That coupled with failed mitigation efforts have given the virus a huge head start across the United States heading into fall. Assuming no safe and effective vaccine is available on a widespread basis soon — experts do not expect one until sometime next year at the earliest — the virus will take advantage of <a href="https://elemental.medium.com/the-most-likely-way-youll-get-infected-with-covid-19-30430384e5a5">any opportunity we give it</a>.</p><p>“With SARS-CoV-2, we don’t have reservoirs of the virus. We have lakes and oceans,” Kissler tells <em>Elemental</em>. “There’s plenty of virus around to keep the epidemic raging through the fall and winter.”</p><p>There are two big unknowns: How many people have been infected, and how immune they are to future infection.</p><p>The number of people who’ve had Covid-19 varies greatly by location, Kissler says. It might be 60% or more in some of the hardest-hit New York City neighborhoods, and 10% or less elsewhere in the city and beyond. It’s reasonable to expect that most people who catch Covid-19 have at least a few months of protection, he says. Those people count toward what scientists call “herd immunity.”</p><p>In places where herd immunity reaches 40%, the rate of spread could slow, Kissler says — assuming people remain vigilant about prevention. At around 50% or 60%, the <a href="https://elemental.medium.com/herd-immunity-may-play-a-bigger-role-than-we-thought-7de88f4ea697">virus might largely subside</a>, he says, though that threshold could be as high as 70% — nobody knows yet.</p><p>Achieving 70% herd immunity could result in at least one million U.S. deaths, scientists say. While herd immunity can be achieved through a vaccine, scientists do not consider natural herd immunity to be a morally conscionable strategy.</p><p>Kissler is optimistic that a worsening of the pandemic can be prevented if people stick with masks and physical distancing. Those same measures would also help reduce spread of flu (as would flu vaccines, which doctors say <a href="https://coronavirus.medium.com/when-should-i-get-the-flu-vaccine-this-year-3680bf3db129">people should get now</a>).</p><p>But Kissler worries about the confluence of <a href="https://elemental.medium.com/what-the-botched-school-reopenings-taught-us-and-how-to-do-it-better-5719523e0404">school reopenings</a>, cooler weather, and holiday gatherings with Covid-19 fatigue. The rate of new infections could rise to unprecedented levels this fall, he says, “if we do nothing.”</p><img src="https://medium.com/_/stat?event=post.clientViewed&referrerSource=full_rss&postId=12eb583d3253" width="1" height="1" alt="">]]></content:encoded>
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            <title><![CDATA[The First Signs of Alcoholic Liver Damage Are Not in the Liver]]></title>
            <link>https://rohitsharma58984.medium.com/the-first-signs-of-alcoholic-liver-damage-are-not-in-the-liver-e9ea9e83054a?source=rss-ac81f98174a5------2</link>
            <guid isPermaLink="false">https://medium.com/p/e9ea9e83054a</guid>
            <category><![CDATA[alcohol]]></category>
            <category><![CDATA[mental-health]]></category>
            <category><![CDATA[body]]></category>
            <category><![CDATA[addiction]]></category>
            <category><![CDATA[health]]></category>
            <dc:creator><![CDATA[Rohitsharma]]></dc:creator>
            <pubDate>Fri, 18 Dec 2020 18:49:50 GMT</pubDate>
            <atom:updated>2020-12-18T18:49:50.331Z</atom:updated>
            <content:encoded><![CDATA[<h4>Not enough alcoholics are educated about this</h4><figure><img alt="" src="https://cdn-images-1.medium.com/max/1024/0*rOJ_lD5mBmfKokC_.png" /><figcaption>Image: <a href="https://pixabay.com/users/VSRao-8105725/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=4081243">VSRao</a>/<a href="https://pixabay.com/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=4081243">Pixabay</a></figcaption></figure><p>Myfather died of alcoholic liver cirrhosis four years ago. It came as a surprise to all of us, even though it was clear he had a <a href="https://elemental.medium.com/driving-my-mom-to-rehab-261c985431ac">severe drinking problem</a> for decades. It was especially surprising to me, as a former nurse and a recovering alcoholic. You would think I’d know more about liver problems and <a href="https://elemental.medium.com/the-latest-findings-on-why-its-so-hard-to-quit-drinking-ae84b37689be">alcohol use</a> than the average person. But the truth is, in the months before his death, I had no idea my father’s liver was struggling at all. Most people know about cirrhosis, but few people know how a liver goes from early damage to end-stage liver cirrhosis.</p><p><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de.html</a><br><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de1.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de1.html</a><br><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de2.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de2.html</a><br><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de3.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de3.html</a><br><a href="http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de4.html">http://tn.buffalo.wi.gov/alo/Berlin-v-BVB-de4.html</a><br><a href="http://tn.buffalo.wi.gov/alo/end-vs-bristol-city-serias-livat-x10.html">http://tn.buffalo.wi.gov/alo/end-vs-bristol-city-serias-livat-x10.html</a><br><a 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href="https://chiefpapers.com/chief/video-u-v-b-im-tv-05.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-05.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-06.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-06.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-07.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-07.html</a><br><a href="https://chiefpapers.com/chief/video-u-v-b-im-tv-08.html">https://chiefpapers.com/chief/video-u-v-b-im-tv-08.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-01.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-01.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-02.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-02.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-03.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-03.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-04.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-04.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-05.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-05.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-06.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-06.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-07.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-07.html</a><br><a href="http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-08.html">http://cancerbulletin.facs.org/pasa/video-u-v-b-im-tv-08.html</a></p><p>The combination of my father’s death and my personal background lit a fire in me to know more. He was admitted to the hospital on June 24, 2016, and he died on July 18. Only 24 days passed between the first sign there was a problem and his subsequent death.</p><p>Now, hearing that he was in end-stage cirrhosis didn’t surprise me, given his heavy drinking. What did surprise me was that he’d visited several doctors and specialists in the months before his death, and no one knew his liver was struggling either.</p><p>So what happened? Does end-stage liver cirrhosis really sneak up that fast? <a href="https://elemental.medium.com/do-i-have-a-drinking-problem-ffaba39c9e6d">Were there other signs</a> that would have alerted someone to his failing liver?</p><p>As for why the doctors and specialists didn’t know what was happening, that mystery resolved reasonably quickly.<strong> </strong>The plain truth is that alcoholics <a href="https://www.theguardian.com/commentisfree/2018/dec/12/alcoholic-patients-keep-drinking-doctor">rarely divulge the amount</a> and frequency of their drinking to their doctors. This was the case for my dad. He had many health issues that he was trying to solve, but he protected his drinking habit fiercely. So he refused to spill the beans, even when it mattered.</p><h3><a href="https://elemental.medium.com/what-alcohol-does-to-a-stressed-out-brain-af3771a36dba">What Alcohol Does to a Stressed-Out Brain</a></h3><h3><a href="https://elemental.medium.com/what-alcohol-does-to-a-stressed-out-brain-af3771a36dba">The relationship between alcohol and stress relief is a lot more complicated than conventional wisdom holds</a></h3><h4><a href="https://elemental.medium.com/what-alcohol-does-to-a-stressed-out-brain-af3771a36dba">elemental.medium.com</a></h4><p>The problem is that liver damage has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513682/">numerous multifaceted symptoms</a> that are confusing and associated with many other illnesses. Unless a doctor knows that the patient is an alcoholic, they may not know how to interpret what’s happening until it’s too late.</p><p>As he was dying, my father told me that he didn’t think to tell the doctors how much he was drinking. He said it was as if he blanked out and “forgot” to mention it. As crazy as that sounds, this strange “forgetting” is a common part of the <a href="https://www.theguardian.com/commentisfree/2018/dec/12/alcoholic-patients-keep-drinking-doctor">alcoholic mindset</a>. It may also be due to the metabolic and physical changes of cirrhosis itself.</p><p>There are many signs of liver problems, but oddly, none seem to point to the liver at first. And in fact, many of the first signs of liver damage occur in other parts of the body. Knowing these signs may help educate alcoholics and their families if they want to understand their risk of developing liver cirrhosis.</p><blockquote><em>Liver damage has numerous multifaceted symptoms that are confusing and associated with many other illnesses. Unless a doctor knows that the patient is an alcoholic, they may not know how to interpret what’s happening until it’s too late.</em></blockquote><h3>Digestive signs</h3><p>The liver plays a huge <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321494/">part in our digestive process</a>. It filters out all toxins from food as well as helping to break down fats and glucose.</p><p>When a liver starts to slow down due to significant damage, it will <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513682/">reduce its digestive work</a>. Instead, it will divert its energy toward vital functions like metabolizing medications and filtering toxins.</p><p>This means that symptoms like bloating, nausea, vomiting, gas, and diarrhea will start to increase. Over time, eating becomes more challenging. In the later stages of liver cirrhosis, toxins that can’t be filtered out begin to build in the bloodstream, which causes more nausea.</p><h3>Cognitive signs</h3><p>Although confusion and brain fog happen in end-stage liver cirrhosis, they can also be early signs.</p><p>The liver is <a href="https://elemental.medium.com/this-holiday-season-give-thanks-to-your-liver-4f652eda6be3">responsible for filtering</a> dangerous substances in the blood. It also helps <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513682/">regulate hormones, blood glucose, and vitamin absorption</a>. In the early stages of liver damage, these processes can be interrupted. Inevitably, this affects our brain and nervous system.</p><p>This means that early liver problems can make you feel <a href="https://jnnp.bmj.com/content/jnnp/75/suppl_3/iii16.full.pdf">tired, confused, slow, and foggy</a>. You may have some memory issues as well.</p><h3><a href="https://elemental.medium.com/covid-cocktail-crisis-adds-to-america-s-serious-drinking-problem-ea8cfa2d2a40">Covid ‘Cocktail Crisis’ Adds to America’s Serious Drinking Problem</a></h3><h3><a href="https://elemental.medium.com/covid-cocktail-crisis-adds-to-america-s-serious-drinking-problem-ea8cfa2d2a40">Lockdowns and other pandemic stresses have certainly primed the drinking pump</a></h3><h4><a href="https://elemental.medium.com/covid-cocktail-crisis-adds-to-america-s-serious-drinking-problem-ea8cfa2d2a40">elemental.medium.com</a></h4><h3>Neuromuscular signs</h3><p>The liver stores <a href="https://elemental.medium.com/should-i-take-b-vitamins-c82631d94c03">vitamins</a> required for the functioning of many organs and systems in the body — one of them is vitamin B1 or thiamine. A deficiency in this particular vitamin has been <a href="https://www.ncbi.nlm.nih.gov/books/NBK537204/">documented in many alcoholics</a> with or without liver damage.</p><p>Unfortunately, alcohol inhibits the absorption of thiamine in the intestine. Over time, as the liver becomes damaged, it can no longer store thiamine in enough quantities. Thiamine deficiency is responsible for <a href="https://www.ncbi.nlm.nih.gov/books/NBK537204/">many neurological issues</a> in people with alcoholism.</p><p>Symptoms of <a href="https://en.wikipedia.org/wiki/Thiamine_deficiency">thiamine deficiency</a> range from mild to severe and include things like: confusion, mental fog, lack of balance, pain and numbness in hands and feet, muscle weakness, rapid heart rate, digestive problems, flushing, and involuntary eye movements.</p><p>Thiamine deficiency happens in almost every alcoholic who consumes frequent and large amounts of alcohol. And if thiamine deficiency due to alcoholism is discovered, you can be sure the liver is suffering damage at the same time.</p><blockquote><em>Many of the first signs of liver damage occur in other parts of the body.</em></blockquote><h3>Vascular signs</h3><p>All alcohol consumption can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321494/">lead to blood vessel dilation</a>, causing flushing in the face and hands. Over time, this can cause damage leading to permanent redness in the face. Although many alcoholics have rosacea or spider-like veins on their faces, this is often benign.</p><p>However, spider angiomas are different from rosacea or spiderlike veins. They’re circular and have a central point called a spider nevus that is darker than the rest of the lesion. <a href="https://en.wikipedia.org/wiki/Spider_angioma">Spider angiomas</a> are a sign of liver disease and can be present in the early stages. They often progress to more extensive and more numerous lesions.</p><p>Spider angiomas are caused by <a href="https://en.wikipedia.org/wiki/Spider_angioma">increased estrogen levels</a> in the blood. When the liver becomes damaged, it can’t properly metabolize estrogens, which causes them to build up in the body.</p><p>Many women who are pregnant or taking birth control pills may have a few spider angiomas. However, in alcoholic liver disease, these lesions are often more frequent and accompanied by <a href="https://en.wikipedia.org/wiki/Spider_angioma">red palms and varicose veins</a> in the esophagus.</p><p>These are a few of the main signs of alcoholic liver damage that happen outside of the liver. It’s important to know this because most of us have no idea how the liver functions and how it communicates distress.</p><p>The liver itself doesn’t show signs like pain or swelling in the early stages of liver damage. This contrasts with other organs like the heart or stomach, where any damage will emit pain or symptoms directly from these organs.</p><p>What happens with liver damage is that its many diverse functions become interrupted, causing symptoms in other parts of the body. This may explain why most people never think they have a problem with their liver.</p><p>Unfortunately, patients with alcoholism are rarely educated about these issues. This is because they often don’t reveal their drinking, to begin with. And even if they do, the symptoms are widespread and complex, which makes patient education challenging.</p><p>My goal in writing articles like this is to help educate regular people about alcoholic liver disease to understand their health and make better decisions.</p><p>It’s hard to say if my father would have changed his drinking habits if he knew more about his vague and complicated symptoms. But I think having proper education would have certainly helped him understand his risks and health problems better.</p><img src="https://medium.com/_/stat?event=post.clientViewed&referrerSource=full_rss&postId=e9ea9e83054a" width="1" height="1" alt="">]]></content:encoded>
        </item>
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            <title><![CDATA[Impressive Source Codes That Every Developer Should See]]></title>
            <link>https://rohitsharma58984.medium.com/impressive-source-codes-that-every-developer-should-see-b99438cdb7a2?source=rss-ac81f98174a5------2</link>
            <guid isPermaLink="false">https://medium.com/p/b99438cdb7a2</guid>
            <category><![CDATA[covid19]]></category>
            <category><![CDATA[nes]]></category>
            <category><![CDATA[coronavirus]]></category>
            <category><![CDATA[germany]]></category>
            <category><![CDATA[alcohol]]></category>
            <dc:creator><![CDATA[Rohitsharma]]></dc:creator>
            <pubDate>Thu, 17 Dec 2020 17:45:29 GMT</pubDate>
            <atom:updated>2020-12-17T17:45:29.502Z</atom:updated>
            <content:encoded><![CDATA[<h3>Sometimes, developers write codes that impress the entire world and the hardware both</h3><figure><img alt="" src="https://cdn-images-1.medium.com/max/44/0*kgDAko6iWaweYfR_" /></figure><p>Last week, on my kids’ fourth day of in-person school, I came down with my first sore throat in six months. At first, I downplayed it — it was just allergies. Then I panicked and had to take a Xanax. Then I thought: How the heck could I have gotten sick? My kids and husband seemed perfectly healthy, and other than their school, which was being held entirely outside, the riskiest place I’d been over the past two weeks was the Walmart parking lot — once — to pick up curbside groceries.</p><p>My most pressing concern, of course, was whether I had Covid-19. Looking up the symptoms, I wasn’t reassured. On its <a href="https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html">website</a>, the Centers for Disease Control and Prevention lists 11 possible coronavirus symptoms (including sore throat), then warns that this seemingly exhaustive list “does not include all possible symptoms.” A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013665/full">systematic review</a> of 16 studies published in July concluded that no symptoms are common enough to distinguish Covid-19 from other infections, including the common cold. …</p><h4><a href="https://elemental.medium.com/colds-are-back-what-does-that-mean-for-your-chance-of-catching-covid-19-2b790ec3734e?readmore=1&amp;source=follow_footer---------0----------------------------">Read more · 11 min read</a></h4><h4>276</h4><h4><a href="https://elemental.medium.com/colds-are-back-what-does-that-mean-for-your-chance-of-catching-covid-19-2b790ec3734e?responsesOpen=true&amp;source=follow_footer---------0----------------------------">6</a></h4><h4><a href="https://danagsmith.medium.com/?source=follow_footer---------1----------------------------">Dana G Smith</a></h4><h4><a href="https://elemental.medium.com/your-brains-response-to-inequality-83ba4ab8505b?source=follow_footer---------1----------------------------">·Sep 29</a></h4><h3><a href="https://elemental.medium.com/your-brains-response-to-inequality-83ba4ab8505b?source=follow_footer---------1----------------------------">How Your Brain Responds to Inequality</a></h3><figure><img alt="" src="https://cdn-images-1.medium.com/max/30/0*lkXc2vk9W0l422mZ" /></figure><figure><img alt="" src="https://cdn-images-1.medium.com/max/700/0*n1V476LuuGKKaodz.jpeg" /></figure><p>Image: Malte Mueller/Getty Images</p><p><em>This is a modified excerpt from Inside Your Head 🧠, a weekly newsletter exploring why your brain makes you think, feel, and act the way you do, written by me, </em>Elemental<em>’s senior writer and a former brain scientist. </em><a href="https://medium.com/elemental-by-medium/newsletters/inside-your-head"><em>Subscribe here</em></a><em> so you won’t miss the next one.</em></p><p>Of all the brain-exploding aspects of These Times, the thing that infuriates me the most is the unfairness of it all: who suffers disproportionately, who skates by unaffected, and who gets away with things that no one should get away with. The injustice and double standards in this world make me furious.</p><p>Turns out there’s an evolutionary reason that being treated unfairly is so rage-inducing — in fact, it’s one of the most primal sources of anger. …</p><h4><a href="https://elemental.medium.com/your-brains-response-to-inequality-83ba4ab8505b?readmore=1&amp;source=follow_footer---------1----------------------------">Read more · 3 min read</a></h4><h4>513</h4><h4><a href="https://elemental.medium.com/your-brains-response-to-inequality-83ba4ab8505b?responsesOpen=true&amp;source=follow_footer---------1----------------------------">6</a></h4><h4><a href="https://danagsmith.medium.com/?source=follow_footer---------2----------------------------">Dana G Smith</a></h4><h4><a href="https://elemental.medium.com/why-unfairness-makes-you-rage-d7f684ae3de?source=follow_footer---------2----------------------------">·Sep 29</a></h4><h3><a href="https://elemental.medium.com/why-unfairness-makes-you-rage-d7f684ae3de?source=follow_footer---------2----------------------------">Why unfairness makes you rage</a></h3><p><em>Welcome back to </em>Inside Your Head<em> </em>🧠<em>, a weekly newsletter exploring why your brain makes you think, feel, and act the way you do, written by Dana Smith, </em>Elemental<em>’s senior writer and a former brain scientist. Forwarded by a friend? </em><a href="https://medium.com/elemental-by-medium/newsletters/inside-your-head"><em>Subscribe here</em></a><em> so you won’t miss the next one.</em></p><h3>Your brain’s response to inequality 🤬</h3><p>Of all the brain-exploding aspects of These Times, the thing that infuriates me the most is the unfairness of it all: who suffers disproportionately, who skates by unaffected, and who gets away with things that no one should get away with. The injustice and double standards in this world make me furious. You too? …</p><h4><a href="https://elemental.medium.com/why-unfairness-makes-you-rage-d7f684ae3de?readmore=1&amp;source=follow_footer---------2----------------------------">Read more · 4 min read</a></h4><h4>530</h4><h4><a href="https://elemental.medium.com/why-unfairness-makes-you-rage-d7f684ae3de?responsesOpen=true&amp;source=follow_footer---------2----------------------------">6</a></h4><h4><a href="https://medium.com/@joannpgalst?source=follow_footer---------3----------------------------">Joann Galst</a></h4><h4><a href="https://elemental.medium.com/my-husband-died-of-covid-19-and-the-president-allowed-it-to-happen-b1ec3e3e9bc2?source=follow_footer---------3----------------------------">·Sep 29</a></h4><h3><a href="https://elemental.medium.com/my-husband-died-of-covid-19-and-the-president-allowed-it-to-happen-b1ec3e3e9bc2?source=follow_footer---------3----------------------------">My Husband Died of Covid-19 — And the President Allowed It to Happen</a></h3><h3>A loving doctor, husband, father, and grandfather was lost. I won’t let his death be in vain.</h3><p>Two hundred thousand is an unfathomable number — a numbing number — but there is real human pain behind it.</p><p>I was married to Jay Galst for 47 years and 10 months until he died needlessly this spring. Until mid-March, he was still working at his Manhattan ophthalmology practice, seeing his patients whom he cared deeply about. As he examined them, they’d discuss their growing families (including children he may have operated on years ago who were now grown with children of their own), music, history, coins, golf, and travel. The coronavirus had only recently appeared stateside. Jay’s work as an ophthalmologist required touching his patients, and the phrase “social distancing” was still new to our daily vocabulary. …</p><p><a href="https://altagamma.it/gamm/zia/r-v-t-01.html">https://altagamma.it/gamm/zia/r-v-t-01.html</a><br><a href="https://altagamma.it/gamm/zia/r-v-t-02.html">https://altagamma.it/gamm/zia/r-v-t-02.html</a><br><a href="https://altagamma.it/gamm/zia/r-v-t-03.html">https://altagamma.it/gamm/zia/r-v-t-03.html</a><br><a href="https://altagamma.it/gamm/zia/r-v-t-04.html">https://altagamma.it/gamm/zia/r-v-t-04.html</a><br><a href="https://altagamma.it/gamm/zia/r-v-t-05.html">https://altagamma.it/gamm/zia/r-v-t-05.html</a><br><a href="https://altagamma.it/gamm/zia/r-v-t-06.html">https://altagamma.it/gamm/zia/r-v-t-06.html</a><br><a href="https://altagamma.it/gamm/zia/r-v-t-07.html">https://altagamma.it/gamm/zia/r-v-t-07.html</a><br><a href="https://altagamma.it/gamm/zia/r-v-t-08.html">https://altagamma.it/gamm/zia/r-v-t-08.html</a><br><a 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href="https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs03.html">https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs03.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs04.html">https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs04.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs05.html">https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs05.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-00.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-00.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-01.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-01.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-02.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-02.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-03.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-03.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-04.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-04.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-05.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-05.html</a></p><blockquote><em>Many of the first signs of liver damage occur in other parts of the body.</em></blockquote><h3>Vascular signs</h3><p>All alcohol consumption can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321494/">lead to blood vessel dilation</a>, causing flushing in the face and hands. Over time, this can cause damage leading to permanent redness in the face. Although many alcoholics have rosacea or spider-like veins on their faces, this is often benign.</p><p>However, spider angiomas are different from rosacea or spiderlike veins. They’re circular and have a central point called a spider nevus that is darker than the rest of the lesion. <a href="https://en.wikipedia.org/wiki/Spider_angioma">Spider angiomas</a> are a sign of liver disease and can be present in the early stages. They often progress to more extensive and more numerous lesions.</p><p>Spider angiomas are caused by <a href="https://en.wikipedia.org/wiki/Spider_angioma">increased estrogen levels</a> in the blood. When the liver becomes damaged, it can’t properly metabolize estrogens, which causes them to build up in the body.</p><p>Many women who are pregnant or taking birth control pills may have a few spider angiomas. However, in alcoholic liver disease, these lesions are often more frequent and accompanied by <a href="https://en.wikipedia.org/wiki/Spider_angioma">red palms and varicose veins</a> in the esophagus.</p><p>These are a few of the main signs of alcoholic liver damage that happen outside of the liver. It’s important to know this because most of us have no idea how the liver functions and how it communicates distress.</p><p>The liver itself doesn’t show signs like pain or swelling in the early stages of liver damage. This contrasts with other organs like the heart or stomach, where any damage will emit pain or symptoms directly from these organs.</p><p>What happens with liver damage is that its many diverse functions become interrupted, causing symptoms in other parts of the body. This may explain why most people never think they have a problem with their liver.</p><p>Unfortunately, patients with alcoholism are rarely educated about these issues. This is because they often don’t reveal their drinking, to begin with. And even if they do, the symptoms are widespread and complex, which makes patient education challenging.</p><p>My goal in writing articles like this is to help educate regular people about alcoholic liver disease to understand their health and make better decisions.</p><p>It’s hard to say if my father would have changed his drinking habits if he knew more about his vague and complicated symptoms. But I think having proper education would have certainly helped him understand his risks and health problems better.</p><p>WRITTEN BY</p><h3><a href="https://gilliancanwrite.medium.com/?source=post_sidebar--------------------------post_sidebar-----------">Gillian May</a></h3><h4>Former nurse turned writer. Focus on mental health, addictions and wellness. Writer for Elemental, Mental Health and Addictions Community &amp; Beautiful Hangover.</h4><p>Follow</p><h4>14.1K</h4><h4>74</h4><p>TABLE OF CONTENTS</p><ul><li><a href="https://elemental.medium.com/the-first-signs-of-alcoholic-liver-cirrhosis-are-not-in-the-liver-2634b3968f00#a0ac">Digestive signs</a></li><li><a href="https://elemental.medium.com/the-first-signs-of-alcoholic-liver-cirrhosis-are-not-in-the-liver-2634b3968f00#58cc">Cognitive signs</a></li><li><a href="https://elemental.medium.com/the-first-signs-of-alcoholic-liver-cirrhosis-are-not-in-the-liver-2634b3968f00#5cf2">Neuromuscular signs</a></li><li><a href="https://elemental.medium.com/the-first-signs-of-alcoholic-liver-cirrhosis-are-not-in-the-liver-2634b3968f00#74fd">Vascular signs</a></li></ul><h3>Sign up for Inside Your Head 🧠</h3><h3>By Elemental</h3><p>A weekly newsletter exploring why your brain makes you think, feel, and act the way you do, by Elemental senior writer Dana Smith. <a href="https://medium.com/elemental-by-medium/newsletters/inside-your-head?source=newsletter_v3_promo--------------------------newsletter_v3_promo-----------">Take a look</a></p><p>Get this newsletter</p><p>Emails will be sent to davidmiller83883838373@gmail.com.</p><p><a href="https://medium.com/m/signin?operation=login&amp;redirect=https%3A%2F%2Felemental.medium.com%2Fthe-first-signs-of-alcoholic-liver-cirrhosis-are-not-in-the-liver-2634b3968f00&amp;source=newsletter_v3_promo--------------------------newsletter_v3_promo-----------">Not you?</a></p><h4>14.1K</h4><h4>74</h4><ul><li><a href="https://elemental.medium.com/tagged/alcohol">Alcohol</a></li><li><a href="https://elemental.medium.com/tagged/addiction">Addiction</a></li><li><a href="https://elemental.medium.com/tagged/health">Health</a></li><li><a href="https://elemental.medium.com/tagged/mental-health">Mental Health</a></li><li><a href="https://elemental.medium.com/tagged/body">Body</a></li></ul><img src="https://medium.com/_/stat?event=post.clientViewed&referrerSource=full_rss&postId=b99438cdb7a2" width="1" height="1" alt="">]]></content:encoded>
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            <title><![CDATA[The First Signs of Alcoholic Liver Damage Are Not in the Liver]]></title>
            <link>https://rohitsharma58984.medium.com/the-first-signs-of-alcoholic-liver-damage-are-not-in-the-liver-a7d22d0c09fe?source=rss-ac81f98174a5------2</link>
            <guid isPermaLink="false">https://medium.com/p/a7d22d0c09fe</guid>
            <category><![CDATA[body]]></category>
            <category><![CDATA[alcohol]]></category>
            <category><![CDATA[nesrin-nas]]></category>
            <category><![CDATA[health]]></category>
            <dc:creator><![CDATA[Rohitsharma]]></dc:creator>
            <pubDate>Thu, 17 Dec 2020 17:44:18 GMT</pubDate>
            <atom:updated>2020-12-17T17:44:18.801Z</atom:updated>
            <content:encoded><![CDATA[<h3>Not enough alcoholics are educated about this</h3><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*QvjCq4aQ42S2kMFF" /></figure><p>Image: <a href="https://pixabay.com/users/VSRao-8105725/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=4081243">VSRao</a>/<a href="https://pixabay.com/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=4081243">Pixabay</a></p><p>Myfather died of alcoholic liver cirrhosis four years ago. It came as a surprise to all of us, even though it was clear he had a <a href="https://elemental.medium.com/driving-my-mom-to-rehab-261c985431ac">severe drinking problem</a> for decades. It was especially surprising to me, as a former nurse and a recovering alcoholic. You would think I’d know more about liver problems and <a href="https://elemental.medium.com/the-latest-findings-on-why-its-so-hard-to-quit-drinking-ae84b37689be">alcohol use</a> than the average person. But the truth is, in the months before his death, I had no idea my father’s liver was struggling at all. Most people know about cirrhosis, but few people know how a liver goes from early damage to end-stage liver cirrhosis.</p><p>The combination of my father’s death and my personal background lit a fire in me to know more. He was admitted to the hospital on June 24, 2016, and he died on July 18. Only 24 days passed between the first sign there was a problem and his subsequent death.</p><p>Now, hearing that he was in end-stage cirrhosis didn’t surprise me, given his heavy drinking. What did surprise me was that he’d visited several doctors and specialists in the months before his death, and no one knew his liver was struggling either.</p><p>So what happened? Does end-stage liver cirrhosis really sneak up that fast? <a href="https://elemental.medium.com/do-i-have-a-drinking-problem-ffaba39c9e6d">Were there other signs</a> that would have alerted someone to his failing liver?</p><p>As for why the doctors and specialists didn’t know what was happening, that mystery resolved reasonably quickly.<strong> </strong>The plain truth is that alcoholics <a href="https://www.theguardian.com/commentisfree/2018/dec/12/alcoholic-patients-keep-drinking-doctor">rarely divulge the amount</a> and frequency of their drinking to their doctors. This was the case for my dad. He had many health issues that he was trying to solve, but he protected his drinking habit fiercely. So he refused to spill the beans, even when it mattered.</p><h3><a href="https://elemental.medium.com/what-alcohol-does-to-a-stressed-out-brain-af3771a36dba">What Alcohol Does to a Stressed-Out Brain</a></h3><h3><a href="https://elemental.medium.com/what-alcohol-does-to-a-stressed-out-brain-af3771a36dba">The relationship between alcohol and stress relief is a lot more complicated than conventional wisdom holds</a></h3><h4><a href="https://elemental.medium.com/what-alcohol-does-to-a-stressed-out-brain-af3771a36dba">elemental.medium.com</a></h4><p>The problem is that liver damage has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513682/">numerous multifaceted symptoms</a> that are confusing and associated with many other illnesses. Unless a doctor knows that the patient is an alcoholic, they may not know how to interpret what’s happening until it’s too late.</p><p>As he was dying, my father told me that he didn’t think to tell the doctors how much he was drinking. He said it was as if he blanked out and “forgot” to mention it. As crazy as that sounds, this strange “forgetting” is a common part of the <a href="https://www.theguardian.com/commentisfree/2018/dec/12/alcoholic-patients-keep-drinking-doctor">alcoholic mindset</a>. It may also be due to the metabolic and physical changes of cirrhosis itself.</p><p>There are many signs of liver problems, but oddly, none seem to point to the liver at first. And in fact, many of the first signs of liver damage occur in other parts of the body. Knowing these signs may help educate alcoholics and their families if they want to understand their risk of developing liver cirrhosis.</p><blockquote><em>Liver damage has numerous multifaceted symptoms that are confusing and associated with many other illnesses. 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href="https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs03.html">https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs03.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs04.html">https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs04.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs05.html">https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs05.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-00.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-00.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-01.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-01.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-02.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-02.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-03.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-03.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-04.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-04.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-05.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-05.html</a></blockquote><h3>Digestive signs</h3><p>The liver plays a huge <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321494/">part in our digestive process</a>. It filters out all toxins from food as well as helping to break down fats and glucose.</p><p>When a liver starts to slow down due to significant damage, it will <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513682/">reduce its digestive work</a>. Instead, it will divert its energy toward vital functions like metabolizing medications and filtering toxins.</p><p>This means that symptoms like bloating, nausea, vomiting, gas, and diarrhea will start to increase. Over time, eating becomes more challenging. In the later stages of liver cirrhosis, toxins that can’t be filtered out begin to build in the bloodstream, which causes more nausea.</p><h3>Cognitive signs</h3><p>Although confusion and brain fog happen in end-stage liver cirrhosis, they can also be early signs.</p><p>The liver is <a href="https://elemental.medium.com/this-holiday-season-give-thanks-to-your-liver-4f652eda6be3">responsible for filtering</a> dangerous substances in the blood. It also helps <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513682/">regulate hormones, blood glucose, and vitamin absorption</a>. In the early stages of liver damage, these processes can be interrupted. Inevitably, this affects our brain and nervous system.</p><p>This means that early liver problems can make you feel <a href="https://jnnp.bmj.com/content/jnnp/75/suppl_3/iii16.full.pdf">tired, confused, slow, and foggy</a>. You may have some memory issues as well.</p><h3><a href="https://elemental.medium.com/covid-cocktail-crisis-adds-to-america-s-serious-drinking-problem-ea8cfa2d2a40">Covid ‘Cocktail Crisis’ Adds to America’s Serious Drinking Problem</a></h3><h3><a href="https://elemental.medium.com/covid-cocktail-crisis-adds-to-america-s-serious-drinking-problem-ea8cfa2d2a40">Lockdowns and other pandemic stresses have certainly primed the drinking pump</a></h3><h4><a href="https://elemental.medium.com/covid-cocktail-crisis-adds-to-america-s-serious-drinking-problem-ea8cfa2d2a40">elemental.medium.com</a></h4><h3>Neuromuscular signs</h3><p>The liver stores <a href="https://elemental.medium.com/should-i-take-b-vitamins-c82631d94c03">vitamins</a> required for the functioning of many organs and systems in the body — one of them is vitamin B1 or thiamine. A deficiency in this particular vitamin has been <a href="https://www.ncbi.nlm.nih.gov/books/NBK537204/">documented in many alcoholics</a> with or without liver damage.</p><p>Unfortunately, alcohol inhibits the absorption of thiamine in the intestine. Over time, as the liver becomes damaged, it can no longer store thiamine in enough quantities. Thiamine deficiency is responsible for <a href="https://www.ncbi.nlm.nih.gov/books/NBK537204/">many neurological issues</a> in people with alcoholism.</p><p>Symptoms of <a href="https://en.wikipedia.org/wiki/Thiamine_deficiency">thiamine deficiency</a> range from mild to severe and include things like: confusion, mental fog, lack of balance, pain and numbness in hands and feet, muscle weakness, rapid heart rate, digestive problems, flushing, and involuntary eye movements.</p><p>Thiamine deficiency happens in almost every alcoholic who consumes frequent and large amounts of alcohol. And if thiamine deficiency due to alcoholism is discovered, you can be sure the liver is suffering damage at the same time.</p><blockquote><em>Many of the first signs of liver damage occur in other parts of the body.</em></blockquote><h3>Vascular signs</h3><p>All alcohol consumption can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321494/">lead to blood vessel dilation</a>, causing flushing in the face and hands. Over time, this can cause damage leading to permanent redness in the face. Although many alcoholics have rosacea or spider-like veins on their faces, this is often benign.</p><p>However, spider angiomas are different from rosacea or spiderlike veins. They’re circular and have a central point called a spider nevus that is darker than the rest of the lesion. <a href="https://en.wikipedia.org/wiki/Spider_angioma">Spider angiomas</a> are a sign of liver disease and can be present in the early stages. They often progress to more extensive and more numerous lesions.</p><p>Spider angiomas are caused by <a href="https://en.wikipedia.org/wiki/Spider_angioma">increased estrogen levels</a> in the blood. When the liver becomes damaged, it can’t properly metabolize estrogens, which causes them to build up in the body.</p><p>Many women who are pregnant or taking birth control pills may have a few spider angiomas. However, in alcoholic liver disease, these lesions are often more frequent and accompanied by <a href="https://en.wikipedia.org/wiki/Spider_angioma">red palms and varicose veins</a> in the esophagus.</p><p>These are a few of the main signs of alcoholic liver damage that happen outside of the liver. It’s important to know this because most of us have no idea how the liver functions and how it communicates distress.</p><p>The liver itself doesn’t show signs like pain or swelling in the early stages of liver damage. This contrasts with other organs like the heart or stomach, where any damage will emit pain or symptoms directly from these organs.</p><p>What happens with liver damage is that its many diverse functions become interrupted, causing symptoms in other parts of the body. This may explain why most people never think they have a problem with their liver.</p><p>Unfortunately, patients with alcoholism are rarely educated about these issues. This is because they often don’t reveal their drinking, to begin with. And even if they do, the symptoms are widespread and complex, which makes patient education challenging.</p><p>My goal in writing articles like this is to help educate regular people about alcoholic liver disease to understand their health and make better decisions.</p><p>It’s hard to say if my father would have changed his drinking habits if he knew more about his vague and complicated symptoms. But I think having proper education would have certainly helped him understand his risks and health problems better.</p><p>WRITTEN BY</p><h3><a href="https://gilliancanwrite.medium.com/?source=post_sidebar--------------------------post_sidebar-----------">Gillian May</a></h3><h4>Former nurse turned writer. Focus on mental health, addictions and wellness. Writer for Elemental, Mental Health and Addictions Community &amp; Beautiful Hangover.</h4><p>Follow</p><h4>14.1K</h4><h4>74</h4><p>TABLE OF CONTENTS</p><ul><li><a href="https://elemental.medium.com/the-first-signs-of-alcoholic-liver-cirrhosis-are-not-in-the-liver-2634b3968f00#a0ac">Digestive signs</a></li><li><a href="https://elemental.medium.com/the-first-signs-of-alcoholic-liver-cirrhosis-are-not-in-the-liver-2634b3968f00#58cc">Cognitive signs</a></li><li><a href="https://elemental.medium.com/the-first-signs-of-alcoholic-liver-cirrhosis-are-not-in-the-liver-2634b3968f00#5cf2">Neuromuscular signs</a></li><li><a href="https://elemental.medium.com/the-first-signs-of-alcoholic-liver-cirrhosis-are-not-in-the-liver-2634b3968f00#74fd">Vascular signs</a></li></ul><h3>Sign up for Inside Your Head 🧠</h3><h3>By Elemental</h3><p>A weekly newsletter exploring why your brain makes you think, feel, and act the way you do, by Elemental senior writer Dana Smith. <a href="https://medium.com/elemental-by-medium/newsletters/inside-your-head?source=newsletter_v3_promo--------------------------newsletter_v3_promo-----------">Take a look</a></p><p>Get this newsletter</p><p>Emails will be sent to davidmiller83883838373@gmail.com.</p><p><a href="https://medium.com/m/signin?operation=login&amp;redirect=https%3A%2F%2Felemental.medium.com%2Fthe-first-signs-of-alcoholic-liver-cirrhosis-are-not-in-the-liver-2634b3968f00&amp;source=newsletter_v3_promo--------------------------newsletter_v3_promo-----------">Not you?</a></p><h4>14.1K</h4><h4>74</h4><ul><li><a href="https://elemental.medium.com/tagged/alcohol">Alcohol</a></li><li><a href="https://elemental.medium.com/tagged/addiction">Addiction</a></li><li><a href="https://elemental.medium.com/tagged/health">Health</a></li><li><a href="https://elemental.medium.com/tagged/mental-health">Mental Health</a></li><li><a href="https://elemental.medium.com/tagged/body">Body</a></li></ul><img src="https://medium.com/_/stat?event=post.clientViewed&referrerSource=full_rss&postId=a7d22d0c09fe" width="1" height="1" alt="">]]></content:encoded>
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            <title><![CDATA[Understanding ProRAW]]></title>
            <link>https://rohitsharma58984.medium.com/understanding-proraw-b255a9623738?source=rss-ac81f98174a5------2</link>
            <guid isPermaLink="false">https://medium.com/p/b255a9623738</guid>
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            <dc:creator><![CDATA[Rohitsharma]]></dc:creator>
            <pubDate>Thu, 17 Dec 2020 17:43:30 GMT</pubDate>
            <atom:updated>2020-12-17T17:43:30.525Z</atom:updated>
            <content:encoded><![CDATA[<p>We make the most popular RAW camera for iPhone, so when Apple revealed their new ProRAW image format, we were beyond excited.</p><p>We make the most popular RAW camera for iPhone, so when Apple revealed their new ProRAW image format, we were beyond excited.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*QgUrU3-t7H53NOOH" /></figure><p>Then they announced it’s coming to the built-in camera app.</p><p>Many developers in our shoes would freak out, thinking Apple wants to gobble up their customers. We were just confused.</p><p>Apple builds products for the broadest possible audience, and RAW is a tool for photo-nerds. These powerful files take skill to edit and come with significant tradeoffs. Why would Apple cram a complicated feature into an app meant for everyone?</p><p>As we dug deeper into ProRAW, we realized it wasn’t just about making RAW more powerful. It’s about making RAW approachable. ProRAW could very well change how everyone shoots and edits photos, beginners and experts alike.</p><p>To understand what makes it so special, the first half of this post explains how a digital camera develops a photo. Then we go on to explain the strengths and weaknesses of traditional RAWs. Finally, we dive into what’s unique about ProRAW, how it changes the game, and its few remaining drawbacks.</p><p>Grab a coffee, because this is a long read.</p><h3>A Short Tour Through a Digital Camera</h3><p>Imagine you’re looking at this scene through your camera.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*yVx0BfO6LBFpFvsJ" /></figure><p>When you tap the camera button on your camera, light passes through a series of optics and lands on a digital sensor where it is captured.</p><p><a href="https://altagamma.it/gamm/zia/r-v-t-01.html">https://altagamma.it/gamm/zia/r-v-t-01.html</a><br><a href="https://altagamma.it/gamm/zia/r-v-t-02.html">https://altagamma.it/gamm/zia/r-v-t-02.html</a><br><a href="https://altagamma.it/gamm/zia/r-v-t-03.html">https://altagamma.it/gamm/zia/r-v-t-03.html</a><br><a href="https://altagamma.it/gamm/zia/r-v-t-04.html">https://altagamma.it/gamm/zia/r-v-t-04.html</a><br><a 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href="https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs00.html">https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs00.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs01.html">https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs01.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs02.html">https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs02.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs03.html">https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs03.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs04.html">https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs04.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs05.html">https://www4.hcdn.gob.ar/bri/Video-murcia-vs-real-betis-vivo-rs05.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-00.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-00.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-01.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-01.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-02.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-02.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-03.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-03.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-04.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-04.html</a><br><a href="https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-05.html">https://www4.hcdn.gob.ar/bri/Video-As-v-Bu-liv-uk-05.html</a></p><p>We’re going to talk through the three important steps that take place as your camera converts sensor values into a picture.</p><h3>Step 1: Demosaic</h3><p>Your digital sensor absorbs light and turns it into numbers. The more light it sees, the higher the number.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*u5GAkysLagcL_vAu" /></figure><p>I used black and white for a reason — digital sensors are totally colorblind. In 1976, a clever engineer at Kodak found a solution: put a grid of color filters over the sensor, so every pixel sees either red, green, or blue.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*7z8oaoOSJlxlO0PT" /></figure><p>This mosaic pattern is called a Bayer pattern, named after its inventor, Bruce Bayer. With a color filter in place, our sensor now sees a grid of alternating colors. Let’s zoom in on the leaves of the tree, and see what the sensor sees.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*c2DrL1gLXuZ_8G24" /></figure><p>Each pixel is either red, green or blue. We figure out the real colors by going over every pixel, looking at its neighbors, and guessing its two missing colors. This crucial step is known as “<a href="https://en.wikipedia.org/wiki/Demosaicing">demosaicing</a>,” or “debayering.”</p><p>It’s a tricky problem. Compare a simple algorithm to a higher quality one, and you’ll spot problems like purple fringes.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*-kk-MUzqCkIfD1rE" /></figure><p>Middle: A fast algorithm. Right: a higher quality one.</p><p>Look at the pebbles in the shot. The fast algorithm is a little more “pixely.”</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*5HkmEK4iRlUfeJ4o" /></figure><p>Left: Fast Right: High Quality</p><p>There are quite a few popular demosaic algorithms to choose from, each with strengths and weaknesses. The perfect algorithm depends on the type of sensor, your camera settings, and even the subject matter. For example, if you’re shooting the night sky, some algorithms produce better results on stars.</p><p>After demosaic, we end up with…</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*Lnt-ytQNJYabBNd2" /></figure><p>(Simulated results to keep things simple)</p><p>That’s not great. As you can see, the color and exposure are off.</p><p>There’s nothing wrong with your camera. Quite the opposite: your camera captures way more information than your screen can display. We have to take those sensor readings, which measures the light from your <strong>scene</strong>, and transform them into pixel values that light up your <strong>display</strong>.</p><h3>Step 2: Transform from Scene to Display</h3><p>Let’s start with color. The following chart represents all the colors a human can see, and the triangle in the middle covers what most screens can display.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*9F8OgSLyxcav6TDM" /></figure><p>When your camera<em> </em>captures colors outside the triangle, we have to push and pull those invalid colors to fit inside.</p><p>One detail makes this especially tricky: deciding which white is “true” white. If you’ve ever shopped for light bulbs, you know every white light in the real world has a slight yellow or blue tint. Our brains adjust our perception of white, based on hints in our surroundings. It’s called <a href="https://en.wikipedia.org/wiki/Color_constancy">color constancy</a>, and it’s why this yellow/blue dress optical illusion fools people.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*-07evAL3IgV5qUWa" /></figure><p>Modern cameras are very good at figuring out the white point in most situations. So we pick our white point, run the math, and end up with a perfectly white-balanced image.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*-ubT6wO6k2Yx7oKT" /></figure><p>That looks pretty close to what we saw, but the awning in the top of the frame is under-exposed.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*gx6A-9sSGcSA2bhi" /></figure><p>Let’s turn up the exposure to bring out detail…</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*44zyWAuvVtjKolRo" /></figure><p>… but unfortunately, now the rest of the image is too bright.</p><p>The technical name for this problem is “dynamic range.” It’s range of light you can capture or display at one time, measured from the brightest bright to the darkest shadow. You’ll frequently hear this range measured in “stops.”</p><p>Ever see terms like ‘HDR’ or ‘XDR’ being thrown around? The “DR” in “HDR” stands for Dynamic Range. People make quite a fuss about it. This is an especially difficult problem in technology, because the human eye is <strong>incredibly good</strong>.</p><p>It’s easily the most powerful camera in the world, as it can see up to 30 stops of dynamic range. Most screens can <em>display</em> 8 stops. Digital cameras capture up to 15 stops. When we try to display all this information on a screen with lower dynamic range, it’s going to look wrong, sometimes in unexpected ways.</p><p>Notice the sky has weird patch of cyan, caused by one of the color channels clipping.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*aOu2DgWupSC9_dHg" /></figure><p>The solution to our dynamic range problem is a little more complicated than bringing up shadows and turning down highlights everywhere. That would make the whole image feel flat.</p><p>Instead, you want to darken and lighten small areas of the image. Fifty years ago, photographers took hours to tweak their negatives using a process called “dodging and burning.”</p><p>Today it’s called “local tone mapping.”</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*aS9UrFEV2w63w0U8" /></figure><p>The image on the right has some gentle tone mapping applied.</p><p>With that, our image looks great.</p><p>Let’s go ahead email it to our friends… oh, oops it’s 100 megabytes. The image still contains all that data we can’t see. Luckily, we don’t need all of that data now that we’re done editing.</p><h3>Step 3: Optimize</h3><p>In computer graphics, if you use more bits, your math gets more accurate. While editing, we needed to use 64-bits per pixel to get nice results. Once we’re done editing we can cut it down to 32-bits — halving our file size — and nobody can tell the difference.</p><p>Next, we can throw out most of our color information. This cuts it in half <em>again</em>.</p><p>Finally, we can apply something called ‘lossy compression’ — the kind you find in JPEGs. We end up with an image that’s only 1.6 mb to share with our friends.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*uhvD21J9rNh0tuEl" /></figure><p>Phew. Take a breath, and let all that sink in. When you’re ready, we can finally answer…</p><h3>What is RAW? Why is it Magic?</h3><p>We just <strong>developed</strong> a photo. Every step in development is destructive, meaning we lose information. For example, in Step 2, once you shift colors around to fit into that triangle, you can never figure out the original, real-world colors.</p><p>So what happens when mistakes are made? Let’s go back to California’s recent wildfires that <a href="https://www.nytimes.com/2020/09/09/us/pictures-photos-california-fires.html">turned the sky orange</a>. I took a photo with a color chart at the time, figuring it would come in handy someday.</p><p>In real life, it looked like this:</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*LE__cmDenPzDc9pW" /></figure><p>The built-in camera app was confused by that orange sky, and tried to make everything neutral — because that’s what the world usually looks like. People were confused to find their cameras refused to take an image of the world as they saw it.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*0gRPOuFlcc8L0zdk" /></figure><p>A lot of folks used manual settings to override their camera’s automatic white balancing, but let’s say you didn’t. I’ll take that incorrect JPEG into an image editor like Lightroom and try to match it back to the original…</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*ZVnJRlyTk3I-iXI2" /></figure><p>The actual scene on the left, and an attempt to adjust our poorly white-balanced image on the right.</p><p>Hmm. Notice that how it’s messed up some colors, shifting blue to purple.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*EKu0QS1tpYgTlZ6s" /></figure><p>Trying to un-process a processed image like a JPEG is like trying to un-bake a cake. When your camera produces JPEGs, you’d better love the choices it made, because there’s no going back.</p><p>Now imagine if instead of saving a JPEG, your camera saved the original sensor values. Now you can make totally different processing decisions yourself, like white balance. You get the raw data.</p><p>Welcome to RAW files.</p><p>We have written about RAW a lot on this blog. We love it. Shooting RAW <a href="https://blog.halide.cam/the-power-of-raw-on-iphone-part-1-shooting-raw-ef02becb7002">gives you magical powers</a>. With a few knobs, you can rescue photos that you thought were lost to poor exposure.</p><p>So far, we’ve only talked about mistakes, but RAWs also give you the freedom to experiment with radically different choices for artistic effect, letting you <strong>develop</strong> the photo so it looks how you experienced it.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*MpseaG1scoyy864t" /></figure><p>These are the kind of edits that a RAW file enables.</p><p>Remember old film cameras? Their photos also had to be developed from a negative. RAW data is usually stored in the DNG file format, which stands for <strong>D</strong>igital <strong>N</strong>e<strong>g</strong>ative. Some camera makers have their own formats, but those companies are jerks.</p><p>DNG is an open standard, so anyone can build software that reads and writes DNGs. Best of all, the file format continues to evolve, as we’ll see shortly.</p><p>First, we have some bad news.</p><h3>RAWs are Great Until They Aren’t</h3><p>We make a <a href="http://halide.cam/">RAW camera app</a>, so of course we’re fans of RAW. That also means we get plenty of support emails about it. By far, the most common question is, “Why do my RAWs look worse than the built-in camera app?”</p><p>iPhone cameras got a lot better over time. At first, these were leaps in hardware: better and bigger sensors and lenses allowed sharper shots. Eventually, though, the processors got faster and the cameras couldn’t get larger. The camera got smarter.</p><p>iPhones take many photos and combine it into one shot, picking detail in the shadows from one photo, the right exposure on your dog’s face from another, and a few other ones for extra detail. This is merged into the final result in milliseconds without requiring any effort on your behalf. It’s very clever stuff, with cool names like Smart HDR and Deep Fusion.</p><p>On the other hand, iPhone RAW files are still just one image. Which means they look quite… different.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*VyJjpXQlFp9Okm7C" /></figure><p>If you’re coming from the built-in iPhone camera app, switching over to manual processing is like switching from a car with automatic transmission to a stick-shift.</p><p>There’s a steep learning curve, and that’s why we built something called “Instant RAW” into our latest Mark II update, so you don’t have to spend an afternoon in an image editor tweaking your shot to get a nice result.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*fg55f2sEJ5l_tAUD" /></figure><p>But even with Instant RAW or editing, sometimes RAWs still look different than what comes out of the built-in camera app, and it has nothing to do with your skills. RAWs lacks that critical piece of the puzzle: Apple’s smarts. Computational photography like Smart HDR and Deep Fusion.</p><p>Even if Apple handed these algorithms to third-party apps, they work on <em>bursts</em> of photos, fusing together the best parts of each image. iPhone RAWs are 12mb each. If you want to reproduce the results of Apple’s camera using one of these algorithms, you’re looking at ten times the storage needed per photo.</p><p>Oh, and there’s one more problem: neither the front-facing camera or ultra-wide camera can shoot RAW.</p><p>ProRAW elegantly solves all of these problems and more. You can finally reproduce the results of the first-party camera, while retaining most of the editing latitude from traditional RAWs.</p><h3>Enter ProRAW</h3><p>Technically, there’s no such thing as a ProRAW file. ProRAW images are regular DNG files that take advantage of some little known features in the specification, and introduce a few new ones.</p><p>Remember how DNG is an open file format? Apple worked with Adobe to introduce a few new tags. DNG released the 1.6 specification, with details about these tags, the very day ProRAW went into public beta tests.</p><p>This may be surprising to some: ProRAW is not a proprietary or closed format. Credit where it is due: Apple deserves kudos for bringing their improvements to the DNG standard. When you shoot with ProRAW, there’s absolutely nothing locking your photos into the Apple ecosystem.</p><p>Let’s dive into what makes ProRAW files different than RAWs of days past…</p><h3>Demosaic is Already Done</h3><p>ProRAWs store pixel values <em>after</em> the demosaic step. It’s like they took the output Step 1, from earlier, and stored those values. We’ll talk about why they’re doing this in a bit.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*kl-xiy1vdCLL5vbn" /></figure><p>It’s just important to understand that these demosaiced color values still represent the <strong>scene</strong>, not your display. They contain all the original dynamic range. They contain all the out-of-range colors. They retain all the flexibility of working with a “true” RAW. They just skip step one.</p><p>In theory, you lose flexibility in choosing specific demosaic algorithms. In practice, most expert photographers don’t bother.</p><p>It’s also quite possible that iOS can do a better job demosaicing your images than any third-party RAW editor. Apple’s greatest strength is its unity of hardware and software, so they know exactly the sensor you’re using, and how it behaves with different ISO setttings. In theory, they could even apply image recognition as part of the process; if iOS detects a night sky, it could automatically pick a star-friendly demosaic algorithm.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*EAyqdQkbXejgh7Wt" /></figure><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*pZHZ4kBEtimOoMTh" /></figure><p>Photographer<a href="https://t.co/VQGZpdaA4B?amp=1"> Austin Mann</a> shows of how ProRAW already changes the game for nighttime photography <a href="https://t.co/VQGZpdaA4B?amp=1">in this fantastic look at ProRAW</a>.</p><p>This sly move also gives Apple greater control over the image sensors they use in the future. Earlier, I said <em>most</em> cameras use a Bayer pattern. Some camera manufacturers use different patterns, which require different algorithms. Fujifilm invented the <a href="https://en.wikipedia.org/wiki/Fujifilm_X-Trans_sensor">X-Trans</a> sensor that creates sharper images, with more film-like grain. There’s even a <a href="https://blog.sigmaphoto.com/2011/faqs-the-sigma-camera-and-its-foveon-x3-direct-image-sensor/">Foveon</a> digital sensor that stacks color filters on top of each other.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*A3m8ylP6vY3nhFYU" /></figure><p>It’s marketing, so take it with a grain of salt.</p><p>Apple is now a company that designs its own silicon, and it’s very good at it. Cameras are a huge driving factor in phone purchases. It seems inevitable for Apple to innovate in the realm of sensors. Taking over the demosaic step would smooth such a transition. Hypothetically speaking, they could swap out their current bayer sensors with an “Apple C1,” and so long as it saves in ProRAW, it would work from day one in every pro photography process and app like Lightroom without having to wait for Adobe to write a new demosaic algorithm.</p><p>We got a taste for these benefits with the surprise reveal that <strong>ProRAW is available on all four cameras.</strong></p><p>Previously, you could not shoot RAW with the front-facing or ultra-wide cameras. Apple is vague on the technical limitations, but indicated that even if third-party developers had access to the RAW data, they wouldn’t know what to do with it. With ProRAW, they can handle the annoying bits, and leave apps like editors to deal with what they’re better at: editing.</p><h3>Bridging the Algorithm Gap</h3><p>So now we have the data, but what about the local tone mapping and other computational photography goodies? Apple could open up their algorithms to third-party apps, but that isn’t as useful as you think. For starters, you’d need a save a ton of RAW files. We’d be back at that 100 megabyte file.</p><p>I also think there are reasonable questions about producing consistent results down the road as these algorithms evolve. It would be surprising to return to a photo a year from now to find Apple’s AI produces different results.</p><p>Instead, ProRAW stores results of computational photography right inside the RAW. This is another reason they need to store demosaiced data, as these algorithms operate on color, not RAW data. Once you demosaic, there’s no going back. I mean, what would you even call that, remosaic?</p><p>Smart HDR does this in the least destructive way. Apple worked with Adobe to <a href="https://helpx.adobe.com/photoshop/kb/dng-specification-tags.html">introduce a new type of tag</a> into the DNG standard, called a “Profile Gain Table Map.” This data gives your editor everything it needs to know to tone map your photo image and end up with results identical to the first party camera. Because it’s separate data, you can turn down its strength, or turn it off completely.</p><p>That’s what we do in Halide when you’re looking at a ProRAW image with Instant RAW disabled.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*Nysh5sCtSqU2mKxX" /></figure><p>Local tone mapping lifts the shadows on the ground.</p><p>Even if you opt-out of local tone mapping, you now have the underlying HDR data to work with in an editor, and the results are…</p><p>Deep Fusion is a different story. While it’s popularly known as “Sweater Mode,” the more technical objective is “noise reduction in low-light.” Unlike those Gain Table Maps, there’s no elegant way to separate its effects from the final image. If you don’t want Deep Fusion, your only option is to opt-out of the process at the time of capture.</p><p>If you’ve read our articles for a while, you know we’re fans of natural noise. Prior to Deep Fusion, the iPhone JPEGs were notorious for their “watercolor effects.” In this image I took a few years ago, notice faces get smeared into nothing.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*Lldt82b5wh4xH-R0" /></figure><p>Taken before social distancing was a thing.</p><p>Deep Fusion produces very different results. Instead of just smearing an image, it combines several results together to sort of “average out” the results. It looks way, way more natural.</p><p>If you’re not a fan of Deep Fusion, there’s an API to opt-out. We expose this in Halide under Capture Settings. As I was writing this article, I realized this toggle makes it easy to run an experiment…</p><p>I used a spotlight to create a high-dynamic range scene in my office.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/24/0*QbJmjPToMYJSVRhM" /></figure><p>I spot metered the two grey cards and measured a difference of 8.3 stops. I then exposed the shot using the top grey card and took three photos:</p><p>1) Native Halide RAW</p><p>2) ProRAW, with smart processing disabled</p><p>3) ProRAW with smart processing enabled</p><p>I took these into Lightroom and boosted the shadows. Let’s zoom in on the test pattern image.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*wPJDErp7jC6RdqCv" /></figure><p>1) Native RAW, 2) ProRAW without the algorithms 3) ProRAW with the algorithms</p><p>If you wonder what camera settings I used to capture this, the answer is a bit complicated. When you enable these algorithms, the iPhone ignores manual exposure settings. After all, Deep Fusion takes multiple exposures with a variety of settings. While the metadata embedded in the final image reported an ISO of 40, it’s unlikely all photos in the burst had that setting.</p><p>As you can see, by disabling this Smart Processing in Halide, we can still skip a lot of the noise reduction in our ProRAW files if we so choose.</p><p>Synthetic tests like this are all fine and good, but what about the real world?</p><p>Sebastiaan spent the last few weeks testing ProRAW in the field with the Halide beta. He found the dynamic range in ProRAW pretty mind-blowing in the day-to-day editing process:</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*v9Sd5gJML-Z7hagf" /></figure><h3>Semantic Maps Included</h3><p>ProRAW has one more surprise up its sleeve. A few years ago, Apple began using neural networks to detect interesting parts of an image, such as eyes and hair.</p><p>Apple uses this to, say, add sharpening to <em>only</em> clouds in the sky. Sharping faces would be quite unflattering.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*czwKPzWy3E8sceGD" /></figure><p>An iPhone 12 Pro RAW file from the ultra-wide camera with a semantic matte for the human in the photo. Super cool.</p><p>ProRAW files contain these maps! Both semantic maps used on faces and Portrait Effect Mattes that power the background blur in Portrait mode.</p><h3>Flexibility in File Size</h3><p>By storing the demosaiced values, ProRAWs can also tackle unwieldy file sizes in a few interesting ways. That’s really important, because when you shoot ProRAW with the first-party camera app, each file is around 25mb — and can get even heavier than that. That’s an order of magnitude or more than a regular photo. It adds up quick.</p><p>First, we can fiddle with bit-depth. By default, ProRAW uses 12-bit data, which can be overkill. JPEGs are only 8-bits per color channel, so going 10-bit means 4x the precision in editing. While the first-party camera app doesn’t present this option, it’s there in the API. we’ve added it to Halide and seen files drop as low as 8mb. In practice, you can get most of the ProRAW benefits at half the file size.</p><p>If you want to further reduce the file size, ProRAW offers lossy compression that can drop these files down to as little as 1mb, but not so fast. These compression APIs currently drop the bit depth to 8-bits. In our opinion, that too great of a tradeoff, as it leaves you with a file that’s only marginally better than a JPEG. We’re certain ProRAW compression will confuse users, so we’ve held off on compression support for the time being. Fortunately Apple’s camera team has been iterating on ProRAW very fast, so we hope 10-bit compression is on the horizon.</p><p>Finally, it turns out that every ProRAW file can also contain the fully-processed JPEG version. This is a fallback image for apps that don’t recognize RAWs — which is <em>most apps. </em>Even Instagram. The first-party camera doesn’t offer this, which means you cannot share ProRAW shots taken with it to apps that do not support RAW images. We’ve added the option in Halide.</p><p>If you’re planning to edit the image, it makes sense to opt-out of these 4mb images. Your RAW editing app will ignore it, and ultimately produce a new JPEG for your Instagrams.</p><h3>Batteries Included</h3><p>The most underrated improvement in iOS 14.3 is that the native Photos app now supports RAW editing. This is huge, because it abstracts away all the complexity of higher-end apps. No fiddling with “black point” and “color profiles.” Casual users who only know how to edit photos in the built-in apps don’t have to do anything different. It just works.</p><p>This is critical because we can expect it to take some time for third-party photo editors to adopt this new metadata. Until then, ProRAWs will not look like system JPEGs. Compare the results viewed inside Lightroom CC and Photos.app.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/42/0*7JDfWM3EOFoUnhPG" /></figure><p>Left: Photos.app, Right: Lightroom CC</p><p>It looks wrong because Lightroom doesn’t yet detect the local tone mapping metadata. However, given Adobe participated in the designing these tags, we can expect an update in the near future.</p><p>As for other iOS editors, Apple has updated its RAW processing frameworks to support these new tags. For the most part, it “just works,” so you’ll find ProRAWs display properly inside Halide’s photo gallery. You can toggle tone mapping on and off with the Instant RAW button.</p><p>That said, not all metadata is exposed by Apple’s frameworks. They don’t even tell you whether the DNG is a native RAW or ProRAW. We’re certain this is just a matter running out of time. They launched this two weeks before Christmas, so this is clearly a feature that was coming down to the wire.</p><p>To get around this, we built our own proprietary DNG parser we call Dingus.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*koI-OnY5ZluYf_RG" /></figure><p>Dingus lets us interrogate low level tags within DNGs, which aren’t yet exposed by Apple. We’re using this to expose the bit depth and type of RAW in our metadata reviewer, but it’s also been useful for poking and prodding at ProRAW internals.</p><h3>Is ProRAW Perfect?</h3><p>ProRAW is a leap forward for everyone, but it will be especially impactful for beginning photographers.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*MNbOnFgkcaRhTQkl" /></figure><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*LDGAbrtQFj3yRMDV" /></figure><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*XgJTRl68cxNYQb-p" /></figure><p>ProRAW in and around San Francisco</p><p>If you know nothing about RAW, but want more flexibility in editing, shoot ProRAW. For true professionals, the decision is a bit more nuanced. Sometimes you’ll want to switch back to regular RAW.</p><p>First, ProRAW is only available on “Pro” level iPhones. Despite the usual conspiracy theories, Apple isn’t just flipping a bit in software to force you to spend more.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*sOwuZJDE4ljyLrmn" /></figure><p>In the past, these algorithms did their math with lower bit depths, because their output was just low bit depth JPEGs. Outputting images in a higher bit depth requires twice the memory. Apple’s Pro iPhones have twice the memory as non-Pro models, and ProRAW needs all of that. It’s that simple.</p><p>Once you get RAW in your hands, the first thing you’ll notice is capture speed. A traditional RAW capture takes as little as 50 milliseconds. ProRAW takes between two and three <em>seconds </em>to finish processing.</p><p>The built in iPhone camera does a great job hiding this, apparently processing each photo in the background in a queue. However, we’ve found the shutter stalls after firing three shots in quick succession.</p><p>ProRAW isn’t coming to burst mode anytime soon. This makes things difficult if you’re covering sports, have small children who refuse to stand still, or you’re a portrait photographer who takes hundreds of photos in a single session. There’s a chance you might miss that perfect shot.</p><p>In Halide, we decided to take a conservative approach at launch, and only let you capture one photo at a time. We’re a week away from the App Store shutting down for Christmas, so this is the worst possible time to contend with memory crashes. But we expect to speed things up soon.</p><p>The next issue we’ve found is sharpness and noise reduction. No multi-photo fusion is perfect. If you want the sharpest images with natural noise, and you’re not planning to boost your shadows through the roof, you might find “native” RAW is still the way to go.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*muL-wU-jO3nXWaCH" /></figure><p>The top image is Halide’s ‘Native’ RAW — which still captures more detail at times, but at the expense of a bit of noise.</p><p>In the field, we often found that in some conditions you can still get more detail in a shot with that quick-and-noisy regular RAW file.</p><p>Then there’s file size. A 12-bit ProRAW is 25mb, while a 12-bit native RAW is only around 12mb. This is almost certainly why the “RAW” button in the first party camera app defaults to off, and returns to off if you leave and return to the app. A casual photographer might leave it on all the time and eat up their iCloud storage in an afternoon.</p><p>Finally, there’s compatibility. Without something like Halide’s ProRAW+ setting, apps have to be updated to support DNG files. Sharing your ProRAW shot to Instagram doesn’t work:</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*Z_eHH77OKY8PPpA_" /></figure><p>You can wait for a long moment — Instagram does not support DNG files, so you can’t open your ProRAW shots unless you shoot ProRAW + JPG in an app like Halide.</p><p>And while Apple has done an amazing job supporting ProRAW development within its own ecosystem — just hop over to Apple’s Photos app, tap the “Edit” button, and you can edit a ProRAW the same way you edit a JPEG file — the DNG spec was only updated a month ago, so there’s no telling how long it will take for your favorite third-party RAW editors to adopt the new tags.</p><p>If you already know how to develop RAW files, and you aren’t shooting in a scenario where computational photography shines, you may find native RAWs give you more bang for your bytes.</p><h3>Introducing ProRAW for Halide</h3><p>We’re excited to announce Halide’s ProRAW support. We didn’t just add ProRAW and ticked the box. By actually extensively using ProRAW in the field and testing it we found how to make the best possible camera for it.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*UvlAxrWl4NHMlXqh" /></figure><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*5et9FFC8Ab8-nPXi" /></figure><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*6dZNKSunXHI5LE8n" /></figure><p>Some shots taken with Halide 2.1 with ProRAW on iPhone 12 Pro Max</p><p>It starts with ProRAW+. When set to this mode, Halide will take a ProRAW photo along with a JPG file so you can quickly share and view images in apps that do not (yet) support RAW files. This makes it a lot easier to just leave ProRAW on and not run into any issues in other apps.</p><p>As we mentioned, ProRAW is great, but there’s tradeoffs.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*a6QT_Z50ZbUuG8_o" /></figure><p>As we beta tested our ProRAW support, it became obvious we had to make it easer to fiddle with capture settings without diving into Settings. Enter the new format picker menu. Just long-press on the RAW button, and you’ll be able to choose between RAW and ProRAW, your desired bit-depth, and whether you wish to save the processed version alongside your DNG.</p><p>Being able to quickly change your shooting format allows in-the-moment decisions depending on your exact needs.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*yU8qFCEKVA4sk5TI" /></figure><p>As mentioned earlier, we allow you to customize your bit-depth, and disable capturing the JPEG version of your photo, inside Capture Settings. Together, you can expect to cut ProRAW file size in half without trading too much in your editing flexibility.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*ZjviTG7snq89398O" /></figure><p>Fine-grained ProRAW settings for fine RAW appreciators.</p><p>We also ensure to remember and persist your ProRAW settings. With great power comes great iCloud consumption, so please use this responsibly.</p><p>We’re still absorbing all of the implications of ProRAW, so we expect continue to iterate on our features over the next few months. We have a list of things we want to improve after the App Store holiday shutdown, so if you’re shooting ProRAW, 2021 is going to be an amazing year.</p><p>However, native RAW is not going away.</p><p>The vast majority of users can’t shoot ProRAW, there are circumstances where regular single-shot RAWs will be superior, and there are certain computational photography algorithms that rely on bayer-level information. We’ve got enough native RAW features planned to keep us busy for quite some time — and to keep bringing fantastic features to all iPhones that can run Halide.</p><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*6bK5_rN8_YiWJRyM" /></figure><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*WUbja3KOk630W3dI" /></figure><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*nag6iT-SabSy2p7b" /></figure><figure><img alt="" src="https://cdn-images-1.medium.com/max/46/0*-dH7MvxV73MYzoY9" /></figure><p>Maybe the real Pro RAW was the shots we made along the way.</p><p>The best part of building <a href="http://halide.cam/download">Halide</a>, and writing these articles, is seeing what folks do with this stuff. If you’re proud of your ProRAW photo, be sure to tag us, because we’d love to see what you can do with it.</p><p>If a picture is worth a thousand words, congratulations on reading over three pictures. <a href="http://halide.cam/download">Now get shooting!</a></p><h3><a href="https://blog.halide.cam/?source=post_sidebar--------------------------post_sidebar-----------">Halide</a></h3><h4>Behind Halide</h4><p>Follow</p><h4>1.8K</h4><h4>14</h4><ul><li><a href="https://blog.halide.cam/tagged/pro">Pro</a></li><li><a href="https://blog.halide.cam/tagged/apple">Apple</a></li><li><a href="https://blog.halide.cam/tagged/iphone">iPhone</a></li><li><a href="https://blog.halide.cam/tagged/photography">Photography</a></li><li><a href="https://blog.halide.cam/tagged/proraw">Proraw</a></li></ul><img src="https://medium.com/_/stat?event=post.clientViewed&referrerSource=full_rss&postId=b255a9623738" width="1" height="1" alt="">]]></content:encoded>
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            <title><![CDATA[39 Websites That Can Make You Unbelievably Smarter Just in 10 Minutes a Day]]></title>
            <link>https://rohitsharma58984.medium.com/39-websites-that-can-make-you-unbelievably-smarter-just-in-10-minutes-a-day-dffdcd3bf71?source=rss-ac81f98174a5------2</link>
            <guid isPermaLink="false">https://medium.com/p/dffdcd3bf71</guid>
            <category><![CDATA[germany]]></category>
            <category><![CDATA[ealden-and-lhiza]]></category>
            <category><![CDATA[work]]></category>
            <category><![CDATA[learning]]></category>
            <dc:creator><![CDATA[Rohitsharma]]></dc:creator>
            <pubDate>Thu, 10 Dec 2020 19:01:18 GMT</pubDate>
            <atom:updated>2020-12-10T19:01:18.547Z</atom:updated>
            <content:encoded><![CDATA[<h3>The best places on the web that can help you expand your mind</h3><figure><img alt="" src="https://cdn-images-1.medium.com/proxy/1*b31hiO4ynbDLRrXWEFF4aQ.png" /></figure><p>Image: <a href="https://www.rawpixel.com/">Rawpixel</a></p><p>“Intellectual growth should commence at birth and cease only at death.” Albert Einstein said that. Lifelong learning is one of the best ways to improve your life and career.</p><p>Self-learning can enrich your knowledge every day. And the good news is that you access free online resources anywhere to help you become a better version of yourself.</p><p>Your career, and personal life will never be the same if you can commit to some of these awesome resources in just ten minutes a day.</p><p>The web is increasingly becoming a powerful resource that can easily help you learn something new everyday. There is a great chance you’ll be able to put at least one of these awesome sites to good use and come out as a better person than you were last year.</p><p>I consistently visit some of these sites every week to learn about new topics, ideas, concepts, and mental models to improve myself.</p><p>1.<a href="http://www.bbc.com/future">BBC — Future</a> — Making you smarter, every day.</p><p>2. <a href="https://getpocket.com/explore">Pocket Explore</a> — discover the best and trending stories of the web.</p><p>3. <a href="https://aeon.co/">Aeon</a> — profound and provocative thinking content.</p><p>4. <a href="http://www.wikiwand.com/">WikiWand</a> — A slick new interface for Wikipedia.</p><p>5. <a href="http://www.theguardian.com/news/series/the-long-read">The long read (The Guardian)</a> — In-depth reporting, essays and profiles.</p><p>6. <a href="https://waitbutwhy.com/">Wait But Why</a> — A popular long-form, stick-figure-illustrated blog about almost everything.</p><p>7. <a href="https://fs.blog/blog/">Farnam Street </a>— master the best of what other people have figured out.</p><p>8. <a href="https://www.reddit.com/r/InsightfulQuestions/">InsightfulQuestions</a> (subreddit) — Intellectual discussions that are not necessarily genre-specific.</p><p>9. <a href="https://www.fastcompany.com/section/30-second-mba">Fast Company’s 30-Second MBA</a> — Learn great business and life lessons in short video clips from accomplished corporate executives.</p><p>10. <a href="http://www.uopeople.org/">University of the People</a> — Tuition-free online university that offers higher education in multiple course streams.</p><p>11. <a href="http://opensesame.com/">OpenSesame</a> — online training platform, now with 22,000+ courses.</p><p>12. <a href="https://www.youtube.com/user/schooloflifechannel">The School of Life</a>: A place that tries to answer the great questions of life with the help of culture.</p><p>13. <a href="https://www.coursera.org/">Coursera</a> — Coursera offers massive open online courses for free, in partnership with some of the best universities.</p><p><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG1.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG1.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG2.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG2.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG3.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG3.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG4.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG4.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S.html">https://www.patchworkposse.com/cva/fbc/M-v-S.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S1.html">https://www.patchworkposse.com/cva/fbc/M-v-S1.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S2.html">https://www.patchworkposse.com/cva/fbc/M-v-S2.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S3.html">https://www.patchworkposse.com/cva/fbc/M-v-S3.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S4.html">https://www.patchworkposse.com/cva/fbc/M-v-S4.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant1.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant1.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant2.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant2.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant3.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant3.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant4.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant4.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG1.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG1.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG2.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG2.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG3.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG3.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG4.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG4.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S.html">https://www.alouettecheese.com/cva/fbc/M-v-S.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S1.html">https://www.alouettecheese.com/cva/fbc/M-v-S1.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S2.html">https://www.alouettecheese.com/cva/fbc/M-v-S2.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S3.html">https://www.alouettecheese.com/cva/fbc/M-v-S3.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S4.html">https://www.alouettecheese.com/cva/fbc/M-v-S4.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant1.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant1.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant2.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant2.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant3.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant3.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant4.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant4.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG.html">http://forcescompare.uk/fbc/KAA-v-TSG.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG1.html">http://forcescompare.uk/fbc/KAA-v-TSG1.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG2.html">http://forcescompare.uk/fbc/KAA-v-TSG2.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG3.html">http://forcescompare.uk/fbc/KAA-v-TSG3.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG4.html">http://forcescompare.uk/fbc/KAA-v-TSG4.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S.html">http://forcescompare.uk/fbc/M-v-S.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S1.html">http://forcescompare.uk/fbc/M-v-S1.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S2.html">http://forcescompare.uk/fbc/M-v-S2.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S3.html">http://forcescompare.uk/fbc/M-v-S3.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S4.html">http://forcescompare.uk/fbc/M-v-S4.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant.html">http://forcescompare.uk/fbc/Tott-v-Ant.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant1.html">http://forcescompare.uk/fbc/Tott-v-Ant1.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant2.html">http://forcescompare.uk/fbc/Tott-v-Ant2.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant3.html">http://forcescompare.uk/fbc/Tott-v-Ant3.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant4.html">http://forcescompare.uk/fbc/Tott-v-Ant4.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it1.html">https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it1.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it2.html">https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it2.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it3.html">https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it3.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it4.html">https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it4.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it1.html">https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it1.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it2.html">https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it2.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it3.html">https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it3.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it4.html">https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it4.html</a></p><p>14. <a href="https://www.edx.org/">edX</a> — Take online courses from the world’s best universities.</p><p>15. <a href="http://www.quora.com/">Quora</a> — You ask, the net discusses — with top experts and fascinating back and forth on everything.</p><p>16. <a href="http://digital-photography-school.com/tips">Digital Photography School</a> <strong>— </strong>Read through this goldmine of articles to improve your photography skills.</p><p>17. <a href="http://www.brainpickings.org/">Brain Pickings</a> — Insightful long form posts on life, art, science, design, history, philosophy, and more.</p><p>18. <a href="https://p2pu.org/en/">Peer 2 Peer University</a> or P2PU, is an open educational project that helps you learn at your own pace.</p><p>19. <a href="http://ocw.mit.edu/index.htm">MIT Open CourseWare</a> is a catalog of free online courses and learning resources offered by MIT.</p><p>20. <a href="http://gohighbrow.com/">Highbrow</a> — Get bite-sized daily courses to your inbox.</p><p>21.<strong> </strong><a href="http://www.investopedia.com/">Investopedia</a> — Learn everything you need to know about the world of investing, markets, and personal finance.</p><p>22. <a href="https://www.udacity.com/">Udacity</a> offers interactive online classes and courses in higher education.</p><p>23. <a href="https://developer.mozilla.org/en-US/">Mozilla Developer Network</a> offers detailed documentation and learning resources for web developers.</p><p>24. <a href="https://www.futurelearn.com/">Future learn</a> — enjoy free online courses from top universities and specialist organisations.</p><p>25. <a href="http://scholar.google.com/">Google Scholar</a> — provides a search of scholarly literature across many disciplines and sources, including theses, books, abstracts and articles.</p><p>26. <a href="http://www.creativitypost.com/">The Creativity Post</a> — high-quality content on innovation and creativity.</p><p>27. <a href="https://www.youtube.com/user/99Uvideos">99U</a> (YouTube) — Actionable insights on productivity, organization, and leadership to help creative people push ideas forward.</p><p>28. <a href="https://www.lesswrong.com/">Less Wrong </a>— tools to make intellectual progress on important problems</p><p>29. <a href="https://www.bbc.co.uk/programmes/b006qy05/episodes/downloads">Thinking Allowed</a> — New research on how society works</p><p>30. <a href="http://behavioralscientist.org/">Behavioural Scientist</a> — Original, thought-provoking reports from the front lines of behavioural science.</p><p>31. <a href="https://alison.com/">Alison</a> — Free online courses from the world’s top publishers</p><p>32. <a href="http://bigthink.com/">Big Think</a> — Articles and videos featuring expert “Big Thinkers.”</p><p>33. <a href="http://www.youtube.com/education">Youtube EDU</a> — The education videos that don’t have cute cats in boxes — but they do unlock knowledge.</p><p>34. <a href="https://www.theguardian.com/lifeandstyle/series/thiscolumnwillchangeyourlife">This column will change your life</a> (The Guardian) — Oliver Burkeman investigates routes to mental wellbeing.</p><p>35. <a href="https://www.datacamp.com/">DataCamp</a> — Online R tutorials and data science courses.</p><p>36. <a href="http://edge.org/">Edge.org</a> — ideas of the most sophisticated minds.</p><p>37. <a href="http://www.ted.com/">TED</a> — Great videos to open your mind on almost every topic.</p><p>38. <a href="https://www.scientificamerican.com/">Scientific American<strong> </strong></a>— a guide to the most awe-inspiring advances in science and technology</p><p>39. <a href="http://nautil.us/">Nautilus </a>— a different kind of science magazine.</p><p>What are your favourite learning tools that are not on this list?</p><p><a href="https://postanly.substack.com/">Join my personal newsletter</a> (tools for growth, wealth, health and happiness) and get a free ebook “Habit Stacking: Deeper Essays on Personal Growth, Productivity and Happiness”.</p><p>WRITTEN BY</p><h3><a href="https://thomas-oppong.medium.com/?source=post_sidebar--------------------------post_sidebar-----------">Thomas Oppong</a></h3><h4>Founder @AllTopStartups | Featured at Forbes, Business Insider, etc. | Join my personal newsletter for life and career tools at <a href="https://postanly.substack.com/">https://postanly.substack.com</a></h4><p>Follow</p><h4>14.7K</h4><h4>72</h4><h3>Sign up for Curiously</h3><h3>By Kaizen Habits</h3><p>Science-based answers and insights for productivity, wealth, health and happiness <a href="https://medium.com/kaizen-habits/newsletters/curiously?source=newsletter_v3_promo--------------------------newsletter_v3_promo-----------">Take a look</a></p><p>Get this newsletter</p><p>Emails will be sent to rohitsharma58984@gmail.com.</p><p><a href="https://medium.com/m/signin?operation=login&amp;redirect=https%3A%2F%2Fmedium.com%2Fkaizen-habits%2F39-websites-that-can-make-you-unbelievably-smarter-just-in-10-minutes-a-day-f6e727764519&amp;source=newsletter_v3_promo--------------------------newsletter_v3_promo-----------">Not you?</a></p><h4>14.7K</h4><h4>72</h4><ul><li><a href="https://medium.com/kaizen-habits/tagged/work">Work</a></li><li><a href="https://medium.com/kaizen-habits/tagged/productivity">Productivity</a></li><li><a href="https://medium.com/kaizen-habits/tagged/education">Education</a></li><li><a href="https://medium.com/kaizen-habits/tagged/learning">Learning</a></li><li><a href="https://medium.com/kaizen-habits/tagged/self">Self</a></li></ul><img src="https://medium.com/_/stat?event=post.clientViewed&referrerSource=full_rss&postId=dffdcd3bf71" width="1" height="1" alt="">]]></content:encoded>
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        <item>
            <title><![CDATA[New iPad Mini Leaks]]></title>
            <link>https://rohitsharma58984.medium.com/new-ipad-mini-leaks-5deb1e5c3527?source=rss-ac81f98174a5------2</link>
            <guid isPermaLink="false">https://medium.com/p/5deb1e5c3527</guid>
            <category><![CDATA[fertility]]></category>
            <category><![CDATA[apple]]></category>
            <category><![CDATA[kjs-book]]></category>
            <category><![CDATA[hyderabad]]></category>
            <category><![CDATA[science]]></category>
            <dc:creator><![CDATA[Rohitsharma]]></dc:creator>
            <pubDate>Thu, 10 Dec 2020 19:00:14 GMT</pubDate>
            <atom:updated>2020-12-10T19:00:14.451Z</atom:updated>
            <content:encoded><![CDATA[<h3>Here’s everything we know about the, soon to be released, iPad Mini.</h3><figure><img alt="" src="https://cdn-images-1.medium.com/max/1024/0*lZCRYG0A60cQV9ft.png" /></figure><p>Rendering of what the latest iPad mini could look like</p><p>Let’s get into the latest leaks and everything we know so far about the iPad Mini 6 launch date and everything else you should expect in terms of the price, specs, performance, etc.</p><p>In 2020, we‘ve had updates to the iPad Pro’s in March, the iPad Air with the redesign, and the 8th generation regular iPad with an upgraded processor inside it. This means all the iPads have been updated recently, except the iPad Mini line.</p><p>The iPad Mini was last updated over 18 months ago in March 2019. It got an upgrade of an A12 Bionic processor, some camera upgrades, and also a true tone screen. These upgrades were great at the time, but 18 months later it is already showing its age again.</p><p>The Mini line really is in need of an upgrade now. As the newest iPad 8th generation is just as fast now with that A12 processor and it’s actually cheaper than the latest iPad Mini by around $70. With all of this being said, I do believe that the newest iPad mini won’t have a 2020 release date to start with.</p><p>Apple recently did an iPad and Watch virtual event in September, and if the iPad Mini 6 was going to have an upgrade, it would’ve been at this point. This means that the release date of the iPad Mini 6 will most likely be March of 2021. This falls in line with most other iPads in recent years, where they have come out in October or March time. For example, the iPad Pro was released on March 25th, 2020, the iPad Air 3 and the last iPad Mini 5 came out on March 18th, 2019.</p><p><strong>I hope you’re getting the picture, we’ll most likely see this iPad in mid to late March 2021.</strong></p><h3>Price</h3><p>As far as price is concerned, we’re looking towards the iPad Mini 5 pricing model. You can get the current 5th generation iPad Mini for $399 if you opt for the basic 6Gb model. A 256Gb version is available too + one with cellular connectivity. I expect the prices to rise a little bit if some of the rumors I’m gonna be talking about do turn out to be true.</p><h3>Rumors breakdown</h3><p>The biggest rumor so far, as you can see in the rendered picture above is that we may get a whole new redesigned iPad Mini. This iPad Mini would be the first one to have a whole new design since it first came out in 2012. The rumors are saying that the iPad Mini 6 will have the same design as the iPad Pro, giving it that more sleek look. This would include far smaller bezels, the removal of the home button in favor of gesture control, and also Face ID.</p><p>It makes sense for Apple to make its iPad line look very similar, just like the full iMac line or the MacBook line looks also quite similar as well.</p><p><strong>One leak that seems to be clear is that the iPad Mini 6 could come in a slightly larger screen, and this would be an 8.5-inch size</strong>. For reference, all previous iPad Minis including the latest five, have featured a 7.9-inch display.</p><p>Ming-Chi Kuo (a credible leaker) predicts the display will be either 8.5 or 9-inches. The move doesn’t necessarily mean we’ll have to squeeze a larger tablet into our bags as Apple has increased the displays of its iPad before by simply slimming down the bezels, just like the iPad 7th generation that came with a 10.2-inch screen instead of a 9.7-inch screen but the overall dimensions remained the same.</p><p><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG1.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG1.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG2.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG2.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG3.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG3.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG4.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG4.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S.html">https://www.patchworkposse.com/cva/fbc/M-v-S.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S1.html">https://www.patchworkposse.com/cva/fbc/M-v-S1.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S2.html">https://www.patchworkposse.com/cva/fbc/M-v-S2.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S3.html">https://www.patchworkposse.com/cva/fbc/M-v-S3.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S4.html">https://www.patchworkposse.com/cva/fbc/M-v-S4.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant1.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant1.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant2.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant2.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant3.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant3.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant4.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant4.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG1.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG1.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG2.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG2.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG3.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG3.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG4.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG4.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S.html">https://www.alouettecheese.com/cva/fbc/M-v-S.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S1.html">https://www.alouettecheese.com/cva/fbc/M-v-S1.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S2.html">https://www.alouettecheese.com/cva/fbc/M-v-S2.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S3.html">https://www.alouettecheese.com/cva/fbc/M-v-S3.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S4.html">https://www.alouettecheese.com/cva/fbc/M-v-S4.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant1.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant1.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant2.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant2.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant3.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant3.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant4.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant4.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG.html">http://forcescompare.uk/fbc/KAA-v-TSG.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG1.html">http://forcescompare.uk/fbc/KAA-v-TSG1.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG2.html">http://forcescompare.uk/fbc/KAA-v-TSG2.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG3.html">http://forcescompare.uk/fbc/KAA-v-TSG3.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG4.html">http://forcescompare.uk/fbc/KAA-v-TSG4.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S.html">http://forcescompare.uk/fbc/M-v-S.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S1.html">http://forcescompare.uk/fbc/M-v-S1.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S2.html">http://forcescompare.uk/fbc/M-v-S2.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S3.html">http://forcescompare.uk/fbc/M-v-S3.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S4.html">http://forcescompare.uk/fbc/M-v-S4.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant.html">http://forcescompare.uk/fbc/Tott-v-Ant.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant1.html">http://forcescompare.uk/fbc/Tott-v-Ant1.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant2.html">http://forcescompare.uk/fbc/Tott-v-Ant2.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant3.html">http://forcescompare.uk/fbc/Tott-v-Ant3.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant4.html">http://forcescompare.uk/fbc/Tott-v-Ant4.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it1.html">https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it1.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it2.html">https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it2.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it3.html">https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it3.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it4.html">https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it4.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it1.html">https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it1.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it2.html">https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it2.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it3.html">https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it3.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it4.html">https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it4.html</a></p><p>Another rumor is that this new iPad <strong>will be getting a mini LED makeover.</strong> These new displays would replace the LCDs in the products and would offer an experience more akin to an LED that we currently get in the iPhone 11 Pro models. It is likely that the iPad Mini 6 will also feature that new A14 Bionic chip that we recently got in the iPhone 12, but RAM size will probably get the same as the normal iPhone 12 models (not the Pro models) — that would be about 4Gb.</p><p>For storage, we’re expecting the minimum to be either 64Gb or 128Gb. Latest leaks and rumors have shown that the iPhone 12 is starting at 128Gb, so it is likely that the Mini will also start at that size.</p><p>Apple Pencil support was also added to the latest version and it’ll likely stick around for the 2021 model, too.</p><p>Another rumor suggests that the iPad Mini 6 might stick with the lighting port rather than jumping to the USB-C standard you find across the iPad Pro range. Apple gave the Pro a USB-C as it’s meant to be more of a laptop replacement device as well as work with pro apps. However, we did get a surprise with the iPad Air this year, and that now it has a USB-C port, but the new Air is a high-end iPad, just sitting under the iPad Pro whereas the Mini is more of a mid-range iPad. Personally, I believe it will be sticking with a lightning port.</p><p><em>These are some of the latest rumors that have been spreading around. If you’ve made it this far, I’d love for you to leave a response to this article and let me know your thoughts regarding these leaks and if you think this is gonna be a good or bad move for Apple.</em></p><p><em>Have a lovely day!</em></p><h3><a href="https://medium.com/macoclock?source=post_sidebar--------------------------post_sidebar-----------">Mac O’Clock</a></h3><h4>The best stories for Apple owners and enthusiasts</h4><p>Follow</p><h4>104</h4><h4>4</h4><ul><li><a href="https://medium.com/macoclock/tagged/apple">Apple</a></li><li><a href="https://medium.com/macoclock/tagged/technology">Technology</a></li><li><a href="https://medium.com/macoclock/tagged/science">Science</a></li><li><a href="https://medium.com/macoclock/tagged/productivity">Productivity</a></li><li><a href="https://medium.com/macoclock/tagged/programming">Programming</a></li></ul><img src="https://medium.com/_/stat?event=post.clientViewed&referrerSource=full_rss&postId=5deb1e5c3527" width="1" height="1" alt="">]]></content:encoded>
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            <title><![CDATA[7 Magic Phrases That Make You Instantly Likable on Video Calls]]></title>
            <link>https://rohitsharma58984.medium.com/7-magic-phrases-that-make-you-instantly-likable-on-video-calls-4a3524c5e8c2?source=rss-ac81f98174a5------2</link>
            <guid isPermaLink="false">https://medium.com/p/4a3524c5e8c2</guid>
            <category><![CDATA[relationships]]></category>
            <category><![CDATA[love]]></category>
            <category><![CDATA[seo]]></category>
            <category><![CDATA[censorship]]></category>
            <dc:creator><![CDATA[Rohitsharma]]></dc:creator>
            <pubDate>Thu, 10 Dec 2020 18:58:16 GMT</pubDate>
            <atom:updated>2020-12-10T18:58:16.135Z</atom:updated>
            <content:encoded><![CDATA[<h3>“I love the way you think.”</h3><figure><img alt="" src="https://cdn-images-1.medium.com/max/60/0*BUmgq764F1rxbn7k" /></figure><p>Photo by <a href="https://www.pexels.com/@matilda-wormwood?utm_content=attributionCopyText&amp;utm_medium=referral&amp;utm_source=pexels">Matilda Wormwood</a> from <a href="https://www.pexels.com/photo/woman-using-laptop-doing-a-video-call-4099096/?utm_content=attributionCopyText&amp;utm_medium=referral&amp;utm_source=pexels">Pexels</a></p><p>I received the ultimate “Can I pick your brain?” email. Quarantine had just begun here in Spain, but I was already feeling burned out from everyone’s initial infatuation with Zoom.</p><p>“<em>Is it cool if we just do an old-fashioned phone call?</em>” I replied.</p><p>“<em>I’d prefer video,</em>” the man immediately shot back. “<em>There’s something cool I’d like to show you.</em>”</p><p>I wanted to insist, but after giving him a warning that my apartment wasn’t very big and I didn’t always get to chose when my youngest son cries, I gave in.</p><p>The next day, however, not even 5 minutes into our call, he asked to do a screen-share and tried to sell me on a product he was pushing.</p><p>Despite not being able to see my knuckles turn white, I thought for sure he’d picked up on the fact that my face was cemented in a permanent yawn.</p><p>Fortunately, I didn’t have to cut him off as shortly after he started his pitch our apartment exploded into tears and I jumped on the opening to end the call.</p><p>Much like in “real” life, during video calls, some people have said or done something that rubbed me the wrong way. But for every call that could have gone better, there have been just as many that have turned out well.</p><p>A big part of this is because someone said something that traveled straight through my ears and hit me hard in both my head and heart.</p><p>When it comes to building relationships, few exercises are more valuable than keeping track of the phrases that both <a href="https://psiloveyou.xyz/11-phrases-that-people-love-to-hear-4c917ba6fe6c?source=friends_link&amp;sk=0dac9f2960b2e9ae356e1f658631ed9e">light people up</a> and those that <a href="https://medium.com/personal-growth/11-things-socially-aware-people-dont-say-f0a5d01c0b8c">bring people down</a>. Then either adopting them for yourself or making a point to banish them from your vocabulary.</p><p>Since the world decided to get weird on us six months ago and video calls have become the norm, I’ve been collecting both the kind and questionable phrases people have said to me.</p><p>To kick things off below are a handful of the phrases people have said that made me instantly like them.</p><p><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG1.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG1.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG2.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG2.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG3.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG3.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/KAA-v-TSG4.html">https://www.patchworkposse.com/cva/fbc/KAA-v-TSG4.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S.html">https://www.patchworkposse.com/cva/fbc/M-v-S.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S1.html">https://www.patchworkposse.com/cva/fbc/M-v-S1.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S2.html">https://www.patchworkposse.com/cva/fbc/M-v-S2.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S3.html">https://www.patchworkposse.com/cva/fbc/M-v-S3.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/M-v-S4.html">https://www.patchworkposse.com/cva/fbc/M-v-S4.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant1.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant1.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant2.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant2.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant3.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant3.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/Tott-v-Ant4.html">https://www.patchworkposse.com/cva/fbc/Tott-v-Ant4.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG1.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG1.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG2.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG2.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG3.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG3.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/KAA-v-TSG4.html">https://www.alouettecheese.com/cva/fbc/KAA-v-TSG4.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S.html">https://www.alouettecheese.com/cva/fbc/M-v-S.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S1.html">https://www.alouettecheese.com/cva/fbc/M-v-S1.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S2.html">https://www.alouettecheese.com/cva/fbc/M-v-S2.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S3.html">https://www.alouettecheese.com/cva/fbc/M-v-S3.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/M-v-S4.html">https://www.alouettecheese.com/cva/fbc/M-v-S4.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant1.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant1.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant2.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant2.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant3.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant3.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/Tott-v-Ant4.html">https://www.alouettecheese.com/cva/fbc/Tott-v-Ant4.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG.html">http://forcescompare.uk/fbc/KAA-v-TSG.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG1.html">http://forcescompare.uk/fbc/KAA-v-TSG1.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG2.html">http://forcescompare.uk/fbc/KAA-v-TSG2.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG3.html">http://forcescompare.uk/fbc/KAA-v-TSG3.html</a><br><a href="http://forcescompare.uk/fbc/KAA-v-TSG4.html">http://forcescompare.uk/fbc/KAA-v-TSG4.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S.html">http://forcescompare.uk/fbc/M-v-S.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S1.html">http://forcescompare.uk/fbc/M-v-S1.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S2.html">http://forcescompare.uk/fbc/M-v-S2.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S3.html">http://forcescompare.uk/fbc/M-v-S3.html</a><br><a href="http://forcescompare.uk/fbc/M-v-S4.html">http://forcescompare.uk/fbc/M-v-S4.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant.html">http://forcescompare.uk/fbc/Tott-v-Ant.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant1.html">http://forcescompare.uk/fbc/Tott-v-Ant1.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant2.html">http://forcescompare.uk/fbc/Tott-v-Ant2.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant3.html">http://forcescompare.uk/fbc/Tott-v-Ant3.html</a><br><a href="http://forcescompare.uk/fbc/Tott-v-Ant4.html">http://forcescompare.uk/fbc/Tott-v-Ant4.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it1.html">https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it1.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it2.html">https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it2.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it3.html">https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it3.html</a><br><a href="https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it4.html">https://www.patchworkposse.com/cva/fbc/video-milan-v-praga-diretta-it4.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it1.html">https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it1.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it2.html">https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it2.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it3.html">https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it3.html</a><br><a href="https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it4.html">https://www.alouettecheese.com/cva/fbc/video-milan-v-praga-diretta-it4.html</a></p><h3>1. “Can you say that again? I want to write it down.”</h3><p>These words have been said to me a few times and whenever I hear them, I melt. Not only that, but it lets me know the person I am speaking with is open-minded and curious.</p><p><em>“That’s an interesting perspective. Give me a second to write that down.”</em></p><p><em>“I never thought of it that way. I want to write that down.”</em></p><p><em>“I love that idea. I’m gonna write it down so I don’t forget it.”</em></p><p>Compliments about someone’s fashion taste or appearance is nice. The same goes for noticing something cool about their apartment.</p><p>But they can’t compete with telling someone you love the way they think.</p><h3>2. “Thanks for asking….”</h3><p>The first time I got on a call with my new friend <a href="https://medium.com/u/1500c6d3f28d?source=post_page-----1de4fdaf36ea--------------------------------">Jake Daghe</a> I quickly noticed a pattern: whenever I asked him a question he would pause and before answering he’d say, “Thanks for asking.”</p><p>I recently asked him where he developed this habit and his answer was just as charming as the phrase itself —</p><blockquote><em>“I had a mentor who told me that the most missed opportunity to instill value in others is when people ask you questions. He explained that typically when people get asked a question, their pride is quick to jump in an attempt to answer it. But if you can delay pride just a fraction to allow gratitude to come out, you not only get to give an answer but you also make the other person feel valuable.”</em></blockquote><p>Whether you know Jake or not, I’d be willing to bet after reading that you also think he’s someone you want in your corner.</p><p><em>“Thanks for asking, I’d love to write you a testimonial.”</em></p><p><em>“Thanks for asking, I learned that from my grandfather.”</em></p><h3>Quick but important aside:</h3><p>It’s also the perfect softener when you need to say no — “<em>Thanks for asking, I’m tied up at the moment but your project sounds cool.</em>”</p><h3>3. “Sorry I interrupted you, I get excited. Please continue.”</h3><p>If there’s a silver lining for Zoom calls and picking up the phone more than normal it’s that I’ve realized how much I interrupt other people. This is especially true when I’m really into a topic or on a group call.</p><p>Fortunately, after being on the receiving end of an interruption a few weeks ago, <a href="https://medium.com/u/ae15d1d3810c?source=post_page-----1de4fdaf36ea--------------------------------">Marina Glazman</a> said something that not only allowed me to finish my thought, but also made me smile —</p><blockquote><em>“Sorry for interrupting you so much. I have a bad habit of getting really excited and I need to learn how to shut up. Please continue and feel free to call me out the next time.”</em></blockquote><p>Much like Jake’s example above regarding, “<em>Thanks for asking,</em>” I’d be willing to bet you too like Marina’s vibe too.</p><p><em>“Sorry to interrupt, I’m really into this topic.”</em></p><p><em>“Sorry to interrupt, please tell me more. What you said really got me thinking.”</em></p><h3>4. “I’d love your input on something.”</h3><p>To connect with people, many experts recommend asking other people if they are facing any challenges. Don’t get me wrong, this is sound advice as it becomes much easier to help someone if you know what they’re struggling with.</p><p>However, not everyone may be up for sharing their problems with someone they just met. A simple way to get people to open up is to flip the script by sharing a struggle of your own and then asking them for their input.</p><p><em>“As someone who has kids, do you have any suggestions on how to better disconnect while working from home?”</em></p><p><em>“As someone who is a natural on camera, do you have any tips to be more comfortable?”</em></p><p>You may find that their suggestions not only helps you. But the person ends up liking you more as you’ve demonstrated you’re someone who admits they don’t have life figured out.</p><h3>5. “I know I shouldn’t complain….”</h3><p>I got on a call with an executive at a magazine I’ve been gunning for and prior to the call, I was a wrecked with nerves.</p><p>Fortunately, after exchanging hellos, the woman said the words, “<em>I know I shouldn’t complain, but I hit a wall today and if I ramble or don’t make any sense, please give me a pass.</em>” The two of us then vented for a few minutes about the state of the world since COVID turned our lives upside down which led to a more relaxed call.</p><p><em>“I hate to complain, but it’s been a tough week and I could use an ear….”</em></p><p><em>“I hate to complain, but man I wish we were sitting at a café right now instead of doing yet another video call.”</em></p><p><em>“I know I shouldn’t complain, and don’t get me wrong I love my kids, but….”</em></p><p>Life right now is weird for some and downright horrible for others. Sometimes letting these frustrations out can build bonds just as quickly as talking about all the goods things we have going on in our lives.</p><h3>6. “Lately, I’ve been sick of video. But this was fun.”</h3><p>I asked my wife for some suggestions of phrases she likes to hear from people and without hesitation, she said the words above.</p><p>It may sound a bit cheesy but it works. Plus, a strong last impression plays a major role in someone’s overall impression of you. So if you enjoyed speaking with them, let them know.</p><p><em>“I gotta be honest, I wasn’t looking forward to another video call, but this was great.”</em></p><p><em>“I can’t remember the last time I laughed so much on a video call. Thanks for that.”</em></p><p>One of the fundamental rules of social psychology is we like people who like us. So whether you’re a fan of this phrase or not let it serve as a reminder to end conversations on a positive note.</p><h3>7. “Do you mind if we turn the video off?”</h3><p>I live in a small town in Catalunya and every time my kids get on a video call with my parents in the US I’m grateful for technology. But not every call needs to be entirely on video and in many cases, it doesn’t need to be used at all (this is especially true if you are talking to someone early in the morning as they may not to be ready to put on a video face).</p><p><em>“If you prefer to get up and move around when you talk, please let me know.”</em></p><p><em>“Since the presentation is over is everyone okay with turning off the camera so we can relax?”</em></p><p><em>“I’m a bit Zoomed out for the day. Is it cool if we just talk?”</em></p><p>If you’re anything like me, you love it when people say these words. So if video isn’t completely necessary, ask the people you are speaking with what they prefer. You may find that be giving them an out, they open up a bit more and let you in.</p><p>There’s a lot of truth to the phrase, “Actions speak louder than words.” But our words still hold tremendous power and this is particularly true since the world moved to video calls and we can only see people from their shoulders up.</p><p>So keep track of the phrases people say that make you smile and sprinkle them around your conversations when you spot an opportunity.</p><p>Just don’t forget to also keep track of <a href="https://medium.com/personal-growth/11-things-socially-aware-people-dont-say-f0a5d01c0b8c">the phrases that bring people down</a>. Not saying the wrong thing doesn’t automatically make you likable. But it sure helps.</p><p><a href="https://mikethompsonblog.com/subscribe">Join my newsletter to get my latest posts and articles featured in places like Business Insider</a> 📖</p><p>WRITTEN BY</p><h3><a href="https://michael-thompson.medium.com/?source=post_sidebar--------------------------post_sidebar-----------">Michael Thompson</a></h3><h4>Co-creator of 2 boys with my dream girl • Career coach • Featured in Business Insider, Fast Co, MSN, &amp; Forbes • Join 37,000 others by following along.</h4><p>Follow</p><h4>8K</h4><h4>31</h4><h4>Thanks to Amardeep Parmar and Marina Glazman.</h4><h4>8K</h4><h4>31</h4><ul><li><a href="https://medium.com/tag/relationships">Relationships</a></li><li><a href="https://medium.com/tag/self-improvement">Self Improvement</a></li><li><a href="https://medium.com/tag/leadership">Leadership</a></li><li><a href="https://medium.com/tag/communication">Communication</a></li><li><a href="https://medium.com/tag/remote-working">Remote Working</a></li></ul><img src="https://medium.com/_/stat?event=post.clientViewed&referrerSource=full_rss&postId=4a3524c5e8c2" width="1" height="1" alt="">]]></content:encoded>
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            <title><![CDATA[The First Signs of Alcoholic Liver Damage Are Not in the Liver]]></title>
            <link>https://rohitsharma58984.medium.com/the-first-signs-of-alcoholic-liver-damage-are-not-in-the-liver-22cac2f47b71?source=rss-ac81f98174a5------2</link>
            <guid isPermaLink="false">https://medium.com/p/22cac2f47b71</guid>
            <category><![CDATA[health]]></category>
            <category><![CDATA[body]]></category>
            <category><![CDATA[mental-health]]></category>
            <category><![CDATA[addiction]]></category>
            <category><![CDATA[alcohol]]></category>
            <dc:creator><![CDATA[Rohitsharma]]></dc:creator>
            <pubDate>Mon, 07 Dec 2020 19:36:34 GMT</pubDate>
            <atom:updated>2020-12-07T19:36:34.316Z</atom:updated>
            <content:encoded><![CDATA[<h4>Not enough alcoholics are educated about this</h4><figure><img alt="" src="https://cdn-images-1.medium.com/max/1024/0*XPkhcpUYcUxdnaCy.png" /><figcaption>Image: <a href="https://pixabay.com/users/VSRao-8105725/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=4081243">VSRao</a>/<a href="https://pixabay.com/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=4081243">Pixabay</a></figcaption></figure><p>Myfather died of alcoholic liver cirrhosis four years ago. It came as a surprise to all of us, even though it was clear he had a <a href="https://elemental.medium.com/driving-my-mom-to-rehab-261c985431ac">severe drinking problem</a> for decades. It was especially surprising to me, as a former nurse and a recovering alcoholic. You would think I’d know more about liver problems and <a href="https://elemental.medium.com/the-latest-findings-on-why-its-so-hard-to-quit-drinking-ae84b37689be">alcohol use</a> than the average person. But the truth is, in the months before his death, I had no idea my father’s liver was struggling at all. Most people know about cirrhosis, but few people know how a liver goes from early damage to end-stage liver cirrhosis.</p><p>The combination of my father’s death and my personal background lit a fire in me to know more. He was admitted to the hospital on June 24, 2016, and he died on July 18. Only 24 days passed between the first sign there was a problem and his subsequent death.</p><p><a href="https://www.acquiescevineyards.com/lds/B-v-S-Liv70.html">https://www.acquiescevineyards.com/lds/B-v-S-Liv70.html</a><br><a href="https://www.acquiescevineyards.com/lds/B-v-S-Liv71.html">https://www.acquiescevineyards.com/lds/B-v-S-Liv71.html</a><br><a href="https://www.acquiescevineyards.com/lds/B-v-S-Liv72.html">https://www.acquiescevineyards.com/lds/B-v-S-Liv72.html</a><br><a href="https://www.acquiescevineyards.com/lds/B-v-S-Liv73.html">https://www.acquiescevineyards.com/lds/B-v-S-Liv73.html</a><br><a href="https://www.acquiescevineyards.com/lds/B-v-S-Liv74.html">https://www.acquiescevineyards.com/lds/B-v-S-Liv74.html</a><br><a href="https://www.acquiescevineyards.com/lds/B-v-S-Liv75.html">https://www.acquiescevineyards.com/lds/B-v-S-Liv75.html</a><br><a href="https://www.acquiescevineyards.com/lds/B-v-S-Liv76.html">https://www.acquiescevineyards.com/lds/B-v-S-Liv76.html</a><br><a 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href="https://www.acquiescevineyards.com/lds/Fiorentina-v-Genoa-Diretta-i016.html">https://www.acquiescevineyards.com/lds/Fiorentina-v-Genoa-Diretta-i016.html</a><br><a href="https://www.acquiescevineyards.com/lds/Fiorentina-v-Genoa-Diretta-i017.html">https://www.acquiescevineyards.com/lds/Fiorentina-v-Genoa-Diretta-i017.html</a><br><a href="https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-01.html">https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-01.html</a><br><a href="https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-02.html">https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-02.html</a><br><a href="https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-03.html">https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-03.html</a><br><a href="https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-04.html">https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-04.html</a><br><a href="https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-05.html">https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-05.html</a><br><a href="https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-06.html">https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-06.html</a><br><a href="https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-07.html">https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-07.html</a><br><a href="https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-08.html">https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-08.html</a><br><a href="https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-09.html">https://www.acquiescevineyards.com/lds/Brig-v-South-liv-hq-tv-09.html</a></p><p>Now, hearing that he was in end-stage cirrhosis didn’t surprise me, given his heavy drinking. What did surprise me was that he’d visited several doctors and specialists in the months before his death, and no one knew his liver was struggling either.</p><p>So what happened? Does end-stage liver cirrhosis really sneak up that fast? <a href="https://elemental.medium.com/do-i-have-a-drinking-problem-ffaba39c9e6d">Were there other signs</a> that would have alerted someone to his failing liver?</p><p>As for why the doctors and specialists didn’t know what was happening, that mystery resolved reasonably quickly.<strong> </strong>The plain truth is that alcoholics <a href="https://www.theguardian.com/commentisfree/2018/dec/12/alcoholic-patients-keep-drinking-doctor">rarely divulge the amount</a> and frequency of their drinking to their doctors. This was the case for my dad. He had many health issues that he was trying to solve, but he protected his drinking habit fiercely. So he refused to spill the beans, even when it mattered.</p><h3><a href="https://elemental.medium.com/what-alcohol-does-to-a-stressed-out-brain-af3771a36dba">What Alcohol Does to a Stressed-Out Brain</a></h3><h3><a href="https://elemental.medium.com/what-alcohol-does-to-a-stressed-out-brain-af3771a36dba">The relationship between alcohol and stress relief is a lot more complicated than conventional wisdom holds</a></h3><h4><a href="https://elemental.medium.com/what-alcohol-does-to-a-stressed-out-brain-af3771a36dba">elemental.medium.com</a></h4><p>The problem is that liver damage has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513682/">numerous multifaceted symptoms</a> that are confusing and associated with many other illnesses. Unless a doctor knows that the patient is an alcoholic, they may not know how to interpret what’s happening until it’s too late.</p><p>As he was dying, my father told me that he didn’t think to tell the doctors how much he was drinking. He said it was as if he blanked out and “forgot” to mention it. As crazy as that sounds, this strange “forgetting” is a common part of the <a href="https://www.theguardian.com/commentisfree/2018/dec/12/alcoholic-patients-keep-drinking-doctor">alcoholic mindset</a>. It may also be due to the metabolic and physical changes of cirrhosis itself.</p><p>There are many signs of liver problems, but oddly, none seem to point to the liver at first. And in fact, many of the first signs of liver damage occur in other parts of the body. Knowing these signs may help educate alcoholics and their families if they want to understand their risk of developing liver cirrhosis.</p><blockquote><em>Liver damage has numerous multifaceted symptoms that are confusing and associated with many other illnesses. Unless a doctor knows that the patient is an alcoholic, they may not know how to interpret what’s happening until it’s too late.</em></blockquote><h3>Digestive signs</h3><p>The liver plays a huge <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321494/">part in our digestive process</a>. It filters out all toxins from food as well as helping to break down fats and glucose.</p><p>When a liver starts to slow down due to significant damage, it will <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513682/">reduce its digestive work</a>. Instead, it will divert its energy toward vital functions like metabolizing medications and filtering toxins.</p><p>This means that symptoms like bloating, nausea, vomiting, gas, and diarrhea will start to increase. Over time, eating becomes more challenging. In the later stages of liver cirrhosis, toxins that can’t be filtered out begin to build in the bloodstream, which causes more nausea.</p><h3>Cognitive signs</h3><p>Although confusion and brain fog happen in end-stage liver cirrhosis, they can also be early signs.</p><p>The liver is <a href="https://elemental.medium.com/this-holiday-season-give-thanks-to-your-liver-4f652eda6be3">responsible for filtering</a> dangerous substances in the blood. It also helps <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513682/">regulate hormones, blood glucose, and vitamin absorption</a>. In the early stages of liver damage, these processes can be interrupted. Inevitably, this affects our brain and nervous system.</p><p>This means that early liver problems can make you feel <a href="https://jnnp.bmj.com/content/jnnp/75/suppl_3/iii16.full.pdf">tired, confused, slow, and foggy</a>. You may have some memory issues as well.</p><h3><a href="https://elemental.medium.com/covid-cocktail-crisis-adds-to-america-s-serious-drinking-problem-ea8cfa2d2a40">Covid ‘Cocktail Crisis’ Adds to America’s Serious Drinking Problem</a></h3><h3><a href="https://elemental.medium.com/covid-cocktail-crisis-adds-to-america-s-serious-drinking-problem-ea8cfa2d2a40">Lockdowns and other pandemic stresses have certainly primed the drinking pump</a></h3><h4><a href="https://elemental.medium.com/covid-cocktail-crisis-adds-to-america-s-serious-drinking-problem-ea8cfa2d2a40">elemental.medium.com</a></h4><h3>Neuromuscular signs</h3><p>The liver stores <a href="https://elemental.medium.com/should-i-take-b-vitamins-c82631d94c03">vitamins</a> required for the functioning of many organs and systems in the body — one of them is vitamin B1 or thiamine. A deficiency in this particular vitamin has been <a href="https://www.ncbi.nlm.nih.gov/books/NBK537204/">documented in many alcoholics</a> with or without liver damage.</p><p>Unfortunately, alcohol inhibits the absorption of thiamine in the intestine. Over time, as the liver becomes damaged, it can no longer store thiamine in enough quantities. Thiamine deficiency is responsible for <a href="https://www.ncbi.nlm.nih.gov/books/NBK537204/">many neurological issues</a> in people with alcoholism.</p><p>Symptoms of <a href="https://en.wikipedia.org/wiki/Thiamine_deficiency">thiamine deficiency</a> range from mild to severe and include things like: confusion, mental fog, lack of balance, pain and numbness in hands and feet, muscle weakness, rapid heart rate, digestive problems, flushing, and involuntary eye movements.</p><p>Thiamine deficiency happens in almost every alcoholic who consumes frequent and large amounts of alcohol. And if thiamine deficiency due to alcoholism is discovered, you can be sure the liver is suffering damage at the same time.</p><blockquote><em>Many of the first signs of liver damage occur in other parts of the body.</em></blockquote><h3>Vascular signs</h3><p>All alcohol consumption can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321494/">lead to blood vessel dilation</a>, causing flushing in the face and hands. Over time, this can cause damage leading to permanent redness in the face. Although many alcoholics have rosacea or spider-like veins on their faces, this is often benign.</p><p>However, spider angiomas are different from rosacea or spiderlike veins. They’re circular and have a central point called a spider nevus that is darker than the rest of the lesion. <a href="https://en.wikipedia.org/wiki/Spider_angioma">Spider angiomas</a> are a sign of liver disease and can be present in the early stages. They often progress to more extensive and more numerous lesions.</p><p>Spider angiomas are caused by <a href="https://en.wikipedia.org/wiki/Spider_angioma">increased estrogen levels</a> in the blood. When the liver becomes damaged, it can’t properly metabolize estrogens, which causes them to build up in the body.</p><p>Many women who are pregnant or taking birth control pills may have a few spider angiomas. However, in alcoholic liver disease, these lesions are often more frequent and accompanied by <a href="https://en.wikipedia.org/wiki/Spider_angioma">red palms and varicose veins</a> in the esophagus.</p><p>These are a few of the main signs of alcoholic liver damage that happen outside of the liver. It’s important to know this because most of us have no idea how the liver functions and how it communicates distress.</p><p>The liver itself doesn’t show signs like pain or swelling in the early stages of liver damage. This contrasts with other organs like the heart or stomach, where any damage will emit pain or symptoms directly from these organs.</p><p>What happens with liver damage is that its many diverse functions become interrupted, causing symptoms in other parts of the body. This may explain why most people never think they have a problem with their liver.</p><p>Unfortunately, patients with alcoholism are rarely educated about these issues. This is because they often don’t reveal their drinking, to begin with. And even if they do, the symptoms are widespread and complex, which makes patient education challenging.</p><p>My goal in writing articles like this is to help educate regular people about alcoholic liver disease to understand their health and make better decisions.</p><p>It’s hard to say if my father would have changed his drinking habits if he knew more about his vague and complicated symptoms. But I think having proper education would have certainly helped him understand his risks and health problems better.</p><img src="https://medium.com/_/stat?event=post.clientViewed&referrerSource=full_rss&postId=22cac2f47b71" width="1" height="1" alt="">]]></content:encoded>
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