Hi everybody, I'm Donna Prosser, Chief Clinical Officer at the Patient Safety MIMA Foundation. Today we're joined by Chuck Stokes, former president and CEO of Memorial Hermann Health System. He's also the founding partner of Relia Healthcare Advisors and was the past chairman of the American College of Healthcare Executives. He's here today to talk to us about high reliability in healthcare. Welcome Chuck. Thank you. Great to be here. Can you tell us just a little bit about your background? Well, sure. I started my healthcare background as a critical care nurse and I thought I was going to become a CRNA and I kind of started down that road training to be a CRNA working in critical care but got sidetracked into nursing administration and then decided that I probably would like to understand a little bit more about how the entire health system worked. So I went back to graduate school at the University of Alabama in Birmingham and got a master's in hospital and healthcare administration and then left the bedside, never went back into the clinical area and stayed in administration for the last 40 years and I've been the COO of four different organizations and the president and CEO of one. And so I have in December of 2019, I retired after 40 years of being in the trenches of healthcare. Excellent. Well, thank you so much for joining us here today. I'm really interested to hear what your thoughts are on high reliability. What does high reliability in healthcare mean to you? Well high reliability to me means the elimination or prevention of patient harm and also harm to the workforce and that's including your nurses and caregivers and your physicians. And it's such an important issue that the public has kind of been a little bit sheltered from over the many over the past decades. And the public has very little idea about how much patient harm actually happens on a daily basis in our industry and if they did, they would be scared to death and some of the frequently quoted numbers which are probably understated was that on an annual basis, there's over 240,000 deaths that occur every year as a result of medical error. And so when you think about that, the metaphor that we have always used using talking about that number is it is the equivalent of somewhere between four and seven fully loaded 737 airplanes crashing every five to seven hours in this country. Now we know that if that were the case and that that was actually happening, there would be no airplanes flying until basically a root cause analysis was done to figure out why airplanes are dropping out of the sky every four to seven hours in the United States. And so until COVID-19, death from medical error was the third leading cause of death in the United States and the public, very few of the public have very little awareness of that. And so I think that when I talk about high reliability, I only talk about zero patient harm. That's what high reliability means to me. It does not mean about I'm making a 50% improvement in my error rate or patient harm. It is only about getting to zero. That is the only acceptable number for high reliability. And that's really what I've spent probably the last 20, 25 years of my career was doing focusing on that. And as a critical care nurse, as an old critical care nurse, of course, we were always cognizant of about patient safety. I mean, it was at the top of our mind all the time. But most of the organizations that experience patient harm, it's not because of bad employees. It is because of broken processes. And that is really what we have to focus on in the industry is fixing broken processes and putting stop gaps in place so that you can't move from one part of the process to the next without going through a step of patient safety. Very well said. Now, we know Memorial Herman is a leader in high reliability. Can you tell us when did you embark on this journey at Memorial Herman and why? Yeah. So I arrived in 2008 at Memorial Herman and they had really started. Dan Walderman was the president and CEO at the time. And they had really already embarked on the journey because the primary reason was in 2007, we had the organization had a series of patient safety events. And it had to do with administering the wrong blood product to the wrong patient. And so anyway, that and we caused patient harm. I mean, there was harm that resulted from that. And it happened within like a period of a few weeks and everybody was kind of dumbfounded. It's like, how can that happen? Because when you think about blood administration, it's always two provider check. You double check the numbers. You double check the blood product. I mean, there were so many checks and balances, but this happened multiple times and a very short period of time. And Dan said, hey, we can't allow this to happen. This can, we have to fix this process. There's something broken about the process and we can't allow this in our organization. And so the organization got very busy pulling apart, basically doing a root cause analysis of the process. How did this happen? And we fixed the process. And so I can say that from 2007 until I left in 2019, when I retired in December of 2019, we had administered over 1.5 million transfusions of blood products during that period of time. And we had zero patient events and no one got the wrong blood product. And so one of the things why that's such an important point is because when you start talking about getting to zero, a lot of times clinical people say, well, look, things are going to happen. You know, you can't prevent everything. This is a very complex world and sometimes things are going to happen. But that is an example of how if you put the right processes in place and you hardwire those processes, you really can get to zero. So when we think about patient harm from things that happen all the time, wrong site surgeries, why did we start marking the site back in 2002? Because there were so many wrong site surgeries across the country. And I think the Society of Orthopedic Surgery, they were the ones first group that said, hey, it would be a safe thing to do to just mark which arm, which leg, which knee, which hip you're going to be operating on from an orthopedic standpoint. And then other specialties where there was laterality involved said, no, this is really a good thing to do for everybody. And of course, over time, it didn't happen overnight. It happened over many years. Organizations said, hey, you know what? You got to mark the site. We, a wrong site surgery is a preventable event. Leaving a retained foreign body, a needle, a sponge, an instrument in somebody's body is a preventable event. We have to take measures to make sure that that does not happen. And so we started doing that. And then we started holding people accountable and holding leaders and holding clinicians, physicians and nurses and other healthcare allied health professionals accountable for making sure that those things were done every patient, every time, timeouts before surgery. When you mark a site, you're doing a right knee surgery, patient comes into the OR. Why do we do a timeout? We want to make sure we've got the right patient on the table. We know what surgical procedure that we're going to do. And we've got that site marked. And then the timeout is we validate that information. We introduce everybody in the room to make sure the doctor, the surgeon knows who's in the room, who's part of the team, and then we move forward. And when you think about this, it really only takes just a minute or two. This isn't a 15 minute procedure. This is just a couple of minute event. But it's say thousands and thousands and thousands of wrong site surgeries and retained foreign bodies. Just before you whip that last stitch and close that incision site, do you have a correct sponge count? Do you have a correct instrument count? And if you don't, let's get an x-ray machine in here and take a quick x-ray just to make sure that we didn't leave something in and we didn't just miscount the sponges. And so those are things that, but the journey of getting there is not an easy journey and it's not a journey for the plane of heart. You're right. It is definitely not an easy journey. So can you share with our audience what challenges you faced at Memorial Hermann and getting this off the ground? Yeah. So I think that there were many. And so let me just start with where high reliability has to start. It has to start in the board room. It has to start with governance. You can't just go out and roll it out to your employees and your physicians. It has to start with the leadership. Governance is the ultimate fiduciary for quality in the organization. And so when you think about it, board meetings for many, many years in healthcare, these kind of things were not discussed in board meetings. Nobody came in. No CEO came in and told their board. Let me tell you what happened since the last board meeting. We killed three people in our healthcare system. Nobody ever said that. And the only way that you can get to higher reliability is being totally transparent and totally honest and starting with the board. You have to do it with the entire organization, but you have to start with the board. And I can tell you when you start that process with governance and if they have never heard of it and they've never heard those kind of discussions in the board room, it's a shocker. And I can tell you that from personal experience when we started that, Ed Memorial-Hurman, Dr. Michael Shabbat, who was our chief medical officer at the time, Michael would stand up and we had the IHI's format about presenting patient harm. So what it was was it was on the big screen. There was a slide that had all the patients with fictitious names. But what actually happened to them from a harm standpoint was underneath their name. And so their names were up there on a slide. And Dr. Shabbat would say, this is what happened since our last board meeting in harm events. And then the next click of the slide was if the name turned red, that means that the patient expired. And so the first time that that was presented was very shocking to the board. And then I, as the chief operating officer, had to stand up in front of the board and say, here's Michael with Dr. Shabbat would say, here's what clinically happened to the board, I mean to the patient, but here's what we're going to do about it from an operational standpoint. And I had to describe what would happen, what we did to mitigate that from ever happening again. A lot of times in board meetings, you can imagine 10 years ago, boards were not, however liability was not a big topic at the board meeting. What do you think boards were most interested in? They were interested in financials, what kind of big project they had, what kind of big capital equipment, what they were going to build. It was about bricks and mortar, how they were going to grow, who they were going to merge with, who they were going to buy. And so one of the things with governance is total transparency, total honesty. And then you have to have time at the board meeting to discuss these events because you're going to be asking the board to submit, to give you resources in order to mitigate some of these harm events. And then you have to educate your board. You have to bring experts in that are from, it's always good to bring outside experts in from a governance standpoint to remind the governance of the organization. What is their fiduciary as it relates to quality and safety? And then you bring people in like physicians that are experts in quality and safety and say, here's what you have to put in place in order to mitigate harm among your physicians, your hospital staff, and your patients. And at Memorial Hermann, what we used to do is we would bring patients and family members into the board meetings and let them tell the story if their family member was harmed. And that's very powerful for governance to actually hear about a harm event from a patient or a patient's family member, what that did to the family. And then we would also, when we had staff that stepped in and did heroic things about saying, we stopped the surgical procedure because the surgeon wouldn't do a time out or mark a site or we did a safety, a double safety check on like a blood administration or something like that, we prevented harm. We would present them at the board meeting and let them tell their stories to reinforce to governance. We are doing the things to keep our patients and our workforce safe in this organization. So that's the first thing, I mean, that's starting with governance. That is the first thing. The second thing you have to then as senior leadership have to declare, we're not going to have harm events and everybody is accountable. Starts with the CEO and it goes right on down to the employee and the organization. And it's not just, how reliability is, we always think about the patient and something bad happening to the patient. But it permeates the culture to the point where you could have a registration clerk sitting in a registration booth registering patients and see somebody spill their coffee in the lobby. That person has a responsibility to stop what they're doing, go over there, and either clean the coffee spill up off the floor to keep another visitor from slipping and falling on the floor, or call housekeeping and go stand by the spill until housekeeping gets there and cleans that up. So the culture, it's about creating a culture of accountability where everybody is responsible for safety of everybody, of visitors, staff, patients, etc. And so senior leadership has to be the next rung down that you're responsible for it. I'm holding you accountable for it and it's no excuses accountability. We don't make excuses when things happen. We make action plans about what we're going to do to mitigate, okay? No excuses, action plans. And then you start tying incentives. You tie your financial incentives for your executive team to quality and safety in the organization. You send a message to the organization that the only way that you get promoted and that you move upward in this organization, is that you have a commitment to quality and safety. And you demonstrate that time and time again and you demonstrate it over time. So that's kind of the second rung and then to your medical staff. And this is, it's no easy feat. And you have to hold the line with the medical staff to say, you know what, if you don't mark a site and you don't do safety procedures here, you can't stay here. And that's very difficult. And it's especially difficult in small hospitals across the country. If you are the only general surgeon in a 150 bed community hospital says, I'm not doing a timeout, are you going to get rid of that general surgeon? You might discipline, but are you going to say you can't really operate here? Now, when you're in a big metropolitan area and you've got thousands of physicians on your staff, people might say, well, if you're not going to do that, there's another one that will come out and take your place. That's not the culture. The culture is we do this for everybody's safety. We're doing it for your patient's safety. You're not trying to do this to be punitive. You're trying to establish the culture of safety for everybody. And you're actually sending the message to the physician, I care about you, but I care about your patients as well. And we're going to do everything we can to keep you safe and to keep you from having a bad outcome as well as your patient. And so the medical staff is, and the thing that I found with the medical staff is 95% of them will always do the right thing. They will always do the right thing. You give them good information, you're honest with them. You're very straightforward. You show them information, you're transparent. You're not spinning anything. There's no spin here. It's about the truth. It is only about getting to the truth. 95% will do the right thing every single time. And sometimes you can say, well, there's few, sometimes physicians, they're scientists. So they're a little skeptical by nature because that's their job to be skeptical. And what I tell people a lot of times is if you ever convert a skeptic, you get an evangelist, right? And so what you want to do is you want to create a lot of evangelists within your organization. They will go out and they will be the ones that will tell their peers, do this because it's the right thing to do. When their peers don't do that, it's not administration coming down on the medical staff. It's the medical staff doing their job of governance from their standpoint of taking care of their own medical staff peers in terms of safety. And then from the medical staff, you get to your employees. So again, everybody is responsible and accountable for high reliability in the organization. So at every leadership meeting on your CEO newsletters, your all communication forms, you have your organizational safety scoreboard out there. You have that thing stuck up on every nursing unit in the hospital and every department in the hospital. So everybody knows every day where you are on quality and safety. Totally transparent. You can't hide anything. That gets a little hairy for a lot of people because they are scared that, oh, legally that might expose us, et cetera. There are legal considerations and I'm not trying to minimize that. But the overwhelming majority of stuff that we have to discuss can be transparent. And if you want to get to high reliability, you're going to have to get there about transparency and honesty and straightforward and candor about things. Wow. Well, you mentioned that Memorial Herman, you went on this journey in 2007. Where is Memorial Herman now on the high reliability journey? Yeah, so they're still recognized as one of the leading health care systems in this country for high reliability because I think we paved the way for a lot of other organizations to start doing that. But we also had a lot of other organizations like ACHE and IHI and other quality-related organizations come together because they actually saw how much harm was being done in the country. And so, for example, when I was chair of ACHE, ACHE and IHI came together and Dr. Gary Kaplan with Aleutian Leap Institute was chair of Aleutian Leap Institute at the time. The chair of ACHE, well, Deborah Bowen and Dr. Tejal Gandhi from IHI, we all came together and said, this is such a national issue. Let's come together and come up with a white paper that we can give and present to the industry about how to become high reliability in health care. And so we interviewed over a year. We got together, there was a group of us. We interviewed like 50 different leading health care organizations, all big name organizations you would recognize them all. We interviewed oil and gas people, aviation, nuclear power, military folks. And we asked them, these are all high reliability organizations. We said, how did you get there? How did you train your people and what was that journey like? And we put that together in a 47-page paper called Blueprint for Safety. And it's free and we gifted that to the country. We gifted it to every health care organization in the country. And I think I can't remember what the latest is, but the last time I heard that document had been downloaded over 18,000 times. And so you can go on IHI's website and ACHE's website and get that document. And it basically breaks it down into six domains of what are the domains of a high reliability organization. And then ACHE and IHI, what we have spent time doing is developing curricula around those six domains. Because one is like I just said, is governments. The second one is senior leadership, diversity and inclusion. How do you embrace diversity and inclusion in order to come up with a safe environment? And so it goes through the six domains and we put together curricula about teaching organizations. If they're having trouble in one of those domains, how do they get help to get there? And so when I was president and CEO of Memorial Hermann, our chairman, Deborah Cannon, she was the CEO for the Houston Zoo. And you think about, that's a pretty high reliability organization. Because I'll tell you, if the tiger gets out of the cage on Saturday afternoon, that's a bad day at the zoo, you know? And so there are a lot of high reliability organizations that you can learn from. It's not that we have it all under control and everything, but it's kind of the journey that just never ends. It just, it just, it's, as I think we were talking earlier, the high reliability environment will get redefined because of changes in technology and in technique. And so when you think about what we've been experiencing for the past year now with the pandemic, with COVID-19, think about the high reliability environment now of telemedicine and telehealth. And how we're going to ensure that patients are not harmed via telemedicine and telehealth where you don't have that direct contact between a caregiver and a patient. And how that information has to get moved back and forth between different kinds of medium. And so we've got a lot of challenges on this, a lot of challenges for us as we're moving forward. So what recommendations do you have for an organization who's just getting started on their journey? I would tell you that the first recommendation would be you just got to bite the bullet and go do it. I mean, it's, you have to do it. It's not a recommendation of, I think you ought to go do that. If you're going to be in healthcare today, you have to go do it. And what I would tell people is, don't, don't do a start, stop thing. I mean, when you get started, people in the organization most of the time and most organizations, they always see it as flavor of the month. Here, you know, we're, we've got a new initiative here to keep people safe and keep workforce safe. Flavor of the month, it'll, it'll pass. It'll go by and we'll lose interest in it. So when you get committed to this, you need to be all in. You got to get your board on, on board first. Governance has to be the first step. And the rest of it is a journey. It is a multiple year journey and you're not going to get there in one or two or three years. It is a multiple year journey. And you have to put resources. The other recommendation is you got to be willing to put forth resources. And, and so for an example of that was we came, we, we decided to be a high reliability organization if you were admitted to the hospital.  So we had a rule. We established a rule and concert with a medical staff and it was not easy. But we said, if you get admitted to any of our 17 hospitals, you had to see a doctor within four hours of being admitted. If you got admitted to the ICU from the emergency room, you had to see an intensivist within two hours of being admitted to the ICU.  Because all across the country, it happens, it happens every day that somebody gets admitted, but the doctor says, I'm admitting my patient. You know, Chuck, I know him well. Go ahead and admitting through the ER. I'll see him when I get through with my office practice this afternoon. Well, that doctor could be tied up all day seeing 30, 35 patients. And they, they come up at eight or nine, 10 o'clock at night. Well, if I have sepsis and I don't get treated for eight hours, you, I could be over the line of being, you know, taking cured from sepsis. I could be, it could be overwhelming sepsis and I could slide down the tubes and I could die. Okay, so we said, you have to have, you have to see a doctor within four hours or two hours if you're in the ICU. And when we said in order to make that happen, we have to put hospitalists in our, in our, in our facilities, all 17 facilities have to have a hospitalist 24 hours a day, seven days a week. We have to have intensivists in our ICUs to see a patient in two hours. And it was not popular at first with the medical staff because they didn't want another doctor seeing their patient. But they got used to it and it became the standard of care. It costs millions and millions and millions of dollars for our board to allocate the funds for us to provide staffing for hospitalists and intensivists in 17 hospitals for 24 hours a day, seven days a week, 365 days a year. But that's what it took in order for us to say high reliability that we wanted to get on that journey. So don't, you can't be tentative about it. You have to be all in to get started. There's a process and you can move that forward. I'm not just trying to say you have to get there overnight because you're not going to do that. I think you've got to be transparent. You've got to become a transparent organization with your data. You've got to be willing to share and share it throughout the organization and you've got to call it for what it is. And when you have bad outcomes, you deal with the bad outcomes. You have to be willing to do that. It's constant communication. You communicate. You start all meetings with high reliability stories about bad events, good events, good catches or something that, you know, prevented. It's not always about looking for the negative, but it's about looking for the positive. And we call, you know, we call that it's opening your kimono.  This is where we are, but we're committed to getting better. And then the no excuses accountability, you got to say, we're not making excuses. We're going to make action plans. And that's how we're going to become a high reliability organization. Well, Chuck, this has been so wonderful. Thank you so much for joining us today and for sharing all of your wealth of knowledge on high reliability organizations. It's our goal here at the Patient Safety Movement Foundation that every healthcare organization across the globe will make a commitment to being highly reliable. So thank you for helping us get started. Absolutely. Thank you. Thank you for having me. I've enjoyed it. We'll have a wonderful day. You too. Bye-bye.


Hello, my name is Patrick Longa. Today, I will talk about our project title, The Cost to Break Psych, a comparative hardware-based analysis with AES and Shathri. This is joint work with Wen Wang and Jakob Zephyr. Before jumping to the main part of the presentation, let me give you a brief summary about the project. Let's start with the problem that we are tackling. Psych, that stands for super-singular soya-niki encapsulation, is an alternate candidate in the third round of the niche post-quantum cryptography standardization process, and it's in fact the only a soya-niki-based scheme in the competition. This is important given that we think that diversity should play an important role in the selection process, in which case, Psych becomes a very attractive alternative, if we notice that most finalists in the competition are lattice-based schemes. Maybe the single most critical drawback of Psych is that it's relatively slow. However, on the other hand, Psych has demonstrated to have a solid security. The problem is that currently, Psych is being penalized because its parameters are chosen very conservatively, using a random maxes memory model. We observe that these hard Psych's performance more than it should. What we do in this work is to analyze the security of Psych, AES, and Shafiri using a more realistic budget-based cost model. We use AES and Shafiri here because these are used as reference points to determine the niche security levels. In our model, we can consider both computing and memory costs, together with historical price data, and the use of a conservative projection of future costs. For our analysis, we also propose an efficient architecture for the single most critical computation in the cryptanalysis of Psych, that is, the large-degree isogenic computation. This architecture is then used to model an ASIC power instance of the Van Orschel Wiener or VAU parallel collision finding algorithm. This algorithm is the most efficient algorithm currently known to break Psych. Now, let me briefly comment on our results. As conjecture, we concluded that the current Psych parameters are very conservative, and offer a wide margin of quantum and classical security. Our model allows us to quantify such security gap. Accordingly, we propose new parameters that fit more closely than niche security targets. These new parameters are still chosen conservatively. We also report new implementations of Psych using these new parameters, and show significant gains in performance and bandwidth. This is a win-win situation. As I said before, the execution time is the most critical drawback of Psych. On the other hand, Van Width is one of the most attractive advantages of Psych. So reducing key sizes makes Psych even more attractive. Okay. So now let's go deeper into the details of the project. Let me give you some basics about post-quantum key exchange from SuperSingular Historianists. Psych is in fact based on SIDH, which stands for SuperSingular Historian Diffie-Hellman Key Exchange. This protocol was proposed back in 2011 by David Zhao and Luca Diffel. As we mentioned before, SIDH has a solid security history in spite of its young age. The best known attack is the classical VAO algorithm. So on a classical and quantum computer, the complexity is exponential. Now, Psych is the in-CCA secure version of SIDH. It was designed in 2017 and then submitted to the NIS post-quantum cryptography standardization process. Let's recall some facts about elliptic curves and iso-units that are important to understand how SIDH and Psych work. Let's assume we have two elliptic curves, E1 and E2, which are defined over an extension field L of characteristic P, where P is prime. An iso-unit is then defined as a non-constant rational map that maps E1 to E2, and that also preserve the identity element. Now, let's mention some relevant properties that are important here. For example, iso-units are group homomorphisms. Another important one is that isomorphism classes are essentially subsets of elliptic curves that share the same J-invariant. Finally, given a prime P, we have approximately P over 12 isomorphism classes of super singular elliptic curves all defined over Fp square. One way to understand SIDH is with this idea of super singular iso-unit graphs. In this graph, we assume that the vertices or dots represent the isomorphism classes of super singular curves, meaning that they contain a subset of curves all with the same J-invariant. Now, the edges that connect these vertices are the iso-units, which have a fixed prime degree. So we can have graphs with different degrees. For example, on the left, we have the degree two iso-unit graph, and on the right, we have the degree three iso-unit graph. So as you can see, the graphs map the isomorphism classes in different ways, and this is the idea behind the SIDH protocol. Now, let me explain how SIDH and site work in a nutshell. Let's start with SIDH. This assume Alice is represented in red and Bob in blue. Again, we have our vertices, which are the isomorphism classes, just visually expanded on this slide. So we start by fixing an initial elliptic curve that we call here E-naught. This one belongs to a certain isomorphism class. Then Alice proceeds by generating a secret iso-unit that we call phi A, and with that secret, she maps E-naught to another elliptic curve that we call E sub A belonging to another isomorphism class. Both does similarly using a secret iso-unit phi B that maps E-naught to another elliptic curve that we call E sub B. Now, E sub A and E sub B are the public key information. They are exchanged between the parties. So then we proceed as follows. Alice takes Bob's public key E sub B, and using another secret iso-unit phi prime A, she maps E sub B to another curve E sub AB. Bob does similarly to map E sub A to another curve that we call E sub BA. If everything is done properly, then E sub AB and E sub BA are expected to belong to the same isomorphism class, meaning that they should have the same J invariant, which then can be used as a share key. All right. But the problem with SIDH is that it is not secure when keys are reused. It is only recommended in a femoral mode. That's why we need Psyche. Psyche uses a variant of the Huffhey-Hobelman skills transform to convert an in-CPA secure public key encryption scheme into an in-CCA secure key encapsulation mechanism. In this slide, you can see the details of the Psyche protocol. I won't go in too much detail here. Just wanted to highlight the three stages that make up SIDH. As again, it has a key generation stage where we generate the secret key and public key pair. The public key is then sent to the end capsulator which proceeds to do an encryption of a randomly generated message M. So it produces a Cypher text C and also a share key. The Cypher text is sent back to the decapsulator which proceeds to do a decryption using the secret key. Then there is a re-encryption to make sure that the Cypher text was well-formed. If that's the case, then the share key is output. Now, the security of SIDH and Psyche is based on the so-called computational super-singular Sogene problem. It is defined as follows. Let's assume we have two super-singular curves, E1 and E2, defined over FB-square. In our setting, these curves are connected by an Isogene with a large and a smooth degree. Then the problem is as follows. Given points P and Q that lie on E1, and the images of these points using the Isogene on E2, then the hard problem is to compute the Isogene phi. Let's talk about how the security strength of a given cryptosystem is determined, and then focus on the specific case of parameter selection for Psyche. Okay. So for a given cryptosystem, one can use a simplistic but very conservative approach that is based on the query complexity of the cryptanalysis of the scheme. In the case of AES-120A, for example, a brute force attack requires two to the 128 AES execution calls. And this determines the security of this scheme in this case. One can do a slightly more sophisticated estimation using the random access memory model. So for example, one can use the complexity of the iteration of the attack in terms of gates, instructions, or cycles. In our example with AES-120A, this determine that implementation of this scheme takes approximately two to the 15 gates. That means that the security of AES-120A is estimated as two to the 128 times two to the 15, which give us a total of two to the 143 classical gates. And this is precisely what is used to determine security level one in the NIST process. What are the disadvantages of this approach? Well, the communication and memory costs are totally ignored. And that crucially penalizes cryptosystems for which cryptanalysis actually requires significant amounts of memory. And this is precisely the case of Syche. All right, in the specific case of Syche and its parameter selection, first of all, we need to determine the search space. This is essentially given by the number of half-order elliptic groups of groups. And this is approximately P to the 1 fourth. And this is the parameter that was used by the Syche team to determine round one parameters. In this case, the supersimilar signal problem can be modeled as a black box clawfinding problem that can be solved classically with mid in the middle in time and space complexity P to the 1 fourth. So for example, to match the 128-bit security of AES 128 at level one, we needed a prime of approximately 512 bits. Later on, Ag and others pointed out that the amount of memory required by the mid in the middle attack was unrealistic. They suggested to use the VAL algorithm instead. You can see the corresponding time complexity in the slide. They also suggested to use the storage to certain amount, specifically to two to the 80 memory units. For example, under the light of this new analysis, the bit length of the prime required for security level one could be reduced to 448 bits. So round two parameters were updated accordingly. For example, you can see here that Syche P503, that uses a prime of 503 bits, was replaced by Syche P434, that uses a prime of 434 bits. And this is for NIST level one. This reduction in sizes translated to an important speedup and reduction of public key and Cypher text sizes. In this table, we can see a summary of security estimates. For Syche, the number correspond to round two and also round three, because the parameters remain unchanged. In the column level NIST classical gate requirements, we display the estimates that determine the different security levels, using AES for levels one, three and five, and SHA-3 for level two. The two last columns on the right correspond to Syche, with numbers estimated by each and others in the first case and by Costello and others in the second case. In both cases, the memory requirement is fixed to two to the 80 memory units as explained before. As can be seen, the estimates marked in red are slightly below the gate requirements from NIST. And this is a first issue that we observe here. This is justified as follows in the Syche specification document, and I quote, although their times fall slightly below NIST required gate counts, the corresponding conversion to gate counts would see these parameters comfortably exceed NIST requirement, end of quote. So in some cases, there is a gap between the NIST levels and the estimates of the official Syche parameters. And this remains somewhat unexplained. The second issue is that there is no fundamental reason to use the memory requirement two to the 80. So in this work, we solve these two issues as we will explain later on. Let's now proceed to explain our budget-based cost model that we used to estimate the cost of crypto analyzing Syche and to estimate its security. So this model consists of some easy to understand steps. First of all, we fix the budget of the attacker. Then we distribute the budget to get computing and storage resources, such that the time to run the crypto analysis is minimized. And finally, the security of the scheme is estimated as the time it takes to break it. Similar approaches have already been used in the literature. For example, Van Orscher and Wiener did it in 94 and 99. However, there are some drawbacks in most previous studies. The main one is that the analysis is typically focused on a specific point in time. We improve the cost model in two crucial aspects that we believe increase the significantly the confidence in the analysis. First, we analyze historical price information of semiconductors and memory components in order to determine the soundness of using this information to evaluate the cost of crypto analysis. And second, we apply simple but conservative projections to estimate the costs in the future, which is ultimately the information that is relevant for a crypto system. The piece of information that we need for the analysis is the cost of components, including gates and memories. What we did was to compile public release prices of microprocessor units or MPUs from Intel and AMD for the years between 2000 and 2020. We use public transistor counts and also we use the standard assumption that a gate consists of four transistors. In addition, we apply some scaling to these release prices to approximate them to actual production costs. Given that release prices include additional costs, including some margin for profit. To do this approximate approximation, we follow the procedure by Canon man. We did a similar estimate for memory components, such as hard disk drives, DRAMs and SSD memories. And finally, we also validated our results with the forecasts provided by the international technology roadmap for semiconductors or ITRS, which was an international consortium that coordinated the progress and development of semiconductors in the 2000s. Here, you can see a graph with the cost estimates for the different components. We display the number of gates that can be bought per dollar that is displayed as a blue line and the number of bytes that can be bought per dollar display as the red lines. In this case, considering different types of memories. As can be seen, the costs of the different components have increased in a very uniform way. This is visible by looking at the solid green line at the bottom that represents the ratio between the costs of gates and the costs of memory. This result provides evidence of the relatively stable relationship between the two costs, which is one of the key aspects that give us confidence in using the cost information to determine the cost of crypt analysis and therefore the security for the scheme. All right, so we obtain robust cost information for the analysis that we were carrying out. What we needed next was to collect area and time data for the different cryptosystems and their analysis. So let's start with Psyche. For Psyche, what we did was to design an efficient large degree isogenic accelerator, which is the main component in cryptanalysing the scheme. The goal in this case was to achieve an optimal area time product on an ASIC. So we implemented all the main computations including point addition, point doubling, isogenic evaluation and isogenic computation for the case of the degree four operations, which are actually the most efficient ones for Psyche. Here in the screen, we show a diagram of our architecture. Under the hood of these operations, we also need an efficient filler arithmetic architecture. And that's what we did. We also proposed a novel unified multiplier of our FPS squared that enables a theoretically optimal parallelization of the internal operations. All right, so we implemented this efficient hardware accelerator and then we proceeded to obtain all the data that was required to plug into our cost model. So first of all, we collected cycle counts for the different operations. You can see the table with the best results that we obtained for each parameter set. At the top, you can see the case of the round two and three parameters. But at the bottom, there are new alternative parameters that I'm going to discuss later on. Note that we applied a very conservative approach. We ignored all the control, computation and data communication overheads. This gives us a safety margin in our analysis. Then we proceeded to obtain every and time results using synthesis tools for ASICs. The results were obtained with an open source NAMGate 45 nanometer library. The results corresponding to the large degree is only accelerator are displayed in the table on the right. As before, we applied a conservative approach, basically all the control circuitry that is required to implement the rest of the VAO algorithm is also ignored, like for example, the hash function. We then proceeded to do the same analysis for AS. In the case of AS, we did the analysis with the parallel attack based on rainbow chains. The complexity of the attack is shown in the screen. In this case, it corresponds to using N parallel engines targeting a key K of B to length B. To obtain the area time information we use to our knowledge, the most efficient AES implementation available in the literature for ASICs. And in this case, efficiency is defined as the best area time product. We follow a similar approach for Shafi, in this case, using the VAO algorithm for collision find. Okay. So at this point, we had area time information and for site AS and Shafi, and what we needed to do was to plug in all this data into our model. For this purpose, we wrote a Python script that made all the calculations for different years using different budgets from one million up to one trillion dollars. And as I mentioned before, we also included simple cost projections up to the year 2040. Let me illustrate our results with the case of the hundred billion dollars. In this case, well, I have to mention that other budgets also achieve similar results. The results for the years between 2000 and 2020 were obtained with historical price information, while the results for the years between 2000 and 25 and 2040 used our projections. On the Y axis, you can see the logarithm of the number of years that it takes to break a certain crypto system. The estimates for AS are in red, corresponding to level one with AS 128, level three with AS 192, and level five with AS 256. The estimates for psych are in blue, corresponding to psych P434, P16, and P751, respectively for the same security levels. And as can be seen, there is a very wide gap between the security estimates for AS and psych, which confirmed that the current round three psych parameters do fulfill the needs targets and in fact offer much higher security than expected. So what we did was to try to choose parameters that follow more closely the needs targets. And these are the ones that I'm showing the screen now are labeled with the word new, psych P377, P546, and psych P697, for levels one, three, and five respectively. Let's remember that this still includes some conservative safety margins, which we think makes our parameters safe to be used to target the needs levels. So to finish this presentation, I will share some software implementation results that we got that showcase the potential benefit of using the proposed parameters. The results in this table in the screen correspond to an X64 machine with an Skylake CPU. The side round three parameters are displayed on the left and the alternative parameters on the right. In each case, there is a very nice reduction in bandwidth that is in the public key sizes, which is displayed in terms of bytes. Given that one of the most attractive features of psych is that it provides the smallest key sizes of any of the post quantum candidates in the next competition, this reduction makes psych even more attractive. Also in the table, we display the computing time in terms of millions of cycles, which you can see the significance speed up when moving from the round two, three parameters to the new alternative parameters. So for example, psych P377 intended for level one can be executed in close to four milliseconds. This is in a 3.4 gigahertz machine and which is about 1.4 times faster than psych P434, which is the current round three parameter for level one. So again, this provides a very important speed up in the computation, which arguably pushes psych in the right direction to make it more amenable for many more applications. To finish, let me point out a couple of links with additional information. We have our full paper version on Eprint containing many more results and analysis. Also, you can visit our GitHub repository that contains our hardware implementations, including a software hardware co-designed prototype of the full ball valve algorithm. And this GitHub repository also contains our software implementations of the new parameters. Thank you.


Here in Davos we see that digital economy is the first subject out of eight to be discussed. Do you think that it's really going mainstream now? Well, when we look at people in the street that start to look at their mobile to check the Bitcoin price, I think indeed the digital economy and as well the crypto world is showing that this is entering the main street. As well when we look at traditional media and most of their headlines is about you know like the ups and downs of Ethereum, Ripple and VTC, well it shows as well that something is changing. So yes, I think we are at the beginning of a new era and now the question is how this moment, this innovations is going to serve populations and humanity as well. I think that it's not your first time in Davos. Do you think that this year it's different because of so many what we are now here in front of crypto headquarters? Well, I think what is interesting is innovation is not related to one place. Innovation is about you know people's art, people's vision and what is certain is something is moving and when we see you know like people like myself you know from a banking industry moving around on becoming a social entrepreneur and we see so many examples like that of people really that at some point reach a point of consciousness and say I want to do something good, I want to do something which is meaningful. So yes, I think we are going to see a spread of innovation here in Davos but as well in all parts of the world. What do you think about regulations and being also a person from the banking sector, what is for you more important? Well, I think you know when there is a disruptive innovation at first we need to let it grow in a way which is not too controlled because what we want is we want to grasp the positive impact it can bring. But at the same time we have you know like on the crypto community be able to self-regulate ourselves to make sure that this is going to follow a serious path, something which is going to be we fiduciary responsibility with the people that entrust their funds, their investments and become you know like members of the community. So I think you know we cannot prevent regulation to look at that because that market right now represents you know like a 300 to 400 billion dollar market. So this is indeed now visible in the radar and probably this is going to continue to increase but what we have to do is we have to set examples, set good practices make sure that speculation is not overwhelming the good-willing associated you know with the crypto and that's how you know like myself for instance with my group we're going to launch over the next few weeks a pre-sale of all you token which is going to be the first cryptocurrency you know for social and economic inclusion. I like to see this energy in your eyes because well you really like this and I see that you see the potential and perspective and promising technologies in blockchain. It's not a stranger to GP Morgan. I can't not ask you about the opinions of Mr. Dimon being said and that have influenced so much the crypto market. Could you please comment on this because do you think that he understands what is Bitcoin really? Well you know I think right now as we speak most of the people don't really understand what is really you know like the potential and the vision associated to it. So even people that can pretend themselves as fund it into the blockchain we are just at the beginning of the understanding of the possibilities. So that's one of the aspects. The second aspect is we are in a world of sensationalism. So sometimes one sentence you know like put out of the context you know is leverage and make you know like a very strong statement. Well at some point it's just like maybe something like if you don't like you know classical music you might just say well I don't know what it is about. I might you know like show a more curious aspect. Now what I would say is we have you know to be open-minded. When we make you know like a tag on condemning without understanding fully the full potential of something which is you know like related to innovation I think we are you know like making a shortcut. And I think that now this new world and new market and new innovations really can prove in so many ways that they are bringing something positive for humanity as a world. So my responsibility as an entrepreneur is to make sure that we can strive to support that blockchain is bringing something positive for the people. And if we can prove that Jamie Diamond and all the other CEOs of the banking industry of that all new world will probably better understand that actually they can even benefit from it and that is good even for their banking industry. Thank you so much. Thank you. It's really a pleasure to talk to you.


Well, in the traditional introduction, I was a Angelo Bacca, I was born in Kisla, Bacca, Chichina. So my name is Angelo Bacca. I'm Navajo and Hopi, and I actually live and have grown up in San Juan County in the various areas of the region. So for indigenous communities, we're always thinking about our children's children's children having this kind of seventh generation thinking of the future. And I think that's a different approach than most Americans, most Westerners have when it comes to thinking about heritage and observing it for future generations. So I do like that framing and that theoretical idea of being in the forever business because we actually do need to shift our attentions and our focus towards the future. So we need to have people who are both in the private sector and in government and in public policymaking actually have that long-term thinking about preserving our heritage for the future. I think land is something that people see materially, visibly in front of them, and that helps because people can position themselves in that landscape, right? But the intangible cultural heritage piece is significant because it makes the intersection between objects or materials interact with human beings.  You can carbon-date it. You can say what basket maker to a period it's from or what design that this particular painting was made from these materials that were gathered. But you don't have the other half of the information. What was that used for? Who was using it? What were the songs affiliated with it? What were the ceremonies that were done, rituals, for what purpose and for what specific reason? And what is it that we still use that is just like it or is exactly like it? And so that's the living cultural heritage piece that you have to complete with your materials. You both go together. The land and the people cannot be separated. Otherwise, you are limiting yourself and the information that the cultural heritage can give you. So you're only giving yourself half of the complete story. Because I think you'll find that once you actually do have a good, positive, productive working relationship with indigenous communities, that many of the same interests and the same allyships that are being built, the movements will start to happen and it will happen easier and in a very smooth and efficient way. And I think the coalition is a good example of that. Like having the acknowledgement of our previous history and what our limitations are, but also what our strengths are, that really helped galvanize us as a single entity, one unit that had one heart and one mind to protect a sacred place that we all thought was important to us. So I think that goes for government offices, for organizations, for nonprofits, for conservation groups. They all could stand to improve their working relationships with indigenous communities. We have working professionals. We have scholars. We have professors. We have lawyers. We have, you know, public officers. We have many different kinds of resources within ourselves, but we still have to be put on an equal and respectful ground with everybody else. Stories are very important because will they hold knowledge? And it's important for us to understand that even the oral traditions, the legends, the myths, all these things that talk about the time before what we understand now actually are very well built in a lecture series of large information that itself is a resource. Traditional knowledge has all of these included elements of things that are being talked about both in behavior of people, in social and cultural building, but also with the environment and how you manage it, how your relationship as a human being is meaningful and significant to other living beings like plants and animals and the elements and, you know, other than human beings, other spirits that live among us. The ability to tell a story and have a narrative, whether that's spoken in oral or through media and film and audio and visual or different kinds of imagery that's like art, like these are very important powerful tools that still persist today telling us the story of the past. Even in various years we can see like all the rock art and petroglyphs, like these are our living histories. They are archives. It's like having the Library of Congress on the wall and nobody's wanting to protect that. That's kind of, you know, it seems like the inverse is happening when really all of us should be working together to protect cultural heritage.


All right, you have a personal question for me. This is your last chance. Otherwise, we're gonna wrap up. Okay, personal question, Jonathan. How do you cope with the discouragement from not landing the eagle, meeting the one? Great final question for the evening. How do I manage the discouragement? Folks, I'd be lying to say, I do feel discouraged. In fact, I was just having a conversation with a friend of mine. We were kind of deciding, am I ready? Is maybe what's really going on at reflection of me? And I've done a lot of personal development work on myself. I put myself out there. I've gone on dates. Some women I've dated, I've been into them. They haven't been into me. Sometimes they've been into me. I haven't been into them. But it's starting to wear on me. Dating can wear on us emotionally, not meeting. And by the way, I'm doing everything I practice. Everything I teach, I do. I'm radically honest. I'd like to think I'm relatively charming. I'd like to think I'm very demonstrative. I plan first dates. I do all the things that men are supposed to do. And I have to wonder, I mean, this is wearing on me. Like, what's wrong with you, Jonathan? But I know nothing is wrong with me because I do genuinely love myself. And I've have to just resign myself that I could have in the last four years, I could have had one or two relationships in the last four years that didn't work out. Now, for the most part, I was dealing with the loss of my son. I was dealing with, I didn't wanna work. For all of 2019, I didn't feel like working after Connor passed away. And thankfully, 2020, I had a stellar year and I'm having even a better year financially so I can feel like I'm in that provider protector mode, if you will. But ultimately, it has worn on me emotionally. But I always sit with this one thing a friend of mine told me and he said, this is when I was lamenting after my significant relationship ended.   But I said to him, I'm never gonna love again. And he said, Jonathan, love is a risk and it's the best game in town. Folks, I am not gonna give up on meeting my soulmate. I'm not gonna give up on meeting the one. I just haven't met her yet. And the old saying, fall off the horse seven times, get up eight. That's where I'm at. I feel like I've fallen off a thousand horses. All right, falling off the horse a thousand times, that's what it feel like, but I still get up because to me, it's raining, beautiful, heart centered, emotionally mature women who share my values, who lifestyles are blendable with mine and we have absolute chemistry for one another. I hold that space and whenever I'm feeling down, I read my love mantra and this is something I teach in my private coaching. Check out the link below. I practice what I preach and my hope is she comes here sooner rather than later and guess what? You know what, if it doesn't happen for a while, it's okay because I also have a great relationship with myself and that's my invitation for every one of you is to have a great relationship with yourself because if it doesn't happen for me in this in lifetime, it's gonna happen. Although I do know what's gonna happen in this time, I know I will meet my partner, someone who wants to go on this journey with me, that's someone that wants to go down the level of spiritual partnership with me and that's who I'm holding space for and I know it's gonna happen for me rather sooner rather than later. So thank you so much for that question, Boo. I really, not Boo, thank you for that question, Monique. I really appreciate it.


I bet you didn't know that Game Freak leaks every new Pokemon game in their older titles. In Pokemon X and Y, they've revealed an item called the Strange Souvenir that represented a Hawaiian Tiki Totem. This item would later represent the Tapu Pokemon in Sun and Moon, which is Generation 7. In Pokemon Sun and Moon, there was a secret Pokemon poster in Game Freak's office. This would later be Gigantamax Toxtricity from Pokemon Sword and Shield, which is Generation 8. In Pokemon Sword and Shield, there was a secret room that had oranges and grapes as a wallpaper, which would go on to represent Pokemon Scarlet and Violet, which is Generation 9. What would be the hint in Scarlet and Violet for Generation 10? Do you think you can find it so you can tell someone?


Hello everybody, and welcome to another hobby cheating video, and I am really excited about this one. It's a short one, but I promise you it's going to be fun. If you know me, you know that I am a huge fan of the Layho metal color. This particular paint I have on screen right now. It's beautiful. It's the perfect acrylic metal color. It is better than any other true metallic acrylic paint. The problem I've always had is that they have no bronze. They have a nice gold and a nice copper, one that's real green, one that's real red. You can mix them together to get nice rich golds and everything in between, but I've always struggled to get a good bronze. I've been experimenting a bunch, and I'm happy to say we finally, finally have a good recipe. So here I've taken some Layho metal color silver. Just straight up silver. It's quite neutral. I also use colors like aluminum, the base aluminum, or pale burnt metal. And I've mixed it at a two to one ratio with drops of fire slayer flesh contrast paint. And at a two to one ratio, you get this nice faded bronze, just like you see here. And at the, and then we're going to go further, I'm going to take it up to a three to one ratio. I actually ended up putting in one more drop. And if you do a three to one ratio, then what you get is a really, really rich, wonderful, wonderful bronze color. Okay. And you can see as I mix that all up, just look at how fantastic that is preserves all the intensity because the silver is such a powerful potent metal color preserves all that intensity, all that coverage power and yet is this wonderful bronze color. So that's just silver in a three to one, or sorry, a fire slayer flesh and silver at a three to one ratio, three drops of fire slayer flesh for every drop of silver. And I just, I really love how this looks. And as you can see on screen right now, I just, I put up in the corners there some other pictures of bronze, just so you can see how well that actually compares the other really great part about this particular trick of just these two colors together, just fire slayer flesh and silver is that you have everything you need to shade and highlight the metal right there. So I'm just using some of the straight fire slayer flesh and creating my shadows in the metal. And it goes over the existing bronze color quite transparently, of course, because it is a contrast paint, but as it goes over so transparently, it just perfectly looks like these really nice rich shadows on the on the existing metal. So you can see you get a nice deep color there. Now, if I take just the pure silver, hey, you guess what, mixing that into the ratio in this case, I'll just use a little pure silver so I can be extreme for the video. But normally I would just, you know, slowly mix it into my other my other bronze mix that I have there. You get a perfect highlight color. So with just these two colors, you get everything you need to do the entire ratio. Okay. It's such a simple, fast, easy color. And I am, I've tried so many different recipes with Vallejo metal color to get a good bronze and nothing really matched what real bronze looks like. But this finally nailed it. So I'm going to show you just very quickly how we take it up all the way. So here it's all dry. You can see how wonderful that fire slayer flesh pure, you know, creates that nice really rich shadow. And now I'm going to take a little bit of blue green. So this is Vallejo model color blue green, which I always use as a starting point for my vertigree. And I'm just hitting some of the rivets, some points around like where the metal connects, some cracks, just places where there's going to be oxidation. The reason I start with this is because it's a little more intense. I don't go straight to something like niloxide. Now, however, I am going to go to our old friend niloxide. So now once I have the base color down, this is much more runny. I can cover it a little. I can leave a little bit of it in place. And there you go. And you look at how amazing that vertigree looks when combined with that combination of fire slayer flesh and silver with that bronze. I just think it's a great combination. So there you go. Quick one today, but I hope it helps. I've been searching for the perfect bronze for a long time. This is my new go-to recipe. I think you'll like it too. Give it a like if you do. Subscribe for additional hobby cheating in the future. If you have any questions or anything like that, feel free to drop those down in the comments below. But as always, I very much appreciate you watching this one and we'll see you next time.


The National Drug Law Enforcement Agency, NDLEA, has intercepted illicit drugs, including cocaine, heroin and cannabis, weighing 37.3 kilograms. The drugs were seized in five operations at the Mata'a Muhammad International Airport Lagos, according to a statement by agency spokesman Femi Babba Femi. The statement said one Agudose Pitaehe attempted to bring into Nigeria 76 pellets of cocaine weighing 1.150 kilograms on May 25, 2021. He was arrested during inward security clearance of passengers of Qatar Airline from Kenya at the E arrival hall at the Mata'a Muhammad International Airport Lagos. Hello, hope you enjoyed the news. Please do subscribe to our YouTube channel and don't forget to hit the notification button so you get notified about fresh news updates.


Chapter 15 of Against the Grain This LibriVox recording is in the public domain. Recording by Martin Giesen. Against the Grain by Joris-Karl Wiesmans Translated by John Howard. Burning at first like a rick on fire, his enthusiasm for the digester as quickly died out. Torpid at first, his nervous dyspepsia, reappeared, and then this hot essence induced such an irritation in his stomach that Dizzy Sant was quickly compelled to stop using it. The malady increased in strength, peculiar symptoms attended it. After the nightmares, hallucinations of smell, pains in the eye, and deep coughing, which recurred with clock-like regularity, after the pounding of his heart and arteries, and the cold perspiration, arose illusions of hearing, those alterations which only revealed themselves in the last period of sickness. Attacked by a strong fever, Dizzy Sant suddenly heard murmurings of water. Then those sounds united into one, and resembled a roaring which increased, and then slowly resolved itself into a silvery bell sound. He felt his delirious brain whirling in musical waves engulfed in the mystic whirlwinds of his infancy. The songs learned at the Jesuits reappeared, bringing with them pictures of the school and the chapel where they had resounded, driving their hallucinations to the olfactory and visual organs, veiling them with clouds of incense, and the pallid light irradiating through the stained glass windows under the lofty arches. At the Fathers the religious ceremonies had been practised with great pomp. An excellent organist and remarkable singing director made an artistic delight of these spiritual exercises that were conducive to worship. The organist was in love with the old masters, and on holidays celebrated masses by Palestrina and Orlando di Lasso, Psalms by Marcello, Oratorios by Handel, Motets by Bach. He preferred to render the sweet and facile compilations of Father Lombiot, so much favoured by priests, the laudy spirituali of the sixteenth century whose sacerdotal beauty had often bewitched Desisante. But he particularly extracted ineffable pleasures while listening to the plain chant which the organist had preserved regardless of new ideas. That form which was now considered a decrepit and gothic form of Christian liturgy, an archaeological curiosity, a relic of ancient time, had been the voice of the early church, the soul of the Middle Age. It was the eternal prayer that had been sung and modulated in harmony with the soul's transports, the enduring hymn uplifted for centuries to the Almighty. That traditional melody was the only one which, with its strong unison, its solemn and massive harmonies, like freestone, was not out of place with the old basilicas, making eloquent the Romanesque vaults, whose emanation and very spirit they seemed to be. How often had Desisante not thrilled under its spell when the Christus factus est of the Gregorian chant rose from the nave, whose pillars seemed to tremble among the rolling clouds from censors, or when the day profundis was sung, sad and mournful as a suppressed sob, poignant as a despairing invocation of humanity, bewailing its mortal destiny, and imploring the tender forgiveness of its saviour. All religious music seemed profane to him compared with that magnificent chant created by the genius of the church, anonymous as the organ whose inventor is unknown. At bottom, in the works of Giumelli and Porpora, Carissimi and Durante, in the most wonderful compositions of Handel and Bach, there was never a hint of a renunciation of public success, or the sacrifice of an effect of art, or the abdication of human pride hearkening to its own prayer. At the most the religious style, august and solemn, had crystallized in le sueur's imposing masses celebrated at Tsarosh, tending to approach the severe nudity and austere majesty of the old plain chant. Since then, absolutely revolted by these pretexts at Stabat Maters, devised by the pergolesis of the Rossinis, by this intrusion of profane art in liturgic art, disissant had shunned those ambiguous works tolerated by the indulgent church. In addition, this weakness brought about by the desire for large congregations had quickly resulted in the adoption of songs borrowed from Italian operas, of low cavertinas and indecent quadrills played in churches converted to boudoirs, and surrendered to stage-actors whose voices resounded aloft, their impurity tainting the tones of the holy organ. For years he had obstinately refused to take part in these pious entertainments, contenting himself with his memories of childhood. He even regretted having heard the tadaeum of the great masters, for he remembered that admirable plain chant, that hymn so simple and solemn, composed by some unknown saint, a saint Ambrose or Hillary, who lacking the complicated resources of an orchestra, and the musical mechanics of modern science, revealed an ardent faith, a delirious jubilation uttered from the soul of humanity in the piercing and almost celestial accents of conviction. Disissant's ideas on music were in flagrant contradiction with the theories he professed regarding the other arts. In religious music he approved only of the monastic music of the Middle Ages, that emaciated music which instinctively reacted on his nerves like certain pages of the old Christian Latin. Then he freely confessed it, he was incapable of understanding the tricks that the contemporary masters had introduced into Catholic art, and he had not studied music with that passion which had led him towards painting and letters. He played indifferently on the piano, and after many painful attempts had succeeded in reading a score, but he was ignorant of harmony, of the technique needed really to understand the nuance, to appreciate a finesse, to savor a refinement with full comprehension. In other respects, when not read in solitude, profane music is a promiscuous art. To enjoy music one must become part of that public which fills the theatres where, in a vile atmosphere, one perceives a lautish-looking man butchering episodes from Wagner to the huge delight of the ignorant mob. He had always lacked the courage to plunge into this mob bath, so as to listen to Berlio's compositions, several fragments of which had bewitched him by their passionate exaltations and their vigorous fugues, and he was certain that there was not one single scene, not even a phrase of one of the operas of the amazing Wagner, which could with impunity be detached from its whole. The fragments cut and served on the plate of a concert lost all significance and remained senseless. Since, like the chapters of a book completing each other and moving to an inevitable conclusion, Wagner's melodies were necessary to sketch the characters, to incarnate their thoughts, and to express their apparent or secret motives. He knew that their ingenious and persistent returns were understood only by the auditors, who followed the subject from the beginning, and gradually beheld the characters in relief, in a setting from which they could not be removed without dying, like branches torn from a tree. That was why he felt that among the vulgar herd of mellomaniacs enthusing each Sunday on benches, scarcely any knew the score that was being massacred, when the ushers consented to be silent and permit the orchestra to be heard. Granted also that intelligent patriotism forbade a French theatre to give a Wagnerian opera, the only thing left to the curious who know nothing of music or larkana, and either cannot or will not, but take themselves de Bayreuth, is to remain at home. And that was precisely the course of conduct he had pursued. The more public and facile music and the independent pieces of the old operas hardly interested him. The wretched trills of Ober and Boille-Dieu, of Adam and Flotoff, and the rhetorical commonplaces of Ambroise Thomas and the Bazins disgusted him, as did the superannuated affectations and vulgar graces of Italians. That was why he had resolutely broken with musical art, and during the years of his abstention he pleasurably recalled only certain programmes of chamber music when he had heard Beethoven, and especially Schumann and Schubert, who had affected his nerves in the same manner as had the more intimate and troubling poems of Edgar Allan Poe. Some of Schubert's parts for Violoncello had positively left him panting in the grip of hysteria. But it was particularly Schubert's leader that had immeasurably excited him, causing him to experience similar sensations as after a waste of nervous fluid or a mystic dissipation of the soul. This music penetrated and drove back an infinity of forgotten sufferings and spleen in his heart. He was astonished at being able to contain so many dim miseries and vague griefs. This desolate music crying from the inmost depths terrified while charming him. Never could he repeat the young girl's lament without a welling of tears in his eyes, for in this plainte resided something beyond a mere broken-hearted state, something in it clutched him, something like a romance ending in a gloomy landscape. And always, when these exquisite, sad planes returned to his lips, there was evoked for him a suburban, flinty and gloomy sight, where a succession of silent, bent persons, harassed by life, filed past into the twilight. While steeped in bitterness and overflowing with disgust, he felt himself solitary in this dejected landscape, struck by an inexpressibly melancholy and stubborn distress, whose mysterious intensity excluded all consolation, pity and repose. Like a funeral knell, this despairing chant haunted him now that he was in bed prostrated by fever and agitated by an anxiety so much the more inappeasable for the fact that he could not discover its cause. He ended by abandoning himself to the torrent of anguishes, suddenly damned by the chant of psalms, slowly rising in his tortured head. One morning, nevertheless, he felt more tranquil, and requested the servant to bring a looking-glass. It fell from his hands. He hardly recognized himself. His face was a clay colour. The lips bloated and dry. The tongue parched, the skin rough. His hair and beard untended since his illness by the domestic, added to the horror of the sunken face and staring eyes, burning with feverish intensity in this skeleton head that bristled with hair. More than his weakness, more than his vomiting, which began with each attempt at taking nourishment, more than his emaciation, did his changed visage terrify him. He felt lost. Then, in the dejection which overcame him, a sudden energy forced him in a sitting posture. He had strength to write a letter to his parish physician and to order the servant to depart instantly, seek and bring him back that very day. He passed suddenly from complete depression into boundless hope. This physician was a celebrated specialist, a doctor renowned for his cures of nervous maladies. He must have cured many more dangerous cases than mine, Desisante reflected. I shall certainly be on my feet in a few days. Disenchantment succeeded his confidence.  Like the others, this one would prescribe the eternal oxide of zinc and quinine, bromide of potassium and valerian. He had recourse to another thought. If these remedies have availed me little in the past, could it not be due to the fact that I have not taken the right quantities? In spite of everything, this expectation of being cured cheered him, but then a new fear entered. His servant might have failed to find the physician, again he grew faint, passing instantly from the most unreasoning hopes to the most baseless fears, exaggerating the chances of a sudden recovery and his apprehensions of danger. The hours passed and the moment came when in utter despair and convinced that the physician would not arrive, he angrily told himself that he certainly would have been saved had he acted sooner. Then his rage against the servant and the physician, whom he accused of permitting him to die, vanished. And he ended by reproaching himself for having waited so long before seeking aid, persuading himself that he would now be wholly cured had he that very last evening used the medicine.  The struggles ended by crushing him and he relapsed into exhausted sleep interrupted by incoherent dreams, a sort of syncope pierced by awakenings in which he was barely conscious of anything. He had reached such a state where he lost all idea of desires and fears, and he was stupefied, experiencing neither astonishment or joy when the physician suddenly arrived. The doctor had doubtless been apprised by the servant of Desessant's mode of living, and of the various symptoms observed since the day when the master of the house had been found near the window, overwhelmed by the violence of perfumes. He put very few questions to the patient whom he had known for many years. He felt his pulse and attentively studied the urine, where certain white spots revealed one of the determining causes of nervousness. He wrote a prescription and left without saying more than that he would soon return. This visit comforted Desessant, who nonetheless was frightened by the taciturnity observed. He adduered his servant not to conceal the truth from him any longer, but the servant declared that the doctor had exhibited no uneasiness, and despite his suspicions, Desessant could seize upon no sign that might betray a shadow of a lie on the tranquil countenance of the old man. Then his thoughts began to obsess him less. His suffering disappeared, and to the exhaustion he had felt throughout his members was grafted a certain indescribable languor. He was astonished and satisfied not to be weighted with drugs and vials, and a faint smile played on his lips when the servant brought a nourishing injection of peptone, and told him he was to take it three times every twenty-four hours. The operation succeeded, and Desessant could not forbear to congratulate himself on this event, which in a manner crowned the existence he had created. His passion towards the artificial had now, though involuntarily, reached the supreme goal. Father, one could not go. The nourishment thus absorbed was the ultimate deviation one could possibly commit. How delicious it would be, he reflected, to continue this simple regime in complete health. What economy of time? What a pronounced deliverance from the aversion which food gives those who lack appetite?  What an energetic protestation against the vile sin of gluttony? What a positive insult held at old nature whose monotonous demands would thus be avoided! And he continued talking to himself half-aloud. One could easily stimulate desire for food by swallowing a strong aperitif. After the question, what time is it getting to be, I am famished. One would move to the table and place the instrument on the cloth, and then, in the time it takes to say grace, one could have suppressed the tiresome and vulgar demands of the body. Several days afterwards the servant presented an injection whose colour and odour differed from the other. But it is not the same at all. Dizzy-sand cried, gazing with deep feeling at the liquid poured into the apparatus. As if in a restaurant, he asked for the card, and unfolding the physician's prescription, read, caught liver oil, twenty grams, beef tea, two hundred grams, burgundy wine, two hundred grams, yoke of one egg. He remained meditative. He who, by reason of the weak and state of his stomach, had never seriously preoccupied himself with the art of the cuisine, was surprised to find himself thinking of combinations, to please an artificial epicure. Then a strange idea crossed his brain. Perhaps the physician had imagined that the strange palette of his patient was fatigued by the taste of the peptone. Perhaps he had wished, like a clever chef, to vary the taste of foods, and to prevent the monotony of dishes that might lead to want of appetite. Once in the wake of these reflections Dizzy-sand sketched new recipes, preparing vegetable dinners for Fridays, using the dose of cod liver oil and wine, dismissing the beef tears and meat food specially prohibited by the church. But he had no occasion longer to ruminate on these nourishing drinks, for the physician succeeded gradually in curing the vomiting attacks, and he was soon swallowing in the normal manner a syrup of punch containing a pulverised meat, whose faint aroma of cacao pleased his palate. Weeks passed before his stomach decided to function. The nausea returned at certain moments, but these attacks were disposed of by ginger ale, and Riviera's anti-emetic drink. Finally the organs were restored. Meats were digested with the aid of pepsins. Recovering strength, he was able to stand up and attempt to walk, leaning on a cane, and supporting himself on the furniture. Instead of being thankful over his success, he forgot his past pains, grew irritated at the length of time needed for convalescence, and reproached the doctor for not effecting a more rapid cure. At last the day came when he could remain standing for whole afternoons. Then his study irritated him. Certain blemishes it possessed, and which habit had accustomed him to overlook, now were apparent. The colours chosen to be seen by lamplight seemed discordant in full day. He thought of changing them, and for whole hours he combined rebellious harmonies of hues, hybrid pairings of cloth and leathers. I am certainly on the road to recovery, he reflected, taking note of his old hobbies. One morning, while contemplating his orange and blue walls, considering some ideal tapestries worked with stoles of the Greek church, dreaming of Russian Orphi Dalmaticas and brocaded coaps flowered with Slavonic letters done in yordle stones and rows of pearls, the physician entered, and noticing the patient's eyes questioned him. Dizisand spoke of his unrealisable longings. He commenced to contrive new colour schemes, to talk of harmonies and discords of tones he meant to produce, when the doctor stunned him by peremptorily announcing that these projects would never be executed here. And without giving him time to catch breath he informed Dizisand that he had done his utmost in re-establishing the digestive functions, and that now it was necessary to attack the neurosis, which was by no means cured, and which would necessitate years of diet and care. He added that before attempting a cure, before commencing any hydrotherapy treatment impossible of execution at Fontenay, Dizisand must quit that solitude, return to Paris, and live an ordinary mode of existence by amusing himself like others. But the pleasures of others will not amuse me, Dizisand indignantly cried. Without debating the matter the doctor merely asserted that this radical change was in his eyes a question of life or death, a question of health or insanity, possibly complicated in the near future by tuberculosis. So it is a choice between death and the hulks, Dizisand exasperatedly exclaimed. The doctor, who was imbued with all the prejudices of a man of the world, smiled and reached the door without saying a word. End of Chapter 15 Recorded by Martin Geeson in Hazelmere Surrey. Chapter 16 of Against the Grain This LibriVox recording is in the public domain. Recording by Martin Geeson. Against the Grain by Georges-Karl Wiesmans. Translated by John Howard. Chapter 16 Dizisand locked himself up in his bedroom, closing his ears to the sounds of hammers on packing cases. Each stroke rent his heart, drove a sorrow into his flesh. The physician's order was being fulfilled. The fear of once more submitting to the pains he had endured, the fear of a frightful agony, had acted more powerfully on Dizisand than the hatred of the detestable existence to which the medical order condemned him. Yet he told himself there were people who live without conversing with anyone, absorbed far from the world in their own affairs, like recluses and trappists, and there is nothing to prove that these wretches and sages become madmen or consumptives. He had unsuccessfully cited these examples to the doctor. The latter had repeated coldly and firmly, in a tone that admitted of no reply, that his verdict, confirmed besides by consultation with all the experts on neurosis, was that distraction, amusement, pleasure alone might make an impression on this malady, whose spiritual side eluded all remedy, and made impatient by the recriminations of his patient. He for the last time declared that he would refuse to continue treating him if he did not consent to a change of air, and live under new hygienic conditions. Dizisand had instantly betaken himself to Paris, had consulted other specialists, had impartially put the case before them. All having unhesitatingly approved of the action of their colleague, he had rented an apartment in a new house, had returned to and white with rage, had given orders to have his trunks packed.  His beatitude was ended. He was compelled to abandon this sheltering haven, and return at full speed into the stupidity which had once attacked him. The physician spoke of amusement and distraction, with whom, and with what, did they wish him to distract and amuse himself? Had he not banished himself from society? Did he know a single person whose existence would approximate his in seclusion and contemplation? Did he know a man capable of appreciating the fineness of a phrase, the subtlety of a painting, the quintessence of an idea, a man whose soul was delicate and exquisite enough to understand malarmée, and love verlaine? Where and when must he search to discover a twin spirit, a soul detached from common places, blessing silence as a benefit, ingratitude as a solace, contempt as a refuge and port, in the world where he had dwelt before his departure for faultonnet? But most of the county's squires he had associated with must since have stultified themselves near card-tables, or ended upon the lips of women. Most by this time must have married. After having enjoyed during their life the spoils of cats, their spouses now possessed the remains of strumpets, for master of first fruits, the people alone waste nothing. A pretty change, this custom adopted by a prudish society, Desisante reflected. The nobility had died. The aristocracy had marched to imbecility or audia. It was extinguished in the corruption of its descendants, whose faculties grew weaker with each generation, and ended in the instincts of guerrillas, fermented in the brains of grooms and jockeys. Or rather, as with the schwaiseurs pralins, polynyaks and chevres, wallowed in the mud of lawsuits, which made it equal the other class's interpretude. The mansions themselves, the secular escutcheons, the heraldic deportment of this antique caste had disappeared. The land no longer yielding anything was put up for sale, money being needed to procure the venereal witchcraft for the besotted descendants of the old races.  They weltered in the mire of fraud and deceit, behaved like cheap sharpers. This eagerness for gain, this lust for lucre, had even reacted on that other class which had constantly supported itself on the nobility, the clergy. Now one perceived in newspapers announcements of corn cures by priests. The monasteries had changed into apothecary or liqueur workrooms. They sold recipes or manufactured products. The citaux order chocolate, the trappists semolina, the mariste brothers buy phosphate of medicinal lime and acribus water, the Jacobins and anti-apoplectic elixir, the disciples of Saint Benoit Benedictine, the friars of Saint Bruno Chartres. Business had invaded the cloisters, where in place of antiphanaries heavy ledgers reposed on reading-desks. Like leprosy the avidity of the age was ravaging the church, weighing down the monks with inventories and invoices. And yet, in spite of everything, it was only among the ecclesiastics that de Te Saint could hope for pleasurable contact. In the society of well-bred and learned canons, he would have been compelled to share their faith, to refrain from floating between skeptical ideas and transports of conviction, which rose from time to time on the water, sustained by recollections of childhood. He would have had to muster identical opinions and never admit, he freely did in his ardent moments, a Catholicism charged with a soup-song of magic, as under Henry III, and with a dash of sadism, as at the end of the last century. This special clericalism, this depraved and artistically perverse mysticism towards which he wended, could not even be discussed with a priest who would not have understood them, and who would have banished them with horror. For the twentieth time, this irresolvable problem troubled him. He would have desired an end to this irresolute state in which he floundered. Now that he was pursuing a changed life, he would have liked to possess faith, to encrust it as soon as seized, to screw it into his soul, to shield it finally from all those reflections which uprooted and agitated it. But the more he desired it, and the less his emptiness of spirit was evident, the more Christ's visitation receded. As his religious hunger augmented, and he gazed eagerly at this faith visible, but so far off that the distance terrified him, ideas pressed upon his active mind, driving back his will, rejecting by common sense and mathematical proofs the mysteries and dogmas. He sadly told himself that he would have to find a way to abstain from self-discussion. He would have to learn how to close his eyes, and let himself be swept along by the current, forgetting those accursed discoveries which have destroyed the religious edifice from top to bottom since the last two centuries. He sighed.  A Dominican friar, Rouard de Carres, had proved in a brochure entitled On the adulteration of sacramental substances, that most masses were not valid, because the elements used for worship had been adulterated by the manufacturers. For years the holy oils had been adulterated with chicken fat, wax with burned bones, incense with cheap resin, and benzoin. But the thing that was worse was that the substances indispensable to the holy sacrifice, the two substances without which no ablation is possible, had also been debased. The wine by numerous dilutions and by illicit introductions of Pernambuco wood, Dainwort berries, alcohol, and alum, the bread of the Eucharist, that must be kneaded with the fine flour of wheat, by kidney beans, potash, and pipe clay. But they had gone even farther. They had dared suppress the wheat, and shameless dealers were making almost all the host with the fecula of potatoes. Now God refused to descend into the fecula. It was an undeniable fact, and a certain one. In the second volume of his treatise on moral theology, Cardinal Goussé had dwelt at length on this question of the fraud practised from the divine point of view, and according to the incontestable authority of this master, one could not consecrate bread made of flour, of oats, buckwheat, or barley. And if the matter of using rye be less doubtful, no argument was possible in regard to the fecula, which according to the ecclesiastic expression was in no way fit for sacramental purposes. By means of the rapid manipulation of the fecula, and the beautiful appearance presented by the unleavened breads created with this element, the shameless imposture had been so propagated that now the mystery of the transubstantiation hardly existed any longer, and the priests and faithful were holding communion, without being aware of it, with neutral elements. Ah, far off was the time when Radigonda, Queen of France, had with her own hands prepared the bread destined for the altars, or the time when, after the customs of Cluny, three priests or deacons, fasting and garbed in alb and amis, washed their faces and hands, and then picked out the wheat, grain by grain, grinding it under millstone, kneading the paste in a cold and pure water, and themselves baking it under a clear fire, while chanting psalms. All this matter of eternal dupery, Desesante reflected, is not conducive to the steadying of my already weakened faith, and how admit that omnipotence, which stops at such a trifle as a pinch of fecula, or a soup-son of alcohol. These reflections, all the more through a gloom over the view of his future life, and rendered his horizon more menacing and dark. He was lost, utterly lost. What would become of him in this Paris, where he had neither family nor friends? No bond united him to the Saint-Germain quarters, now in its dotage, scaling into the dust of desuitude, buried in a new society like an empty husk. And what contact could exist between him and that bourgeois class, which had gradually climbed up, profiting by all the disasters to grow rich, making use of all the catastrophes to impose respect on its crimes and thefts. After the aristocracy of birth had come the aristocracy of money. Now one saw the rain of the caliphates of commerce, the despotism of the rue du Saint-Germain, the tyranny of trade, bringing in its train, venal, narrow ideas, naivish and vain instincts. Viola and more dishonest than the nobility despoiled, and the decayed clergy, the bourgeoisie borrowed their frivolous ostentations, their bragadocio, degrading these qualities by its lack of savoir vivre. The bourgeoisie stole their faults and converted them into hypocritical vices. And authoritative and sly, low and cowardly, it pitilessly attacked its eternal and necessary dupe, the populus, unmuzzled and placed in ambush, so as to be in readiness to assault the old castes. It was now an acknowledged fact. Its task once terminated the proletariat of bled, supposedly as a measure of hygiene. The bourgeoisie reassured, strutted about in good humour, thanks to its wealth and the contagion of its stupidity. The result of its accession to power had been the destruction of all intelligence, the negation of all honesty, and the destruction of the world. The bourgeoisie, the nobility despoiled by the nobility despoiled, had been the destruction of all intelligence, the negation of all honesty, the death of all art, and in fact the debased artists had fallen on their knees and they eagerly kissed the dirty feet of the eminent jobbers and low satraps whose arms permitted them to live. In painting, or now beheld a deluge of silliness. In literature an intemperate mixture of dull style and cowardly ideas, for they had to credit the businessman with honesty, the buccaneer who purchased a dough for his son and refused to pay that of his daughter with virtue. Chased love to the Volterian agnostic who accused the clergy of rapes, and then went hypocritically and stupidly to sniff in the obscene chambers. It was the great American hulks transported to our continent. It was the immense, the profound, the incommensurable peasantry of the financier and the parvenu, beaming like a pitiful sun upon the idolatrous town which wallowed on the ground the while it uttered impure psalms before the impious tabernacle of banks.  This cry of hate broke the nightmare that oppressed him. Ah, he exclaimed, to think that all this is not a dream, to think that I am going to return into the cowardly and servile crowd of this century. To console himself he recalled the comforting maxims of Schopenhauer, and repeated himself the sad axiom of Pascal. The soul is pained by all things it thinks upon. But the words resounded in his mind like sounds deprived of sense. His ennui disintegrated, lifting all significance from the words, all healing virtue, all effective and gentle vigor. He came at last to perceive that the reasonings of pessimism availed little in comforting him. That impossible faith in a future life alone would pacify him. An axis of rage swept aside like a hurricane his attempts at resignation and indifference, he could no longer conceal the hideous truth. Nothing was left, all was in ruins. The bourgeoisie were gormandising on the solemn ruins of the church which had become a place of rendezvous, a mass of rubbish soiled by petty puns and scandalous jests. Were the terrible god of Genesis and the pale Christ of Golgotha not going to prove their existence by commanding the cataclysms of yore by rekindling the flames that once consumed the sinful cities? Was this degradation to continue to flow and cover with its pestilence the old world planted with seeds of iniquities and shames? The door was suddenly opened. Clean shaven men appeared, bringing chests and carrying the furniture. Then the door closed once more on the servant who was removing packages of books. Disysant sank into a chair. I shall be in Paris in two days. Well, all is finished. The waves of human mediocrity rise to the sky and they will engulf the refuge whose dams I open. Ah, courage leaves me, my heart breaks. Oh, Lord, pity the Christian who doubts, the skeptic who would believe, the convict of life embarking alone in the night under a sky no longer illumined by the consoling beacons of ancient faith. End of chapter 16. Recording by Martin Giesen in Hazelmere Surrey. End of Against the Grain by Joris Karl Wiesmans. Translated by John Howard.