Spa Technology

Spa Technology and TreatmentsFloat
Floating your way to Health and Relaxation

A first floater’s experience!
Several years ago I first heard about flotation tanks and the benefits they offer in achieving phenomenal heights of relaxation and well being. Yet whenever I asked anyone what it was like all I got was vague responses such as, "it's like being in your mother's womb", "it's out of this world - it really helps you tap into your creativity," "I get my best ideas and solve my problems when I float". "It's awesome, almost a spiritual experience". "Absolutely blissful. I feel so relaxed and revived."

All this sounded great, but it didn't really tell me what to expect, it only told me how they felt from the experience. Then I heard that the PHOENICIAN SPA RETREAT on the Gold Coast were offering Float Tank 'treatments' as part of their rejuvenation and relaxation packages so I decided it was finally time that I experienced a flotation for myself. For all of you first-time floaters who have the same curiosity as me for details, here is my experience.

After showering, Maree Keenan, the owner of the Phoenician escorted my to the Float Room where I was introduced to Apollo - apparently the latest in Australian Float Tank design and technology. I was surprised to see that Apollo had the appearance of a sports car or Star Trek capsule with a 'cockpit-styled' door. Very modern and slick, in fact it reminded me of a joy ride experience I had at Disneyland in California.

Maree explained to me that it was impossible to sink as the salts contained in the tank created such buoyancy that floating would not only be effortless, but the only thing I could do. Furthermore, the float is relatively shallow so there is no danger even if I could sink. "And what about hygiene?" I asked Maree. I was assured that the very high mineral salt content keeps the water sterile. This combined with a filtration system used after each user, ensures maximum hygiene standards which comply with FDA requirements.

"What about claustrophobia or getting trapped in the tank?" "The good looks of the Apollo are not only cosmetic" Maree assured me. "Every little detailed has been thought of throughout the design process for maximum comfort for the client."

The sliding door is very light and easy to operate with the minimum of effort enabling the floater to adjust the space to their own comfort level. Other features for my convenience were:

* In-tank light switch with external control and dimmer
* In-tank audio volume control so that I could adjust the music
* In- tank alarm or call bottom in the case of an emergency

Maree explained all these features, reassuring me that I was at all times safe and in control of the environment I wanted to create.

For example, for my own comfort I decided to orientate myself with the door partially open for the first 3-5 minutes. Initially, I did not feel comfortable to cacoon myself entirely from the outside word. However, as I adapted to my new environment I decided to block out external light and airflow, becoming aware that it was interrupting my feeling of oneness with the water.

As the water is set at the same temperature as the skin, I experienced a sense of comfort as my body temperature and the water temperature in the float tank was both the same. The air circulating in the Apollo maintains this accuracy in temperature through the use of electronic sensors and a purpose built heating system, that runs across the entire surface of the bath, which is digitally controlled and programmed. By closing the door I was now able to relax and float on this bed of silky fluid which felt like an extension of me. Once I identified the beauty of this sensation I let go of my analytical thinking, relaxed and enjoyed the benefits. Instead of experiencing a gravitational pull, I felt that the water was actually pushing against my body giving it a gentle, comforting support, particularly in my neck, back and hips - areas where I carry the most tension. Progressively, all the aches and pains gave in to the gentle caress of the water and I found myself floating into shear bliss.

And what about the sounds? I found that having the music turned very, very low was more relaxing than having it booming around the tank at medium volume. Being in control of your own orientation process is very important because, believe me, it is a very different experience to anything else you have ever had. To gain the maximum you need to allow yourself to truly yield to the water, and this requires letting go of your reservations and putting your trust in the therapy of this unique experience.

Research Data
Scientists estimate that the effects of environmental stimulation cause 90% of the brain’s normal workload. At every given moment our nervous system and sensory organs are kept active, responding to things such as light, sound, touch gravity and temperature. Adding to this, the stresses of modern life contributes to an overload of sensory stimulation. Letting go of all this sensory stimulation in a float tank brings the body to such tranquillity and relaxation that you can actually hear your own heart beat.

The benefits of this experience transcend from physical to psychological. Floating re-sets the body's chemical and metabolic balance, strengthening resistance to the negative impact of stress, illness or injury alleviating the affects of a number of diseases from arthritis, blood pressure problems, to hormonal imbalance. Through the deep sense of relaxation which the body experiences, muscle tension is relieved, while blood pressure and heart rate drop considerably. Oxygen and nutrients are transported to the cells while harmful chemicals are released. Endorphins, the body's natural pain killers are stimulated giving a sensation of intense well being while improving memory and learning.

This environment also has a phenomenal affect on our emotions. Your powers of emotional control can improve reducing compulsive behaviour leading to overeating, smoking or excessive alcohol consumption. Scientist tell us that floating helps balance and synchronise the left and right hemispheres of the brain, enhancing the activity of theta brain waves which are responsible for learning, inspiration and creativity.

The beginning of a new good habit
My first session was only 30 minutes. How did I feel? I can honestly say I can't remember when I felt more relaxed, yet at the same time energised, as if I had woken up from a good night's sleep but without any sense of drowsiness. My shoes were suddenly very loose, as all swelling had left my feet and body. In fact, physiologically, I felt as if some positive adjustments had happened in my bones, muscles and organs and I felt very, very cleansed and revived. My mind gained a certain degree of clarity and I was suddenly aware of being overcome by a real sense of cheerfulness and joy to be alive and wanting more of life. I now know why some people become so passionate and 'addicted' to floating, enjoying hourly sessions every week. I am convinced more good stuff awaits me on my next visit and I have no doubt that this is the beginning of a good habit. But, don't take my word for it, try it for yourself, you have nothing to loose and everything to gain.

- Article submitted by Tina Viney

Spa Technology

Spa Technology and TreatmentsFloat
Floating your way to Health and Relaxation

A first floater’s experience!
Several years ago I first heard about flotation tanks and the benefits they offer in achieving phenomenal heights of relaxation and well being. Yet whenever I asked anyone what it was like all I got was vague responses such as, "it's like being in your mother's womb", "it's out of this world - it really helps you tap into your creativity," "I get my best ideas and solve my problems when I float". "It's awesome, almost a spiritual experience". "Absolutely blissful. I feel so relaxed and revived."

All this sounded great, but it didn't really tell me what to expect, it only told me how they felt from the experience. Then I heard that the PHOENICIAN SPA RETREAT on the Gold Coast were offering Float Tank 'treatments' as part of their rejuvenation and relaxation packages so I decided it was finally time that I experienced a flotation for myself. For all of you first-time floaters who have the same curiosity as me for details, here is my experience.

After showering, Maree Keenan, the owner of the Phoenician escorted my to the Float Room where I was introduced to Apollo - apparently the latest in Australian Float Tank design and technology. I was surprised to see that Apollo had the appearance of a sports car or Star Trek capsule with a 'cockpit-styled' door. Very modern and slick, in fact it reminded me of a joy ride experience I had at Disneyland in California.

Maree explained to me that it was impossible to sink as the salts contained in the tank created such buoyancy that floating would not only be effortless, but the only thing I could do. Furthermore, the float is relatively shallow so there is no danger even if I could sink. "And what about hygiene?" I asked Maree. I was assured that the very high mineral salt content keeps the water sterile. This combined with a filtration system used after each user, ensures maximum hygiene standards which comply with FDA requirements.

"What about claustrophobia or getting trapped in the tank?" "The good looks of the Apollo are not only cosmetic" Maree assured me. "Every little detailed has been thought of throughout the design process for maximum comfort for the client."

The sliding door is very light and easy to operate with the minimum of effort enabling the floater to adjust the space to their own comfort level. Other features for my convenience were:

* In-tank light switch with external control and dimmer
* In-tank audio volume control so that I could adjust the music
* In- tank alarm or call bottom in the case of an emergency

Maree explained all these features, reassuring me that I was at all times safe and in control of the environment I wanted to create.

For example, for my own comfort I decided to orientate myself with the door partially open for the first 3-5 minutes. Initially, I did not feel comfortable to cacoon myself entirely from the outside word. However, as I adapted to my new environment I decided to block out external light and airflow, becoming aware that it was interrupting my feeling of oneness with the water.

As the water is set at the same temperature as the skin, I experienced a sense of comfort as my body temperature and the water temperature in the float tank was both the same. The air circulating in the Apollo maintains this accuracy in temperature through the use of electronic sensors and a purpose built heating system, that runs across the entire surface of the bath, which is digitally controlled and programmed. By closing the door I was now able to relax and float on this bed of silky fluid which felt like an extension of me. Once I identified the beauty of this sensation I let go of my analytical thinking, relaxed and enjoyed the benefits. Instead of experiencing a gravitational pull, I felt that the water was actually pushing against my body giving it a gentle, comforting support, particularly in my neck, back and hips - areas where I carry the most tension. Progressively, all the aches and pains gave in to the gentle caress of the water and I found myself floating into shear bliss.

And what about the sounds? I found that having the music turned very, very low was more relaxing than having it booming around the tank at medium volume. Being in control of your own orientation process is very important because, believe me, it is a very different experience to anything else you have ever had. To gain the maximum you need to allow yourself to truly yield to the water, and this requires letting go of your reservations and putting your trust in the therapy of this unique experience.

Research Data
Scientists estimate that the effects of environmental stimulation cause 90% of the brain’s normal workload. At every given moment our nervous system and sensory organs are kept active, responding to things such as light, sound, touch gravity and temperature. Adding to this, the stresses of modern life contributes to an overload of sensory stimulation. Letting go of all this sensory stimulation in a float tank brings the body to such tranquillity and relaxation that you can actually hear your own heart beat.

The benefits of this experience transcend from physical to psychological. Floating re-sets the body's chemical and metabolic balance, strengthening resistance to the negative impact of stress, illness or injury alleviating the affects of a number of diseases from arthritis, blood pressure problems, to hormonal imbalance. Through the deep sense of relaxation which the body experiences, muscle tension is relieved, while blood pressure and heart rate drop considerably. Oxygen and nutrients are transported to the cells while harmful chemicals are released. Endorphins, the body's natural pain killers are stimulated giving a sensation of intense well being while improving memory and learning.

This environment also has a phenomenal affect on our emotions. Your powers of emotional control can improve reducing compulsive behaviour leading to overeating, smoking or excessive alcohol consumption. Scientist tell us that floating helps balance and synchronise the left and right hemispheres of the brain, enhancing the activity of theta brain waves which are responsible for learning, inspiration and creativity.

The beginning of a new good habit
My first session was only 30 minutes. How did I feel? I can honestly say I can't remember when I felt more relaxed, yet at the same time energised, as if I had woken up from a good night's sleep but without any sense of drowsiness. My shoes were suddenly very loose, as all swelling had left my feet and body. In fact, physiologically, I felt as if some positive adjustments had happened in my bones, muscles and organs and I felt very, very cleansed and revived. My mind gained a certain degree of clarity and I was suddenly aware of being overcome by a real sense of cheerfulness and joy to be alive and wanting more of life. I now know why some people become so passionate and 'addicted' to floating, enjoying hourly sessions every week. I am convinced more good stuff awaits me on my next visit and I have no doubt that this is the beginning of a good habit. But, don't take my word for it, try it for yourself, you have nothing to loose and everything to gain.

- Article submitted by Tina Viney

Gejala Stroke

Rasa Kantuk sebagai Gejala Dini Serangan Stroke
Berhati-hatilah apabila Anda mengalami rasa kantuk berlebihan setiap hari. Sebab, bisa jadi itu gejala awal stroke. BERDASARKAN hasil penelitian ilmuwan Amerika Serikat (AS), rasa kantuk yang berlebihan setiap hari merupakan tanda awal serangan stroke. Dalam penelitian yang dipimpin Dr Bernadette Boden-Albala, asisten profesor bidang neurologi pada Universitas Columbia, New York, AS, orang yang sering mengantuk berisiko mengalami stroke dua hingga empat kali lebih tinggi.
’’Kami sangat terkejut ketika mengetahui efek dari mengantuk itu terjadi pada periode waktu yang tidak terlalu lama. Namun, pertanyaan sesungguhnya adalah apa yang harus kita lakukan pada tubuh kita?”ujarnya. Berbicara di depan Konferensi Stroke Internasional, para peneliti menyarankan kepada para dokter untuk lebih sering memeriksa pasien yang usianya sudah uzur, apakah mereka mudah tertidur ketika menonton TV atau tidak. Sebab, risiko stroke terhadap orang yang sudah lanjut usia jauh lebih tinggi.
Kesimpulan Dr Boden-Albala berdasarkan penelitian terhadap sekitar 2.000 responden yang sering mengantuk dan tertidur dalam berbagai situasi. Dalam riset itu, mereka juga meneliti orang yang tertidur ketika menonton televisi, duduk, saat berbicara bersama, duduk terdiam setelah makan siang tanpa mengonsumsi alkohol, dan tiba-tiba berhenti mengemudi saat berkendaraan. Setelah dua tahun, pada orang yang beberapa kali suka mengantuk dalam sehari, risiko terkena stroke itu 2,6 kali lebih besar.
Sementara itu, orang yang mengantuk secara sangat berlebihan risiko terkena stroke meningkat menjadi 4,5 kali lebih besar.Penelitian itu juga menemukan bahwa risiko serangan jantung atau kematian akibat penyakit kardiovaskular ikut meningkat akibat mengantuk setiap hari. Dr Boden-Albala menambahkan, penelitiannya itu menunjukkan bahwa orang yang kurang tidur mudah kelelahan sepanjang hari. ’’Hasil penelitian ini akan sangat membantu memberikan pengertian kepada pasien terhadap masalah tidur dan efek dalam jangka panjang,” tuturnya.
Pada penelitian sebelumnya menunjukkan bahwa orang yang menderita apnoea (yaitu tiba-tiba berhenti napas sejenak saat tidur) memiliki risiko tinggi terkena stroke. Bisa jadi, rasa mengantuk pada siang hari akibat dari kurangnya kualitas tidur malam itu juga terkait apnoea. Dr Heinrich Audebert, dokter konsultan stroke di Rumah Sakit St Thomas dan Guys di London, menemukan bahwa temuan hasil penelitian Dr Boden- Albala dan kawan- kawannya sangat beralasan. ’’Apnoea adalah faktor risiko stroke yang sering ditemui pada negaranegara di kawasan Mediterania,” ungkapnya.
Dia menjelaskan, pasien yang mengalami apnoea meningkatkan level tekanan darahnya sepanjang malam.Salah satu penyebab potensial dari hasil penelitian ini bisa jadi tidak terdiagnosis sebelumnya karena kerusakan jaringan otak.Kerusakan itulah yang mengakibatkan rasa kantuk selama seharian. ’’Untuk itu, kami menyarankan kepada para pasien yang sulit tidur malam menjalani skrining apnoea,” ujarnya. Hal itu sangat penting. Sebab, berdasarkan laporan terakhir, setiap tahun ada sekitar 150.000 orang di Inggris yang mengidap stroke.

Kamera Beresolusi Tinggi dan Berlayar Lebar

MELENGKAPI rangkaian kamera digital seri EXILIM, Casio Electronics meluncurkan sebuah kamera digital EXILIM Zoom EX-Z75 dengan berbagai peningkatan kemampuan dan fitur baru.

Anggota terbaru dari keluarga EXILIM ini didukung dengan resolusi sebesar 7,2 megapixel. Ditilik dari bentuk, sekilas tampilan EXILIM Zoom EX-Z75 mengingatkan pada seri pendahulunya, yakni EX-Z70. Seperti desain yang elegan dan bentuk ramping dengan dimensi 95,4 x 60,6 x 19,6 mm. Kelebihan EXILIM Zoom EXZ75 dibandingkan dengan seri terdahulunya tersebut adalah dukungan layar liquid crystal display (LCD) berukuran 2,6 inci beresolusi 114.960 pixel.

Perlu diketahui, layar pada EXILIM Zoom EX-270 hanya berukuran 2,5 inci. Selain tampilannya yang sederhana dan bergaya, kamera digital dengan bobot 122 gram ini dilengkapi resolusi sebesar 7,2 megapixel dan tiga kali pembesaran optik. EXILIM Zoom EX-Z75 ditanamkan lensa dengan panjang 38–114 mm (35 mm equiv) untuk menghasilkan foto yang berkualitas dari jarak jauh.

Sementara untuk jarak fokus, pengguna dapat menggunakan setting auto focus (AF) dengan jarak 40 cm hingga tidak terbatas, kemudian setting macrodengan jarak 10–50 cm, dan yang terakhir setting manual dengan jarak 10 cm hingga tidak terbatas. Ada tujuh pilihan resolusi untuk hasil foto,mulai dari 3.072 x 2.304 pixel hingga 640 x 480 pixel sehingga pengguna dapat menghemat kapasitas memori.

Seperti halnya kamera digital lain,EXILIM Zoom EX-Z75 juga dilengkapi dengan fitur movie clip.Untuk fitur ini,pengguna dapat memilih tiga resolusi,yakni 640 x 480 pixel,512 x 384 pixel,dan 320 x 240 pixel. Hasil dari foto dan movie clip tersebut dapat disimpan dengan format JPEG Exif v2.2,DCF,DPOF,Motion JPEG,dan AVI. Kamera digital buatan Casio ini dapat menampilkan informasi di sisi kanan layar yang terpisah dari subjek pada layar ketika merekam objek.

Tampilan informasi ini membantu pengguna mengubah setting melalui tampilan informasi ketika merekam objek. Informasi tersebut salah satunya adalah menu Easy Mode yang digunakan untuk menyederhanakan setting kamera seperti flash, self-timer, dan ukuran gambar menjadi satu kesatuan dan ditampilkan pada sisi kanan monitor.Hal tersebut bertujuan untuk membantu pengguna mengoperasikan kamera dengan lebih mudah. Untuk fitur self-timer sendiri, pengguna EXILIM Zoom EX-Z75 dapat men-set waktu 10 atau dua detik, bahkan triple (tiga kali) self-timer.

Selain itu, EXILIM Zoom EX-Z75 juga dilengkapi dengan fitur standar seperti Auto Flash, On, Off, Soft Flash, dan Red Eye Reduction. Keunggulan lain dari EXILIM Zoom EX-Z75 adalah penambahan fitur Anti-Shake digital signal processors (DSP). Fungsi fitur ini untuk mengurangi gambar kabur yang diakibatkan tangan fotografer yang bergetar atau objek yang bergerak. Kamera digital yang dikategorikan ke dalam jenis kamera compact ini baru tersedia di pasar pada Maret dengan harga ritel sekitar USD229,99. Pengguna dapat memilih EXILIM Zoom EX-Z75 dengan pilihan warna-warni cerah seperti merah muda,biru,hingga warna elegan hitam dan perak. EXILIM Zoom EX-Z75 menggunakan baterai jenis Lithium-ion yang dapat di-charge ulang. Baterai ini sudah termasuk satu paket dengan kamera digital. Selain baterai, kamera digital terbaru dari Casio ini juga dilengkapi kapasitas memori built-in sebesar 8 MB dan tambahan slot kartu memori yang kompatibel dengan berbagai jenis kartu memori, seperti SDHC, SD, MMC, dan MMC.

techno

Google Bantu Pembangunan Kabel Bawah Laut
RAKSASA internet Google Inc bekerja sama dengan lima operator telekomunikasi untuk membangun jaringan kabel bawah laut baru yang menghubungkan langsung Jepang dan AS.

Jaringan baru itu dibangun untuk mengantisipasi lonjakan lalu lintas internet Trans-Pasifik. Perusahaan telekomunikasi yang tergabung dalam konsorsium bernama Unity tersebut adalah Bharti Airtel, Global Transit, KDDI Corp, Pacnet, dan Singapore Telecommunications (SingTel). Pembangunan jaringan baru itu membutuhkan kabel serat optik sepanjang sekitar 10.000 km.

Adapun investasi yang ditanam keenam perusahaan mencapai USD300 juta. Jaringan itu diperkirakan siap digunakan pada kuartal pertama 2010. ”Sistem kabel Unity memungkinkan para anggota konsorsium menyediakan kapasitas lebih tinggi karena akan semakin banyak aplikasi dan layanan disajikan secara online,” tutur juru bicara Unity Jayne Stowell.

Kamera Beresolusi Tinggi dan Berlayar Lebar

MELENGKAPI rangkaian kamera digital seri EXILIM, Casio Electronics meluncurkan sebuah kamera digital EXILIM Zoom EX-Z75 dengan berbagai peningkatan kemampuan dan fitur baru.

Anggota terbaru dari keluarga EXILIM ini didukung dengan resolusi sebesar 7,2 megapixel. Ditilik dari bentuk, sekilas tampilan EXILIM Zoom EX-Z75 mengingatkan pada seri pendahulunya, yakni EX-Z70. Seperti desain yang elegan dan bentuk ramping dengan dimensi 95,4 x 60,6 x 19,6 mm. Kelebihan EXILIM Zoom EXZ75 dibandingkan dengan seri terdahulunya tersebut adalah dukungan layar liquid crystal display (LCD) berukuran 2,6 inci beresolusi 114.960 pixel.

Perlu diketahui, layar pada EXILIM Zoom EX-270 hanya berukuran 2,5 inci. Selain tampilannya yang sederhana dan bergaya, kamera digital dengan bobot 122 gram ini dilengkapi resolusi sebesar 7,2 megapixel dan tiga kali pembesaran optik. EXILIM Zoom EX-Z75 ditanamkan lensa dengan panjang 38–114 mm (35 mm equiv) untuk menghasilkan foto yang berkualitas dari jarak jauh.

Sementara untuk jarak fokus, pengguna dapat menggunakan setting auto focus (AF) dengan jarak 40 cm hingga tidak terbatas, kemudian setting macrodengan jarak 10–50 cm, dan yang terakhir setting manual dengan jarak 10 cm hingga tidak terbatas. Ada tujuh pilihan resolusi untuk hasil foto,mulai dari 3.072 x 2.304 pixel hingga 640 x 480 pixel sehingga pengguna dapat menghemat kapasitas memori.

Seperti halnya kamera digital lain,EXILIM Zoom EX-Z75 juga dilengkapi dengan fitur movie clip.Untuk fitur ini,pengguna dapat memilih tiga resolusi,yakni 640 x 480 pixel,512 x 384 pixel,dan 320 x 240 pixel. Hasil dari foto dan movie clip tersebut dapat disimpan dengan format JPEG Exif v2.2,DCF,DPOF,Motion JPEG,dan AVI. Kamera digital buatan Casio ini dapat menampilkan informasi di sisi kanan layar yang terpisah dari subjek pada layar ketika merekam objek.

Tampilan informasi ini membantu pengguna mengubah setting melalui tampilan informasi ketika merekam objek. Informasi tersebut salah satunya adalah menu Easy Mode yang digunakan untuk menyederhanakan setting kamera seperti flash, self-timer, dan ukuran gambar menjadi satu kesatuan dan ditampilkan pada sisi kanan monitor.Hal tersebut bertujuan untuk membantu pengguna mengoperasikan kamera dengan lebih mudah. Untuk fitur self-timer sendiri, pengguna EXILIM Zoom EX-Z75 dapat men-set waktu 10 atau dua detik, bahkan triple (tiga kali) self-timer.

Selain itu, EXILIM Zoom EX-Z75 juga dilengkapi dengan fitur standar seperti Auto Flash, On, Off, Soft Flash, dan Red Eye Reduction. Keunggulan lain dari EXILIM Zoom EX-Z75 adalah penambahan fitur Anti-Shake digital signal processors (DSP). Fungsi fitur ini untuk mengurangi gambar kabur yang diakibatkan tangan fotografer yang bergetar atau objek yang bergerak. Kamera digital yang dikategorikan ke dalam jenis kamera compact ini baru tersedia di pasar pada Maret dengan harga ritel sekitar USD229,99. Pengguna dapat memilih EXILIM Zoom EX-Z75 dengan pilihan warna-warni cerah seperti merah muda,biru,hingga warna elegan hitam dan perak. EXILIM Zoom EX-Z75 menggunakan baterai jenis Lithium-ion yang dapat di-charge ulang. Baterai ini sudah termasuk satu paket dengan kamera digital. Selain baterai, kamera digital terbaru dari Casio ini juga dilengkapi kapasitas memori built-in sebesar 8 MB dan tambahan slot kartu memori yang kompatibel dengan berbagai jenis kartu memori, seperti SDHC, SD, MMC, dan MMC.(maya sofia)

Tampil Memikat dengan MakeUpTepat

Tampil Memikat dengan MakeUpTepat

TAK hanya menutupi wajah yang sedang letih,make upnyatanya juga dapat “mendongkrak”penampilan dari nothing menjadi something.
Tak salah kiranya kalau banyak kalangan yang mengatakan “make up is my soul”.Pasalnya, banyak kaum hawa yang tak percaya diri jikalau harus keluar tanpa pulasan make up sedikit pun.Mereka percaya dengan menggunakan make up dapat membuat penampilan lebih baik dan sempurna.
Karenanya, make up dianggap sang “dewa penyelamat” untuk mengubah penampilan secara instan. Namun,bila tak pandai memilih alat kosmetik, justru akan menjadi bumerang.Untuk itu,Anda harus pandai memilih produk make up yang pas dan sesuai.
Harus disesuaikan dengan jenis dan warna kulit, kepribadian,kepentingan,dan tentunya anggaran.Semua elemen ini merupakan hal yang memengaruhi dalam pemilihan produk kosmetik.
Pada dasarnya kulit merupakan faktor yang paling penting dalam memilih produk kecantikan.Jika kulit cenderung berminyak, membeli kosmetik untuk kulit kering maupun sebaliknya sama saja dengan “bunuh diri”.
Tak kalah penting, faktor warna kulit juga turut memengaruhi. Warna apa pun yang akan dipakai, sejatinya akan memberikan kesan natural pada warna kulit, mata dan rambut si empunya. “Warnawarna tanah, orange, marun, dan warna kuning lemon merupakan warna yang sedang banyak digandrungi sekarang untuk riasan make up,” tutur make up artist,Andiyanto.
Namun, jangan lantas bereksperimen apabila warnawarna tersebut malahan akan menghancurkan penampilan. Pastikan terlebih dahulu pantas dan tidaknya. Alih-alih ingin memperoleh tampilan sempurna malahan mendapat petaka. Agaknya agar tak salah langkah,harus mempelajari riasan seperti apa yang cocok untuk warna kulit.
Secara umum,warna pada riasan wajah dibagi menjadi dua,yaitu bluishyangmemberi kesan dingin dan gold yang akan memberi kesan hangat. Tipe warna kulit yang cocok dengan riasan bluish adalah orang yang mempunyai kecenderungan kulit berwarna kebiruan, lembayung muda, pink,kemerahan,dan abu-abu.
Sebaliknya make up gold sangat cocok diaplikasikan pada kulit yang berwarna kuning,beige,orange, cokelat, hingga kehijauan. Namun, tak kalah penting, busana juga memberikan pengaruh kuat terhadap riasan apa yang cocok untuk dipakai.
“Industri mode sangat memengaruhi riasan wajah sehingga pakaian menjadi hal yang turut bersinergi dengan make up,” kata Andiyanto. Andiyanto menambahkan, produk kecantikan sekarang ini lebih mengutamakan dan memperhatikan kesehatan kulit. Karena itu, rias wajah yang ringan cenderung natural banyak dipilih dan menjadi favorit. (sita ap)

Tampil Memikat dengan MakeUpTepat

Tampil Memikat dengan MakeUpTepat

TAK hanya menutupi wajah yang sedang letih,make upnyatanya juga dapat “mendongkrak”penampilan dari nothing menjadi something.
Tak salah kiranya kalau banyak kalangan yang mengatakan “make up is my soul”.Pasalnya, banyak kaum hawa yang tak percaya diri jikalau harus keluar tanpa pulasan make up sedikit pun.Mereka percaya dengan menggunakan make up dapat membuat penampilan lebih baik dan sempurna.
Karenanya, make up dianggap sang “dewa penyelamat” untuk mengubah penampilan secara instan. Namun,bila tak pandai memilih alat kosmetik, justru akan menjadi bumerang.Untuk itu,Anda harus pandai memilih produk make up yang pas dan sesuai.
Harus disesuaikan dengan jenis dan warna kulit, kepribadian,kepentingan,dan tentunya anggaran.Semua elemen ini merupakan hal yang memengaruhi dalam pemilihan produk kosmetik.
Pada dasarnya kulit merupakan faktor yang paling penting dalam memilih produk kecantikan.Jika kulit cenderung berminyak, membeli kosmetik untuk kulit kering maupun sebaliknya sama saja dengan “bunuh diri”.
Tak kalah penting, faktor warna kulit juga turut memengaruhi. Warna apa pun yang akan dipakai, sejatinya akan memberikan kesan natural pada warna kulit, mata dan rambut si empunya. “Warnawarna tanah, orange, marun, dan warna kuning lemon merupakan warna yang sedang banyak digandrungi sekarang untuk riasan make up,” tutur make up artist,Andiyanto.
Namun, jangan lantas bereksperimen apabila warnawarna tersebut malahan akan menghancurkan penampilan. Pastikan terlebih dahulu pantas dan tidaknya. Alih-alih ingin memperoleh tampilan sempurna malahan mendapat petaka. Agaknya agar tak salah langkah,harus mempelajari riasan seperti apa yang cocok untuk warna kulit.
Secara umum,warna pada riasan wajah dibagi menjadi dua,yaitu bluishyangmemberi kesan dingin dan gold yang akan memberi kesan hangat. Tipe warna kulit yang cocok dengan riasan bluish adalah orang yang mempunyai kecenderungan kulit berwarna kebiruan, lembayung muda, pink,kemerahan,dan abu-abu.
Sebaliknya make up gold sangat cocok diaplikasikan pada kulit yang berwarna kuning,beige,orange, cokelat, hingga kehijauan. Namun, tak kalah penting, busana juga memberikan pengaruh kuat terhadap riasan apa yang cocok untuk dipakai.
“Industri mode sangat memengaruhi riasan wajah sehingga pakaian menjadi hal yang turut bersinergi dengan make up,” kata Andiyanto. Andiyanto menambahkan, produk kecantikan sekarang ini lebih mengutamakan dan memperhatikan kesehatan kulit. Karena itu, rias wajah yang ringan cenderung natural banyak dipilih dan menjadi favorit. (sita ap)

Tampil Memikat dengan MakeUpTepat

Tampil Memikat dengan MakeUpTepat

TAK hanya menutupi wajah yang sedang letih,make upnyatanya juga dapat “mendongkrak”penampilan dari nothing menjadi something.
Tak salah kiranya kalau banyak kalangan yang mengatakan “make up is my soul”.Pasalnya, banyak kaum hawa yang tak percaya diri jikalau harus keluar tanpa pulasan make up sedikit pun.Mereka percaya dengan menggunakan make up dapat membuat penampilan lebih baik dan sempurna.
Karenanya, make up dianggap sang “dewa penyelamat” untuk mengubah penampilan secara instan. Namun,bila tak pandai memilih alat kosmetik, justru akan menjadi bumerang.Untuk itu,Anda harus pandai memilih produk make up yang pas dan sesuai.
Harus disesuaikan dengan jenis dan warna kulit, kepribadian,kepentingan,dan tentunya anggaran.Semua elemen ini merupakan hal yang memengaruhi dalam pemilihan produk kosmetik.
Pada dasarnya kulit merupakan faktor yang paling penting dalam memilih produk kecantikan.Jika kulit cenderung berminyak, membeli kosmetik untuk kulit kering maupun sebaliknya sama saja dengan “bunuh diri”.
Tak kalah penting, faktor warna kulit juga turut memengaruhi. Warna apa pun yang akan dipakai, sejatinya akan memberikan kesan natural pada warna kulit, mata dan rambut si empunya. “Warnawarna tanah, orange, marun, dan warna kuning lemon merupakan warna yang sedang banyak digandrungi sekarang untuk riasan make up,” tutur make up artist,Andiyanto.
Namun, jangan lantas bereksperimen apabila warnawarna tersebut malahan akan menghancurkan penampilan. Pastikan terlebih dahulu pantas dan tidaknya. Alih-alih ingin memperoleh tampilan sempurna malahan mendapat petaka. Agaknya agar tak salah langkah,harus mempelajari riasan seperti apa yang cocok untuk warna kulit.
Secara umum,warna pada riasan wajah dibagi menjadi dua,yaitu bluishyangmemberi kesan dingin dan gold yang akan memberi kesan hangat. Tipe warna kulit yang cocok dengan riasan bluish adalah orang yang mempunyai kecenderungan kulit berwarna kebiruan, lembayung muda, pink,kemerahan,dan abu-abu.
Sebaliknya make up gold sangat cocok diaplikasikan pada kulit yang berwarna kuning,beige,orange, cokelat, hingga kehijauan. Namun, tak kalah penting, busana juga memberikan pengaruh kuat terhadap riasan apa yang cocok untuk dipakai.
“Industri mode sangat memengaruhi riasan wajah sehingga pakaian menjadi hal yang turut bersinergi dengan make up,” kata Andiyanto. Andiyanto menambahkan, produk kecantikan sekarang ini lebih mengutamakan dan memperhatikan kesehatan kulit. Karena itu, rias wajah yang ringan cenderung natural banyak dipilih dan menjadi favorit. (sita ap)

Natural Relaxation

Natural Relaxation, Health and Wellbeing Information Resource
Tranquil Sounds is the natural relaxation, health and wellbeing information resource centre.
There's lots of things happening at the moment. Go to the News page for some more information.
Check out this new series of articles about the bi-polar condition. Madeleine Kelly is the author of the prizewinning book Bipolar and the Art of Roller-coaster Riding (Two Trees Media ISBN 0-646-44939-7).

* How To Find A Bipolar-Resistant Job And Bipolar-Proof It!
* Seven Tips to Rescue Christmas from Bipolar Disorder!
* Bipolar: How to beat unfair mental health funding!
* Bipolar: Run For Your Life From The Mental Illness Ghetto

Angel Fingers is a wonderful massage tool that nurtures your mind, body and spirit. Re-energize your life with this simple, copper healing tool!

Tonya Zavasta, food lifestyle expert and author of the books Beautiful On Raw: UnCooked Creations and Your Right to Be Beautiful: How to Halt the Train of Aging and Meet the Most Beautiful You was named a 2004 Health Book of the Year Award finalist by ForeWord Magazine.

Read her great features:

* Divine Food For Divine Beauty
* How to Halt the Train of Aging
* Rawsome Beauty: Luck of the Draw or Within Reach of All
* Nature Always Right, Cooks Never
* Health Is Internal Beauty

Visit Tonya at http://www.beautifulonraw.com.

Three new articles:

* The Truth About Omega 3
* The Bach Flower Remedy Story
* Chemicals used in cosmetics and personal care products

This three part article on Depression is easy to understand and very informative:

* Depression - A Misused Word and Misunderstood Concept - Part One
* Depression - A Misused Word and Misunderstood Concept - Part Two
* Depression - A Misused Word and Misunderstood Concept - Part Three

There is a great story on Transformation Through Belly Dancing by author and belly dancing instructor Helen Patrice.

Go to our three great new articles on Stress and Stress Management

Our aim is to bring you the finest relaxation, health and wellbeing resources available anywhere, including:

* Free information and reports on relaxation, health and wellbeing
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Thailand

Thailand

Lokasi
Negeri seluas 510.000 kilometer ini kira-kira seukuran dengan Perancis. Di sebelah barat dan utara, Thailand berbatasan dengan Myanmar, di timur laut dengan Laos, di timur dengan Kamboja, sedangkan di selatan dengan Malaysia (Peta).

Secara geografis, Thailand terbagi enam: perbukitan di utara di mana gajah-gajah bekerja di hutan dan udara musim dinginnya cukup baik untuk tanaman seperti strawberry dan peach; plateau luas di timur laut berbatasan dengan Sungai Mekong; dataran tengah yang sangat subur; daerah pantai di timur dengan resor-resor musim panas di atas hamparan pasir putih; pegunungan dan lembah di barat; serta daerah selatan yang sangat cantik.

Waktu
Jam di Thailand sama persis dengan Indonesia (GMT +7).

Iklim
Thailand memiliki iklim tropis yang ramah, dengan musim semi dari Maret sampai Mei, musim hujan - namun tetap banyak matahari - di Juni sampai September, dan musim dingin dari Oktober sampai Februari. Rata-rata suhu tahunan adalah 28 derajat C.

Sejarah
Kebudayaan Masa Perunggu diduga dimulai sejak 5600 tahun yang lalu di Thailand (Siam). Kemudian, datang berbagai imigran antara lain suku bangsa Mon, Khmer dan Thai. Salah satu kerajaan besar yang berpusat di Palembang, Sriwijaya, pernah berkuasa sampai ke negeri ini, dan banyak peninggalannya yang masih ada di Thailand. Bahkan, seni kerajinan di Palembang dengan Thailand banyak yang mirip.

Di awal tahun 1200, bangsa Thai mendirikan kerajaan kecil di Lanna, Phayao dan Sukhotai. Pada 1238, berdirilah kerajaan Thai yang merdeka penuh di Sukhothai ('Fajar Kebahagiaan'). Di tahun 1300, Sukhothai dikuasai oleh kerajaan Ayutthaya, sampai akhirnya direbut oleh Burma di tahun 1767. Jatuhnya Ayutthaya merupakan pukulan besar bagi bangsa Thai, namun tak lama kemudian Raja Taksin berhasil mengusir Burma dan mendirikan ibukotanya di Thon Buri. Di tahun 1782 Raja pertama dari Dinasti Chakri yang berkuasa sampai hari ini mendirikan ibukota baru di Bangkok.

Raja Mongkut (Rama IV) dan putranya, Raja Chulalongkorn (Rama V), sangat dihormati karena berhasil menyelamatkan Thailand dari penjajahan barat. Saat ini, Thailand merupakan negara monarki konstitusional, dan kini dipimpin oleh YM Raja Bhumibol Adulyadej.

Agama
Buddha Theravada adalah agama yang dianut lebih dari 90% penduduk Thai yang religius. Thailand juga sangat mendukung kebebasan beragama, dan terdapat umat Muslim, Kristen, Hindu dan Sikh yang bebas menganut agamanya di Thailand. Untuk alamat tempat ibadat, klik di sini.

Bahasa
Meskipun bahasa Thai hampir tak dapat dimengerti oleh wisatawan, namun bahasa Inggris dipahami luas di tempat-tempat utama seperti Bangkok, dan juga menjadi bahasa bisnis resmi di sana. Nama-nama jalan menggunakan bahasa Inggris di bawah bahasa Thai.

Satu keunikan yang kami temukan adalah adanya kemiripan dengan bahasa Indonesia yang berasal dari Sansekerta, seperti 'putra', 'putri', 'suami', 'istri', 'singa', 'anggur', dan sebagainya. Selain itu, biro penerjemahan juga banyak tersedia, baik untuk bahasa Thai, Inggris, dan Indonesia.

Formalitas
Warganegara Indonesia dengan tujuan liburan bebas visa selama 30 hari ke Thailand.

Keuangan
Mata uang Thailand adalah Baht, yang pada saat website ini dibuat setara dengan Rp 270. Bank-bank dan tempat penukaran mata uang banyak tersedia di Thailand. Hotel, toko dan restoran utama menerima kartu kredit internasional seperti Visa, Master Card, American Express dan Diners.

Transportasi
Bandara internasional Bangkok adalah Don Muang, yang terhubung dengan berbagai penerbangan dari seluruh penjuru dunia. Anda juga bisa melanjutkan perjalanan ke seluruh dunia melalui Don Muang. Selain itu, juga terdapat bandara internasional di Phuket, Hat Yai, dan Chiang Mai di utara Thailand.

Kereta api tersedia dari Singapura dan Kuala Lumpur. Di laut, banyak kapal berlayar menuju Thailand, misalnya cruise ship Star Virgo yang singgah di Phuket.

Transportasi di Bangkok

Transportasi umum di Bangkok antara lain BTS Skytrain, kereta bawah tanah, bis, taksi dan tuk-tuk. Anda harus menawar dahulu harganya sebelum naik Tuk-tuk ini.

Di sungai Chao Phraya, juga banyak terdapat taksi sungai atau perahu. Terdapat pula yang khusus untuk wisatawan, dilengkapi pemandu yang berbahasa Inggris.

PERINGATAN: Jika ada pengemudi taksi atau Tuk Tuk yang mengajak Anda ke suatu tempat tertentu, jangan mau. Tolaklah tegas (katakan "No, thanks"), kalau perlu ganti kendaraan. Untuk keadaan darurat, hubungi Tourist Police Center, Unicohouse Building, Soi Lang Suan, Phloen Chit Rd. Bangkok (Tel 6521721-6),

Citarasa Thailand

Citarasa Thailand
Untuk rekomendasi Restoran dalam WORD, klik di sini
Untuk Info resto Halal dan Kursus Memasak dalam WORD, klik di sini
Hidangan Kelas Dunia
Citarasa hidangan Thailand sangat istimewa, dengan penggunaan bumbu dan rempah yang banyak, dan menggabungkan seni kuliner dari China dan India, serta melahirkan karakternya yang tersendiri.
Beberapa hidangan yang boleh Anda cicipi antara lain Kai Ho Bai Toei (ayam bungkus daun), Thotman Plakrai atau Thotman Kung (ikan atau udang goreng ala Thai), berbagai jenis Yum (selada Thai), dan aneka jenis Tomyan (sup asam manis) yang terkenal itu. Jangan lupa akhiri dengan kue-kue mungil dan lezat alat Thai.
Santap Malam dengan Pertunjukan
Beberapa restoran menyediakan pertunjukan kesenian, misalnya Baan Thai, Piman Thai Theatre dan Season yang terletak di jalan Sukhumvit, atau Royal Dragon, restoran terbesar di dunia menurut Guiness Book of Records yang terletak di Bangna.
Santap Malam dengan Berlayar di Chao Phraya
Sungai Chao Phraya memberikan pemandangan yang menakjubkan saat Anda bersantap malam romantis bersama kekasih hati. Umumnya, setiap hotel di tepi sungai ini menyediakan acara santap malam ini, atau coba hubungi Loy Nava, Yok Yor Marina, Riverside, dan Supatra River House.
Santap Malam Super Trendi
Bangkok kini bisa membanggakan diri dengan restoran dan Hip Bar kelas dunia. Saat restoran Sirocco/The Dome membuka atap State Tower, seluruh Bangkok terpana. Vertigo di puncak Banyan Tree Hotel juga tak kalah menggetarkan. Klub Mystique menawarkan tiga tingkat suasana dewasa, sedangkan Bed Supper Club menjadi fenomena baru di Asia. Semua tempat ini sangat tepat untuk membuat kagum relasi bisnis, ataupun kekasih hati!
Sekolah Memasak
Anda sudah datang di jantung kuliner Asia, mengapa tidak mempelajari rahasianya sekalian? Beberapa tempat yang menyediakan kursus memasak antara lain Thai Cooking School di Oriental Hotel, Royal Dragon, UFM Food Centre, Landmark Hotel, dan Institute of Culinary Art. Satu sekolah yang juga terkenal sampai ke mancanegara adalah Blue Elephant Cooking School. Kursus ini diadakan mulai dari setengah hari sampai lima hari kursus profesional dari sang juru masak. Miss World 2005 juga belajar rahasia memasak di Blue Elephant ini.
Jelajahi sendiri keistimewaan citarasa Thailand
Hampir semua ruas jalan di Bangkok dipenuhi penjaja makanan yang lezat. Sukhumvit 38, Khao San, dan Pratunam boleh Anda jelajahi. Cicipi Som Tum (selada pepaya pedas), mie Thai, Khao Tom Pla (sup nasi ikan), Tom Yum Talay (sup hidangan laut), atau Khao Man Gai (nasi ayam).
Ingin masakan China? Chinatown, tentunya! Cobalah Kwei Touw Kao Kai (kwetiau ayam), Bau Loy Nga Dam (manisan dalam sup jahe), atau kunjungi Saphan Luang area, terus ke Silom. Semua hidangan jalan ini buka sampai larut malam.
Selain makanan oriental, Thailand juga menyediakan berbagai hidangan kelas satu dunia lainnya, baik hidangan Muslim, Perancis, Italia, Jepang, Skandinavia, India, Burma, Vietnam, Jerma, Korea, Irlandia, Mexico, Arab, maupun makanan vegetarian.
Informasi mengenai Restoran yang khusus Halal: klik di sini
Jika Anda sedang beruntung, Anda tiba saat musim Raja & Ratu Buah: Durian dan Mangga Bangkok. Pesan langsung ketan Durian atau ketan Mangganya!

Mantra Restaurant & Bar

Mantra Restaurant & Bar
Seven Open Kitchens
Japanese, Indian, Chinese, Western, Mediterranean, Charcoal Grill and Seafood

Preparing unique cuisine, chefs take centre stage in a well-orchestrated display of their craft.
Enjoy a pre-dinner or post-work drink, before settling in to enjoy a fabulous culinary journey,
through various mouthwatering Asian and Mediterranean cuisines.

Chic Interiors & Special Corners
With its awe-inspiring architecture and eclectic and unique décor, the restaurant boasts 180 seats on two levels and dramatic towering treasure walls create focal points with an artfully placed eclectic collection of artifacts. What’s your pleasure? Reserve your spot in the Hedonist Harlem, Opium Den, the Sultan’s Table, Opera Seats or Main Theatre.

Walk-in Wine Cellar
A walk-in glass wine cellar allows you to select from an impressive list of over 160 branded wines from all over the world, including bottles of rare Bordeaux.

Dress Code
Mantra is chic, smart and stylish – and that’s how we like our patrons to dress. Gentleman – no shorts, tanktops or sandals please. The Mantra Team reserves the right to refuse entry.

Opium Den

Chinese Bench Seating

Bisul

Bisul karena Pasta Gigi?
MULUT dan gigi mutlak bersih dan segar.Selain menjadikannya sehat dan kuat, penampilan pun semakin pede. Menggosok gigi teratur merupakan kebiasaan yang harus dijalani untuk menjaga kebersihan gigi.

Para dokter gigi menyarankan melakukannya minimal dua kali sehari, sesudah sarapan pagi dan sebelum tidur malam. Salah satu syarat gosok gigi efektif,tentu dengan menggunakan pasta gigi. Namun, tidak sembarang pasta gigi dapat dipakai. Di pasaran banyak ditemukan pasta gigi beragam merek,mulai produksi dalam negeri maupun impor.

Ternyata, sebagian besar merek pasta gigi yang ada menggunakan deterjen dalam formula mereka. Kandungan deterjen inilah yang menghasilkan efek banyak busa. Beberapa hasil penelitian yang dilakukan para ahli menemukan, pemakaian deterjen lebih banyak memiliki efek negatif.

Penelitian yang dilakukan Bente Brokstad Herlofson dan Barkvoll dari Department of Oral Surgery and Oral Medicine,Dental Faculty,University of Oslo, Norwegia, membandingkan efek penggunaan pasta gigi dengan deterjen dan bebas deterjen.

Tujuan penelitian klinis tersebut untuk meneliti efek dari jenis pasta gigi yang menggunakan deterjen dengan kandungan sodium lauryl sulfate( SLS) dan cocoamidopropylbetaine (CAPB) dibandingkan dengan pasta gigi bebas deterjen pada 30 pasien yang mengalami recurrent aphthous mouth ulcers(RAU) atau luka seperti bisul yang terus-menerus.

Penelitian tersebut selama enam minggu. Pada periode terebut, pasien diminta untuk menggosok gigi dua kali sehari dengan dua jenis pasta gigi berbeda.Dari hasil penelitian tersebut dapat dinilai lokasi dan jumlah dari luka bisul yang terlihat. Frekuensi yang lebih tinggi secara signifikan dari penampakan luka pada mulut ditunjukkan ketika pasien menggosok gigi dengan pasta gigi yang mengandung sodium sulfate lauryl sulfate (SLS), dibandingkan dengan pasta gigi yang mengandung cocoamidopropyl betaine (CAPB) atau pasta gigi bebas deterjen.

Penelitian tersebut mengungkapkan bahwa efek dari SDS yang membuat lapisan musin dalam mulut tidak berfungsi secara alami yaitu dengan membuka lapisan dasar epitelium, ternyata me- mengaruhi timbulnya peningkatan RAU. ”Pasta gigi yang bebas kandungan SLS bisa direkomendasikan dengan pasien yang mengalami luka bisul di mulut secara terusmenerus,” kata Herlofson.

Penelitian lainnya mengenai efek dari SLS dilakukan oleh Chahine L, Sempson N, dan Wagoner C dalam laporan bertajuk “The effect of sodium lauryl sulfate on recurrent aphthous ulcers: a clinical study”. Berkurangnya angka dari kemunculan RAU secara statistik diobservasi selama 2 bulan.

Mereka mengamati penggunaan pasta gigi yang bebas SLS dan pasta gigi dengan kandungan SLS.“Hasil penelitian ini mendukung penelitian independen sebelumnya yang menyarankan penggunaan pasta gigi tanpa SLS untuk orang-orang yang mengalami RAU,” tegas Chachine dalam laporannya. Drg MD Vela Momang dari PT Enzym Bioteknologi Internusa mengungkapkan, sebenarnya penggunaan deterjen pada pasta gigi dimulai ketika penggunaan batu apung dan fluoride sebagai bahan pasta gigi tidak saling mengikat.

”Salah satu versi menyebutkan, awalnya menyikat gigi dimulai dari para bangsawan Mesir dengan menggunakan sejenis rumput-rumputan,” kata Vela. Penelitian tersebut kemudian berkembang dengan penggunaan serbuk batu apung.Lalu pada saat Perang Dunia I di Prancis ditemukan masyarakat suatu desa yang giginya bagus.

“Ternyata, air yangmerekagunakanmengandung fluor.Disatukanlahpemakaian serbuk batu apung dan fluor,”papar Vela. Namun,kedua bahan tersebut ternyata tidak bisa berfungsi secara optimal.Kemudian, mulailah digunakan bahan deterjen dan fluoride. Fungsi deterjenuntukmengangkatlemak, sementara itu fungsi fluorideuntuk memperkuat gigi.

”Ternyata dari penggunaan deterjen, ada efek samping yaitu berupa perubahan indra perasa. Bisa dibuktikan, jika seseorang menggosok gigi dengan pasta gigi yang mengandung deterjen kemudian makan atau minum, rasanya akan berubah. Meskipun hanya sementara,” sebutnya. (ririn sjafriani)

The New Clairvoyance

The New Clairvoyance
Clairvoyance is often associated with gypsies, crystal balls, tarot cards and the like, but these are only remnants of a type of clairvoyance which existed many thousands of years ago when humanity was still in direct contact with the heavens. Today, we are no longer in contact with the heavens; in most cases, we are not even aware that the spiritual worlds exist, so these remnants of the “old” clairvoyance have little value for the modern world. The clairvoyance spoken of in this book has nothing to do with the lower psychic levels, fortune-telling, trances or other unconscious states. The clairvoyance spoken of in this book is new. The word “clairvoyance” literally means “seeing clearly” and the term “new clairvoyance” describes a new kind of perception that is opening up in humanity. In the beginning, it will be involuntary. It will come with a flash of memory here and there. With training and the right motivation, it can be developed into a spiritual gift which will be of much blessing to the person and to those around them.

The Emergence of my Clairvoyant Abilities
My own experience has taught me that such a consciousness is born out of a longing to perceive the spirit behind the physical appearance of things. All my life I have had a strong love for the Christ and I have longed to see him, know him, and understand him. A natural consequence of this love for Christ is a love for people also, for one can see the Christ reflected in people everywhere. To love is to grow more perceptive; the person who loves another is always gazing at that person and trying to perceive the other’s needs. Therefore from love comes greater sensitivity. Love is the, perhaps unexpected, source from which clairvoyance flows.
The way in which clairvoyance then grows varies from one person to another. My gift became apparent when I was just over thirty-five years of age. From the spiritual point of view thirty-five is the turning point in a person’s life in one way or another. People either carry on in the pattern they are used to, or they take a decisive step in response to a challenge presented to them. A person is spiritually ready at this stage to express the mission for which they came into the world. In my case I had been prepared for thirty-five years to receive the mission of portraying Christ in terms relevant to the modern age.
The preparation involved long years of training within the Catholic Church where I became acquainted with the Bible and liturgy. I was disciplined in such a way that I learned to direct my mind and apply realistic thinking and observation. Because of this strict training I can now concentrate and get straight to the point. This did not just happen, for one needs to be willing to be trained and willing to put in the effort. Then there was the training of the emotions so that I could control my emotional needs and wants, and lastly there was the learning to associate with people on an ordinary social level.
I am not at liberty to divulge all the details of the unfolding of my clairvoyant perception, but one incident in particular will shed some light on this. After certain spiritual experiences in Europe, I left Holland in 1955 and came to Australia where I trained to become a minister of the Congregational Church in Perth, Western Australia. In Perth I had an experience which enabled me to begin to realise the potential of my clairvoyant abilities.
One night in 1966 I was sitting in front of the fire in the lounge room with my wife and a few friends. Although I was not even consciously meditating I was taken out of my body into a cathedral-like building. In this spiritual atmosphere burning coals were placed on my forehead and stomach which actually left burns on the flesh at these two points. When I came back into the body I could see colours. Nothing was defined, but colours were streaming from all directions towards me.
This continued for days and weeks until I learnt to control my perception of the colours so that it did not interrupt my normal daily routine. Part of learning to work with my clairvoyance was the ability to switch it on and off. If a person cannot do this the eventual result is insanity, because the person does not live in the reality of the flesh. Even though I saw that reality for the human soul lies in the heavens, we are nevertheless in the flesh and have to deal with material things. Therefore we must control our spiritual levels and gifts.
I then set about learning how to understand the meaning of each colour so that I could interpret its symbolic language. I studied colour symbolism and also carefully observed the subtle colours which spirit revealed to me. I began using my gift for friends and those I encountered who were in need of help. Very gradually I was able to associate a colour in a person’s aura with a particular past life, so that I could tell from a colour the century and life experience which had contributed to the building of that colour in the auric field. From an experiential knowledge of colour there came the reading of the records of the soul in certain incarnations. This process, which commenced in 1966, was not complete until about 1975, by which time I could use the gifts to the extent that I could do a Spiritual Reading in the form described here.

The Clairvoyant’s Relationship with Christ
I cannot talk about my work without also talking about my Lord, for in doing a Spiritual Reading I see the way in which Christ works in a person’s life. Christ is part of the Godhead which set creation into motion. Christ is that divine individuality which entered this earth almost two thousand years ago in the man called Jesus. But, since the incarnation, Christ is also the inner self of humankind. So, Christ is at work cosmically in the universe and he is also at work mystically within each soul. The purpose of world evolution is the growth of the soul into a Christ-like being, and this is what I have always tried to express in my Spiritual Readings. Even though I may never actually say the word “Christ”, my ideal is that I speak as Christ would have spoken to that soul had he been physically present.
When I call myself a clairvoyant, a clear-seeing person, then I stress that this is on a spiritual rather than psychic level because it is only through the spiritual level that the Christ force can pour out from someone. I always see myself as subject to the force of Christ. I do not go to any of the beings in the spiritual hierarchies, be they angels or archangels. I go to Christ, but the exact way in which he comes to me I am unaware of. All I know is that when I speak I speak from a lofty level. This level is acquired, firstly, by compassion for the client and, secondly, through the realisation of my utter dependence on the higher worlds to give me that knowledge. If one opens oneself to the higher forces through the meditation of Christ, negative forces may be near but they cannot take hold. Therefore a constant relationship with Christ is of great importance.
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Beauty and the Beast

Beauty and the Beast, Story Origins
The story of Beauty and the Beast has been around for centuries in both written and oral form, and more recently in film and video. Many experts trace similarities back to the stories of Cupid and Psyche, Oedipus and Apuleius’ The Golden Ass of the second century A.D.

The tale of Beauty and the Beast was first collected in Gianfranceso Straparola’s Le piacevolo notti (The Nights of Straparola) 1550-53. The earliest French version is an ancient Basque tale where the father was a king and the beast a serpent. Charles Perrault popularized the fairy tale with his collection Contes de ma mere l’oye (Tales of Mother Goose) in 1697. The 17th century Pentamerone is also said to include similar tales.

The first truly similar tale to the one we know today was published in 1740 by Madame Gabrielle-Suzanne Barbot de Gallon de Villeneuve as part of a collection of stories La jeune amériquaine, et les contes marins (told by an old woman during a long sea voyage). Mme. de Villeneuve wrote fairy tale romances drawn from earlier literature and folk tales for the entertainment of her salon friends.

Almost half of the Villeneuve story revolves around warring fairies and the lengthy history of the parentage of both Beauty and the Prince. Beauty is one of 12 children, her stepfather is a merchant, her real father being the King of the Happy Isles. The Queen of the Happy Isles is both Beauty’s mother and the Dream Fairy Sister. Villeneuve also made various digs at the many enforced marriages that women had to submit to, and her Beauty ponders that many women are made to marry men far more beastly than her Beast. The story was 362 pages long.

French aristocrat Madame Jeanne-Marie Le Prince de Beaumont (1711 - 1780) emigrated to England in 1745 where she established herself as a tutor and writer of books on education and morals. She took Mme. de Villeneuve’s tale and shortened it, publishing it in 1756 as part of a collection entitled Magasin des enfants. Although taking all the key elements from the Mme. de Villeneuve story, Mme. de Beaumont omits some dream sequences and the fact that in the original the transformation to handsome prince takes place after the wedding night. Intended as a lesson for her students, some of the subversive edges were polished off the story. It is pretty well the version we consider traditional today. Mme. Le Prince de Beaumont’s story was translated into English as The Young Misses Magazine, Containing Dialogues between a Governess and Several Young Ladies of Quality, Her Scholars (1757).

The French tradition of the time was to unfold stories in a more everyday situation, with a tendency to substitute dramatic development founded on human emotions in place of actions based on magic forces. They eliminated whatever was bloody or cruel and relied on a story with direct action and without accessory actions, a style sober and unadorned. French storytellers subjected traditional stories to their own classical, logical, even rational taste. Perrault began this trend away from the traditional folk manner, and the ladies who followed him - Mlle. Lhéritier, Mme. d’Aulnoy and Mme. Le Prince de Beaumont - went even further. The lowliest of people in their tales are gentlemen, shepherds are princes in disguise, and the stories are peopled by the upper levels of the court. These influences over the story explain some of the differences we find between today’s Beauty and the Beast rooted in these French tales and more traditional versions.

Since its initial publishing the story has been revised many times. In 1756 the Comptesse de Genlis produced a play on the theme; in 1786 Mme. de Villeneuve reprinted her story as part of Le Cabinet des Fées et autres contes merveilleux.

The nineteenth century saw a proliferation of retellings in France, England and America. 68 different printed editions are listed in the Index to Fairy Tales. Notable versions include the 1811 poem by Charles Lamb, an 1841 ‘grand, romantic, operatic, melodramatic fairy extravaganza in 2 acts’ by J.R. Planchée which premiered April 12, 1811 at the Covent Garden Theatre with Mme. Vestris as Beauty, Walter Crane’s picture book in 1875, and Eleanor Vere Boyle’s illustrated novella of 1875.

Moving into this century we have been treated to the landmark film of Jean Cocteau (La Belle at la Bete), Walt Disney Studio’s cartoon adaptation and a science fiction Beauty by Tanith Lee. A fuller listing follows later.

The story of Beauty and the Beast appears in many other cultures in different forms. Aarne-Thompson lists 179 tales from different countries with a similar theme to Beauty and the Beast. There are usually three daughters, the youngest being the most kind and pure, her sisters displaying some of the undesirable traits of humankind. Beauty often has no name but is referred to as the youngest daughter. (For purposes of identification I shall use "Beauty" when referring to the heroine of the story.) There never seems to be a mother, thus omitting the possible conflicts a mother would have allowing her daughter to leave to live with a monster and allowing a closer relationship with the father who is, in most cases, wealthy. Although the Beast takes on many guises (serpent, wolf, even pig) he is never appealing in appearance but is rich and powerful. Hidden powers seem to guide the humans. At one point the Beauty is separated from her Beast and at that time some ill befalls him. Beauty’s remorse, sometimes as simple as shedding a tear and sometimes as onerous a penance as going to the end of the earth, saves the Beast and his transformation to handsome man is achieved.

Much psychological hay has been made of the story of Beauty and the Beast; the men are all passive, the older women are less sympathetic, the youngest one pure and virginal and even the desired rose has come in for its share of analysis. To the Greeks and Romans the rose was a symbol of pleasure associated with extravagance and luxuriousness. It is considered the flower of romance that ‘blushes with the warmth of worldly delights.’ Is the father dying in a literal sense or is he dying for the love of his Beauty who is now devoted to the Beast?

As stories swap back and forth, new elements are introduced and exchanged. Folklorists have developed a system for categorizing stories, (e.g. the number 425A has been assigned to tale of the type "The Monster or Animal as Bridegroom"). Whatever the varying versions or systematic cataloging, the basic values that the stories convey are similar. The story and its questions regarding human values run deeper than the simple facts and details of the tale and remain timeless. We all have the potential to be beautiful or beastly; how do we overcome our ‘monsters’?

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Beauty and the Beast, The Madame Le Prince de Beaumont version.The rich merchant not only has three daughters but also three sons who have little to do with the story. All the girls are good looking, particularly the youngest who becomes known as Little Beauty. The sisters are vain and jealous of Beauty who is by contrast modest and charming and wishes to stay with her father.

All of a sudden the family loses its money and is forced into a poorer lifestyle which makes life more difficult all around and exaggerates the differences between Beauty and her sisters. Beauty and the three brothers throw themselves into working for their new life while the sisters are bored. The father takes a trip in the hopes of regaining his wealth, and the older sisters demand he bring them expensive garments. Beauty asks simply for a rose.

The father is unsuccessful in his attempt to regain his wealth and in despair, wandering in the forest, is trapped in a snow storm. He comes upon a seemingly deserted palace where he finds food and shelter for the night. In the morning he wanders into the garden where he sees the perfect rose for Beauty. Upon plucking it, a hideous Beast appears and says that for his thievery he must die. The father begs for his life and, the Beast agrees to let him go if one of his daughters will take his place. If she refuses, then he must return to die himself. The Beast gives him a chest filled with gold and sends him home. This treasure enables the older daughters to make fashionable marriages. On giving Beauty the rose, her father cannot help but tell her what happened. The brothers offer to slay the Beast but the father knows that they would die in the process. Beauty insists on taking her father’s place, and so she returns with him to the Beast’s palace where he reluctantly leaves her.

In a dream Beauty sees a beautiful lady who thanks her for her sacrifice and says that she will not go unrewarded. The Beast treats her well; all her wishes are met by magic. He visits her every evening for supper and gradually Beauty grows to look forwards to these meetings as a break to the monotony of her life. At the end of each visit the Beast asks Beauty to be his wife, which she refuses although agreeing never to leave the palace. Beauty sees in the magic mirror that her father is desperately missing her and asks that she might return to visit him. The Beast assents on the condition that she return in seven days, lest he die.

The next morning she is at home. Her father is overjoyed to see her but the sisters are once again jealous of Beauty, her newly found happiness and material comfort with the Beast. They persuade Beauty to stay longer, which she does, but on the tenth night she dreams of the Beast who is dying. Wishing herself back with him, she is transported back to the castle where she finds the Beast dying of a broken heart. She realizes that she is desperately in love with the Beast and says that she would gladly marry him. At this the Beast is transformed into a prince, the Father joins them at the palace and the sisters are turned into statues until they own up to their own faults.

The Prince and Beauty live happily ever after because their "contentment is founded on goodness."

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Beauty and the Beast, Variations on the theme.
The Scarlet Flower - Russia
The Enchanted Tsarevitch - Russia
The Fairy Serpent -China
The Princess and the Pig - Turkey
A Bunch of Laurel Blooms for a Present - Appalachia
The Small Tooth Dog - England
The Lizard Husband - Indonesia
The Monkey Son-in Law - Japan

Some years before his death, the Russian writer Sergei Aksakov (1791 - 1859) included The Scarlet Flower in his Tales of Pelagea the Housekeeper. Beauty is nameless and the Beast is described thus: "His arms were crooked, his hands were the claws of a wild beast, his legs were those of a horse, he had two large humps like those of a camel in front and behind, and he was covered with hair from head to foot. A boar’s fangs protruded from his mouth, his nose was hooked like the beak of the golden eagle, and his eyes were those of an owl."

Beauty’s time at the castle is luxurious and comfortable, and the Beast is always a gentleman to her. She returns only to visit her sick father but the sisters impede "Beauty’s" return to her Beast by setting the clocks back. Her words "Arise my dearest friend. I love you as I would my betrothed!" are enough to raise the Beast from the dead and transform him into a prince of ample wealth. As a child, he had been stolen by a sorceress who sought revenge on his father by transforming him into a Beast.

Many of the Russian ballets are based on this version of the story.



Also from Russia, The Enchanted Tsarevitch which was included in a collection of folk tales by Aleksander Nikolaevich Afanas’ev between 1855 and 1864. The father does not fall upon hard times but in recompense for picking the exotic flower he agrees to send the Beast the first thing he sees on arriving home, which turns out to be his youngest daughter. The Beast is a three headed, winged snake for whom Beauty eventually feels compassion. Her visit home is extended by her greedy sisters so that on her return the snake is almost dead. Upon kissing him he turns into a "good youth." There are many other Russian folk tales of enchanted men saved by women and of women freed by men such as The Snake Princess and Maria Morevna.



A snake is also the Beast in the Chinese The Fairy Serpent where the father unwittingly steals a few flowers for his daughters. The father is only released when he promises that one of his three daughters will return to marry the serpent. The youngest daughter is the one who eventually is selfless enough to go to the serpent and eventually grows to like him despite his appearance. Leaving for a few hours she returns to find the serpent dying of thirst; plunging him into water to save his life she is amazed at his transformation into a strong and handsome young man. Men also appear in Chinese folklore enchanted as frogs and young women as plants.



In the Turkish The Princess and the Pig, the father is a padishah (king) who manages to find the worldly goods for the elder sisters but fails to find a gift for his youngest daughter, in this case fruit. However, he meets the Beast, a pig, when his carriage is stuck in mud. The pig is the only one able to set him loose, but only after extracting the promise that he be given the padishah’s youngest daughter as his bride. Despite trying to trick the pig into accepting another, he eventually takes away the youngest daughter, who in her goodness accepts the lowly circumstances she is forced into. During her sleep her surroundings are transformed into incredible luxury and the pig into a handsome young man.



A Bunch of Laurel Blooms for a Present, from Appalachia, finds the father the debtor of a witch from whom he has taken some laurel blooms for his youngest daughter. It is he who must stay with the witch, but when the youngest daughter hears this she rushes off to take his place. The witch installs her in a house with a large ugly toad-frog whom she learns to love. One night she awakes to see a handsome young man lying next to her with an old warty toad skin hanging on the bed post. This she takes downstairs and burns in the fire. The next morning the young man is still with her and he thanks her for saving him from the witch’s spell. They live happily ever after and the other sisters are jealous. There are similar versions of this story such as the Irish The Three Daughters of King O’Hara where our heroine is punished for impatience in destroying her Beast’s disguise and has to endure a long search to find him again.



The father in The Small Tooth Dog from England is a merchant who is attacked by thieves and whose life is saved by a dog. In return the dog asks for the merchant’s only daughter. The daughter goes with the dog readily enough, but cannot bring herself to be happy with him. In return for being allowed to visit her home, she eventually is able to call the dog "Sweet-as-a-honeycomb." This statement in front of her father is enough to transform the dog into the most handsome of young men.

This nineteenth century folk tale was collected and published in 1895.



The Beauty in the Indonesian The Lizard Husband has six other sisters who in turn are rude and abusive to the mother of a lizard who requests that they consider her son for marriage. It is the youngest, Kapapitoe, who does take the lizard as a husband, but the other sisters heap abuse upon them both. Eventually the lizard and his wife work together to build their own farm and during the process the lizard transforms himself into a handsome man when bathing in the river. It takes his wife some time to accept this change and the sisters, in jealousy, try to steal him away from her. During the night a castle arises in which Kapapitoe and her husband live happily ever after protected from the sisters.



From Japan comes The Monkey Son-in Law. The father is indebted to the monkey for giving him water for his crops. In return one of his three daughters must go and live with the monkey. The youngest is the one who eventually complies. After a year she tricks the monkey into falling into the river to be carried away. She returns home to a thankful father but two rude sisters who are transformed into rats for their disloyalty to their father.

There are other examples that end tragically where the Beauty forsakes her Beast, e.g. the Lithuanian Egle, Queen of Snakes and the French The Ram.

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Beauty and the Beast, Bibliography

BEAUTY AND THE BEAST, VERSIONS IN PRINT

At best this is a partial listing that is subject to change due to books going in and out of print. Even within similar tellings of the tales you will find artistic interpretations that may change the perception of the story.

Beauty and the Beast retold by Rosemary Harris illustrated by Errol Le Cain - Doubleday

Beauty and the Beast illustrated by Cooper Edens - Green Tiger Press

Beauty and the Beast retold by Deborah Apy illustrated by Michael Hague - Holt & Co.

Beauty and the Beast retold by Mary Pope Osborne illustrated by Winslow Pinney Pels - Scholastic Inc.

Beauty and the Beast retold and illustrated by Warwick Hutton - Atheneum

Beauty and the Beast retold by Marianna Mayer illustrated by Mercer Mayer - Four Winds Press

Beauty and the Beast translated by Richard Howard illustrated by Hilary Knight - Simon and Schuster

Beauty and the Beast retold by Sir Arthur Quiller-Couch illustrated by Edmund Dulac - Gramercy Books

Beauty and the Beast translated from Mme. Le Prince de Beaumont by P.H. Muir, illustrated by Erica Ducornet - Knopf

Beauty and the Beast retold by Nancy Willard with engravings by Barry Moser - Harcourt, Brace, Jovanovich. The classic story retold in a Victorian New York setting.

Beauty and the Beast retold and illustrated by Diane Goode - Bradbury Press.

Sleeping Beauty and Other Favorite Fairy Tales includes the Mme. Le Prince de Beaumont story of Beauty and the Beast translated by Angela Carter - Victor Gollancz/David & Charles.



RELATED STORIES

The Scarlet Flower, Sergei Aksadov translated by Isadora Levin - San Diego: Harcourt, Brace, Jovanovich, 1989. A long 19th century Russian variation on the theme of Beauty and the Beast.

Finist the Falcon, a story by Aleksandr Nikolaevich Afanas’ev (1826 - 1871) included in Russian Folk Tales - Shambhala Publications, Inc./Random House 1980.

Beauty: A Retelling of the Story of Beauty and the Beast by Robin McKinley - Harper and Row.

Snowbear Whittington: An Appalachian Beauty and the Beast. 1994

Beauty. Short science fiction story, part of Red as Blood or Tales from the Sisters Grimmer by Tanith Lee. 1983 - Daw Books



CRITICAL AND ANALYTICAL PUBLICATIONS

Beauties & Beasts by Betsy Hearne - Oryx Press. Highly Recommended. Some historical perspectives on the fairy tale, many different versions of the story from different lands and times. Extensive bibliography.

Beauty and the Beast: Visions and Revisions of an Old Tale by Betsy Hearne - University of Chicago Press.

A Psychiatric study of Myths and Fairy Tales. Their origin, meaning and usefulness. by Julius E. Heuscher - Charles C. Thomas.

The Uses of Enchantment, The Meaning and Importance of Fairy Tales by Bruno Bettelheim - Alfred A. Knopf

The Borzoi Book of French Folk Tales edited by Paul Delarue - Alfred A. Knopf.

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Kontemporer Minimalis Nan Memikat

Kontemporer Minimalis Nan Memikat
SEPERTI sebuah harmoni dalam kehidupan, Ross Carey melantunkan nada-nada indah melalui sentuhan jemarinya. Pianis asal Selandia Baru itu menggelar pertunjukan resital pianonya di Teater Utan Kayu, Jakarta, pada 20 Februari lalu.

Ross mengusung sepuluh karya dalam pertunjukan berdurasi 90 menit itu. Ross menyajikan komposisi yang sangat menyentuh. Dari cerita mengenai kehidupan,cinta,hingga kesendirian di paparkan secara gamblang. Pianis yang mulai belajar piano sejak usia tujuh tahun itu menggeber karya-karya ternama,seperti : Melodrama(Kate Moore,Australia,2007), Love Songs(Garreth Farr,Selandia Baru,2001), Meditaciones (Alfredo Votta Jr, Brazil, 1999), Per Piano Forte (Luca Vanneschi, Italia, 1996), dan Idiot Sorrow (James Rolfe, Kanada,1990).

Tidak ketinggalan pula dua karya dari musisi Indonesia, Svara (Slamet Abdul Sjukur, 1979) dan The River (Michael Asmara, 1986).Menurutnya, set list tersebut merupakan komposisi favorit yang kebetulan diberikan kepadanya. Ross pun tidak membuang kesempatan itu dan memainkannya sebaik mungkin. “ Kebanyakan merupakan komposisi yang diberikan kepada saya,dan saya sangat menyukainya,”tutur Ross. Ross sendiri sebenarnya sudah banyak menciptakan karya. Namun, komposisi tersebut menurutnya kurang tepat untuk dibawakan pada pertunjukan kali ini. Sebab untuk pertunjukan di Jakarta ini, Ross mengusung tema The New Minimalism.

Itu sebabnya dia memilih set list yang dianggapnya pas.“Saya menampilkan komposisi minimalis dari sejumlah komposer dunia,”ungkapnya. Sebagai pembuka,Ross memilih karya komposer Jepang Ayuo, When Illusions looks like Reality, then reality becomes just a fantasy. Ross mengajak penonton memasuki dunia imajinernya yang menuangkan keindahan dalam sebuah labirin panjang.

Baik secara penjiwaan, dinamika lagu, atau pun sentuhan nada-nada manis yang terdapat pada komposisi tersebut, kesan manis berlanjut saat ia memainkan komposisi Love Song, karya Gareth Farr.Ross membawakannya dengan penuh perasaan. Seperti hati yang tengah dilanda melodrama cinta,Ross mengayunkan nada demi nada dengan lembut. Permainan Ross memang cenderung mengolah perasaan. Namun, bukan berarti dia lebih suka mengekspos cerita cinta yang berlebihan.

Dari set list komposisi yang ada, lagu cinta hanyalah bagian kecil dari cerita yang diusungnya. Ross lebih banyak mengutarakan kisah-kisah kehidupan serta suasananya.Seperti komposisi Meditaciones,karya Alfredo Votta Jr, yang disuguhkan dengan penghayatan tinggi. Penonton dibawa ke dalam dunia perenungan yang sangat dalam.Permainannya terasa lambat dan terkadang datar. Namun,di sisi lain terasa begitu ekspresif.

Secara pribadi,Ross mengaku senang dengan komposisi kontemporer yang terasa berat. Namun saat konser, dia sangat berkompromi dengan penonton. Pasalnya, tak semua penonton bisa menyukai komposisi berat yang dimainkannya. Saat tampil di Yogyakarta beberapa waktu lalu, Ross sempat merasakan kesulitan yang dirasakan penonton. Penonton di Yogyakarta ternyata sulit memahami sejumlah komposisi berat yang dimainkannya. “Makanya saya lebih menampilkan komposisi yang familier di kuping orang banyak,”ungkapnya.

Perjalanan musik Ross memang sudah cukup panjang. Sejak 1994, Ross mulai berkarier sebagai pianis profesional. Dia juga menjadi komponis di Selandia Baru, Australia,dan Kanada.Pada 2000,ia menjadi Mozart Fellow di Otago University,Dunedin serta Selandia Baru. Pada 2005, Ross juga sempat menjadi komponis tamu bagi International Society for Contemporary Music (ISCM) di Visby International Centre for Composer,Swedia.Selain instrumen piano, Ross juga tertarik dengan berbagai instrumen tradisional.Tidak heran bila dia juga mempelajari seni musik tradisional Jawa di Yogyakarta.

“Banyak pengalaman yang saya dapat dari perjalanan atau pun konser di berbagai tempat.Tapi yang saya suka adalah bagaimana proses belajar yang saya dapat dari perjalanan tersebut,”tuturnya. Ross memang baru pertama kali menggelar konser di Jakarta. Sebelumnya, Ross sudah beberapa kali tampil di Indonesia,namun itu hanya di Yogyakarta dan Medan.Saat ini,dia tengah mendalami musik klasik Hindustani,dengan perhatian utama pada instrumen harmonium. (juni triyanto)

public health

What is public health?
Contents [show|hide]
Introduction
A bit of history
Interested?
Recommended reading
Introduction

Public health relates to the health of the population, rather than the individual. This more holistic approach involves tracking illness frequency within a population (including infectious disease outbreaks), preventing illness and promoting good health. Much ill health is a direct or indirect result of socioeconomic background and another responsibility of public health is to try to reduce health inequalities.

Because assessments are made for the good of the population, rather than purely the individual, in health services where resources are limited (as in most countries with a publicly-funded service) public health also plays a part in allocating resources and health service structure.

Many different governmental and non-governmental agencies are involved in practising public health in the UK including the National Health Service (NHS), local councils and education authorities, the Prison Service, pharmacies and private businesses, and charities. Because the subject crosses so many different fields, public health is practised by a large number of different professionals from a wide variety of backgrounds, including nursing, medical and dental backgrounds.
A bit of history

One of the earliest notable Public Health practitioners was a physician called John Snow. During a high mortality cholera outbreak in London in the mid-19th century he narrowed down the source of the infection to one particular well; it is worth bearing in mind that this logic went against a lot of the received wisdom of the day concerning disease transmission. Dr Snow famously removed the handle of the well pump - making it inoperable - and therefore managed to control the spread of the disease.
Interested?

Read more about formal training to be a Public Health specialist in the UK, a day in the life of a Public Health trainee, particular topics in Public Health or the latest news, or browse the menu on the left. Need help with any of the jargon? See the Glossary.
Recommended reading

Pencheon D, Guest C, Melzer D, Muir Gray JA (Eds). Oxford Handbook of Public Health Practice, Oxford University Press (2001) - an excellent and concise introduction to a wide variety of Public Health topics

Farmer R, Lawrenson R. Lecture Notes on Epidemiology and Public Health Medicine, Blackwell Science (2004) - a very brief but informative introductory text
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In this section
What is public health?
Glossary

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Day in the life of a public health trainee
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Immunoglobulin A Deficiency

You are in: eMedicine Specialties > Allergy and Immunology > Immunodeficiencies
Immunoglobulin A Deficiency
Article Last Updated: Jul 13, 2006
AUTHOR AND EDITOR INFORMATION
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* Authors and Editors
* Introduction
* Clinical
* Differentials
* Workup
* Treatment
* Medication
* Follow-up
* Miscellaneous
* Multimedia
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Author: Rebecca Bascom, MD, MPH, Professor of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Pennsylvania State College of Medicine, Milton S Hershey Medical Center

Rebecca Bascom is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Physicians, American Industrial Hygiene Association, American Public Health Association, and American Thoracic Society

Coauthor(s): Marina Y Dolina, MD, Staff Physician, Division of Pulmonary, Allergy, and Critical Care Medicine, Milton S Hershey Medical Center, Penn State University; Bettina C Hilman, MD, Consulting Staff, The Asthma and Allergy Center

Editors: Zuhair Ballas, MD, Director, Program Director, Department of Internal Medicine, Division of Allergy-Immunology, Professor, University of Iowa College of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Michael R Simon, MD, MA, Professor, Departments of Pediatrics and Internal Medicine, Department of Allergy and Immunology, Wayne State University School of Medicine; Consulting Staff, Henry Ford Health System; Timothy D Rice, MD, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Associate Professor, Saint Louis University School of Medicine; Michael A Kaliner, MD, Clinical Professor of Medicine, Section of Allergy and Immunology, Washington Hospital Center, George Washington University School of Medicine; Chief, Medical Director, Institute for Asthma and Allergy

Author and Editor Disclosure

Synonyms and related keywords: immunoglobulin A deficiency, IgA deficiency, immunodeficiency, selective IgA deficiency, SIgAD, selective immunoglobulin A deficiency, sIgA, primary antibody deficiencies, primary antibody deficiency, antibody deficiency, IgAD, immunodeficiency disease, sinopulmonary infection, sinus infection, otitis media, stomach cancer, Giardia lamblia, G lamblia, Escherichia coli, E coli, Helicobacter pylori, H pylori, GI cancer, gastrointestinal disease, GI disease, Crohn disease, upper respiratory tract infection, lower respiratory tract infection, chronic diarrhea, transfusion complication, blood product reaction, adverse transfusion reaction
INTRODUCTION
Section 2 of 11 Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic

* Authors and Editors
* Introduction
* Clinical
* Differentials
* Workup
* Treatment
* Medication
* Follow-up
* Miscellaneous
* Multimedia
* References


Background

Selective immunoglobulin A deficiency (SIgAD) is a primary immunodeficiency disease and is the most common of the primary antibody deficiencies (Bonilla, 2005). Total immunoglobulin A deficiency (IgAD) is defined as an undetectable serum immunoglobulin A (IgA) level at a value of 5 mg/dL (0.05 g/L) in humans. Partial IgAD refers to detectable but decreased IgA levels that are more than 2 standard deviations below normal age-adjusted means (Daele, 2000).

IgAD is commonly associated with normal B lymphocytes in peripheral blood, normal CD4+ and CD8+ T cells, and, usually, normal neutrophil and lymphocyte counts. Anti-IgA autoantibodies may be present. Peripheral blood may also be affected by autoimmune cytopenias, eg, autoimmune thrombocytopenia (Spickett, 1991; Longhurst, 2002).

IgA was first identified by Graber and Williams in 1952; ten years later, the first patients with IgAD were described.

IgAD is a complex disorder, and the results of intensive study are beginning to elucidate the genetic loci and molecular pathogenesis of this disorder. Several lines of evidence support a common pathogenesis for IgAD and common variable immunodeficiency (CVID), which is discussed further in Pathophysiology. Family studies show variable inheritance patterns. Familial inheritance of IgAD occurs in approximately 20% of cases (Hammarstrom, 2000), and, within families, IgAD and CVID are associated (Vorechovsky, Am J Hum Genet, 1999; Vorechovsky, J Immunol, 1999).

Associated conditions reported in some IgAD patients include (1) deficits in one or more immunoglobulin G (IgG) subclasses (20-30% of IgA-deficient patients) and (2) a deficient antibody response to pneumococcal immunization. Some patients with IgAD later develop CVID.

Primary IgAD is permanent, and below-normal levels have been noted to remain static and persist after 20 years of observation (Koskinen, 1994).

Environmental factors such as drugs or infections can cause IgAD, but this form is reversible in more than half the cases (see Causes).

Although individuals with IgAD have largely been considered healthy, recent studies indicate a higher rate of symptoms. A 20-year follow-up study that compared 204 healthy blood donors with incidentally identified IgAD to 237 healthy subjects with normal IgA levels demonstrated that 80% of IgAD donors and 50% of control subjects had episodes of infections, drug allergy, or autoimmune or atopic disease. Severe respiratory tract infections occurred in 26% of IgAD subjects, in 24% of subjects with decreased IgA levels, and in 8% of control subjects; however, the incidence of life-threatening infections was not increased. IgAD is more common in adult patients with chronic lung disease than in healthy age-matched control subjects (International Union of Immunological Societies, 1999).

Patients with IgAD are at a high risk of developing severe reactions after receiving blood products (Sazama, 1990; Rogers, 1998; Sanz, 1999). IgA-deficient patients with immunoglobulin E (IgE)–class anti-IgA antibodies are at risk for anaphylaxis if they receive blood or intravenous immunoglobulin. Only intravenous immunoglobulin depleted of IgA should be used in patients with confirmed or probable IgE anti-IgA antibodies. A history devoid of previous blood product administration does not exclude the possibility of anti-IgA antibodies or adverse reactions. Fortunately, appropriate precautions can significantly reduce morbidity (see Treatment).

Pathophysiology

IgA is the second most common immunoglobulin in human serum (after IgG) and is the predominant immunoglobulin found in mucosal secretions.

Structurally, IgA has 2 different forms. Serum IgA is a monomer, and secretory IgA is a dimer; it is this property that makes this unique immunoglobulin resistant to the proteolytic enzymes found in many human secretions.

Secretory IgA antibodies can neutralize viruses, bind toxins, agglutinate bacteria, prevent bacteria from binding to mucosal epithelial cells, and bind to various food antigens, thus preventing their entry into the general circulation. The role of serum IgA is unclear.

IgAD is a primary immunodeficiency disease presumed to result from a failure of terminal differentiation in IgA-positive B cells. Multipotent hematopoietic stem cells give rise to progenitors of T cells, B cells, and natural killer cells.

The development of B-lineage cells begins in the fetal liver. B-lineage cell development then transfers to the bone marrow when it becomes the major hematopoietic organ. Pre–B cells become immature immunoglobulin M (IgM)–positive B cells and then migrate from the bone marrow to lymph node germinal centers. After leaving the bone marrow, the B cells mature and express immunoglobulin D receptors, respond to antigens, and, with the help of T cells (CD4+), undergo proliferation and plasma cell differentiation (International Union of Immunological Societies, 1999).

In germinal centers, antigen is presented by follicular dendritic cells with help from CD4+ T cells and stimulates B cells to proliferate and undergo somatic mutation and immunoglobulin class-switching. B cells that produce high antigen affinity antibodies are selected to develop into plasma cells that produce different immunoglobulin isotypes (ie, IgM, IgG, IgA, or IgE) or become recirculating memory B lymphocytes. These processes are regulated by cell interaction molecules (eg, CD40 on B cells, CD40 ligand on activated T cells), and cytokines (ie, interferon-gamma and interleukin [IL]–2, IL-4, IL-5, IL-6, IL-7, IL-10, IL-12, IL-13, IL-14, and IL-15) and their cell surface receptors (International Union of Immunological Societies, 1999).

Patients with IgAD have a normal number of B cells expressing surface IgA in their blood, but the amount of surface IgA on each B cell is markedly decreased. Based on animal studies, the failure of B cells to terminally differentiate into IgA-secreting plasma cells may be due to the lack of effects caused by cytokines such as IL-4, IL-6, IL-7, or IL-10.

Molecular analysis of B-cell differentiation in a small number of patients with selective or partial IgA deficiency indicated that a decreased expression level of alpha germline transcripts before a class switch might be critical for the pathogenesis of some patients with SIgAD. However, in patients with a partial IgA deficiency, B-cell differentiation might be disturbed after a class switch (Asano, 2004). Missense mutations in one allele of the tumor necrosis factor receptor family member TACI (transmembrane activator and calcium-modulator and cyclophilin ligand interactor) were found in 4 of 19 unrelated individuals with common variable immunodeficiency and in 1 of 16 individuals with SIgAD. The B cells from individuals with the TACI mutations expressed TACI but did not produce IgG and IgA in response to a TACI ligand, a finding thought to reflect impaired isotype switching (Castigli, 2005).

IgAD has been noted to evolve into CVID and is often observed in pedigrees containing individuals with CVID (Buckley, 1992). Evidence for a common pathogenesis of CVID and IgAD include shared susceptibility alleles major histocompatibility complex class III genes (D locus) (Cucca, 1998), a similar spectrum of IgG subclass deficiencies, a gradual decline of immunoglobulin levels in concordant siblings, and the development of CVID in some patients with IgAD.

Previous studies of multiple-case families of patients with IgAD showed a higher prevalence of CVID among close relatives than in the general population. In multiple-case families with dominant transmission of CVID and IgAD, CVID was usually present in parents, followed by IgAD in the descendants. That study indicated the presence of a predisposing locus in the proximal part of the major histocompatibility complex. The recurrence risk was found to depend on the sex of the parents transmitting the defect. Affected mothers were more likely to produce offspring with IgAD than affected fathers (Vorechovsky, Am J Hum Genet, 1999; Vorechovsky, J Immunol, 1999; Vorechovsky, 2000; Vorechovsky, 2001).

IgAD has been reported in patients with constitutional chromosome 18 abnormalities, and a case series of 83 cases of 18p- syndrome showed an increased frequency of IgAD; however, attempts to identify a specific locus on chromosome 18 have not been successful (Vorechovsky, J Immunol, 1999).

Structural lung disease such as chronic obstructive pulmonary disease (COPD) was previously thought not to impair the ability to generate antigen-specific IgA. Studies of acute exacerbations of chronic bronchitis show that new mucosal IgA to surface-exposed epitopes of the infecting Moraxella catarrhalis isolate developed in sputum supernatants after 42% of exacerbations (Bakri, 2002), and significant increases in mycoplasmal-specific IgA occurred in 85% of a group of 34 patients hospitalized for acute exacerbations of COPD. In a prospective study of 250 hospitalizations for acute exacerbations of COPD, the geometric mean serum titer for IgG and IgA against Chlamydia pneumoniae was higher, with 33% meeting criteria for chronic infection (Lieberman, 2001). In another series from India, serum and sputum IgA levels were higher in subjects with COPD than in control subjects (Chauhan, 1990).

Recent studies, however, suggest that the mucosal IgA response is impaired in COPD with deficient transport of IgA across the bronchial epithelium, possibly involving degradation of the Ig receptor involved in transepithelial routing (Pilette, 2004).

Observations that SIgAD is associated with an increased prevalence of atopy suggest a role for IgA in asthma pathogenesis. A protective role of IgA has been seen in murine models of asthma (Pilette, 2004).

Frequency
United States

At a minimum, an estimated 250,000 individuals have IgAD in the United States (Gustafson, 1997). In African Americans, the prevalence of IgAD is 1 case per 6000 persons.
International

* Factors associated with the prevalence of IgAD include a family history of IgAD and the country of origin. Family studies using IgAD blood donors as probands show that first-degree relatives have a 7.5% prevalence rate of IgAD, which is 38-fold higher than that of unrelated donors (Oen, 1982). The serological prevalence of IgAD varies 100-fold among populations. Prevalences, in decreasing order, are as follows:

o Arabian peninsula - One in 142 persons.


o Spain - One in 170 persons


o Eastern Nigeria - One in 255 persons


o Finland - One in 396 persons


o Czech Republic - One in 408 persons


o Basque regions of Spain and France - One in 521 persons


o Iceland - One in 533 persons


o England - One in 875 persons


o Brazil - One in 965 persons


o France - One in 3040 persons


o China (Han) - One in 2600 persons


o China (Zhuang) - One in 5300 persons


o Japan - One in 14,850-18,500 persons


o Sweden - Approximately 20,000 persons affected


o United Kingdom - Approximately 120,000 persons affected (Gustafson, 1997)

Isolated IgAD is present in a minority of cases of transient hypogammaglobulinemia of infancy. Of a series of 40 patients presenting with recurrent responsive infections, otitis media, bronchitis or bronchial asthma, or recurrent gastroenteritis when aged 4-29 months, only 1 had isolated IgAD, 10 had reduced IgG and IgA levels, and 6 had diminished IgA and IgM levels. The majority recovered immunoglobulin levels by age 3 years, but 3 had persistently low IgG and IgA levels.

A study performed by Weber-Mzell et al (2004) on 7293 healthy white volunteers demonstrated an IgAD prevalence of 0.21% (definition of IgAD was level <0.07g/L). The same study showed seasonal fluctuations of serum IgA (SIgA) concentration; levels of SIgA increased in winter.

Mortality/Morbidity

IgAD is more frequent in adult subjects with chronic lung disease than in a healthy, age-matched control subjects (International Union of Immunological Societies, 1999).

The 20-year longitudinal study of healthy blood donors with incidental findings of IgAD used questionnaires and medical record reviews to demonstrate a 3-fold increase in rates of severe childhood respiratory conditions (9% vs 3%), a 4-fold increase in rates of severe adult respiratory conditions (16% vs 4%), a similar increase in recurrent mild respiratory tract infections, and a significant increase in rates of recurrent viral infections (16% vs 1%).

This study also noted a 4-fold increase in the rate of autoimmune conditions (23% in subjects with SIgAD vs 5% in control subjects); a 2.5-fold increase in the rate of abdominal symptoms caused by milk (16% vs 6%); and slight increases in the rates of atopic eczema (8% vs 5%), drug allergy (9% vs 5%), and food hypersensitivity (3% vs 1%). A slight decrease was observed in the rate of allergic rhinitis and/or eczema (11% vs 17%).

In previous reports, most individuals with IgAD (ie, 60-90%) were asymptomatic. A longitudinal design may have been needed to appreciate the cumulative burden of this disorder.

Patients with SIgAD commonly present with anaphylactic transfusion reactions (patients with anti-IgA antibodies) or autoimmune antibodies, autoimmune disorders, or both.

When IgAD is associated with one or more IgG subclass deficiencies or an impaired polysaccharide responsiveness, some individuals with IgAD may develop recurrent sinopulmonary infections, especially in patients with concurrent IgG type 2 subclass deficiency; GI tract infections and disorders in patients with absent secretory IgA; or an increased incidence of cancer. Lack of secretory IgA has been hypothesized to compromise the defense against infection with Helicobacter pylori, which is thought to be a cause of stomach cancer.

The risk for cancer among 562 Danish and Swedish subjects with CVID or IgA was compared with that of 2017 relatives for the period 1958-1996. Among 176 subjects with CVID, the incidence of cancer (all sites) was increased (standardized incidence ratio [SIR], 1.8; 95% confidence interval [CI], 1-2.9). Stomach cancer was increased (SIR, 10.3; 95% CI, 2.1-30.2), and malignant lymphoma was increased (SIR, 12.1; 95% CI, 3.3-31). Among 386 subjects with IgAD, the incidence of cancer (all sites) was not increased (SIR, 1); however, the incidence of stomach cancer was increased, albeit to an insignificant degree (SIR, 5.4; CI, 0.7-19.5) (Mellemkjaer, 2002). The same study did not show an increase in lymphoid malignancies (non-Hodgkin lymphoma, Hodgkin disease) in IgAD subjects, even though some evidence in the literature indicates that the risk of developing a lymphoid malignancy is increased (Cunningham-Rundles, 1993).

Patients with IgAD who have a compensatory increase in secretory monomeric IgM in their upper respiratory tract secretions and GI fluids tend to be less symptomatic. Note that patients with total IgAD are more symptomatic than patients partial IgAD.

A previously unrecognized clear association of SIgAD with recurrent parotitis of childhood (PTC) was demonstrated by Fazekas et al (2005) in an Austrian pediatric clinic population. The prevalence of PTC in IgA-deficient patients (22%) was much higher than in a large population of healthy Austrian volunteers (0.3%; Weber-Mzell, 2004).

* Recurrent sinopulmonary infections are reported. IgAD usually manifests as recurrent otitis (in children), tonsillitis, sinusitis, and bronchitis with extracellular encapsulated bacteria (eg, Haemophilus influenzae, Streptococcus pneumoniae). Severe respiratory tract infections occur more often in adult subjects with IgAD than in normal control subjects, with a cumulative prevalence rate over 20 years of 16% (see Images 1-3).

The substantial risk of developing lung damage, which is often reported in patients with CVID, is not a major threat to individuals who only have SIgAD. Lung function is significantly impaired among patients who have a combination of IgAD and a deficiency of one or more IgG subclasses. A few recently published cases reported the occurrence of hypersensitivity pneumonitis in patients with SIgAD and the authors suggest that SIgAD is a risk factor for a more severe course of the disease and increased susceptibility to develop extrinsic allergic alveolitis. (Yalein, 2003; Sennekamp, 2004)


* Autoimmune disease is reported in approximately 20% of patients with CVID and is associated with IgAD. Autoantibodies are often produced but may be difficult to detect. The sera of individuals with IgAD may contain various autoantibodies that cause no disease or cause myasthenia gravis or thyroid disease. Other selective case reports indicate an association between SIgAD and type 1 diabetes mellitus, vertigo, vitiligo, and alopecia. Rheumatoid arthritis and systemic lupus erythematosus are the diseases most commonly connected with IgAD. In a survey of serum specimens from 60 healthy subjects with SIgAD, 16 of 21 different autoantibody levels were higher in IgAD subjects than in healthy control subjects (Barka, 1995).

The prevalence rate of anti-IgA antibodies among white persons with IgAD is 30-40%. In patients with combined IgA-IgG type 2 deficiency, the rate is 50-60 %.

IgA-deficient patients with anti-IgA antibodies may develop severe anaphylactic reactions when they are transfused with blood components that contain IgA. These autoantibodies are typically of the IgE class; however, IgG class anti-IgA antibodies can also cause anaphylactic-type reactions (Bjorkander, 1987). Although anaphylactic reactions occur in 1 in 20,000-47,000 transfusions, they constitute one of the frequent nonhemolytic causes of transfusion-related mortality.


* GI tract infections and disorders are reported. Patients with SIgAD have a 10-fold increased risk of celiac disease. Milk intolerance is common in patients with primary IgAD. Reports indicate that patients with IgAD may have IgG antibodies against cow milk and ruminant serum proteins. Patients with a high titer of antibodies to cow milk reportedly are more likely to have other autoantibodies (Cunningham-Rundles, 1981).

Other conditions, such as ulcerative colitis, inflammatory bowel disease, Crohn disease, and pernicious anemia, have been described in IgA-deficient individuals. Friman et al (Microb Pathol, 2002) showed that individuals with SIgAD have an increased risk of becoming a carrier of E coli strains that have increased proinflammatory properties, and hypothesize that this may contribute to the development of gastrointestinal disorders in SIgAD patients. Mucosal infections include acute diarrhea caused by viruses, bacteria, or Giardia lamblia parasites. A higher occurrence of serum antibodies to milk antigens in patients with IgAD suggests that normal serum IgA responses protect the host from continuing exposure to environmental antigens.

Race

IgAD occurs in Asian persons at a rate of 1 case per 14,840-18,500 persons, in Arab persons at a rate of 1 case per 142 persons, in white persons at a rate of 1 case per 500-700 persons, and in African American persons at a rate of 1 case per 6000 persons.
Sex

A study of 7293 Austrian volunteers showed a greater frequency of SIgAD in men than in women (0.19% vs 0.014%) and a greater frequency of subnormal serum IgA levels (0.07-0.7 g/L) in men (2.66%) than in women (0.93%; Weber-Mzell, 2004).
Age

This disease can be diagnosed in persons of any age.

Average serum IgA levels increase 0.2 ±0.06 g/L per decade of life (Weber-Mzell, 2004).

* Those older than 6 months who have recurrent upper and lower respiratory tract infections with encapsulated bacteria (eg, H influenzae, S pneumoniae) should be evaluated for IgAD. Patients with humoral deficiencies do not usually present with recurrent infections in the first few months of life because they have circulating immunoglobulins due to placental transfer of maternal immunoglobulins.


* Children and adults present with recurrent sinopulmonary infections or GI infections or diseases. Case reports exist of severe life-threatening infections in patients with SIgAD (Gomez-Carrasco, 1994; Lantz, 2001; Chen, 2002).


CLINICAL
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History

Previous studies based on analysis of blood donor banks have suggested that up to 90% of patients with SIgAD are asymptomatic. However, recent follow-up studies demonstrate that 80% of individuals with IgAD developed symptoms later in their life (Koskinen, 1996). Symptomatic patients have a history significant for recurrent otitis media, sinusitis, bronchitis, pneumonia, GI tract infections, severe allergic reaction following infusions with immunoglobulins or blood transfusions, or, in children, failure to thrive.

* Recurrent sinopulmonary infection is the most common illness associated with IgAD. Most upper and lower respiratory tract infections are caused by bacterial or viral pathogens characteristic of community-acquired pneumonia. Patients with concomitant IgG type 2 subclass deficiency may have a higher risk for recurrent infections from S pneumoniae, H influenzae, M catarrhalis, or Staphylococcus aureus.


* Various GI tract infections with viruses, bacteria, and G lamblia parasites manifest as chronic diarrhea with or without malabsorption. Biopsy specimens may show nodular lymphoid hyperplasia with flattened villi.


* Food allergy and other atopic disorders, such as allergic conjunctivitis, rhinitis, urticaria, atopic dermatitis, and asthma, are common in patients with IgAD.


* Of patients with IgAD, 10-44% have anti-IgA antibodies, and these patients may have severe adverse reactions to IgA-containing materials such as blood, plasma, or immunoglobulin.

Physical

Patients present with various signs of recurrent respiratory tract infections, including swelling, pain, or tenderness upon palpation over the maxillary and frontal sinuses; nasal discharge; fever; nonproductive or productive cough; and dyspnea. GI findings may include abdominal distention, focal tenderness to direct palpation (without rebound), diffuse pain, and increased peristalsis.

Causes

The underlying cause of this disease remains unknown. Familial inheritance has been recognized in 25% of affected individuals, suggesting a strong genetic influence.

* Case reports of some affected families indicate that inheritance may be autosomal dominant or recessive. In other families in which multiple members are affected, the pattern of inheritance does not conform to strict mendelian rules.
*
o In some families, the immunodeficiency can appear to skip generations; in others, one family member may have IgAD, while another may have CVID, suggesting variable expressivity and penetrance of a disease susceptibility gene.

o Recent studies have shown that susceptibility to either CVID or IgAD may be linked to specific alleles of the major histocompatibility complex, suggesting that these alleles, or alleles of closely linked genes with which they are in linkage disequilibrium, are somehow involved in the pathogenesis of CVID and IgAD.

* In his 1991 report of 2 mothers with IgAD, de Laat suggests that transplacental passage of anti-IgA antibodies can also cause IgAD in an infant by inducing excessive IgA-specific T-cell suppressor activity.
*

* Certain drugs may also cause IgAD, but this form usually resolves once the medication is stopped. The following drugs have been implicated:
*
o D-penicillamine

o Sulfasalazine

o Aurothioglucose

o Fenclofenac

o Gold

o Captopril

o Zonisamide

o Phenytoin

o Valproic acid

o Thyroxine

o Chloroquine

o Carbamazepine

o Hydantoin

o Levamisole

o Ibuprofen

o Salicylic acid

o Cyclosporin A

* Infections may cause a transient IgAD. The following have been recognized as causes:
*
o Rubella

o Cytomegaloviruses

o Toxoplasma gondii

o Congenital rubella and Epstein-Barr virus infection - May result in persistent IgAD

* IgAD can follow bone marrow transplantation from an IgA-deficient donor into a histocompatible sibling not previously deficient in IgA.


DIFFERENTIALS
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Combined B-Cell and T-Cell Disorders
Severe Combined Immunodeficiency
Wiskott-Aldrich Syndrome

Other Problems to be Considered

Primary immunodeficiencies include agammaglobulinemia, hypoglobulinemia, selective deficiency of IgG subclasses with or without IgAD, X-linked agammaglobulinemia, autosomal recessive agammaglobulinemia, impaired polysaccharide responsiveness, B-cell disorders, T-cell disorders, combined B- and T-cell disorders, CVID, severe combined variable immunodeficiency, transient hypogammaglobulinemia of infancy, and Wiskott-Aldrich syndrome.

Acquired immunodeficiencies include drug-induced hypogammaglobulinemia (most commonly, long-term therapy with anticonvulsants and steroids), AIDS, and postinfectious hypogammaglobulinemia.

Recurrent sinopulmonary infections include cystic fibrosis, immotile cilia syndrome, endobronchial obstruction, and recurrent aspiration.

WORKUP
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Lab Studies

* IgAD is defined as an undetectable serum IgA level, traditionally measured using the low-level radial immunodiffusion method (lower limit of detection is 50 mg/mL [5 mg/dL]). The lower limit of detection differs depending on the sensitivity of the method used. It is 0.2 g/L for nephelometry, 0.05 g/L (5 mg/dL) for low-level radial immunodiffusion plates, and 0.0016 g/L for hemaglutination inhibition techniques (Booth, 1995).


* Almost all patients with IgAD also exhibit loss of both secretory IgA type 1 and secretory IgA type 2 in their external secretions, but these are not routinely measured.


* Low serum IgA levels in children aged 6 months to 4 years should be confirmed to be persistently low at age 4 years before making a lifetime diagnosis of IgAD. Some children with a low level when aged 6 months to 4 years progress to CVID, whereas others completely normalize.


* Normal serum levels of IgG and IgM are necessary for a diagnosis of SIgAD. Other causes of hypogammaglobulinemia should be excluded (see Differentials). Repeat tests for low IgA serum values in children younger than 5 years. Some children with low levels progress to CVID, but levels can normalize by age 4-5 years.


* The most common mistake clinicians make is when they diagnose IgAD or transient hypogammaglobulinemia of infancy in children using the adult reference range for serum IgA levels.

Imaging Studies

* Perform chest radiography together with CT scans of the sinuses to investigate for structural lesions or chronic disease, and perform CT scans of the chest for a sensitive assessment of possible bronchiectasis.

o

In patients with primary humoral immunodeficiency and chronic productive cough, high-resolution computed tomography (HRCT) is helpful in evaluating the extent of lung damage (Rusconi, 2003).
o In a Mayo Clinic series, 95% of 50 patients with a late onset of adult hypogammaglobulinemia had grossly abnormal findings on sinus films but did not necessarily have symptoms of purulent sinusitis (Hermans, 1976).


o

In Denver, Colo, 28 (98%) of 30 patients had abnormal sinus films (Kohler, 1984).
* Patients who are first diagnosed with immunodeficiency after age 45 years should undergo an imaging study to rule out thymoma.

Other Tests

* Pulmonary function tests may show an obstructive pattern in patients with IgAD and hypogammaglobulinemia.
*

* Jejunal biopsy specimens of patients with IgAD who have chronic diarrhea and malabsorption may show blunting of the villi. IgM-secreting plasma cells are observed in the lamina propria, instead of IgA-secreting plasma cells. Otherwise, lymph node architecture is normal.


TREATMENT
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Medical Care

The approach to treatment includes identification of comorbid conditions, preventive measures to reduce the risk of infection, and prompt and effective treatment of infections.
Surgical Care

Some patients with recurrent sinusitis require surgical interventions to promote drainage.
Consultations

* Rheumatologist
*

* Otolaryngologist
*

* Allergist/immunologist

Diet

Dietary modifications may be necessary to manage chronic diarrhea and malabsorption or food allergy. A gluten-free diet and, possibly, other restricted diets are important for treatment in patients with celiac disease.

MEDICATION
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IgAD has no specific treatment. Replacement therapy is not practical for IgAD because of the short half-life of IgA and the relative paucity of IgA in commercial immunoglobulin preparations.

Antibiotic therapy is the first line of treatment, specific to respiratory or GI tract infection. Associated sinopulmonary infections are treated according to treatment protocols used for community-acquired respiratory tract infections in healthy persons.

Immunization with pneumococcal polysaccharide vaccine is important; however, not all patients are able to mount an immune response. Postvaccination IgG titers can be obtained to confirm the presence of an age-appropriate protective level of antipneumococcal IgG. Patients with CVID may be unable to mount a response to polysaccharide antigens; therefore, pneumococcal vaccination in CVID patients is ineffective.

Use of IV IgG is warranted in patients with CVID. Previously, prophylactic IgG replacement therapy was contraindicated in patients with IgAD because of the risk of a severe systemic adverse reaction or the development of anti-IgA antibodies. Reports now indicate safe and effective prophylactic IgG replacement therapy with SC administration to patients with SIgAD, including those with IgA antibodies (Gustafson, 1997; Sundin, 1998).

Patients with known or possible anti-IgA antibodies are still at high risk of anaphylaxis.

Precautions must be used in the administration of IV immunoglobulin for replacement of IgG subclass deficiency in patients with IgAD because IV immunoglobulin preparations contain small amounts of IgA.

Drug Category: Vaccines, inactivated bacteria

Used to induce active immunity.
Drug Name Pneumococcal vaccine 23-valent (PPV23; Pneumovax 23; Pnu-Imune 23)
Description Contains capsular polysaccharides of 23 pneumococcal types, which comprise 98% of pneumococcal disease isolates. For use in children >2 y and adults at increased risk of pneumococcal disease and its complications because of other underlying health conditions. Also benefits adults >65 y.
Adult Dose 0.5 mL IM/SC
Following bone marrow transplant (use of PCV7 under study): One dose PPV23 at 12 mo and 24 mo following procedure
Pediatric Dose <2 years: Not recommended (see PCV7)
>2 years: Administer as in adults; PPV23 can be given to children >2 y and offers protection not covered with PCV7; can be given to children with newly recognized SIgAD
Serum can be obtained to determine if protective levels are achieved; if IgG pneumococcal antibody levels in the PCV7 remain low after children >2 y are given the PPV23, the authors give an additional PCV7; the authors see some children who have specific IgG pneumococcal antibody deficiency and lose immunologic memory (Sorensen, 1996)
Previously vaccinated with PCV7 vaccine, children >2 years, and adults with sickle cell disease, asplenia, immunocompromise, or HIV infection: 0.5 mL at age 2 y and then 2 mo after last dose of PCV7; revaccination with PPV23 administered 3-5 y after previous dose of PPV23 for children <10 y and, for children >10 y, every 3-5 y; revaccination should not be administered <3 y after previous PPV23 dose
Chronic illness: 0.5 mL in children >2 y and then 2 mo after last dose of PCV7; revaccination with PPV23
Contraindications Documented hypersensitivity to vaccine or any component; active infection, Hodgkin disease, 10 d prior to or during treatment with immunosuppressive drugs or radiation; children <2 y (children <2 y do not respond satisfactorily to capsular types of 23 pneumococcal vaccine); pregnancy (safety of vaccine has not been evaluated; do not administer during pregnancy unless risk of infection is high)
Interactions Effects decrease with immunosuppressive agents (eg, immunosuppressive doses of corticosteroids, antimetabolites, alkylating agents, cytotoxic agents); globulin preparations may interfere with immune response to pneumococcal vaccine and reduce efficacy (do not administer within 3 mo of vaccine)
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Epinephrine injection (1:1000) must be immediately available in case of anaphylaxis; use caution in individuals who have had episodes of pneumococcal infection within preceding 3 y (preexisting pneumococcal antibodies may result in increased reaction to vaccine); may cause relapse in patients with stable idiopathic thrombocytopenia purpura

Drug Name Pneumococcal 7-valent conjugate vaccine (PCV7; Prevnar)
Description Pneumococcal conjugate vaccine approved for infants and toddlers. Contains 7 purified capsular polysaccharides of S pneumoniae serotypes, accounting for 71% of infection among children <24 m, each coupled with a nontoxic variant of diphtheria toxin, CRM 197.
Licensed for use in infants and young children in Feb 2000. Recommended for children aged 2-23 mo and for children aged 24-59 mo who are at increased risk for pneumococcal disease (eg, with sickle cell disease, HIV infection, other immunocompromising or chronic medical conditions). Licensed for infants aged >6 wk.
Adult Dose Not recommended; see PPV23
Pediatric Dose 0.5 mL IM at ages 2, 4, 6, and 12-15 mo
Contraindications Documented hypersensitivity to any component or diphtheria toxoid; severe or moderate febrile illness; infants or children with thrombocytopenia or coagulation disorder contraindicating IM injection (unless benefits outweigh risks)
Interactions Effects may decrease with immunosuppressive agents (immunosuppressive doses of corticosteroids, antimetabolites, alkylating agents, cytotoxic agents); pneumococcal 7-valent conjugate vaccine may increase effects of anticoagulant therapy; globulin preparations may interfere with immune response to pneumococcal vaccine and reduce efficacy (do not administer within 3 mo of vaccine)
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Concurrent administration of PCV7 and PPV23 not recommended because safety and efficacy of concurrent vaccination have not been studied; epinephrine injection (1:1000) must be immediately available in the case of anaphylaxis; caution in individuals who have moderate or severe illness with or without fever, or delay vaccination until child has recovered


FOLLOW-UP
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* Introduction
* Clinical
* Differentials
* Workup
* Treatment
* Medication
* Follow-up
* Miscellaneous
* Multimedia
* References


Deterrence/Prevention

* Primary prevention for IgAD has not been developed. If a medication is under consideration as the cause of the IgAD, it should be discontinued.


* Secondary prevention is vaccination (see Medication). The role of prophylactic antibiotics is controversial because they increase the hazard of infection with fungi or other resistant organisms.


* Tertiary prevention includes (1) prompt antibiotic treatment for respiratory tract infections, (2) microbial identification of diarrheal pathogens, (3) dietary modification for malabsorption syndromes, and (4) screening for anti-IgA antibodies if reactions to blood products occur (not routinely performed).

Complications

* Severe anaphylactic reactions to blood products
*

* Bronchiectasis
*

* Recurrent sinopulmonary infections
*

* Chronic diarrhea
*

* Severe otitis media resulting in hearing loss; case reports of deaths
*

* Malabsorption syndrome
*

* Growth retardation secondary to malabsorption and chronic infection

Prognosis

* In children aged 6 months to 4 years, IgAD may be transient and resolve permanently by age 5 years; in others, the syndrome may progresses to CVID.


* Adults with SIgAD are often asymptomatic; however, up to 90% have frequent bacterial respiratory tract infections.

Patient Education

* Educate patients to recognize early signs of respiratory tract infections, such as increased phlegm, discolored phlegm, cough, or dyspnea.


MISCELLANEOUS
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* Authors and Editors
* Introduction
* Clinical
* Differentials
* Workup
* Treatment
* Medication
* Follow-up
* Miscellaneous
* Multimedia
* References


Medical/Legal Pitfalls

* Advise patients with SIgAD that they have a 10-44% chance of having anti-IgA antibodies. Patients with IgE anti-IgA antibodies are at increased risk of anaphylactic transfusion reactions. They should discuss their condition with their doctor before receiving blood or blood-derived products. Recent recommendations address the identification of an IgA-mediated mechanism for transfusion-associated anaphylaxis and qualification of patients to receive IgA-deficient plasma-containing products (Vassallo, 2004).


* IgAD has no specific treatment, but patients need prompt and vigorous treatment of infections.


* Except in children or if drug-induced IgAD is diagnosed, IgAD is usually permanent.


* While uncommon, drug-induced SIgAD is a possibility; clinicians should review the patient's medication list.


* The inheritance patterns are variable, and clinicians cannot easily predict whether offspring will be affected. In rare cases, inheritance patterns are known for specific families.


* Avoid the diagnosis of SIgAD in children younger than 6 months.


* SIgAD cannot be regarded as asymptomatic; however, it is usually not life-threatening.


* False-positive beta human chorionic gonadotropin (beta-HCG) test results have been reported in patients with IgAD (Knight, 2005). Consider that possibility before recommending medical and surgical procedures for the evaluation of elevated beta-HCG levels.


* Transfusion of apheresis platelets from IgA-deficient donors with anti-IgA is not associated with an increase in transfusion reactions (Winters, 2004).

Special Concerns

* Importantly, patients with total IgAD are at high risk of developing a severe anaphylactic reaction upon receiving IgA-containing blood and blood products. In many cases, these reactions are associated with anti-IgA antibodies; however, they may occur in patients naive to blood products. As a precaution, super-washed normal donor erythrocytes or blood products from other IgA-deficient individuals should be used in these patients. Case reports exist of successfully avoiding transfusion reactions in such patients by using IgA-deficient and washed blood components. One case report described this method in a bone marrow transplant recipient who received IgA-reduced intravenous immunoglobulin.


MULTIMEDIA
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* Authors and Editors
* Introduction
* Clinical
* Differentials
* Workup
* Treatment
* Medication
* Follow-up
* Miscellaneous
* Multimedia
* References


Media file 1: Chest radiograph of a 50-year-old man with immunoglobulin A deficiency and severe bilateral pneumonia. He also had congenital heart disease. Serum immunoglobulin G and immunoglobulin M levels were normal.
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Media type: X-RAY

Media file 2: Lateral chest radiograph of a 50-year-old man with immunoglobulin A deficiency and severe bilateral pneumonia.
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Media type: X-RAY

Media file 3: Portable chest radiograph of a 50-year-old man with acute respiratory distress syndrome as a complication of severe bilateral pneumonia. The patient died from respiratory failure 2 days after this x-ray film was taken.
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Media type: X-RAY


REFERENCES
Section 11 of 11 Click here to go to the previous section in this topic Click here to go to the top of this page

* Authors and Editors
* Introduction
* Clinical
* Differentials
* Workup
* Treatment
* Medication
* Follow-up
* Miscellaneous
* Multimedia
* References


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Immunoglobulin A Deficiency excerpt

Article Last Updated: Jul 13, 2006