Close Reading, Improved Writing, and Service Learning: A Virtuous Circle!

I'm in Vermont at the Bread Loaf School of English, a Middlebury College program in which the students, primarily high school and middle school English teachers, can get a Master's degree in the course of five summers. My wife has been teaching here every summer since 1992 and I enjoy the potential for (a) telecommuting and (b) swimming and hiking in Vermont.

In the past four years I've been doing an annual workshop on "Making Ethics part of High School and Middle School English Class." Working with the students here is a great pleasure and privilege. There's very little that's more important than educating the next generation.The teachers are doing God's work!

There were 18 participants in the workshop I did a week ago, plus three members of the Bread Loaf faculty. The participants taught in settings ranging from the Navajo Nation to public schools in urban and rural settings to elite independent schools.

We focused the workshop around a question that came from a 10^th grade teacher, whose class does a service learning module that combines class discussion, a service project chosen by the student, and a research paper. She felt that the unit was well-intentioned, but many students experienced it as a burden, and it didn’t feel integrated with the rest of the semester’s work. She asked the group – did other teachers have ideas about how to make service learning more engaging for students? 

I’ve distilled 4 points from the wonderfully rich discussion:

1. English class is often asked to be the vehicle for humanistic goals in the school curriculum. Ideally, moral development and heightened humanism would be a goal for everycomponent of the school  – inside and outside of class. But this kind of full court press rarely happens, and English teachers are asked to take the lead. Being looked to for leadership in moral development is a challenge and an opportunity! I mentioned to the group that my medical specialty – psychiatry – is in a similar situation. We’re often asked to be responsible for the “understanding the patient’s point of view” component of the medical school curriculum. ..”

2. Several participants suggested that preparatory exercises can help students become more open to and engaged with reflection about values. A participant reported that hypothetical questions like “A lifeboat has 10 people but will sink from too much weight. Everyone will drown unless someone is thrown off. What should be done?” triggers lively discussion. Another participant described how she gives the class statements dealing with issues that come up in a book they are reading. Then she has them do “speed dating” – i.e., talking for 30 seconds with another student about their reactions to the statement. Another participant described how she did a similar exercise before reading Hamlet. She poses questions like “do you believe in ghosts?” or “if someone kills your father, should you kill that person for revenge” and asked students to stand up if they agreed. These teachers reported that like warming up before physical exercise, activities of this kind can help students “warm up” into a more reflective state of mind in which they are prepared to see ethics as something important to their lives.

3. When schools require service learning, unless students are prepared well they can cause harm when they enter into the space of those they are “serving.” And the very idea of doing “service for those in need” can create a noblesse oblige attitude (“the poor can’t help themselves – they need me to do this service for them…”) or cynicism (“this is just resumé padding…”). Some argued that requiring service learning and giving academic credit for it is corrupting. But others who agreed that these risks are real nevertheless felt that some students who would never get involved on their own might be turned on and transformed by the service learning experience.

4. Independent schools and public schools in wealthy communities are increasingly sponsoring “voluntourism” – programs in which students go for a short time to a poorer country to do “service.” With rigorous preparation, a strong relationship with local community partners, and opportunity to reflect on the experience, these programs can be excellent learning opportunities for the students and even if not helpful at the “service” site, at least not harmful. A participant contrasted “asset based community development” to “voluntourism charity work”.” ABCD involves identifying the strengths in a community and helping the strengths to be extended. Another participant questioned why “voluntourism” programs travel to other countries when there are valuable opportunities to contribute in their own or nearby communities.  With regard to the stance of noblesse oblige” I mentioned a favorite quote from Thoreau: “If I knew for a certainty that a man was coming to my house with the conscious design of doing me good, I should run for my life!”

The core idea that has emerged from the workshops is an understanding of a virtuous circle involving literature, writing, and social action, which I've represented in a diagram:

Close reading strengthens empathy and humanism by entering into the worlds that literature creates, and improved writing does the same by asking students to think about the audience they are speaking to and how they can best reach that audience. Understanding our values and biases and empathizing with perspectives of others even if we disagree with them increases “ethical sensitivity.” And when students identify values important to themselves and for their communities, they are primed for ethical activism on behalf of these commitments. Activism can create a virtuous circle by stimulating further learning opportunities that strengthen engagement with literature and writing. 

I hope the high school and middle school teachers learned as much as I did from the workshop!

FoodBeast Big Mac Pizza

Working at Foodbeast, we've tried and written about countless kinds of pizza. We've eaten Big Mac pizzas and breakfast pizzas. We've even watched delicious Vietnamese Pho and Japanese eel pizzas get thrown into the oven, coming out as delicious as we could have dreamed.

All those pale in comparison to the simple pizza at Da Michele's in Naples, Italy.

If there's one pizza you have to add to your bucket list, this is it.

Fresh off a scorching hot tour of Pompeii, fellow Foodbeast members Isai, Marc, Elie and myself were exhausted and starving. We only had a couple of hours left before our Carnival Cruise ship left the port, when Marc suggested what we later learned was the best idea in our entire trip.

With a Promised Land to trek towards, we were ready to try this pizzeria Marc spoke so highly of.

It was a half hour walk from the port. Marc in the lead with his phone held high, Elie close behind him, looking at the souvenirs in the street stands, myself snapping photos like the typical tourist and Izzy in last place as he texted some girl he didn't want us to know about.

What was minutes seemed like hours thanks to our hunger pangs. As we rounded the corner of the busy Italian street, my heart sank. In what looked like a crowd at a soccer game, the large sea of people we spotted was the line for the Michelin-starred Da Michele.

While Elie, Isai and myself quietly considered slumming it at the pizza spot across the street, Marc shot straight through the crowd like a bullet. His Los Angeles Football Club scarf flapping in the wind like a superhero. He had a fire in his eyes as bright red as his ginger beard.

As the three of us waited on the outskirts of the crowd of hungry patrons, our own stomaches began to growl with uncertainty.

About 15 minutes later, he triumphantly waded through the sea of people with two boxes of pizza held high over his head. There was a fat smile on his face, like he had just accomplished the impossible. In a way, he had.

A man ran out of the pizzeria right after him.

Turns out the dude was an employee who saw the LAFC scarf our video director was wearing. In this moment, the two fans of football bonded over their mutual love of the sport and a box of pizza. As a thank you, Marc removed the scarf from his shoulders and draped it over the man as a sign of friendship.

As beautiful as that moment was, I was starving. Twenty minutes prior to this event, I had eaten it on the Italian sidewalk after tripping over my two left feet. A bruised ego and an even more bruised camera lens. Not a great pairing to hunger.

We took the pizzas up the street, which seemed like hours of more walking, and finally opened the boxes.

As Elie eagerly swung open pizza box I got a huge waft of the freshly-made pizza. Like my earlier incident with the sidewalk, I was completely floored by how glorious it smelled.

Elie handed me an Isai a box to share as he split the other with Marc. As I took a bite, my pizza-eating life flashed before my eyes. I remembered the first time I tried Costco pizza, when Domino's re-did their crust, even my brief but amazing stint as a pizza delivery boy for a mom and pop shop.

Looking back, those pizzas seemed like cardboard compared to this masterpiece. The disappointment of falling on my camera vanished into the warm Napoli air in an instant.

All Da Michele's pie had was crust, sauce, cheese, a piece of basil and some olive oil drizzled on top. Simple and spectacular.

I looked to Elie and Marc, who were savoring every bite of their respective slices. At first, I was worried we loved it so much because we were starving. Then, I remember Isai had already gotten pizza not too long ago while the rest of us were souvenir shopping. He had a relatively full stomach, yet he was still savoring ever morsel like it was the last time he'd ever have that pie.

He later promised it would not be his last time trying that magnificent pizza.

After we finished our food, we sat there in an Italian alleyway, talking about the pizza as if it was a summer blockbuster we just finished watching. Everyone had a smile on their face. From the chewy crust to the tangy sauce, every bit of Da Michele's pizza was dissected and analyzed.

If this pizza was a movie, it would have a near perfect Rotten Tomatoes score.

Whenever I tell people I work for Foodbeast, they immediately ask what the best thing I've eaten on the job was. I always drew a blank with so many delicious foods over the years. Now, I'll tell them it was this pizza.

We'll see you again Da Michele. One day.

Taco Bell

Taco Bell just announced that they'll be testing new Cheetos Burritos starting in August. The beefy new burritos are stuffed with seasoned meat, buttery rice, a cheese sauce and everyone's favorite puffy cheese snack.

We have to say, it's kind of a relief that they're not Hot Cheetos for once.

Taco Bell Canada introduced Beefy Cheddar Cheetos Crunchwrap Sliders and Supreme Cheetos Crunchwrap Sliders earlier this year. While the chips are not a first for the fast food chain, it's the first time they'll be using Cheetos in US menus.

You can expect the upcoming Cheetos Burrito to hit Taco Bell test sites around the US starting in August. They'll be available for $1. Kind of perfect if you've got the munchies and you're strapped for cash.

Hopefully it makes the main menu. Could always use more Cheetos in our lives.

Elite Cyclists and Brain Fatigue Resistance

In a Brain Post from 2012 I reviewed a study of fatigue in elite athletic performance. This study supported a key role in the brain insula in regulating the perception of exercise-induced fatigue. You can access this post by clicking HERE.

An update on this topic was recently published in PloS One by a research team in Australia.

This study compared performance on a cognitive task after extreme 20 minute cycling time trial. Professional cyclists were compared to recreational cyclists on the Stroop test that requires inhibitory control.

The results of the study were that elite cyclists performed significantly better on the Stroop test (more correct responses) following exercise than non-elite cyclists. This is indicative of a greater resistance effects of fatigue on brain performance.

The authors note in the discussion section:

"These finding suggest that successful endurance performance may require superior inhibitory control and resistance to mental fatigue."

This resistance to mental fatigue at high levels of exercise may be a key component in successful performance at the elite level.

Inhibitory control has been shown to have a significant genetic association and to be stable over time. It is possible that training interacts with genetic factors to produce brain fatigue resistance in the elite cyclist population.

Readers with more interest in this topic can access the free full-text research manuscript by clicking on the PMID link in the citation below.

Follow the author on Twitter HERE.

Photo of non-elite cyclist participating in triathlon is from the author's files. 


Martin K, Staiano W, Menaspà P, Hennessey T, Marcora S, Keegan R, Thompson KG, Martin D, Halson S, & Rattray B (2016). Superior Inhibitory Control and Resistance to Mental Fatigue in Professional Road Cyclists. PloS one, 11 (7) PMID: 27441380

Effects of Fast Food on the Body

Fast foods often contain too many calories and too little nutrition. If fast food is a regular component of your diet, you might find yourself struggling with weight problems and ill health.

These foods are often high in calories yet offer little or no nutritional value. When fast food frequently replaces nutritious foods in your diet, it can lead to poor nutrition, poor health, and weight gain. Test in lab animals have even shown a negative effect in short duration diets. Being overweight is a risk factor for a variety of chronic health problems including heart disease, diabetes, and stroke.

According to the Robert Wood Johnson Foundation, most people underestimate the number of calories they’re eating in a fast-food restaurant. A 2013 study published in JAMA Pediatrics showed that children and adolescents take in more calories in fast food and other restaurants than at home. Eating at a restaurant added between 160 and 310 calories a day.

Digestive and Cardiovascular Systems

Many fast foods and drinks are loaded with carbohydrates and, consequently, a lot of calories. Your digestive system breaks carbs down into sugar (glucose), which it then releases into your bloodstream. Your pancreas responds by releasing insulin, which is needed to transport sugar to cells throughout your body. As the sugar is absorbed, your blood sugar levels drop. When blood sugar gets low, your pancreas releases another hormone called glucagon. Glucagon tells the liver to start making use of stored sugars.

When everything is working in sync, blood sugar levels stay within a normal range. When you take in high amounts of carbs, it causes a spike in your blood sugar. That can alter the normal insulin response. Frequent spikes in blood sugar may be a contributing factor in insulin resistance and type 2 diabetes.

Sugar and Fat

Added sugars have no nutritional value but are high in calories. According to the American Heart Association, most Americans take in twice as much sugar as is recommended for optimal health. All those extra calories add up to extra weight, which is a contributing factor for getting heart disease.

Trans fats are a manufactured fat with no extra nutritional value. They’re considered so unhealthy that some countries have banned their use. Often found in fast food, trans fats are known to raise LDL cholesterol levels. That’s the undesirable kind of cholesterol. They can also lower HDL cholesterol, which is the so-called good cholesterol. Trans fats may also increase your risk of developing type 2 diabetes.

Sodium

Too much sodium causes your body to retain water, making you feel bloated and puffy. But that’s the least of the damage overly salted foods can do. Sodium also can contribute to existing high blood pressure or enlarged heart muscle. If you have congestive heart failure, cirrhosis, or kidney disease, too much salt can contribute to a dangerous buildup of fluid. Excess sodium may also increase your risk for kidney stones, kidney disease, and stomach cancer.

High cholesterol and high blood pressure are among the top risk factors for heart disease and stroke.

Respiratory System

Obesity is associated with an increase in respiratory problems. Even without diagnosed medical conditions, obesity may cause episodes of shortness of breath or wheezing with little exertion. Obesity also can play a role in the development of sleep apnea, a condition in which sleep is continually disrupted by shallow breathing and asthma.

A recent study published in the journal Thorax suggests that children who eat fast food at least three times a week are at increased risk of asthma and rhinitis, which involves having a congested, drippy nose.

Central Nervous System

A study published in the journal Public Health Nutrition showed that eating commercial baked goods (doughnuts, croissants, and, yes, even bran muffins) and fast food (pizza, hamburgers, and hot dogs) may be linked to depression. The study determined that people who eat fast food are 51 percent more likely to develop depression than those who eat little to no fast food. It was also found that the more fast food study participants consumed, the more likely they were to develop depression.

A junk food diet could also affect your brain’s synapses and the molecules related to memory and learning, according to a study published in the journal Nature. Animal tests have shown a similar effect. Rats fed a steady diet with over half the calories from fat (similar to a junk food diet) for just a few days had trouble completing a maze they had previously mastered in a 2009 study.

Skin and Bones

Chocolate and greasy foods are often blamed for acne, but they’re not the real culprits. It’s carbs that are to blame. According to the Mayo Clinic, because foods that are high in carbohydrates increase blood sugar levels, they may also trigger acne.

The study in Thorax showed a higher risk of eczema (inflamed, irritated patches of skin) among children with a diet high in fast food.

When you consume foods high in carbs and sugar, bacteria residing in your mouth produce acids. These acids can destroy tooth enamel, a contributing factor in dental cavities. When the enamel of your tooth is lost, it can’t be replaced. Poor oral health has also been linked to other health problems.

Excess sodium may also increase your risk of developing osteoporosis (thin, fragile bones).

Effects on Society

According to the Centers for Disease Control and Prevention (CDC), the definition of obesity is when your body mass index (BMI) is 30.0 or higher. BMI is a calculation of your height and weight. You can calculate your BMIhere. There’s also a category referred to as “extreme obesity,” which is defined as a BMI of 40. Across all race groups, one in three Americans is considered obese while one in 20 is considered extremely obese. Those statistics are higher in the black and Latino communities. Approximately 75 percent of people in these groups who are over age 20 are considered obese.

The Obesity Action Coalition (OAC) reports that the number of fast food outlets has doubled since 1970, a period during which the number of obese Americans also doubled. It’s likely that many factors have contributed to the obesity epidemic, but the correlation between the availability of cheap and fattening fast food and national weight increase is stark. Obesity increases the likelihood of heart disease, high blood pressure, kidney disease, diabetes, joint problems, and more. In 2008, obesity-related medical costs were estimated at $147 billion. Diabetes alone was estimated to be responsible for $69 billion just in lost productivity. Numbers like these suggest that the costs of cheap fast food are surprisingly high. 

Alzheimer's Disease Behavioral Checklist: Link

Yesterday I posted on a research effort to develop a more behavioral-based screening process for early detection of Alzheimers and other dementia.

You can access that post by clicking HERE.

Since I posted that I have come across a proposed 34 item screening scale. The link to that scale is HERE.

This is not validated scale for clinical use but is in the development stage. I wanted readers who were interested in this research to have access to a PDF copy of the scale.

Follow the author on Twitter HERE (WRY999)

Photo of Etruscan burial statue is from my personal file of a trip to Italy last year.

Behavioral Warnings in Early Alzheimer's Disease

There are some interesting research updates coming out of the Alzheimer's Association International Conference in Toronto.

One finding that caught my eye was a report on behavioral changes that might precede significant cognitive impairment in Alzheimer's and other dementia.

This is being labelled "mild behavioral impairment" and like mild cognitive impairment may precede the clinical presentation of a dementia.

The Alzheimer's Association has put together a committee to formalize these criteria. The behavioral changes must be not characteristic of the individual and be present for at least six months.

The slide accompanying this post lists some of the behavioral warning signs being considered for "mild cognitive impairment".

Read about this effort in the Medical Xpress story HERE.

Follow me on Twitter WRY999

4 HEALTH BENEFITS OF JUICING

Juicing fresh fruits and vegetables from home is trending now in the lives of those who are living a healthy life. But what is Juicing? It simply means extracting the juice out of fruits and vegetables. This is achieved with the help of a juicer or juice extractor. Some people always ask, why not just eat the fruit and vegetable instead of wasting time to extract the juice before consuming it? Well here are some health benefits of juicing.

1 Your body receives nutrients almost instantly

Juicing helps in extracting the nutrients out of fruits and vegetables. When you juice, you skip the process of chewing.  Furthermore, the process of absorption and digestion will be faster compared to when you ate whole fruits or vegetables.

The process of juicing is also very beneficial for patients who have been hospitalized. This is because most of the time they have lost the appetite to eat and juicing their fruits and vegetables will make them take in a huge quantity of nutrients with just one sip. This will greatly enhance the healing process.

2 You spend little time to consume a large quantity of nutrients

Juicing makes you consume great quantities of fruits and vegetables. A glass of carrot juice may be equivalent to I kg of fresh carrots. Juicing also saves time from hundreds of bites and thousands of chewing. Furthermore, the work time table of the majority of people is very tight and time consuming such that they may miss breakfast and even lunch. But with juicing they will take few seconds to consume what would have cost them an hour 

3 You can easily consume healthy foods that have an unpleasant taste

Aloe vera has so many health benefits when consumed but are you able to eat a whole leave? Bitter leaf and ginger also have unpleasant taste. However they are packed with health benefits and juicing makes it easier to consume. These unpleasant foods can also be mixed with sweet fruits like pineapple, carrots or orange to mask the unpleasant taste

4 You will receive more nutrients

In order to get the best out of food, you have to chew it properly so that it becomes ready for absorption and digestion. However, some people do not take time to chew properly before swallowing and as a result of this not all the nutrients will be released for digestion and absorption in the stomach and small intestines.

Juicing breaks down the food to cellular level making it ready for absorption and digestion and almost all the nutrients will be absorbed.

Despite these health benefits of juicing, it is still important to consume whole fruits because juicing extracts the nutrients and leaves out the important fiber that helps in digestion and prevents constipation. Some fruits and vegetables have the greatest health benefits when consumed in whole too. So juicing shouldn't be a replace the process of eating whole foods. 

Purify your drinking water at home by installing a reverse osmosis water filter

Drinking water is good for our health. But the most important question we fail to ask is if we are drinking the right kind of water.  There are many different sources of water and not all of them are good for health.

The need for water purification is very essential in the 21^st century. We have evolved with time and the side effects of this evolution (pollution) has also had its toll on the safety of drinking water.

There exist safe sources of drinking water that have been filtered through reverse osmosis like “tangui” water being sold in Cameroon.

You may be tempted to ask why people are buying reverse osmosis filters or bottled water. It is because some health experts have raised have questioned the safety of tap water for drinking. They are:

1Tap water contains Aluminum

Aluminium is used to treat water.  This is because aluminium makes organic materials in water to coagulate and sediment. However after treatment, it is impossible to remove all traces of Aluminium in water. Aluminium when ingested is more dangerous that chlorine and fluoride. Aluminium has been found to cause cancers and Alzheimer’s disease.

 2 Tap water contains fluorides

Adding fluorides to water is a common public health measure to treat water in developed countries. This fluoride is in the form of Sodium silicofluoride which is toxic to man when ingested. Fluoride has been shown to have a link between cancer, arthritis and osteosarcoma. According to the World Health Organization, low levels of fluoride consumption can help in preventing dental caries. However they have also pointed out that excessive consumption of Fluorides can cause skeletal fluorosis which is characterized by painful and stiff joints.  

3 Our tap water contains chlorine

Some health experts such as Dr. Don Colbert have raised concerns, stating that tap water is not very safe for drinking is because it contains chlorine. Chlorine is popularly known in the health world as an anti-vitamin. This means that chlorine destroys vitamins.

Chlorine is added to water as a means of purifying it, to make it safe for home use. However, some studies have showed that chlorine may be responsible for causing some cancers.

4 Tap water may contain microorganisms

The water that flows from the taps especially from those living in towns like Douala (Cameroon) may sometimes be brown in colour. This may be because underground pipes may have cracks that allow impurities to get in.

The solution: Purifying Water by Reverse Osmosis

How does water filtration by Reverse Osmosis work?

Reverse Osmosis works by which salts, impurities and heavy metals are removed from water whereby tap water is made to flow through a semipermeable membrane under pressure. This semipermeable membrane allows only water to pass through. Reverse osmosis also stabilizes the pH, optimizes the mineral balance of water, removes any a pathogens/microbes and reduces heavy metals.

This filter doesn't require the use of electricity to function. 

Water filtration by reverse osmosis is available in Cameroon and is being supplied by MelHRcons & Safety Associates International at a very cheap and affordable price.

Contact: +237 6988 27 699

Dextromethorphan for Alzheimer's Disease Agitation

In my last post I summarized a review of the pharmacology of the drug dextromethorphan.

This drug is receiving significant attention for disorders in neuroscience medicine. 

A phase 2 clinical trial of dextromethorphan-quinidine (DM-Q) was published last fall in JAMA.

Here are the key design and results from this study:

Subjects: 220 subjects with a diagnosis of probable Alzheimer's disease with clinically significant agitation.
Randomization Design: This was a five week trial of 3:4 randomization to received DM-Q or placebo. Placebo subjects were re-randomized and enrolled in a 1:1 DM-Q versus placebo trial
Drug Dose Design: DM-Q 20mg-10mg daily for one week, then 20-10 twice daily for two weeks then 30mg-10mg twice daily for remainder of study.
Outcome: The primary outcome score was the agitation/aggression subscale score from the Neuropsychiatric Inventory. Active drug assignment reduced this score more than placebo (7.1 to 3.8 versus 7.0 to 5.3).
Adverse effects: Serious adverse effects were more common in active drug groups 7.9% versus 4.7% and included higher rates for falls, diarrhea and urinary tract infections. 

The authors note in the discussion that the higher rate of falls may have been due to an imbalance of fall risk at randomization.

This is an important study of a novel treatment approach to agitation in the elderly with Alzheimer's disease. Current drug treatment approaches are limited and linked to significant side effects.

Phase 3 studies of this drug combination are recruiting at the present time.

Follow the author on Twitter WRY999
Readers can access the free full-text manuscript by clicking on the PMID link below.

Figure of dextromethorphan comes from a Wikipedia Creative Commons file authored by Benjah-bmm27.

Cummings JL, Lyketsos CG, Peskind ER, Porsteinsson AP, Mintzer JE, Scharre DW, De La Gandara JE, Agronin M, Davis CS, Nguyen U, Shin P, Tariot PN, & Siffert J (2015). Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer Disease Dementia: A Randomized Clinical Trial. JAMA, 314 (12), 1242-54 PMID: 26393847

When Laughing Isn't Funny

Inappropriate uncontrollable laughing or crying is common in many neuroscience medicine disorders including after traumatic brain injury or stroke. It can be socially embarrassing and restrict opportunities for social interaction.

This loss of control over emotional responses is known by the term pseudobulbar affect or PBA. Until recently, few therapeutic options were available to treat this condition.

Now a relatively new drug Nuedexta uses a combination of dextromethorphan and quinide to treat pseudobulbar affect. This drug combination has received FDA approval in the U.S.

A recent review article summarized what is known about the pharmacology of the drug dextromethorphan (DM). DM is found in over-the-counter cough medications, for example Robitussin DM.

The DM mechanism of action is felt to be due to the blocking of the NMDA receptor (N-methyl-D-aspartate). This results in a inhibition of the excitotoxic neurotransmitter glutamate. The effect of DM on neurotransmitter function is non-specific and effects on other neurotransmitter systems include:

• Inhibition of serotonin reuptake
• Inhibition of norepinephrine uptake
• Antagonism of the nicotinic acetylcholine receptors
• Agonism of sigma1-R gene

Quinidine inhibits CYP2D6 the cytochrome P450 liver enzyme involved in liver enzyme metabolism of DM. This results in much higher and prolonged blood levels of dextromethorphan.

The potential therapeutic targets for DM mentioned in the review include the following:

• Pseudobulbar affect
• Epilepsy
• Pain
• Peripheral neuropathy
• TBI
• Stroke
• Alzheimer’s disease (agitation)

I will take a look at some of the specific research studies in these additional targets over the next week or two.

Follow the author on Twitter WRY999

Figure of Advertising Card showing phases of laughter is from Wikipedia Creative Commons.
By not known, printed by Young's, The Hatter - eBay store Web page: http://ebay.to/29rwilh

Taylor CP, Traynelis SF, Siffert J, Pope LE, & Matsumoto RR (2016). Pharmacology of dextromethorphan: Relevance to dextromethorphan/quinidine (Nuedexta®) clinical use. Pharmacology & therapeutics PMID: 27139517