science – Page 3 – Go Retire Psychiatrist

Moon Halo This Morning?

I was picking up our mail at the mailbox pod this morning around 5:45 a.m. and noticed what looked like a faint circle of color around the nearly full moon in the western sky. There were streaky white clouds. Not far from it and to the left was something that looked like a big star-which I guessed was Venus. It didn’t twinkle like stars do.

I’ve never seen anything like it before. It reminded me of a rainbow and I thought I’d heard something about moonbows (probably on the Weather Channel). By the time Sena got up and I told her about it, she suggested I get a video. By that time, it was pretty much gone, though.

According to one article, this might have been a moon halo, which differs from a moonbow. Moon halos can form from ice crystals. It was about 25 degrees outside.

So, according to some cultures, moon halos might herald bad weather, maybe in a couple of days. On the other hand, it’s going to be pretty quiet around here for next several days.

Svengoolie Movie: “The Creation of the Humanoids”

Svengoolie Intro: “Calling all stations! Clear the air lanes! Clear all air lanes for the big broadcast!”

Last night, I watched the Svengoolie movie, “The Creation of the Humanoids,” and I don’t mind telling you, I was reminded of Isaac Asimov’s book, “I, Robot.” Believe it or not, I purposedly avoided reading any other reviews of this movie to see if they mention the possible connection of Asimov’s book with this movie. It preceded the film by 12 years, and it’s at least conceivable that producers and writers might have been inspired by the plot, took the idea of the robot laws from the book and dressed it up in at least some of the dialogue. I think there’s also a connection to Artificial Intelligence (AI) in our own time.

The last two stories in Asimov’s book are “Evidence” and “The Evitable Conflict,” both of which seem to be exemplified in “The Creation of the Humanoids.” They’re both about the conflict between robots and humans and how difficult it is to apply the Laws of Robotics, the first of which is that “a robot not injure a human being or, through inaction, allow a human being to come to harm.”

The robots in the film actually create the humanoids with the overall goal of saving the human race from extinction. And they’re programmed to obey the “Prime Law” which prevents them from killing humans. The psychological conflict of Captain Kenneth Cragis (Don Megowan) and Maxine Megan (Erica Elliot) and the rationale the robots supply for what they did both to and for humans echo the Laws of Robotics.

In the movie, the politics of the racist conflict between the robots and the group calling themselves the members of the Order of Flesh and Blood remind me of the Civil War—right down to the uniforms of the latter and their slur for the robots, which is “Clickers” (substitute another two-syllable slur and you get the idea).

In Asimov’s story “The Evitable Conflict,” something called the Machine takes control of a variety of factors manipulating natural resources, goods, services, and even the social fabric on the planet to protect humans, who have a penchant for overusing and destroying resources and each other. The robots in “The Creation of the Humanoids” do something similar and break the fourth wall to tell you about it.

Anyway, Captain Kenneth Cragis is a member of the Order of Flesh and Blood and reminds me of a character in the 2004 movie “I, Robot,” which is Sonny. An important part of Cragis is hidden from the audience as well as himself.

The dialogue is heavily intellectualized and the robots, which are supposed to be blue, wind up showing up in different colors and those eyes! Cragis and his sister, Esme Cragis Milos (Frances McCann) have a protracted and almost poetic discussion about their differences of opinion about the robots. I wonder if McCann’s revealing dress was intended to distract the audience from the dry declamations.

The scene in which Cragis confronts the robot Pax who has somehow chosen Esme to be his main squeeze is puzzling. Cragis sort of breaks Pax (David Cross) and converts him into a ’57 Chevy, which barely upsets Esme. The scene in which Dr. Raven (Don Doolittle), a robotic scientist, makes some adjustments on a disembodied arm is one example of many which proves why even Svengoolie calls this movie “a low budget” production. The furniture pieces look like they’re made for children; both Cragis and Esme might as well have sat on the floor.

Ok, so this sounds more like a review than my usual fibs and jokes, but I think it’s because the movie reminds me of something that is on a grander scale. Speaking of scales, except for the low production value, I thought movie was pretty good and I would give it a 4/5 Shrilling Chicken Rating. Sena, who watched it this morning, thought it was really good and would give it a 5/5 rating despite “the glassy eyeballs.” So, I’ll give it a 4.5/5.

Special Mention on Dr. George Dawson’s Post Today

I just want to send a link to Dr. George Dawson’s post The Phenomenological Suicide Assessment – The Legacy of Dr. H. It’s a great Christmas gift to teachers and learners everywhere. Happy holidays to George and everyone else.

Profound Thoughts on Topological Brain Changes

I ran across this article in the news about topological changes that happen in our brains as we age. You can try to read the original open access paper published by the author Alexa Mousley.

The topological changes in the brain that occur in the brain are linked to the structural connections that are made or not in human development and roughly correspond to the main epochs of brain structure in our lives: childhood (transition to adolescence around 9 years old), adolescence lasts until around 32 years old when we finally reach adulthood, then at age 66 we reach the early ageing stage and that finally changes into late ageing or old farthood around age 83. It’s a good thing I retired 5 years ago.

What this says, of course, is that nobody should be getting married or driving until they hit age 32. There are buses, you know, although we do have self-driving cars which explode on impact so thank goodness we don’t need to worry about that.

Also, it implies that you shouldn’t be drafted into military service until you’re presumably old enough to know that war doesn’t solve any problems.

Furthermore, this could lead to earlier retirements, reducing the need for awkward discussions with tenured professors who are apparently unaware they often arrive at the office with their pants on backwards. Just boot them out the door!

Why didn’t we think of this topology thing a long time ago?

For an interesting topology discussion, see the Wikipedia article, which has an interesting photo of something called homeomorphic topology, an amusing example of which is the picture of continuous transformation of a coffee mug into a donut, or as many Iowa City people would prefer, a bagel (something that looks like a doughnut but is so tasteless you have to slather it with a pound of cream cheese).

If you have any questions, call the author of the study. You’re welcome!

Mousley, A., Bethlehem, R.A.I., Yeh, FC. et al. Topological turning points across the human lifespan. Nat Commun 16, 10055 (2025). https://doi.org/10.1038/s41467-025-65974-8

Swearing as a Performance Improvement Method?

I read this article about swearing being a good thing to do to increase your workout performance or whatever. There’s a link to the study that a researcher says supports that conclusion. I mean this story is talking about really bad words being good for you. It reminds me of a time when I was a pre-teen kid and broke my wrist falling out of a barn loft. I don’t remember exactly how I got to the emergency room. We didn’t have a car so our next-door neighbor must have driven me with my crooked arm and my hysterical mom to the hospital.

My mom was in the emergency room with me. When I cut loose with a torrent of really bad words, nurses had to practically carry her out because she fainted. This was right after I asked the doctor if it was OK if I swore and he said “Go ahead,” injected anesthetic—and immediately started to manhandle my wrist. I don’t think I ever swore in front of my mom before that.

I don’t remember if the swearing helped me withstand the pain or not. I don’t think so.

There was my other trip to a hospital for chest surgery when I was in my early teens. I had a chest tube after the operation. My roommate had undergone some kind of abdominal surgery. We had a lot of stitches and were in a lot of pain, which was bearable if we didn’t move at all. It even hurt to breathe. But the other factor was the TV in our room. It was way across the room and there was some kind of comedy show on. It was really funny—which made us feel really terrible. We could barely move and even had to talk quietly, yet this funny show made us laugh, which expanded our chest and abdomen areas, stretching the sutures. It was excruciating.

Even swearing would have hurt, not to mention laughing out loud. We really couldn’t stand to laugh and it was too bad I can’t describe the sound of two guys trying not to even chuckle. If you e4ver watched Loony Tunes cartoons and remember how Elmer Fudd sounded with he laughed—that was how we sounded because we were trying to suppress laughing. It was funny but pitiful. My roomie finally made this desperate slow motion move out of bed, crept to the TV and shut it off. I was so grateful. Neither one of us ever swore.

The other thing this swearing for power reminds me of is the movie Signs, which starred Mel Gibson as Graham Hess. It was about an alien invasion and in one scene, some people/aliens (they don’t’ yet know what) are running around the house and Graham’s brother Merril (Joaquin Phoenix) are getting set to chase them. Merril tells Graham to yell and curse, although because Graham is a former Episcopal priest, swearing is beyond him:

All right, listen, we both go outside, move around the house in opposite directions. We act crazy, insane with anger, make them crap in their pants, force them around till we meet up on the other side.
Graham Hess: Explain “act crazy”.
Merrill: You know, curse and stuff.
Graham Hess: You want me to curse?
Merrill: You don’t mean it. It’s just for show. What?
Graham Hess: Well, it won’t be convincing. It doesn’t sound natural when I curse.
Merrill: Just make noises, then.
Graham Hess: Explain “noises”.
Merrill: Are you gonna do this or what?
Graham Hess: No, I’m not.
Merrill: All right, you want them stealing something in the house next time?
[outside light comes on]
Merrill: On the count of three. One…
Graham Hess: All right.
Merrill: two… three!
Graham Hess: Ahh! I’m insane with anger!
Merrill: We’re gonna beat your ass bitch! We’re gonna tear your head off!
Graham Hess: I’m losing my mind! It’s time for an ass-whupping!
[Merrill and Graham meet each other]
Graham Hess: I cursed.
Merrill: I heard.

Anyway, I think we have to make a distinction between cursing about something or cursing at someone before we start claiming, like the author of the study says:

“Swearing is literally a calorie-neutral, drug-free, low-cost, readily available tool at our disposal for when we need a boost in performance.”—psychology researcher Richard Stephens of Keele University in the UK.

Dr. Susan Shen University of Iowa Psychiatrist Wins Prestigious Avenir Award for Research!

This just in! University of Iowa Psychiatrist Dr. Susan Shen, MD, PhD, is an assistant professor of psychiatry at The University of Iowa Carver College of Medicine and, hold on to your hat, she’s the first female psychiatrist, the first from Iowa, and only the third psychiatrist overall to receive to win the Avenir Award (French for “future), a highly competitive grant!

The $2.3 million dollar grant will help fund her lab’s research into the underpinnings of substance use and psychiatric disorders. The grant is administered through the National Institute on Drug Abuse (NIDA), one of the National Institutes of Health (NIH).

Give Dr. Susan Shen a big shout-out!

New Do it Yourself (more or less) Electrotherapy for Depression at Home!

OK, so the title is a little provocative; on the other hand, this is my take on a legitimate treatment for depression that was just approved by the FDA only last week. A company called Flow Neuroscience is marketing the newly approved FL-100 device for treatment of depression and their website definitely has their marketing skills down. And I definitely was reminded of a TV commercial about removing your own appendix.

That’s my smartass joke, but hang on, there’s more to it than jokes. I had to search around a while to find actual FDA web evidence that they actually did approve the FL-100, but I was saved by the reliable and trustworthy Psychiatric Times article about the FL-100 with references that I could verified the FDA’s approval.

So, I’m a retired psychiatrist and I was a clinician educator type doctor, not a neuroscientist, but I can read the FDA approval document section XV. Conclusions Drawn from Preclinical and Clinical Studies (starts on page 12). It boils down to, yeah, this device’s probable benefits outweigh its probable risks.

The Effectiveness Conclusions subsection on effectiveness outcomes at Week 10 contains what sounds like realistic answers: “The medical literature lacks consensus regarding what constitutes a clinically significant or meaningful between-group difference in HDRS-17 scores. As such, the clinical significance or meaningfulness of the between-group difference of -2.3 points on the HDRS-17 scale has not been established. Nevertheless, the 2.3 point between-group difference helps support the view that FL-100 provides probable benefit.”

I’m not familiar with the EQ-5D-3L scale of health-related quality of life but the summary says:

“The EQ-5D-3L measures a person’s health-related quality of life by assessing five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. There was no between-group statistical difference in EQ5D-3L scores at Week 10. The EQ-5D-3L frequently fails to detect mild depressive symptoms, as individuals with subclinical depression often select “no problems” on the anxiety/depression dimension. The insensitivity of EQ-5D-3L is documented in the literature.”

I happen to think that comparison of medical treatments with psychotherapy is a good idea but: “Data were not provided regarding FL-100 used adjunctively with psychotherapy or with psychotherapy and antidepressants.”

The device has no recommendation for use with patients with treatment-resistant depression:

“Patients who previously had an inadequate clinical response to two or more antidepressants at an adequate dose and duration were excluded from the study, limiting the evidence for use of the FL-100 in a more treatment resistant population.”

The potential risks are first degree skin burns if you’re not careful with the electrodes, headaches, and scalp pain. The benefit is modest but outweighs the risk.

You can use the device at home under the supervision of a clinician—they don’t do house calls so you’d presumably do this by zoom call. You can also get advice through an app on your device, which may or may not be a monotonal AI. You pay $500-800 and there won’t be any answers to questions about insurance coverage until at least next spring. But it’s being used by tens of thousands of people in Europe and beyond.

So go ahead, take your own appendix out (just kidding; put that jack knife away!). Did you know that at least one guy actually did that? A Russian surgeon, Dr. Leonid Rogozov managed it in 1961 while he was stranded in Antarctica.

It’s just my opinion, but the headset could be more stylish.

What’s the Skinny on a Vaccine that Might Prevent or Slow Down Dementia?

You don’t want to just take my word for it but there seems to be conflicting messages on a live, attenuated shingles vaccine called Zostavax.

One message is that “the live, attenuated herpes zoster (HZ; shingles) vaccine” might prevent or slow down dementia, especially in women according to a study in Wales and Australia. The article doesn’t mention the name Zostavax (the trade name for the live, attenuated herpes zoster vaccine), which according to a Wikipedia article was “discontinued in the U.S. in November of 2020.”

The other message is that partly because of several lawsuits against Merck (the manufacturer, which faced a lot of Zostavax lawsuits) regarding possible severe, potentially life-threatening side effects alleged to be associated with it, production and marketing of the vaccine was discontinued in the United States as of 2020. The other reason was that Shingrix, a recombinant form of the vaccine, was developed.

Shingrix is said to be superior to Zostavax, although it is also associated with some side effects.

I don’t know why I don’t find any FDA or CDC notifications that Zostavax is no longer available in the United States. Both agencies have archived approval notices still on their websites.

CIDRAP doesn’t mention that residents of the U.S. can longer get Zostavax (in other words, the live attenuated vaccine against shingles) as of 2020.

One of the problems I find with web-based information is that some of the entries can be confusing. I found several articles on line from law firms including one which posted a report on November 14, 2024 that two Black Box Warnings were published by the FDA about Zostavax. I could find only one safety warning on the FDA website (not labeled as “Black Box”) and it was about the new recombinant vaccine, Shingrix. It’s been associated with Guillain Barre Syndrome (GBS) and it’s dated March 24, 2021—a year after Zostavax was removed from the market in the U.S.

OK, as an old retired doctor, my bottom line on this issue of live, attenuated herpes zoster vaccine being touted as an agent that could delay or prevent dementia is that it would be a lot more helpful to me as a consumer to know the whole story about the product. It might be scientifically interesting but it’s moot because the product is not even available in this country and for good reason. And even if it were, would the potential risk and benefit assessment be favorable to recommend its use? And how does this affect the ongoing disagreement dividing the country about the safety and effectiveness of vaccines? Only about 20% of Iowans are even getting the flu shot this season so far.

One thing people could do which might slow down some of the cognitive impairment is to take up the game of cribbage. As far as I know, it has almost no detrimental side effects unless you insist on playing the muggins rule.

Cannabinoid Hyperemesis Syndrome in the News Lately

I’ve seen a few articles about Cannabinoid Hyperemesis Syndrome (CHS) and because my funny bone is sensitive to provocative titles, I first read the one with the title that starts off with “I still partly think this is bullshit…” My reference list resulting from a quick search is below.

Of course, I don’t think CHS is “bullshit” (quote from an emergency room patient in the Collins et al paper). I agree it’s hard to diagnose and the news media tends to sensationalize it by promoting popular terminology like “scromiting,” which my spell checker doesn’t recognize. This is a vogue portmanteau word combining screaming and vomiting. It makes me wonder why someone didn’t try harder to come up with a portmanteau that might be more descriptive of the complex triad of vomiting, belly aches, hot baths, and screaming. Why not barfinbawlinbellyachinbathingbadness?

But it’s not funny and attempts to attach funny words like scromiting to the condition by the press (or whoever) is misguided.

I found one systematic review and treatment algorithm (Hsu et al) written to guide consultation-liaison psychiatrists who are likely to get called when CHS patients are admitted to emergency departments. However, I think the place to start would be the StatPearls review by Cue et al. One thing I found out from that paper is that the interesting ACCENT study ((Achieving Cannabis Cessation: Evaluating N-Acetylcysteine Treatment) the authors cite does not yet have results available, although it was started way back in 2014.

Just a couple of comments about the treatment algorithm by Hsu et al: haloperidol can cause dystonic reactions and akathisia as well as cardiac conduction problems like QTc prolongation and more. One episode of neck dystonia or akathisia or both can lead to mistrust of physicians who administer the causative agents, especially if there were no explanations of side effects as well as potential benefits. Benzodiazepines, while they may work, may also lead to some patients with substance use disorders becoming attached to them. Less commonly, patients with somatoform, factitious, or eating disorders will complicate the diagnostic picture.

Reference List:

Alexandra B. Collins, Francesca L. Beaudoin, Jane Metrik, Rachel S. Wightman,

“I still partly think this is bullshit”: A qualitative analysis of cannabinoid hyperemesis syndrome perceptions among people with chronic cannabis use and cyclic vomiting,

Drug and Alcohol Dependence,

Volume 246,

2023,

109853,

ISSN 0376-8716,

(https://www.sciencedirect.com/science/article/pii/S0376871623000911)

Abstract: Background

Cannabis is the most widely used psychoactive substance in the United States (US), with reported use patterns increasing among adults in recent years. Cannabinoid hyperemesis syndrome (CHS) has been one concern related to increased cannabis use patterns. US emergency departments have reported an increase of CHS cases over the last decade, yet little is known about CHS. This study explores the experiences of people with chronic cannabis use and cyclic vomiting and their perceptions of CHS.

Methods

Semi-structured interviews were conducted with 24 people recruited from a prospective cohort of patients presenting to Rhode Island emergency departments with symptomatic cyclic vomiting and chronic cannabis use. Data were analyzed thematically using NVivo.

Findings

Participants characterized their cyclic vomiting as related to food and alcohol consumption patterns, stress, and existing gastrointestinal issues. Despite recurrent episodes of cyclic vomiting, nausea, and abdominal pain, many participants remained uncertain whether their symptoms were driven by cannabis. Many participants relied on at-home research to assess their symptoms and seek out management approaches. Clinical treatment recommendations focused on cannabis cessation. However, most participants felt clinical recommendations failed to consider the complexity and challenge of stopping cannabis use given the chronicity of use and therapeutic benefits some perceived cannabis to have.

Conclusions

Although cannabis cessation is the only reported CHS cure to date, additional clinical and non-clinical treatment approaches are needed to better support people with chronic cannabis use and cyclic vomiting to meet their ongoing needs.

Keywords: Cannabinoid hyperemesis syndrome; Cyclic vomiting; Cannabis use; Qualitative

Cue L, Chu F, Cascella M. Cannabinoid Hyperemesis Syndrome. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549915/

Jennifer Hsu, Saurabh Kashyap, Cheryl Hurd, Lauren McCormack, Zachary Herrmann, Ann C. Schwartz, Joshua Jackson, Dustin DeMoss,

Treatment of cannabinoid hyperemesis syndrome: A systematic review and treatment algorithm for consultation-liaison psychiatrists,

General Hospital Psychiatry,

Volume 97,

2025,

Pages 185-191,

ISSN 0163-8343,

(https://www.sciencedirect.com/science/article/pii/S0163834325002038)

Abstract: Background

Cannabinoid Hyperemesis Syndrome (CHS) is a cyclical vomiting syndrome associated with chronic cannabis use and is often resistant to anti-emetics. Despite increasing incidence of suspected CHS, literature regarding its treatment is limited, and there are no established treatment guidelines.

Objectives

With the goal of establishing treatment guidelines for consultation-liaison (C-L) psychiatrists managing CHS, the authors systematically reviewed existing literature for pharmacologic treatment strategies using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. With the results of the review, the authors propose a treatment algorithm for CHS.

Methods

We searched PubMed, PyschINFO & PsychARTICLES, Embase, and Web of Science from inception to July 2021 to identify literature describing treatment of CHS. We included cases of CHS where patient-level data describing the treatment of CHS was available. Pharmacologic treatments were considered beneficial if the patient’s nausea, hyperemesis, and urge to take hot showers resolved. Non-independent review of exclusion criteria assisted in reducing individual bias of the literature.

Results

The authors identified 34 eligible articles, consisting of 63 individual cases. Among these articles and cases, capsaicin cream, antipsychotics, and benzodiazepines were reported to improve CHS more effectively than other, more frequently used anti-emetics, such as promethazine, ondansetron, and metoclopramide.

Conclusion

An examination of treatment strategies for CHS can allow for more effective care while providing a foundation for further research in treatment. This proposed algorithm is designed to aid in establishing treatment strategies for C-L psychiatrists who assist with managing CHS for patients in general medical settings. The goal of this research is to establish evidence-based treatment guidelines for C-L psychiatrists who are managing patients with CHS in general medical settings. Recognizing the limitations of this algorithm being based on case reports adds to the necessity of further research in this area.

Registration

PROSPERO (https://www.crd.york.ac.uk/PROSPERO/view/CRD42021254888) registration number CRD42021254888.

Keywords: Cannabinoid hyperemesis syndrome; Treatment strategies; Systematic review; Pharmacologic treatment

Loganathan, P.; Gajendran, M.; Goyal, H. A Comprehensive Review and Update on Cannabis Hyperemesis Syndrome. Pharmaceuticals 2024, 17, 1549. https://doi.org/10.3390/ph17111549

Svengoolie Show Movie: The Valley of Gwangi!

I watched the Svengoolie show 1969 movie, “The Valley of Grungi” on Saturday. Sorry, that’s Gwangi. That was a pretty good day for TV. I saw “Men in Black” on cable, which is rare. We also saw the Iowa Hawkeye vs Oregon Ducks football game. Too bad they lost, and by only 2 points.

Anyway, “The Valley of Gwangi” was released in 1969, was directed by Jim O’Connolly, and featured the stop motion wizardry of Ray Harryhausen. It starred James Franciscus as Friar Tuck (oops, different movie), I mean Tuck Kirby, Gila Golan as T.J. Breckenridge, and Laurence Naismith as paleontologist Professor Bromley. Franciscus and Bromley both won Academy awards for “Whitest Teeth on the Planet.” Sena watched the show intermittently while flipping channels but noticed the brilliant white teeth.

But really white teeth were not the only bright spots in the film. I’ll let you know if I think of any others.

The main idea of the story is that Tuck and T.J. have this dysfunctional relationship based on Tuck’s inability to settle down and stop being a jive hustler, which happens to also be T.J.’s problem, frankly. T.J. is in this decaying wild west rodeo show which barely supports a living and Tuck is chasing a dream of a ranch in Wyoming and wants T.J. to team up with him.

But they get distracted by a paleontologist, a little horse (Eohippus) from the dinosaur age millions of years ago, and a valley containing giant lizards like an Allosaurus, a Styracosaurus, and a Pteranodon.

But they left out the dinosaur the remains of which were recently found in Montana: the dreaded dome-headed dinosaur, Brontotholus harmoni, a frequent combatant in mud-wrestling contests with Fred Flintstone.

But Bromley has his eyes set on capturing the Eohippus for scientific study (hah!), scheming to raise a corral full of Eohippi (is that the plural?), apparently to sell to people like Tuck and T.J. who have a fixation on ranches and wild west shows but can’t get along with each other long enough to run a lemonade stand.

Most of the action involves cowpokes falling off their horses while attempting to rope the dinosaurs with lariats clearly not strong enough to hold a 2-ton Allosaurus. Yet they manage to subdue it and drag it back to the wild west show arena where they make it dance to the tune Putting on the Ritz, which it apparently hated.

One of the characters in the movie is a boy named Lope, who is smart enough to stay out of some trouble than the boy Juanito in the movie “The Black Scorpion” but still manages to get nabbed by the Pteranodon, from which he has to be rescued. He is also pretty much cut from the same cloth as Tuck and TJ in that he’s a clever hustler and a matchmaker as well. Later, both Juanito and Lope team up in the combination sequel to both of these movies, “Misfit Monkeyshines and the Dome-Headed Dinosaur.” More stop action magic that you should not miss!

This movie is just a bit better than fair and I give it a 3/5 shrilling chicken rating.