Hum. Psychopharmacol Clin Exp 2007; 22: 217–222. Published online 13 April 2007 in Wiley InterScience(www.interscience.wiley.com) DOI: 10.1002/hup.842Metabolic differences between Asian and Caucasian patientson clozapine treatmentMythily Subramaniam1*, Chee Ng2, Siow-Ann Chong1, Rathi Mahendran1, Tim Lambert2,Elaine Pek1 and Chan Yiong Huak31Institute of Mental Health and Woodbridge Hospital,
Shvoong.co.ilThere are many motives driving people to come to Israel, from the purely religious to the awakening of a desire to discover its vast and ancient historical and artistic heritage. But you're reading Finisher, and there can be only one reason for our visit: a Luis Torrente
Eilat is Israel's southernmost city, globally renowned as a favorite destination for lovers of water sports, for its pleasant climate even in winter, being surrounded by the Negev desert and bathed by the crystalline waters of the Red Sea. Nearly 800 triathletes gathered in this corner of the world, mostly locals but also visitors from 16 countries, to compete in the Israman, the only long-distance, Ironman triathlon held in the Middle East. Among the visitors from abroad were three Spaniards: Manuel Cimadevilla, signed up for the Half, and Lennart Cromstedt and Daniele Guernieri both registered for the full Ironman distance. In addition, Lennart's partner, Irache, arrived, and although the race had already begun, she would eventually play a part in the story, too. The race started at 6.15 am, when the sun had scarcely risen above the mountains of neighboring Jordan. The pros came out at various intervals, followed by those registered for the full distance, then those who would tackle half the contest distance, and finally, the relay-style participants: Teams that were judged in each section by a different athlete and who tested the contestants, who were eager to learn and take on the challenge but lacked sufficient experience to compete in all three disciplines. Soon the water was full of flapping arms, ready to traverse the triangular area marked by floats, which the "Ironmen" were to cover in two laps coming out onto the beach at the end of the first, while the "Half's" would cover it in just one. It's quite a pretty calm swim, since there are no strong waves or currents on this beach, and no crowds of swimmers battling for space, and whoever gazed down into the clear water could see masses of colorful fish. However, Lennart, born in Madrid but of Swedish ancestry, is so determined and excited that not only does he not notice the fish, but he starts racing towards the boxes after only one lap, and is just a hundred meters or so from the beach, when a policeman, against a background of shouts from the crowd of spectators, stops him and sends him back to the water. When he does as directed, he almost cuts across the Half's and the relays, who are already crossing over towards T1, where, as they change into cycling apparel, they start to realize something that will prove very important later on: Eilat's proverbial good weather is about to play tricks on them, and the temperature is going to drop way below the anticipated 21 degrees (Eilat has an annual average of 359 days of sun). Those who are less aware mount their bikes with only a pair of shorts and a sleeveless top for protection, and even without any socks. This is a mistake which will cost many dearly, later on. The cycling portion ran from the well-known Highway 12 that ascends from Eilat into the mountains close by, and follows much of the border with Egypt amidst the spectacular Negev Desert scenery. It was largely closed to traffic. Actually, it was not easy to locate the three Spaniards who competed in the Israman. Manuel Cimadevilla is a resident of Madrid, who spent 20 years working at the Hebrew University of Jerusalem and participated in the Half. His connection with the event is via the Israeli Federation and so all his personal details appeared in Hebrew and he was taken for a local throughout the competition. As to the remote Spanish Ironman contingent, consisting of Madrid-born, Lennart Cromstedt Vallina (43 years old) and Daniele Guernieri Ferron (46 years old), their names are somewhat confusing for Spaniards, given that they are of Swedish and Italian descent respectively, even though both reside in Barcelona. However, when we did locate these last two triathletes, we found they had a nice story to tell. They had come together to the Israman: "We knew about the Israman through Finisher, checked it out on the Web and decided to come for several reasons. The first is that we wanted to run somewhere not too far away but exotic, and we thought the Israman seemed a good option. Next, we had hoped to run in Lanzarote and, despite the wintry conditions there, we thought it would be a good opportunity to put our capabilities to the test as well as having time to rest and perfect our preparations, if necessary" . The two are two exact opposites. Daniele is an utterly calm and a true veteran, as this will be his tenth Ironman contest, while for Lennart, totally on edge, this will be his first time because, a year previously, Daniele succeeded in persuading him to "try out at this triathlon". With Daniele's guidance, and the support of the I3 Team and of the Gavá Mar Club, and thanks to their prior track running preparation, Lennart got into good form for the race. Both were known to have worked at Spanair, Daniele as a pilot and Lennart as a flight attendant, so once they decided to come to Israel, they sought help from the company, which decided to sponsor their adventure. From that point onwards and up to the time of the race they adopted an approach of tenacity, sacrifice and training to unbelievable hours, recognized by all who engaged in the triathlon. In the end, the try out finished unevenly for them, but both agreed, "Whether you finish well or badly, you will have lived an extraordinary experience in a unique place, and it will be something you'll remember forever. Now, it's time to rest and enjoy a few days of tourism…" Lennart, moreover, was doubly satisfied not only because he finished very well-placed and ascended the podium, but also his ecstasy continued with an "I do" from Irache at the finish line. However, Daniele, who tends to be more cerebral, commented that "the triathlon is for singles or for people who want to divorce." [Above are Lennart and Daniele just before the start of the Israman. In between,
Manuel Cimadevilla. On the right are Lennart and Irache at the finish line with
their double prize.]
Along the two urban kilometers, and especially the next ten kilometers that included a 700-meter climb up some difficult mountain slopes, the various categories of triathletes progressively merged to discover that the race would be even tougher than they had expected: the Israman finish exactly coincided with the coldest day in decades, and on Highway 12, the temperature dropped below 50, the sky darkens with heavy cloud and, although it does not rain, no sun gets through to warm the cyclists. What is more, the hallmark of the circuit rider, apart from continuous up and down riding and leg-breakers, is a strong, changing wind causing a much lower thermal sensation. Despite the weather conditions, the Israeli Lior Zach Maor sets a demanding pace and commands a solo lead with a huge advantage. His strategy was to gain significant ground, knowing his rivals would close in during the marathon. As to the Spaniards, Lennart is very well positioned, he is a good climber, the contest profile is going really well for him, and he continues to improve his placement although without coupling. As a rider, Dani is more conservative, since he recently underwent Achilles tendon surgery and wants to reserve his strength for the walking contest. So, fighting the wind and cold, the cyclists arrive at Ein Netafin, the point of return for the Halfs, where the first dramatic images become visible: Some athletes get off their bikes and abandon the race, while others continue with contorted facial expressions twisting into a smile when enthusiastic volunteers, as frozen as they are, shout out encouragement to them. From this point on, where the Ironmen continue their journey through the Arava Valley, the true spirit of this contest is revealed. Perhaps there is nowhere else in the world where the landscape is such a true reflection of what it means to run an Ironman's race: Kilometer upon kilometer of sheer solitude in the midst of a desolate desert, both terrible and beautiful, surrounded by mountains that seem to whisper to the triathlete in long-forgotten languages, and he, despite appearances, remains insignificant – just one more of all those who have passed this way throughout history, from prehistoric peoples to Egyptians, Nabataeans, Edomites, Romans, Arabs, Bedouins, Turks or British to Bible characters like Abraham, Solomon or the Queen of Sheba. However, when the overcast sky lets a few rays of sunshine escape, the mountains take on a golden glowing, as if to remind the competitors of what awaits them at the end of that hard road. And toward the end of that road T2 awaits them, where a lot more retired competitors can be seen (at the end of Day 10, some of the triathletes will end up in hospital suffering from severe hypothermia). However, Lennart arrives with in a very good position, right behind Dora Heller, the female leader, although his feet are so cold that, after a few tries, the volunteers have to put his socks on for him. Dani gets so cold that he does not even try to change his clothes, and just changes his shoes to start the marathon. Fortunately, the sun rises timidly, and the first part of the course is clearly downhill, giving some respite and encouragement to the participants arriving from above as they approach the sea and the beach. But such relief is short-lived on the Ironman road, and soon they reach Eilat, where three-quarters of the marathon happens, running at night through streets full of tourists and souvenir shops, where the cold returns to deter the runners on their way to the finishing line. And at last, the finish. Here, finally the Israman race winner can be seen at the finishing line with a running-time of 10:26:36. It is 26 year-old Tom Marmareli, who has managed to cut on foot the enormous advantage gained by Lior Zach Maor on his bike, who comes in four minutes later. Amir Bachar completes the podium with a final time of 11:17:54. Among the women, the result seems to echo what happened in the men's contest: After maintain a lone lead almost all the way, Dora Heller is overtaken in the final kilometers by 40 year-old Irena Mazin, who finishes with a total running-time of 11:45:45, and with an advantage of less than two minutes over Dora. After they crossed the finish line, the very young, 24 year-old Miriam Bar, attains the third tier of the podium. The first Israman, like every serious contest, attracted a limited participation. Only 20 triathletes dared to face the challenge of the desert. In this latest contest, the eighth, nearly 800 athletes presented themselves at the starting line, representing an incredible 83% more than in the last contest, including many women, in spite of it being known as one of the toughest Ironman contests for its participants. This is the result of the determination and passion felt by the Israelites for the sport, and in recent years, for the triathlon. Despite this limitation, the race continues to enjoy a great atmosphere, very intimate, with few crowds and it is difficult to feel like a mere number – even in swimming, you can swim without feeling that you are battling like a gladiator. In addition, the whole contest has taken on a special international role, foreigners are welcomed and assisted, and are impressed by the ease with which almost all Israelis speak at least two languages, and particularly English. Talking to Matthaus Piksa, a German amateur, commented that "coming here, finally, if you calculate the cost and take all the elements into account, it works out almost as cheap for me as to run in Frankfurt, and with the added benefit that I get to see something of the world". Normann Stadler, after participating in the race, commented: "I like what I've seen in this race, the people are very friendly, there's a family feeling, but the organization is very professional. The conditions are similar to Hawaii, hard, with wind, usually hot. but with a better hotel infrastructure " ("Norminnator" dixit). Another feature of the contest, that is very typical of the Israelis, is the passion for technology. This was the first Ironman in which, thanks to a chip, we have been able to track the course of each runner live via the Internet. A system was also implemented enabling you, with certain cameras, to automatically upload to Facebook any photos you take of a runner. Obviously, in any contest there are things that can be improved, but at least here you can feel a genuine desire for improvement whenever you talk to someone in the organization, and they ask what you thought of the contest and what aspects might be improved. This is a very different attitude from that of other organizations, who give the impression of inflexibility, that the event is considered perfect, although the participants themselves are aware that there is no such thing as a perfect race. Moreover, there are some very interesting plans for this contest. In the most recent contest, a major effort was made to make it more spectacular and more attractive to spectators and the general public. A similarly significant effort was made to bring the contest into line with international standards, whether by ensuring that the floats for the swimming were at the right depth or that distances were measured exactly, with a view to entering into one of the major circuits like Ironman or Challenge. There is also an ambitious project to open up the race and extend its route to run through neighboring territories of Jordan and Egypt, thereby facilitating and encouraging the participation of Arab triathletes. and in this place in the world from which we only seem to hear bad news, so that it seems condemned to an eternal spiral of violence and misunderstanding, perhaps a triathlon can make a contribution to reaching a common understanding peace. "You may say I'm a dreamer, but I'm not the only one." The Spanish participants finished with mixed luck: Manuel had already finished his Israman Half (he finished in 27th place overall and 17th in his age group), when Lennart crossed the finishing line, going on not only to finish second in his age-group and 17th place overall, but at the finishing line to ask the hand of the astonishing Irache, who had raced the final meters alongside him. The public was happy, as everyone has known his story, and has been talking about it and following it since the beginning of the contest and waiting its outcome excitedly. Daniel's luck was not so good. He withdrew less than 10 km from the finish. He told us that this was after "suffering for a long time from cold and exhaustion, but looking ahead, I realized that several of my companions had had to be hospitalized, so then I noticed that I had begun to see double and was staggering. I decided it was better not end up like them and to stop despite my proximity to the target. If I had gone a few yards, I would have fallen to the ground. The awards ceremony and final party were held on the beach the next day, where everyone chatted, encouraged by the free beer and splendid sunshine that they had missed the previous day. They shared experiences and took pictures with Normann Stadler, who served as both sponsor and advisor to the contest, and put their names forward for the next contest that has already gained sufficient statue to become a tradition.
Deutscher Bundesverband der akademischen Sprachtherapeuten Vertretung der Sprachheilpädagogen, Klinischen Linguisten, Klinischen Sprechwissenschaftler, Patholinguisten Tabletten gegen Aphasie? „Forschung ist die beste Medizin“ steht in gut lesbaren weißen Lettern auf einem knallroten T-shirt – getragen von einem Betroffenen, der einen Schlaganfall überlebt hat. „Dass ich übe