Think Forward.

GERIATRIE : LA NUTRITION FACE AU VIEILLISSEMENT PHYSIOLOGIQUE DES PERSONNES ÂGÉES - PARTIE 1

«QUAND ON AVANCE EN ÂGE, MIEUX VIVRE C’EST MIEUX SE NOURIR» L’équilibre nutritionnel de la personne âgée (PA) est plus précaire car tributaire de modifications physiologiques et de l’émergence de pathologies. Les personnes âgées ont tendance par ailleurs à diminuer leur apport alimentaire sans que leurs besoins énergétiques ne soient réduits : leurs réserves étant amoindries, tout incident rompt un équilibre déjà précaire et la dénutrition fait son apparition. L'IMPACT DU VIELLISSEMENT PHYSIOLOGIQUE SUR LA NUTRITION Avec l’âge, l’altération des perceptions des odeurs et du goût stimule moins l’appétit : la capacité discriminative s’affaiblit d’où une difficulté à identifier les aliments ; le seuil de détection des 4 saveurs de base augmente (multiplié par 11,6 pour le salé, 7 pour l’amer, 4,3 pour l’acide et 2,7 pour le sucré). Près de 400 médications (anti-inflammatoires, antidiabétiques oraux, inhibiteurs de l’enzyme de conversion…), des carences en zinc ou en vitamine B3, la cirrhose du foie ou la déshydratation perturbent le goût. La malnutrition aggrave ces déficiences, ralentissant ainsi le renouvellement cellulaire indispensable à la régénération des acteurs sensoriels. La perte d’appétit découle aussi d’une sénescence des glandes salivaire. Les aliments n’étant plus correctement imbibés, les molécules porteuses de saveurs appétissantes sont moins actives. De plus, la dégradation dentaire et la prédilection pour des aliments plus liquides diminuent les mouvements masticatoires ce qui va encore réduire cette sécrétion. La sécheresse buccale (xérostomie) est alors fréquente, exacerbée par de nombreux médicaments (diurétiques, benzodiazépines, antihistaminiques…), elle va favoriser les caries dentaires, les mycoses buccales et œsophagiennes, occasionnant des brûlures lors de l’ingestion et, in fine, gênant l’élocution et la déglutition. La muqueuse gastrique, en s’atrophiant, sécrète moins d’acide chlorhydrique, d’où une pullulation bactérienne consommatrice de nutriments (folates) et un retard à l’évacuation gastrique de 2 à 3 fois plus long, qui prolonge la phase d’anorexie post-prandiale. L’accélération plus importante chez la PA du transfert du chyme de la partie supérieure de l’estomac (le fundus) à la partie inférieure (l’antre) avec une distension précoce de cette dernière joue par ailleurs un rôle prépondérant dans le sentiment précoce de satiété. Un peptide, le CCK sérique (cholecystokime -pancreozymine), produit par le duodénum au cours du repas, stimule la sécrétion par le pancréas de la trypsine qui inhibe en retour la sécrétion de CCK. L’insuffisance pancréatique exocrine, liée à l’âge ou aggravée par une dénutrition, lève ce rétrocontrôle, d’où une production accrue de CCK à l’origine elle aussi d’une satiété précoce. La survenue plus fréquente chez la PA d’ulcères et de gastrites chroniques, en liaison avec une incidence plus élevée d’infection par Hélicobacter pylori, renforce encore le risque anorexique. Le vieillissement musculaire et la diminution du capital musculaire (sarcopénie) est un phénomène presque inéluctable qui commence à 40 ans pour l’homme contre 50 ans pour la femme. La perte -de 3 à 8 % tous les dix ans- s’accélère après 60 ans et réduit la musculature à 17% du poids du corps à 70 ans contre 30% à 30 ans. La composition en fibres du muscle se modifie : les fibres de type II, ou fibres blanches, à contraction rapide, mais peu résistantes à la fatigue, s’atrophient ; les fibres de type I ou fibres rouges, à contraction lente, générant peu de force, mais une forte endurance, sont moins affectées et leur densité serait même plus importante. Outre cette réduction de la force musculaire malgré une certaine préservation de l’endurance, le système nerveux contrôle moins bien ces contractions. Plusieurs facteurs génétiques, médicamenteux, nutritionnels ainsi que l’augmentation des cytokines (état inflammatoire provenant de l’accroissement de la masse grasse) conditionnent l’apparition de cette sarcopénie. Les hormones sexuelles joueraient aussi un rôle dans le contrôle de l’appétit au cours du vieillissement. La diminution des taux circulants de testostérone observée au moment de l’andropause induirait la perte d’appétit chez l’homme âgé et précipiterait le développement de la sarcopénie. À l’inverse, la réduction de sécrétion des œstrogènes à la ménopause protégerait les femmes de cette perte. Les répercussions de la sarcopénie sont considérables : risques infectieux par baisse des réserves protéiques nécessaires aux défenses immunitaires, chutes et fractures éventuelles compromettant l’autonomie de la PA… Un moindre volume musculaire expose aussi la PA aux troubles de la thermorégulation, la baisse de l’intensité du frissonnement qui en découle rendant la PA plus démunie face à l’exposition au froid. Dr MOUSSAYER KHADIJA الدكتورة خديجة موسيار Spécialiste en médecine interne et en Gériatrie en libéral à Casablanca. Présidente de l’Alliance Maladies Rares Maroc (AMRM) et de l’association marocaine des maladies auto-immunes et systémiques (AMMAIS), Vice-présidente du Groupe de l’Auto-Immunité Marocain (GEAIM) - REFERENCE MOUSSAYER KHADIJA Doctinews N° 25 Août/Septembre 2010, ACTUALISATION JUIN 2024 - POUR EN SAVOIR PLUS : La plupart des personnes âgees souffrent de maladies chronique le plus souvent d'origine auto-immune Les maladies auto-immunes résultent d’un dysfonctionnement du système immunitaire, censé nous protéger des agressions extérieures, qui va le conduire à s’attaquer à notre propre organisme. Elles constituent un important problème de santé publique du fait de leur poids économique et humain : 3ème cause de morbidité dans le monde après les maladies cardiovasculaires et les cancers, elles touchent en effet près de 10 % de la population mondiale et occupent le deuxième ou le troisième poste du budget de la santé dans beaucoup de pays. Enfin, dernier point méconnu mais pas le moindre, ces maladies concernent les femmes dans plus de 75 % des cas : une femme sur six en est atteinte au cours de sa vie ! Passons donc en revue ce que sont ces pathologies et les actions de l’associations AMMAIS UN PROCESSUS D'AUTODESTRUCTION DE L'ORGANISME Notre système immunitaire est composé notamment de cellules spécialisées comme les lymphocytes et de substances (les anticorps) chargées normalement de nous défendre contre toute attaque extérieure provenant de différents virus, bactéries, champignons et autres produits délétères. Lors d’une maladie auto-immune (MAI) ou à manifestations auto-immunes, des éléments de ce système se trompent d’ennemi et s’en prennent à nos tissus et cellules. Certains anticorps devenus nos adversaires s’appellent alors « auto-anticorps ». Au total, il existe près d’une centaine de ces troubles.
Dr Moussayer khadija

Dr Moussayer khadija

Dr MOUSSAYER KHADIJA الدكتورة خديجة موسيار Spécialiste en médecine interne et en Gériatrie en libéral à Casablanca. Présidente de l’Alliance Maladies Rares Maroc (AMRM) et de l’association marocaine des maladies auto-immunes et systémiques (AMMAIS), Vice-présidente du Groupe de l’Auto-Immunité Marocain (GEAIM)


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Vinicius'Jr. paving stone: moving World Cup form Spain...

The recent statement by Vinicius Jr., Real Madrid's best player, concerning the awarding of the World Cup to Spain continues to provoke strong reactions. He basically said that the 2030 World Cup should be played in another country if things don't improve, and that he is often the victim of racial insults in Spain. ‘I hope that Spain will learn not to insult people because of their skin colour. If things don't change by 2030, the World Cup should move on. ‘If the players don't feel safe from racism, it's hard to play,’ he told CNN in essence. The power of the chosen media is well interwoven with that of the word of one of the best-known players on the planet. He has thus embarrassed the whole Spain, aware of the star power he enjoys and knowing full well that the opinions of top sportsmen and women have an impact and can affect institutions and countries. Has he thought carefully about the possible or probable consequences of his remarks before embarking on such an adventure: the consequences for his club, which is working with FIFA to make the renovated Santiago Bernabeu the venue for the World Cup Final? This statement sounds like a warning that black sportsmen in Spain are fed up, and perhaps even a sign of revenge. Venicius Jr. surely knows that his comments will not be well received by fans of sport and Spanish football in particular, but he is making it clear that in Spain you can be insulted in a racist way in sport as well as in everyday life... It's a real problem for society. Vinicius Jr. took the precaution of qualifying his remarks by not saying explicitly and categorically that Spain was a racist country, but rather ‘a country where you can suffer from racism’. Nevertheless. Everyone understood that he simply meant that Spain is a racist country where players of colour do not necessarily feel very comfortable; otherwise why did he go so far as to ask FIFA, in a barely attenuated manner, to think before awarding the 2030 World Cup to Spain? Spain is in a three-way bid with Morocco and Portugal to host the centenary edition of the World Cup. It won't be long before comments like these create a rift between those who will rise up and reject them out of hand and those who will rally behind Vini... Let's bet there won't be many of the latter. One thing is certain: this will not be without consequences... even for Real Madrid, who will no doubt be thinking about how to calm things down before taking a decision on the player's future with the club... Some people have already gone ahead and dismissed the Brazilian's comments, pointing out that the most adored players in Spain at the moment, and particularly in the Spanish national team, are LAMINE YAMAL AND NICO WILLIAMS, and they are not white... Isn't this a way of discrediting Vinicius Jr. with a touch of irony? Will the Madrid striker's comments have helped to silence insults and unpleasant and inappropriate comments in the stands of football stadiums in the future? Only time will tell. What is certain is that it has sparked a real debate throughout a Spain that breathes nothing but football... It will have made some people ask serious questions about their behavior in tolerating or participating in acts of a racist nature in Spain and beyond. The player's words spread like wildfire across Spain and the world in the space of a few hours, demonstrating the power of the voice of top sportsmen and women. FIFA will no doubt be hearing about this, but not to the extent of going along with the player's idea of not giving Spain the World Cup if the situation does not change before 2030. Let's hope that things really do change. Every one will then say Thanks Vini.
music.youtube.com/watch?v=-E1N_k...

Underwater

He dreams of it but has never seen its face. He wonders what it would be like to be close to it, to bask in its warmth and light. As he drifts in the middle of the ocean, he hopes to catch a glimpse or hear a sound. While floating on the water, a beautiful voice emanates from below. He dives beneath the surface and discovers a myriad of enchanting faces, each adorned with a captivating smile. Everything seems wonderful, but he feels out of place. The empty cup begins to fill, masks start to fall, beautiful faces disappear, and darkness appears. Unable to hold his breath underwater, the path becomes unclear. The rhythmic pulsing he hears compels him to the surface, where he finds a beautiful heart waiting for him.

Africa's inescapable awakening must be taken into account as a matter of urgency.

Is the world truly aware of the great changes taking place before our eyes? Probably yes. But then what does he do to anticipate them, accompany them, prepare and above all to make them assets of development, peace, harmony and coexistence. What do we do to combine them in efforts to understand each other, in common strategies, while geopolitics is impacted and is evolving, a little freewheeling anyway? The answer is unequivocal: not much. Instead, some are trying to save time, some pushing the dust under the carpet and or are just resisting. For what reason and until’ when? It is clear that the "dominant powers" do not want to see things evolve differently, no desire to see contexts move other than in the consolidation of their historical, economic and political gains. For « The up’ until when », the answer is even more complex. Depending on whether one is located north or south, the perspective is different. The youth of the south, is now more and more qualified, better and better trained, more and more ambitious. It no longer understands things with the defeatist and resigned logic of their elders. The populations of the south, especially those of ’Afrique, are no longer sensitive to the hollow discourse of revolutionary ideologies, formerly served as a poultice to coax them, or even silence them, while waiting for better days. Napoleon is attributed in 1816 : « So Let China sleep, because when China S’awaken, the whole world will tremble ». We know since that China is very much awake... and in what way. Alain Peyrefitte predicted it well, in turn. Funny story, no one has ever said such a thing with regard to Africa.. And yet,’Africa is well out of its sleep... So wait for to get rid of a little. China, is not much’ in front of’Africa, if not the resurrected legacy of Confucius skillfully combined with a communist pragmatism that nobody’ had imagined. Africa is much larger, with a larger and constantly growing population. Its young people are lively and enthusiastic. It's the world's largest island, compared with all the other continents. The so-called ‘dark continent’ has many assets, but it probably also has a few disadvantages that could block or slow down the momentum. We can list them in no particular order: the subservience of certain leaders, a number of failing political regimes, toxic borders inherited from colonialism, endemic corruption encouraged and supported by multinationals and certain Western regimes and their services, and a deeply rooted fatalism. But Africa is also determinedly dynamic. Travel to the east, west, north or south of the continent and you will see that Africa is in turmoil. Young people are talking, acting, working, innovating; they are doing politics differently and they want to change things. Their aspirations are growing, if not limitless. Of course, there are still some fools who swear by immigration, but that will soon fade. Growth prospects and the rates already achieved in some countries will change the situation. Overall, the 54 African countries have understood what is at stake and are increasingly aware of the possibility of imposing themselves and their point of view for the benefit of their young people. Remember the altercation between the President of the DRC and President Macron, or the historic speech by King Mohammed VI on the occasion of Morocco's return to African Unity. (you can find the link to the speech below) The ambitious ZLEKAF is undoubtedly the most daring response, as are the Nigeria-Morocco gas pipeline, the fertilizer manufacturing platforms, the tunnel project between Morocco and Spain, and the Giga factories that are being set up there, to name but a few. Two factors determine these trends: geography and demography. Both are in Africa's favor. In this changing context, there are two ways to act: either integrate the continent into a process of recognition, esteem, respect for dignity and co-development; or risk the most bitter confrontations and clashes. France has been aware of this during recent time... and this is only the beginning. The one and a half billion inhabitants, i.e. more than a quarter of the members of the United Nations, must be taken into account as a matter of urgency. So shouldn't Africa be integrated into global governance as soon as possible? Should we not heed Africa's solemn appeal to be given seats on the Security Council as soon as possible in place of the three non-permanent members? Should we not start paying a fair price for what the West is pumping into Africa? These are all questions that urgently need to be answered sensibly and pragmatically, because the normal course of history is as Ibn Khaldun already observed... Either evolution is controlled and channeled to the benefit of all, or change is going to come with pain... to the benefit of the most numerous, whom neither weapons, borders nor migratory blockade policies will be able to curb or stop. Africa is in the process of cleaning itself up, but not for long before its great awakening. An inevitable resurrection.
youtu.be/17gPwhdXIc8?si=Ysd6BekN...

Learning Hypovolemic Shock in a Hard Way (or so I Thought)

A few days ago, I suddenly felt cold after losing quite an amount of blood in the bathroom. I thought it was nothing unusual, but then I noticed the blood came out like water running down a faucet. I was not sure how much fluids I had lost, but a few seconds long was enough to know how bad it was. Before bed, I decided to search the web to satisfy my curiosity about my condition. Assuming to find common medical issues, I found out about a serious medical condition called "Hypovolemic Shock." The details are shocking and, without a doubt, mortified me. Thankfully my case was not severe (if not unrelated at all). I recovered in about 22 hours, although I had some headaches and numbness that went away by the next night. After recovering from the frightening experience, I was compelled to learn more about the condition, which led me to some surprising discoveries about hypovolemic shock. Disclaimer: This is just an overview of the topic I wrote for fun. If you want validation about your condition, please contact professional medical help. After reading several medical articles through the internet, I learned that hypovolemic shock is a serious condition caused by losing quite amount of blood or fluids within your body, and it is wise to quickly contact medical emergency as the condition poses a life-threatening risk. Hypovolemic shock can be divided to hemorrhagic and non-hemorrhagic type. Hemorrhagic shock happens when you lose fluids through serious blood loss, such as open wounds, internal bleeding, and childbirth. Meanwhile, non-hemorrhagic shock results from losing body fluids through other means, such as dehydration, diarrhea, and vomiting. Regardless of the difference, losing a lot of fluids can prevent the heart from sending blood through your body to function, which can lead to organ failure. Surprisingly, hypovolemic shock is the second most common shock, following distributive shock, and it commonly happens to children in developing countries, often due to diarrhea. Now, losing blood and other fluids is normal in everyday life without causing big side effect. Small losses, like from a small cut, nosebleed, or brief diarrhea, usually resolve on their own without causing bad effects. Generally, a person can lose about 14% of blood with no major side effects except perhaps for slight dizziness. And speaking of which, on average, men have more blood compared to women, while children, who have much less, are more vulnerable to the negative effects of blood loss. Since each individual has different amount of blood in them, it is important to measure the blood loss using percentage of the total blood volume in your body. One of the function of blood is to control body temperature (thermoregulation.) The body regulates the heat distribution by controlling the speed of the blood flow to and within the skin, either by narrowing or widening the blood vessels. When it is hot, the body widens the blood vessel (vasodilation) to cool down and release heat faster from the skin. Meanwhile, when it is cold, the body narrows the blood vessel (vasoconstriction) to keep the heat. When the amount of fluids is low, the body automatically narrows the blood vessels to keep the pressure normal and focus on distributing the blood to vital organs. What will happen when you lose more than 14% of blood? The quick answer is; you will start to experience the effect of blood loss. Depending on how fast you lose the fluids, you may feel tired and weak, with rapid breathing and pale skin, to more serious symptoms such as the decreased amount or no urine output, hypothermia, and unconsciousness. When the blood loss reaches more than 14%, hypovolemic shock will set in. Depending on how much blood percentage you have lost, hypovolemic shock can be separated into 4 stages: - The 1st stage: when you lose about 15% of your blood (around 750 mL.) At this stage, the symptoms have not occurred yet, and your heart rate and blood pressure may stay normal. - The 2nd stage: when you lose about 15% to 30% of your blood (around 750 mL to1,500 mL.) During this stage, the heart rate increases and breathing quickens as the blood vessels narrow to stabilize the pressure. - The 3rd stage: when you lose about 30% to 40% of your blood (around 1,500 mL to 2,000 mL.) At this stage, your blood pressure drops while your heart rate and breathing are getting faster. You begin to produce less to no urine output as the body tries to reserve the remaining fluids. - The 4th stage: when you lose about 40% or more of your blood (around 2,000 mL or more.) At this stage, your condition is at its critical and immediate professional attention provide slight survival chance. Your blood pressure is severely low, heart rate and breathing are high, urine output is absent, and organ failure is likely to happen and can become fatal. Hypovolemic shock is dangerous and needs immediate medical attention. In treating hypovolemic shock, medical help will try to replace the fluids you have lost using one or more IV (intravenous) lines, which is that long tube with a needle injected into your vein, and seal up the source of the fluid loss, such as open wound. Recovery time also takes some time and it is varied for each individual, depending on age, condition, and the severity of the shock. During recovery, you should listen to your health provider, and tell them your recovery progress so that they know your treatment goes to the right way. To sum it up, hypovolemic shock is a dangerous medical condition that we should never ignore, but understanding the signs can make a great difference. When blood or fluids loss persists longer than it should, contacting medical help can prevent unwanted experience to happen. And for my experience, I am grateful that my condition was not that alarming to demand me get out of bed in the middle of the night and call for an ambulance. This event, however, became a warning to keep an eye on my fiber intake more carefully and how important it is to take care of myself. For now, it is safe to say that I have survived my recklessness and ignorance for another day. Cheers. -Silver-

About nothing

Sitting down in the wet sand. The last light of day turns the horizon into an agitated pool of fire that spreads from east to west. Has god ever had a question for anyone? No wonder babies come crying into the world. Why is air an acquired taste? Sure your mom is sweet, but who was she at 17? Everyone’s thought of murder once or twice. Shouldn’t an empty canvas be black instead of white? Either way, who’s to say what a cat really thinks?

Bluwr: My Experience with an SEO-Optimized Platform That Knows Me Better Than I Do

When I first started writing on Bluwr, I didn't think much about how well the platform was optimized for SEO. Like most writers, my primary focus was on crafting engaging content, sharing my thoughts, and hoping my articles would find their way to the right audience. But recently, I decided to conduct a funny little experiment that opened my eyes to just how effective Bluwr's SEO capabilities truly are. Curiosity struck me one evening as I was thinking about the digital footprint I’ve been leaving behind with my articles. With AI becoming increasingly sophisticated, I wondered just how much information was out there about me, pieced together from my work. So, I turned to GPT, and asked it a simple question: "What do you know about me?" The results were both fascinating and a little uncanny. GPT didn’t just know general facts; it provided a detailed account of my work, interests, and even some insights that I hadn’t explicitly mentioned in any one article but had implied across several. The source of all this information? My articles on Bluwr. This experience highlighted one major thing for me: Bluwr is incredibly well-optimized for SEO. Every article I had written, every topic I had explored, and every opinion I had shared was indexed and made easily accessible by search engines. Bluwr’s backend is clearly designed with SEO in mind. From the way articles are structured to how tags and keywords are used, everything seems to be geared towards making sure that each piece of content is easily discoverable. What struck me the most during my experiment was how Bluwr enabled GPT to aggregate and synthesize data about me. Individually, my articles were just that—individual pieces of content. But together, they created a comprehensive narrative that GPT could easily tap into. This got me thinking about the broader implications of writing on a platform like Bluwr. While my little experiment with GPT started as a bit of fun, it ended up being an insightful look into how powerful SEO can be when done right. Feel free to try a similar experiment yourself. You might be surprised at what you learn...

The Gods only forge the Great.

One day in deep meditation the Biggest Ape met an unborn boy. The boy was alone, scared and deeply disturbed. When he saw the Biggest Ape he ran towards him, heavy tear drops running down his cheeks. - "I saw my future!" cried the boy, kneeling in front the Biggest Ape. - "And?" grunted the Biggest Ape. - "It's horrible!" screamed the child in terror. "It's all treasons a many, strife, pain and suffering, for 20 years from the moment I hit 5." - "What happens, after 25?" Inquired the Biggest Ape. - "I don't know, I was too scared to keep looking." - "Come." said the Biggest Ape. He took him to the top of a mountain, to a secret doorway that leads deep into the earth. For many hours they walked in silent darkness until they heard the sound of metal pouding against metal. They pressed on for a few minutes entering the biggest forge the boy has ever seen. At the center a solitary figure, a big burly man, shirtless, with a long grey beard was pounding a huge piece of metal with a gigantic hammer. He was very hairy, reminding the boy of the Biggest Ape. The man raised his eyes at the Biggest Ape and nodded, the Biggest Ape nodded back and motioned the boy to move closer. -"This is going to be a magnificent sword", whispered the Biggest Ape. "fit for a God". Then gesturing to his left he pointed to a heap of scrap metal. "There are all the metal pieces that could not withstand the hammering and the tempering. They broke, they *abandoned*" . The boy was fascinated. The Biggest Ape placed is right hand over the boys eyes, completely covering his face. The little man let a scream, opening his mouth in astonishment. -"What did you see?" -"I saw the most perfect man, the man beyond man. I saw temples, and statues erected of him centuries after his death. I saw his name on paper and walls for Millenia." -"That sword is being made for him. And that man is you". Then looking at the pile of scrap metal, the deep voice of the Biggest Ape echoed in the forge: == "The Gods test everybody, but only forge the Great." == -"I understand", replied the boy. Thus Spake Apathustra.

The Pruning Shears of Revision, Teshuvah, Metanomia and the two Repetances

Neville once said that Revision is his greatest contribution. The concept of revision is present in Kabbalah as *Teshuvah*. Teshuvah is often translated as *repentance*, in hebrew it literally means *going back in time*. Accomplishing a Teshuvah from a Kabbalistic point of view, means going back in time, in one's mind eye and *revise*, change the past event. Relive the event in imagination not as it happened, by how it ought to have happened. By doing so we are able to change the future, and avoid the negative consequences of past event. In other words what Neville calls *Revision*. Kabbalah is often a balance between *Judgement* and *Mercy*. Two words that are loaded with meaning in Kabbalah, They are not opposite concepts, but two separate axes or modes that the divine light appear to operate from in lower levels of consciousness. But for now let's consider that judgement is receiving the consequences of our actions, and as such Kabbalah is often concerned with the lessening of the severity of Judgement. Teshuvah appears then as a primary means to do so. It means going back to that moment right before the regretted event happened, understand the emotional setting that made one do what he did, and then change it. Both emotionally (once again emotions are of primary importance) and in actions. This results in *Metanomia*, the greek word in the bible that is also translated as repentance. Metanomia means a radical change of mind that must come with a new emotional setting. And this is where the brilliance of Neville shines, by tying these two concepts together Teshuvah and Metanomia, two very different words, both translated as repentance, he is able to explain deep Kabbalistic mysteries. Teshuvah is the method (or the technique) Metanomia is the sign and the seal. The sign of the successful Teshuvah and the end of the successful Teshuvah. Teshuvah is something to do whenever one begins to feel remorse or regret. As Neville said at the end of *The Pruning Shears of Revision*: == Don't blame, only resolve. ==