Crossfit Gifts Guide: Cool Gift Ideas for the Hardcore

We did a Crossfit Gifts Idea Guide last year for Christmas and featured some practical and off-beat gifts. This year we found some really cool stuff and thought Christmas is just too far away.  Enjoy.

1.  Kitty Lifting Singlet.

by Blue Chip Wrestling.

Crossfit gifts Olympic weightlifting singlet with cat design

Lifting singlet for the serious lifter.  Also available in “Pug.”

Singlet Features Sublimated Design – The colors are dyed deep into the fabric so they will never crack, peel, or fade. The singlet also reduces ‘grinning’ so that colors stay true when the fabric is stretched. Flat lock double stitching – All seams in the singlet are flat lock so they will lay flat and maximize comfort. Double stitching ensures long life and singlet that will stand up to wear and tear. Hand Made in the USA.

 

 

 

 

2.  Viking Ship Fire Pit.

crossfit gifts viking fire pit

Great gift for the hardcore

What could possibly be a better way to send your marshmallows off to Valhalla?  by ImagineMetalArt:  ” This hand made fire pit is one of a kind!!! its made from 18 gage metal and is approx. 40 inches in length and 16 inches wide. Thicker steel available on request…SHIPPING COSTS to US depends on your location and I can get quote for you and email you the costs.. There are axes in the shields now and viking symbol on sail can be custom made with customer’s name in it if requested.”   $401.67

 

 

 

 

 

3. Forged kettle bell Bottle Openers by Ballard Forge.  $15.

Kettlebell Bottle Opener by Ballard Forge

Hand Forged Kettlebell Bottle opener

In the words of the artist:
“Inspired by a custom request from a personal trainer- Perfect for your crossfit customers, small enough to fit into a pocket, robust enough to tackle the burliest of micro brews! As always I will stamp your choice of text at no charge. Let me know if you would also like a small hole for a key chain. Grab one today and do some 12oz. weightlifting~

This handmade bottle opener is available through Ballard Forge’s Etsy Shop.  Support an artist and enjoy beer while looking cool.

4. Hardcore Kettlebell Mug

kettlebell mug crossfit gifts

Kettlebell Mug

By Clayzday Ceramics.  “Get your very own customized Kettlebell coffee mug. No matter what box you find yourself working out at, this coffee mug is sure to draw attention. This mug looks like a real kettlebell when it is sitting upright and as a coffee mug It holds 16 oz or 24 oz of liquid depending on which size you choose. It is made from ceramic slipcast and features a high gloss glaze finish.”   Clayzday will also do custom orders if you want them for everyone in your box.  $45.

 

 

 

5. Kettlebell Hat

Crossfit hat kettlebell hat

Handmade Kettlebell Hat

by Monstrous Crochet.  A little out of season, but so completely off-beat we felt it had to be included.  “Here’s the perfect hat for the gym lover. It’s shaped like a kettle bell so you can bring your workout with you wherever you go. The 32KG writing and the lining are fully customizable by color. Fits most adults. Leave a message to seller as to your color choice. If no color choice is given I will make it as is in the photo.”  $25.

 

 

 

6. Weightlifter’s Cufflinks

crossfit gift cufflinks weightlifting father's day

Weightlifters cufflinks

These cufflinks feature 45lb (20.4 kg) standard barbell plates in miniature.  By HandicraftsUkraine.  Shipping might take a while because these will ship from the Ukraine.  But cool Crossfit gift ideas for father’s day or a weightlifter’s gift nonetheless.   Made of mostly brass.   $17.

 

 

 

7.  Torque Soap 

crossfit gifts soap

crossfit gifts soap on a rope

by Saponesoaps of Texas.  “TORQUE Soap Bar..
“Fierce, smooth, and sexy!
This 5.5oz soap bar is made with our own unique design on black Shea butter and silver glycerin soap.Added on top is fierce skull soap.
Scented with our own Torque fragrance.
(Can be made onto a soap on the rope)”.  Who doesn’t need Fierce, smooth and sexy?  $6

 

 

 

 

8.  Portable, rollable dry erase board

by Twentyonefifteenine.

Crossfit gifts crossfit father's day gifts

Rollable whiteboard.

“Do you have trouble counting your reps? Or is the whiteboard too far away for you to easily see the sequence of the WOD? Use one of these handy personal whiteboards to help stay on track.Whiteboards are all made with a white vinyl fabric and cotton backing. They are flexible – easy to roll up and throw in your bag as your leave the box. All whiteboards come ready to use with any dry-erase marker.This whiteboard is backed with tan wood grain fabric with navy stitching.”  $14.  Pretty good deal.

9. Cast Iron Fish Bottle Opener by Rob’s Rustics

il_570xN.595309320_6kg8A handmade cast iron bottle opener with fish handle.  Available in distressed or new. This guy also does custom pieces, so if you have a unique idea contact him through his etsy shop.  $11.99.  Also a great deal and possible stocking stuffer or small gift for your Crossfit coach or other special person.

  • Handmade item
  • Materials: cast iron, distressed paint, bottle opener, wrought iron, fish
  • Made to order

10.  Unique Art Quality Athletic Shirts by WODWomen

“Artfully designed athletic shirts for strong women and the men who think they are awesome”  These shirts are available through the WODWomen Etsy shop or through our own website.  Shirts are printed in high detail using traditional screen printing techniques.  Prices range from $20 to $30.  Tanks, Tees and Long Sleeves.

WODMasters shirts for strong women and the men who think they are awesome.

WODMasters shirts for crossfit women shirts kettlebell workouts and everyone else, including masters athletes

11. Hand-Crafted Inspirational Leather Bracelets by a Crossfit Games-Bound Masters Athlete

leather bracelet“Wear your inspiration on your wrist.  These bracelets were made, in the beginning, for the fitness community. The word ‘RELENTLESS’ is a commonly said word to them and maybe to you as well. You may choose any word up to 10 letters for this style. If you want more letters, please ask for a custom listing as there will be an additional charge.
Leather is hand cut and riveted here by hand as well and hand cutting and stamping your brass plate. This bracelet measures 1″ wide and fits a small to a large wrist.
Please let us know in ‘notes to seller’ at checkout what word you would like to have around your wrist.”  $58.

A Crossfit women considers alcohol consumption and its effect on performance

Potential Concern for Crossfit: Sudden Cardiac Arrest in Athletes

Sudden cardiac arrest can occur in apparently healthy, well-trained people.  I’ve only seen this happen once.  It is tragic and scary.  Since I often write about Crossfit I will state write off that Crossfit had nothing to do with this particular case.  A young boy was running a 400 m race when he collapsed and died at about the 300 m mark.  I was a senior in high school.  The boy was a kid I coached as a volunteer.    I remember him telling me before the race that he felt like something “bad” was about to happen.  I spoke with him about how we all get nervous before a competition.  At 17, I don’t know there was anything I could have done to prevent this horrible outcome.  Such things happen, even today, with presumably better screening.  One thing to keep in mind in Crossfit, is that while people are usually asked to complete a waiver, they may have no idea if they are at risk for cardiac arrest.  Sudden cardiac arrest is believed to affect 1,000 people annually.  In young people who experienced arrest during vigorous exercise, only ~70% showed any abnormality on autopsy (Pilmer et al. 2014).

Crossfit Masters Athlete at Crossfit Seven in Fort Worth. Quinoa and Paleo

Crossfit Masters Athlete at Crossfit Seven in Fort Worth.

Major causes of sudden cardiac arrest in athletes.

Here are some causes of sudden cardiac arrest  for which there may be no obvious outward signs.

    • Hypertrophic cardiomyopathy: This is more commonly known as an enlarged heart.  It may be genetic or triggered by disease.
    • Coronary artery Disease:  This can happen to young people too, for example, if they have a genetic disorder that leaves them unable to clear cholesterol from their blood streams.
    • Commotio Cordis: This can be caused by a blow to the chest that disrupts the heart beat.  Commotio Cordis has happened to weight lifters, including Russian powerlifter  Igor Golushkin, during a bench press.  It might be worth keeping risk from chest blows in mind for your general population too.  I’ve been told by a well-meaning “authority” at my Crossfit Box (not a coach, just another member with an authoritative personality and “natural leadership ability”) that I couldn’t get hurt weight lifting because I am female and not strong enough. It is stunning what people believe sometimes. Yes . . . just about everyone is strong enough to get themselves in serious trouble.
    • Anomalous arteries: this is basically a birth defect.  Some people have extra artery branches or arteries that take unusual pathways.  This can cause problems when the heart is stressed, or it may not.  Most people will nerve know if they have anomalous arteries.
    • Wolff-Parkinsons White syndrome: is an irregularity in the heart’s electrical system.  It may be genetic.  People with this disorder may get sudden rapid increases in heart rate that can increase their risk of heart failure.
    • Myocarditis: this is inflammation usually due to an infection.
    • Arrythmogenic Right ventricular dyplasia: the right ventricle becomes weak.  This may be genetic but can occur for no apparent reason in a healthy person.  This may be the leading cause of sudden cardiac arrest in athletes.
    • Long QT syndrome: This is also an electrical irregularity of the heart’s conduction system.  It can cause irregular heart beat, fainting or death.

Get Training and Offer Training for Basic Life Support

Getting trained in basic life support is easy.  It might be something your box members would enjoy doing as an organized workshop.  Here is a video explaining the cardiac conditions discussed above.  It is a little dry, but helpful anyway.

There has been much debate as to whether the costs of screening outweigh the benefits to the few individuals who would benefit from them.  You can read more here in Link & Estes 2012:

ResearchBlogging.org
Link MS, & Estes NA 3rd (2012). Sudden cardiac death in the athlete: bridging the gaps between evidence, policy, and practice. Circulation, 125 (20), 2511-6 PMID: 22615422
Refaat, M., Hotait, M., & London, B. (2015). Genetics of Sudden Cardiac Death Current Cardiology Reports, 17 (7) DOI: 10.1007/s11886-015-0606-8

Pilmer, C., Kirsh, J., Hildebrandt, D., Krahn, A., & Gow, R. (2014). Sudden cardiac death in children and adolescents between 1 and 19 years of age Heart Rhythm, 11 (2), 239-245 DOI: 10.1016/j.hrthm.2013.11.006

Masters athletes protein intake improves recovery. Virgin initiation ceremony for the Hash House Harriers, Grenada West Indies

Crossfit to Hash House Harriers

Above is a photo from a Hash House Harriers Virgin Initiation Ceremony.

I’ve run what we used to call “long distance” for almost 40 years.  And started Crossfit about six years ago. I love running for relaxation.  I love Crossfit for the community and for the way it works out absolutely every part of your body.  I put both on hold last August when I started medical school. I’ve been through grad school. Have a PhD.  Did incredibly long hours of study and lab work as a post-doc.  But, Medical School is tough in a different way.  Performance on tests is everything. Your ideas do not matter. What you think does not matter.  That was hard to get used to. However, I discovered something that helped me keep my sanity. You may like it too: Hashing with The Hash House Harriers.

Hash House Harriers in Grenada

Back Country Grenada Hash Route.

The Hash House Harriers and Hashing: like Crossfit but Weirder.

The Hash House Harriers are described as a drinking club with a running problem.  The aims of Hashing are:

  • To promote physical fitness among our members
  • To get rid of weekend hangovers
  • To acquire a good thirst and to satisfy it in beer
  • To persuade the older members that they are not as old as they feel

Essentially the Hash is a run.  Walkers and hobblers are welcome.  No one seems to care who comes in first or last as long as it doesn’t turn into a lengthy search for the missing.  The route changes every time.  It is set by “The Hare” ahead of time with the path marked by chalk dust or similar.  Our group, Grenada Hash House Harriers, used piles of shredded paper.  The Hash is usually 4-6 miles and runs through woods and streams, along beaches and over mountains and along rural roads and tracks.  Sometimes through people’s yards and farms (with permission).   It was beautiful and a great way to get out of the library, the study hall and the anatomy lab and see life.  As with Crossfit, people help and support each other.  As with Crossfit there are “rules” and “customs”.  In Crossfit you would not spew chalk all over the place.  In Hashing, you should not wear new shoes.  The traditional Down Down for new shoes, is having to drink beer out of them before the Hash.

Hash House Harrier Down Down

A Young Man gets a Down Down for some offense and pours beer on his head with the aid of some PVC pipe

The Beer Part of the Hash

After the Hash there is a party with beer, ceremonies and a cook out.  Those who finish first start partying first. (Other Hashes may end at a bar or restaurant — depends where you are.) Ceremonies include initiation for “virgin” Hashers (first timers), honors for those who deserve them, and dishonors (or down downs) for those who well . . . . this can be kind of arbitrary.  Down Downs can be given for taking short cuts, taking fruit from a farm, or not wearing the appropriate attire for the Hash.  Some Hashes require, for example, wearing a red dress.  The formerly virgin hashers may be awarded “Certificates of Loss of Virginity.”  Make sure you keep your certificate, unless you wish to be “initiated” again.

The Beer Part of the Hash is likely to differ depending on what group your with.  In Grenada, there was plenty of beer (or water) and local food prepared by cookout on site, lots of loud Caribbean music and often dancing.  I met a lot of interesting people.  Some were my classmates at SGU (click that link if you want info on a good medical school that is non-traditional student-friendly).  Others were locals and others were passers through.   There are people who travel the world from Hash to Hash.

Andrea B. Kirk

The author on a great hair day.  Shirt is “Our Lady of the Kettlebells”

Read more about the Hash House Harriers at their Wikipedia entry.  I usually try to add Pub Med references at the end of the articles I write.  But a search for Hash House Harriers revealed nothing.

A Crossfit women considers alcohol consumption and its effect on performance

Can one daily drink of alcohol increase risk of heart disease?

Can one drink of alcohol increase risk of heart disease?  Reporters are saying a new study says “Yes”.  Many people have been advised through print or conversation that a daily glass of wine or beer is a healthy practice. And it might be for some. Many studies have found a longer lifespan in people who drink moderately.  People who are heavier drinkers have higher death rates, but so do people on the lower end of the scale when compared to “light to moderate” drinkers.  Heavy drinkers have been advised to drink less, while very light drinkers have been encouraged to drink a little more.  It has been thought that there is an ideal level of alcohol consumption for best heart health.

alcohol increase risk of heart disease.

Can alcohol increase risk of heart disease? It depends. Read the article and then join us and get the Experienced as Hell Shirt!

The idea that some people are genetically vulnerable to alcoholism is widely known.  However, some people seem to be genetically-disposed to drink less.  It was assumed that people genetically-disposed to drink less alcohol would have poorer heart health on average than people who drank lightly to moderately because so many of them miss the “golden window” of optimal intake.

Genetic variant is associated with some measures of better heart health

A new study has looked at data on drinking habits health data from over a quarter of a million people who had participated in dozens of different studies.  The large amount of pooled data allows for a more powerful analysis and reduces the likelihood that any differences among groups was due to chance.  In this pooled data study, researchers compared drinking habits and health of people with a particular gene variant called ADH1B rs 1229984 A-allele had

  • lower BMI
  • lower blood pressure,
  • less interleukin-6 (a marker of inflammation)
  • lower levels of C-RP (C-reactive protein, another protein involved in inflammation and associated with poorer health)
  • narrower waists
  • lower risk of stroke.

Their risk factors for heart disease were 10% lower than non-carriers at each drinking level.

People with theADH1B are faster at metabolizing alcohol.  This leads to a rapid  increase in acetyl aldehyde (which is toxic and makes you feel crappy and can give you a hangover.)  People with this gene variant drink 17% less alcohol than people without the gene.  Apparently it puts them off alcohol a bit, but not really all that much.   Possibly they just don’t need as much alcohol to feel it’s effects.

One of the things the researchers mentioned in the paper was the possibility that reducing alcohol intake, even if you are a light to moderate drinker might improve your health.

Why this study may be important to the genetically “normal” person.

Many studies have shown that the dose-response relationship between alcohol intake and cardiovascular disease is U-shaped.  This is what you would see with vitamin A.  Too little is bad for you and too much is bad for you.  Moderate is best.  This study shows that people with the ADH1B have a linear curve for alcohol.  Their risk factors decrease steadily as intake moves from high to low:  /   that brown slash there is supposed to represent a linear relationship.  This means we might want to look a bit more into the dose-response curves for everyone.  Or dose-responses for specific groups.

Study limitations and things to consider

Articles in the press are starting to appear stating that lowering alcohol intake is better for everyone’s health.   It might. But it might not. It may be true only for ADH1B. They seem to have better heart health even when you compare heavy drinking ADH1B with heavy drinking “normals”.

Correlational studies matter.

As many like to remind themselves and others: Correlation does mean causality (if only I had a quarter for every time the phrase wafts by my ears!)   Statistics are a wonderful tool.  Epidemiology studies, which are correlational studies, have been incredibly valuable in figuring out what factors influence our health.   Human experimental studies are better in many respects.  Researchers can control many of the variables. But they are extremely difficult to do and very expensive.

Final take-away:  People with gene variant ADH1B may be able to lower their risk of heart disease by drinking less alcohol.  This effect has not been observed in people who have other forms of the gene.

Read the original BMJ article here.

Other WODMASTERS articles about alcohol and health:

Athletes Alcohol Performance and Recovery

Alcohol and Diabetes

 

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Holmes, M., M., Asselbergs, F., Sattar, N., Lawlor, D., Whittaker, J., Davey Smith, G., Mukamal, K., Psaty, B., Wilson, J., Lange, L., Hamidovic, A., Hingorani, A., Nordestgaard, B., Bobak, M., Leon, D., Langenberg, C., Palmer, T., Reiner, A., Keating, B., Dudbridge, F., Casas, J. et al . (2014). Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data BMJ, 349 (jul10 6) DOI: 10.1136/bmj.g4164

ResearchBlogging.org

Weighted vest exercise program can build hip bone mineral density

Low Vitamin D, Atherosclerosis and CardioVascular Disease

Vitamin D has received tremendous interest over the last ten years.  One of the many things to come out about Vitamin D is that is that it protects against vascular calcification.  Vascular calcification causes or contributes to:

  • Stiff arteries
  • Poor elasticity
  • Increased blood pressure
  • Kidney damage
  • Increased risk of heart attack and stroke
  • Congestive heart failure
  • Early death
Womens crossfit shirt Birth of Venus

Artfully-designed womens tee, featuring the face of Botticellli’s Spring, a backdrop of 19th century American flags and the upper body of a good friend. $29.

That is terrible.  Not long ago calcification was considered a normal part of aging. Then it was considered an issue of cholesterol and a high fat diet.  The contributions of dietary cholesterol and dietary fats continue to be explored and challenged, however, researchers are uncovering other factors.  Vitamin D insufficiency has been strongly associated with risk of poor health and death.  This includes increased risk of death from cardiovascular disease.  Research groups are  now working to figure out more of the details.

Chronic Vitamin D Deficiency vs. On-again Off-again Vitamin D deficiency

A recent article in the Journal of Nutrition reports on an investigation of Vitamin D and vascular calcification.  The study used groups mice.  It lasted 32weeks.  Different groups of mice were fed either

  1. mouse version of a typical Western diet with adequate vitamin D for 16 weeks
  2. mouse version of a typical Western diet with low vitamin D for 16 weeks
  3. mouse version of a typical Western diet low vitamin D for 32 weeks
  4. mouse version of a typical Western diet with low vitamin D for 16 weeks then switched to a normal D diet for another 16 weeks.

Research Findings

Mice on the 16 week low vitamin D diet had more calcified arteries than mice fed the higher vitamin D diet, but not by that much.  (See the article for details).  The low vitamin D diet, however. turned up something interesting:

  • Vascular cells in the Low Vitamin D mice appeared to change into osteoblast-like cells.  Osteoblasts are build bone.  They also create dense, crosslinked collagen and create a matrix for bone.   This may not be the best thing for vascular health.
  • Mice fed a low D diet for 32 weeks had significantly more plaque than other mice, more osteoblast-like cells and more tumor necrosis factor.
  • Mice who were returned to the normal D diet had less calcification.  This is a nice finding.  It looks like increasing vitamin D  will improve the quality of arteries if your diet has been low in vitamin D.

Takeaway:

Womens Crossfit Shirt Mona List Hits the Bells - Kettle Bell Shirt

Mona Lisa hoists her bells. Our model is a Masters Crossfit Athlete from CrossFit Seven

It looks like low vitamin D plays a strong role in hardening of the arteries. Not all is lost,  Damage you have accumulated to date may be reduceable.  Please note too that this was a study of dietary vitamin D and not vitamin D made through sun exposure.  You can make your own vitamin D with exposure to sun light.  Please remember not to go overboard.  Too much vitamin D may also cause calcification of arteries.

 

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Nadine Schmidt, Corinna Brandsch, Alexandra Schutkowski, Frank Hirche, & Gabriele I. Stangl (2014). Dietary Vitamin D Inadequacy Accelerates Calcification and Osteoblast-Like Cell Formation in the Vascular System of LDL Receptor Knockout and Wild-Type Mice Journal of Nutrition

Ellam T, Hameed A, Ul Haque R, Muthana M, Wilkie M, Francis SE, & Chico TJ (2014). Vitamin d deficiency and exogenous vitamin d excess similarly increase diffuse atherosclerotic calcification in apolipoprotein e knockout mice. PloS one, 9 (2) PMID: 24586387

Caffeine Timing Crossfit Team Training for the crossfit open wod 14.3

Caffeine Timing, Time of Day and Athletic Performance

Summary: athletic performance is generally better in the afternoon than in the morning.  Caffeine timing may be important.  Caffeine levels peak in the blood stream 30-60 minutes after ingestion.  Muscles are more responsive to caffeine in the afternoon over morning.  Caffeine abstinence before-hand gives stronger effect.

Compete, if possible, in the afternoon over the morning.

Keep Austin Weirdfest 5K CrossFit Seven Athlete prepares for the event.

CrossFit Seven Athlete waits for his event. He’d look better in a WODMASTERS shirt

Athletes perform better in the afternoon and early evening than in the morning. This is the case for weightlifting as well as for endurance exercise like running, swimming and cycling.  Even penmanship is less precise in the morning.  Possibly it’s a warm up issue.  But it looks like a circadian rhythm issue too.  The circadian rhythm is an internal clock that regulates what you do during a day.  It regulates sleeping patterns.   Also body temperature, hormones and fluid regulation. Muscle response to stimulation is stronger in late afternoon.  A 2012 study (Mora-Rodriguez et al.) looked at electrically-induced response in weight lifters.  And they looked at voluntary contraction too, comparing morning and afternoon response.  All weightlifters were men.  All were described as highly trained elite weightlifters. The weightlifters lived in a research facility and were denied caffeine for 4 days before testing.  (That must have been tough.) The study also compared voluntary and electrically induced response in the morning with and without caffeine.  If you are wondering “what is caffeine” get some coffee.  Lifters were given caffeine on a body weight basis.  Caffeine was taken 60 minutes before performance testing.

Study Details: Caffeine Timing, Weightlifting and Performance.

  • Test times were at 10:00 am and 6:00 PM.  Caffeine intake was 3mg per kg.  (if you weigh 80kg.  that’s about 240 mg or  about one 12 ounce cup of extremely strong starbucks style coffee.)  Caffeine was taken 45 minutes before lifting.
  • Morning performance vs. evening performance
  • Morning performance with Caffeine supplement vs. Placebo.

Caffeine Timing  Results

Strength and power output with placebo was better in the evening by 3% to 7.5% over morning strength and power output.   Caffeine in the morning increased strength and power output by 4.6% to 5.7% for squats when compared to no morning caffeine.  Electrically invoked response increased by 14.6% and nerve activation jumped 96.8%.  Squats seemed to be more caffeine dependent than bench press.  Maybe mornings are just meant to be spent drinking coffee.

If you are doing Crossfit Open competitions:

This site started as a site for Crossfit Masters Athletes, so here is the info for Crossfit readers:  For people trying to qualify for regionals or the CrossFit Games 2013 this could be important.  Do your Open CrossFit WOD’s in the afternoon.   If you can.  Caffeine in the morning will get your muscles up to the level they’d be if you did your workout in the afternoon.  So when you are competing during a morning WOD, have some coffee 45 minutes before the event.  And don’t forget the four days of abstinence before hand.Last note: caffeine peaks in your blood stream 30-60 minutes after its taken.

  • Abstain from coffee for 4 days before your event
  • Drink Coffee 30-45 minutes before you start
  • Do your event in the afternoon if possible

Note: Tablet or pure caffeine may not give the same results as coffee.

The study discussed here was of the effects of caffeine on athletic performance.  Coffee may provide additional benefits.  You can read more about the effects of coffee vs caffeine here.

Mora-Rodríguez R, García Pallarés J, López-Samanes Á, Ortega JF, & Fernández-Elías VE (2012). Caffeine ingestion reverses the circadian rhythm effects on neuromuscular performance in highly resistance-trained men. PloS one, 7 (4) PMID: 22496767