NOSE SCALE

Hypothermia increased the risk of hypocapnia in neonates with HIE during transport.

Hypothermia increased the risk of hypocapnia in neonates with HIE during transport.

PN

4108-3635

Meier-Gorlin syndrome is a condition primarily characterized by short stature. It is considered a form of primordial dwarfism because the growth problems begin before birth (intrauterine growth retardation). After birth, affected individuals continue to grow at a slow rate. Other characteristic features of this condition are underdeveloped or missing kneecaps (patellae), small ears, and, often, an abnormally small head (microcephaly). Despite a small head size, most people with Meier-Gorlin syndrome have normal intellect.

Some people with Meier-Gorlin syndrome have other skeletal abnormalities, such as unusually narrow long bones in the arms and legs, a deformity of the knee joint that allows the knee to bend backwards (genu recurvatum), and slowed mineralization of bones (delayed bone age).

Most people with Meier-Gorlin syndrome have distinctive facial features. In addition to being abnormally small, the ears may be low-set or rotated backward. Additional features can include a small mouth (microstomia), an underdeveloped lower jaw (micrognathia), full lips, and a narrow nose with a high nasal bridge.

Abnormalities in sexual development may also occur in Meier-Gorlin syndrome. In some males with this condition, the testes are small or undescended (cryptorchidism). Affected females may have unusually small external genital folds (hypoplasia of the labia majora) and small breasts. Both males and females with this condition can have sparse or absent underarm (axillary) hair.

Additional features of Meier-Gorlin syndrome can include difficulty feeding and a lung condition known as pulmonary emphysema or other breathing problems.

LEX MESS

bronch

Infants with apnea and dehydration more likely to received EBST,EVIDENCE BASED SUPP THERAPY  while those with chest retractions and dehydration were more likely to receive nonrecommended pharmacotherapies and chest radiographies, respectively.

The Splitting of the Adam

RIGHT AWAY: FESS UP Admit your mistake as soon as it comes to light. Don’t wait around for the error to be found out, in the hope that maybe it simply won’t. By owning up to the misstep proactively, your boss will be more confident that you’ll come forward in the future whenever there’s a problem. That creates trust. After all, error is inevitable. You’ll never get through your entire career without making any mistakes. And chances are, your boss has made a few mistakes over the years as well.

RIGHT AWAY: FESS UP

Admit your mistake as soon as it comes to light. Don’t wait around for the error to be found out, in the hope that maybe it simply won’t. By owning up to the misstep proactively, your boss will be more confident that you’ll come forward in the future whenever there’s a problem. That creates trust. After all, error is inevitable. You’ll never get through your entire career without making any mistakes. And chances are, your boss has made a few mistakes over the years as well.

THE SAME DAY: ZERO IN ON A SOLUTION

As soon as you admit your mistake, start looking into what you can do to make it better. This is something you want to do in that same initial conversation with your boss, right after conceding your error. Ask how you can help play damage control, and maybe come armed with an idea or two. Then let your boss decide the best course of action.

BY THE END OF THE WEEK: SHOW HOW YOU’RE LEARNING TO DO BETTER

That doesn’t mean that winning back your boss’s trust is only a matter of the steps you take right away. After you’ve done everything you can to repair the damage in the immediate aftermath, it’s time to figure out how to do the work better in the future. Ask other people in the organization to check your work the next time. Find people who do your job well and take them out for coffee. Watch videos and read articles online (like this one) to make sure you’re figuring out how to improve.

FOR THE FORESEEABLE FUTURE: TRY NOT TO MAKE THAT SAME MISTAKE AGAIN

Finally, none of these other steps matter if you keep making the same mistake over and over again. Now that you’ve learned what it’ll take to avoid the mistake, you’ve got to put in the effort to actually avoid it. Nothing will undermine your relationship with your boss faster than cleaning up a mess and then making the same mess all over again

Bawa-Garba’s unit was understaffed and she was working a double shift with compromised consultant cover, looking after many more patients than usual. Because of a shortage of nurses, she was doing so without experienced ward staff to rely on. An IT failure prevented crucial test results being relayed expeditiously to her. And her hospital had no system for referring deteriorating patients to senior colleagues.

Bawa-Garba’s unit was understaffed and she was working a double shift with compromised consultant cover, looking after many more patients than usual. Because of a shortage of nurses, she was doing so without experienced ward staff to rely on. An IT failure prevented crucial test results being relayed expeditiously to her. And her hospital had no system for referring deteriorating patients to senior colleagues.

how complex serious illnesses can unfold unpredictably within a typical day in our grossly overstretched NHS.

how complex serious illnesses can unfold unpredictably within a typical day in our grossly overstretched NHS.

You may encounter many defeats, but you must not be defeated. In fact, it may be necessary to encounter the defeats, so you can know who you are, what you can rise from, how you can still come out of it. ~ Maya Angelou

You may encounter many defeats, but you must not be defeated.  In fact, it may be necessary to encounter the defeats, so you can know who you are, what you can rise from,  how you can still come out of it. ~ Maya Angelou 

ADL BATTED

Moderate coffee consumption is linked to reduced depression risk and lower levels of Parkinson’s and dementia, new research finds.

Moderate coffee consumption is linked to reduced depression risk and lower levels of Parkinson’s and dementia, new research finds.

We delight in the beauty of the butterfly, but rarely admit the changes it has gone through to achieve that beauty. - Ma ya Angelou

We delight in the beauty of the butterfly, but rarely admit the changes it has gone through to achieve that beauty. - Ma ya Angelou 

DALI "The thermometer of success is merely the jealousy of the malcontents."

"The thermometer of success is merely the jealousy of the malcontents."

COLLINS "The problem with beauty is that it's like being born rich and getting poorer."

"The problem with beauty is that it's like being born rich and getting poorer."

LO RISK YOUNG INFANT FOR SBI

To be considered to be at low risk for SBI, the febrile infant had to fulfil all the following included in the ‘step by step’ approach20when evaluated in the ED:

• Well appearing
• Older than 21 days of age.
• No leucocytes on the urine dipstick.
• ANC ≤10 000
• Serum CRP ≤20 mg/L
• Serum PCT <0.5 ng/mL
• No clinical deterioration during the stay in the ED (always <24 hours).

SG When there is no envy, jealousy, and comparison within you, you can focus your full capabilities on doing what is needed.

When there is no envy, jealousy, and comparison within you, you can focus your full capabilities on doing what is needed.

TIME X PATIENCE

The strongest of all warriors are these two— time and patience. ~ Leo Tolstoy

MTX P

Management of acute oral poisoning: Due to the low bioavailability of MTX, treatment is not necessary for single ingestions. Oral folinic acid may be used to lower the bioavailability further with large ingestions >1 g m-2. Oral followed by intravenous folinic acid may be used in patients with staggered ingestion >36 h or patients with acute overdose and renal impairment (eGFR <45 mL/min/1.73 m2).

NTHI

Non-typeable Haemophilus influenzae (NTHi) is a major cause of mucosal infections such as otitis media, sinusitis, conjunctivitis, and exacerbations of chronic obstructive pulmonary disease. In some regions, a strong causal relation links this pathogen with infections of the lower respiratory tract. In the past 20 years, a steady but constant increase has occurred in invasive NTHi worldwide, with perinatal infants, young children, and elderly people most at risk. Individuals with underlying comorbidities are most susceptible and infection is associated with high mortality. β-lactamase production is the predominant mechanism of resistance. However, the emergence and spread of β-lactamase-negative ampicillin-resistant strains in many regions of the world is of substantial concern, potentially necessitating changes to antibiotic treatment guidelines for community-acquired infections of the upper and lower respiratory tract and potentially increasing morbidity associated with invasive NTHi infections.

Vulnerable child syndrome- A ‘condition’ that affects the family of an infant or child who has suffered what the parents believe is a ‘close call’ with death. The child is thereafter perceived as vulnerable to serious injury or accidents

Vulnerable child syndrome- A ‘condition’ that affects the family of an infant or child who has suffered what the parents believe is a ‘close call’ with death. The child is thereafter perceived as vulnerable to serious injury or accidents

dwm

pygmalion effect

In 1968, Rosenthal and Jacobsen introduced the concept that expectations in the classroom can positively or negatively affect students. This phenomenon was dubbed, “The Pygmalion Effect.

Spending time alone is linked to increased creativity among some people, research finds.

Spending time alone is linked to increased creativity among some people, research finds.

Probability of Neonatal Early-Onset Sepsis Based on Maternal Risk Factors and the Infant's Clinical Presentation The tool below is intended for the use of clinicians trained and experienced in the care of newborn infants. Using this tool, the risk of early-onset sepsis can be calculated in an infant born > 34 weeks gestation. The interactive calculator produces the probability of early onset sepsis per 1000 babies by entering values for the specified maternal risk factors along with the infant's clinical presentation.

https://neonatalsepsiscalculator.kaiserpermanente.org

BLOOD CULTURE X 1 ML

You need at least 1ml of blood in the blood culture bottle

CRP X EONN SEPSIS

There is no trans-placental transfer of CRP
•Using moderate to high quality evidence:
–CRP at presentation is, at best, a very useful test for ruling in early-onset neonatal infection particularly when serial testing is performed over a period of 2 days following presentation;
–It is NOT a useful test for ruling out early-onset neonatal infection as a single test, especially in the first eight hours of life.

ENTEROVIRUS MENINGITIS, ECHO ONLY IF TACHYCARDIC

Neonates who appear septic without bacterial etiology during EV seasons may have EV sepsis and/or meningitis that can be diagnosed rapidly by CSF PCR testing. Cases may be underdiagnosed in the early neonatal period if specific testing is not performed. In the absence of EV PCR testing or cultures, the lack of CSF pleocytosis in the EV-infected neonate may lead physicians to fail to make a correct diagnosis and subsequently not screen for serious complications. Patients should be followed for periventricular leukomalacia, signs of myocarditis, and considered for treatment with large total doses of IVIG

CF X INQUILINUS LIMOSUS RX IMIPENEM

Inquilinus limosus, a new multidrug-resistant species, was reported in 1999 as an unidentified gram-negative bacterium in a lung transplant patient with cystic fibrosis (CF)

UMB CORD BILI X NN JAUNDICE

For infants of mothers with blood group O, aUCB predicts development of neonatal jaundice. There was no evident utility for infants of mothers with other blood groups. Estimation of aUCB should be considered as a strategy for early identification of those at risk of neonatal haemolytic jaundice.

BPD

he NLS 3:1 strategy is designed for when babies lungs full of fluid and never been opened - as soon as you are beyond this period I would use APLS (15:2) algorithm

he NLS 3:1 strategy is designed for when babies lungs full of fluid and never been opened - as soon as you are beyond this period I would use APLS (15:2) algorithm

GLOBUS OHARYNGEUS

Foden N, et al. A feeling of a lump in the throat. BMJ. 2014 Jan 7;348:f7195.

Red flags associated with a feeling of a lump in the throat:

• Weight loss
• Pain
• Unilateral or lateralising symptoms
• Otalgia
• Change in voice that is constant or worsening
• Systemic symptoms
• Risk factors for malignant disease, such as smoking or excess alcohol intake
• Abnormal neck examination, such as lymphadenopathy or neck lump
• Regurgitation
• Dysphagia

BDHS X MIDDLE

It has a somewhat more profound sense than that, and I think the easiest way of understanding what the Buddha meant by "the middle way" would be to call it "the balanced life" - avoiding falling into one extreme or to another extreme. When you ride a bicycle, you do something that is very much like following the Middle Way, because to stay upright as you go along you balance to avoid falling to either side. But the curious thing about riding a bicycle, which is so difficult for beginners to understand, is that when you start falling, say to the right, you have to turn the handlebars and the wheel to the right, to the direction in which you're falling. And as a result of this, surprisingly enough, you come upright. One would ordinarily think, perhaps, that if you start falling to the right you should turn your wheel to the left, but if you do that you'll collapse.

BDHA X WATTS

Another source of frustration arises when we do not see that the world in which we live is fundamentally impermanent. One of the cardinal features of the Buddha's teaching is that all life, however solid it may seem to be, and all things, however separate they may seem to be, are in a state of flux. That is to say that the world we live in doesn't consist so much of things or entities as it consists of process. Everything is in a constant state of ?owing pattern. By way of illustration you might say that it's something like the flowing pattern you see when you look at smoke: a dancing, constantly changing arabesque of pattern; flowing, ?owing, all the time. Or that the substance of life is something like water, which I can hold in my hand so long as I cup it gently, but if I clutch at the water, I immediately lose it.

RELATIONAL BDHA

Now in Buddha's method duhkha stems from another factor which is sort of intermediate between suffering, or anguish, and its cause. And he said that clutching, which is the basis of our anguish, is ultimately dependent upon a kind of unconsciousness or ignorance, which in Sanskrit is called avidya, literally "not knowing," thus ignorance. And it is really a way of seeing the world in an unrelated way, and thinking of it as consisting simply of so many things, like a rock, a foot, a plant, a man, when, actually, the world is not composed of bits and pieces. Everything that exists exists only in relation to other things. In other words, an egg, for example, looks very separate. It looks like a very definite, particular thing. But you don't find eggs without chickens. And you don't find chickens without the sort of environment in which chickens can live. Likewise, in a similar fashion you don't find fingers lying around without a hand. Although we think of the fingers as separate, they are related to the hand; the hand, in turn, to the arm; the arm to the body; and the body to its whole environment of earth and sky, sunlight and air.

his man is called the Buddha, but that's not his proper name. It is a title and it means, approximately, "the man who woke up."

his man is called the Buddha, but that's not his proper name. It is a title and it means, approximately, "the man who woke up." 

BDHA X WAY OF LIBERATION

The nearest thing in our culture to Buddhism, although it isn't exactly the same, is probably psychotherapy. And the reason is that what constitutes the essence of Buddhism is not beliefs, not ideas, not even practices, but a way of experiencing. I could almost call it a way of feeling. Now in psychotherapy, if a person goes to a psychotherapist because they feel miserable, are depressed, anxious, or profoundly worried, the object of the psychotherapist's practice is to change the person's state of consciousness, to change their state of mind. And, in this respect, it is something like Buddhism because Buddhism envisages a transformation, a very radical transformation, of the way in which ordinary people feel themselves and the surrounding world. And so, in this sense, I have coined for Buddhism a special term to contrast it with a religion. I would call it a "way of liberation," a way of liberation from the ordinary way in which most civilized and probably many primitive people feel themselves and the world. That is to say, for example, the feeling that I am a lonely, separate, transient individual locked up inside my skin, and therefore different from, even hostile to and alienated from, everything else.

RELGN

The word religion comes from the Latin religare - to bind - and thus a religion is the following of a rule of life that is believed to be divinely revealed

BDHA

Buddhism as distinct from other forms of Asian philosophy and religion. The reason is that Buddhism is a method of liberation which has emerged as a way of life in Asia, but which is not so closely tied to the different cultures of Asia as such other philosophies or religions as Hinduism or Confucianism or Shinto. Shinto, for example, is the national cult of Japan, and it would be impossible, really, for Shinto to migrate to any other people than the Japanese. In the same way, Confucianism is intimately bound up with Chinese culture. And also Hinduism is tied to the particular culture and social order of India. Although it began in India, Buddhism has migrated to all parts of Asia and has adapted itself to all kinds of different cultures. And so, in this way you might say Buddhism is an intercultural or even international way of life, and therefore of all the forms of Asian philosophy it is probably of most interest to the West.

ILHL MED SCHL4

School	Imperial	Liverpool	Hull York	Leicester
Phone	+44 (0)20 7594 7259	+44 (0)151 795 4370	+44 (0)1904 32 1690	+44 (0)116 252 2969
Email	medicine.ug.admissions@imperial.ac.uk	mbchb@liv.ac.uk	Admissions@hyms.ac.uk	med-admis@le.ac.uk
Course Structure	Integrated	Integrated	PBL	Integrated
Applications pa	2594	1868	1000	1401
Accepted pa	511	580	300	469
Success Ratio	0.19	0.31	0.3	0.33
Graduate Entry Available	Yes	Yes	No	No
Foundation / Access Courses Available	No	No	No	Yes
Intercalated BSc	Compulsory	Selective	Selective	Selective
GCSE Subjects Required	Grade B in English Language. If candidates don't have this, GCSE English must be resat (and made clear on the application).	GCSEs in nine separate subject areas: attained by the end of Year 11 and at least a score of 15 points or better (where A*/A = 2; B = 1) from the nine and including: Core & Additional Science (or Biology, Chemistry, and Physics), English Language, and Mathematics (all at least grade B).	8 GCSEs at grade A*-C or equivalent, or grades 4-9 in the reformed GCSEs. English Language and Maths at GCSE grade B or above, or reformed GCSE grade 6 or above (with a Pass in Spoken English), or equivalent.	At least Grade B in English Language, Maths and two sciences, including Chemistry, or Double Science. They do not specify a minimum number of A* grades at GCSE but do take GCSE performance into consideration when selecting applicants for interview, as competition for our places is so intense.
A-Level Subjects Required	Chemistry, Biology and any third subject (excluding vocational subjects, General Studies and Critical Thinking).	Chemistry, Biology and a third academic A-Level.	Biology and Chemistry. For the third subject, we consider all subjects of equal merit except General Studies, Applied Science, Citizenship or Critical Thinking. For 2017 entry, the requirement for a 4th subject at AS-level will cease. They strongly encourage applications from students who are studying arts or humanities subjects. They do not consider Maths and Further Maths, or Biology and Human Biology, as distinct subjects for the purposes of offering 3 distinct A-Level subjects.	Three A-Levels, to include Chemistry and Biology (or Human Biology). Biology doesn't have to be taken to A2 if AS Biology offered. If you study Maths and Further Maths, only one of these can count towards your potential offer.
IB Subjects Required	Higher Level Biology and Chemistry. If either Biology or Chemistry is offered at Standard Level, one other science of maths subject must be offered at Higher Level. Also require English at Standard Level.	Higher Level Biology & Chemistry, with one further HL subject, plus three Standard Level subjects.	Higher Level Biology and Chemistry.	Three Higher Level subjects to include Chemistry & Biology, and three Standard Level subjects.
IB Grades Required	38. Biology and Chemistry at Higher Level 6. English at Standard Level 5.	36 points to include 3 subjects at Higher Level; at least 6 and 6 in Biology and Chemistry and at least 6 in one other subject, plus 3 further subjects at standard level, minimum of 5 points each.	You must have 6,6,5 in three Higher-level subjects, including Biology and Chemistry. You must also have an overall total of 36 points for the diploma. Please note that we don't accept English Language B as proof of English language ability to GCSE grade B standard, nor do we accept Maths Studies as proof of maths ability to GCSE grade B standard. You may include these as part of your IB course, but if you do we will also ask for separate qualifications to GCSE grade B standard.	36, with a minimum of 6 points in each subject.
UKCAT Required	No	Yes	Yes	Yes
How is UKCAT used?	n/a	At Liverpool, the UKCAT is assessed alongside academic criteria. It is expected that applicants who achieve Band 4 in the Situational Judgement Test of the UKCAT will not have their applications processed beyond the first stage. Of the remainder, only those applicants who meet or exceed their minimum academic criteria and who offer the most competitive overall UKCAT scores will have their applications proceed to the second stage. The UKCAT threshold is determined each year on a competitive basis. For Home/EU applicants a competitive score was considered to be 2500 or greater.	At Hull York, applicants with a Situational Judgement Test Band of 4 (the lowest band) will not be considered. Prior to interview, they use your total UKCAT score (allocated points out of 50) alongside your GCSE results (allocated points out of 40) in order to decide who to invite to interview. Following interview, they make offers based primarily on interview performance, and they use the UKCAT Situational Judgement Test as an extra interview station.	Leicester do not have a minimum UKCAT cut-off score, but your total UKCAT score (scored up to a maximum of 34 points) is used in selection for interview alongside academic ability (also scored up to a maximum of 34 points, making the maximum possible score out of 68). Applications from candidates with Band 4 in the Situational Judgement Test will be fully scrutinised prior to interview. UKCAT will be scored according to the total by dividing your score by 100 as follows: 2,400 = 24; >2250 = 22.5; >2100 = 21; >1950 = 19.5; >1800 = 18; >1650 = 16.5 and so on. The Situational Judgement Test (SJT) may be used as a virtual multiple mini-interview station, should you reach that stage of the process.
BMAT Required	Yes	No	No	No
How is BMAT used?	Invitations to an interview will be based on the content of your UCAS application and your performance in all three sections of BMAT. BMAT cut-off scores are calculated each year, as a result of ranked candidate BMAT scores versus number of expected interview sessions. As a result, the absolute BMAT cut-off changes each year. For 2016 entry, the minimum scores required were: a score of 4.5 in Section 1; a score of 4.5 in Section 2 and a score of 2.5 and grade B in Section 3.	n/a	n/a	n/a
Interview Style	Traditional	MMI	MMI	MMI
Fees (EU students)	£9,250 pa	£9,250 pa	£9,250 pa	£9,250 pa
Fees (Non-EU students)	£38,500 pa	£32,400 pa	£29,400 pa	Years 1-2: £18, 855 pa; Years 3-5: £38,410 pa

SG Success need not always be measured in economic terms. It has to be measured in quality of life.

Success need not always be measured in economic terms. It has to be measured in quality of life.

MNY X QOL

DISRUPTIVE CHILD X RX

Summary of findings: pharmacotherapy, compared with placebo, for oppositional behaviour, adolescents with ADHD, ODD, or CD14,15

Medication	Population	Outcome	Placebo-controlled trials, n	Total number of participants, n	Effect size or OR (95% CI)	Quality of evidence
Psychostimulants	Children and adolescents with ADHD, with or without ODD or CD	Oppositional behaviour, conduct problems, and aggression	40	2364	Studies from 1970 to 200126:	High
					Cohen d:
					Clinician: 0.77 (0.63 to 0.88)
					Parent: 0.71 (0.42 to 1.15)
					Teacher: 1.04 (0.79 to 1.32)
					Studies from 2002 to 2013:
					SMD:
					Parent: 0.55 (0.36 to 0.73)
					Teacher: 0.84 (0.59 to 1.10)
Atomoxetine	Children and adolescents with ADHD, with or without ODD or CD	Oppositional behaviour	15	1907	SMD 0.33, (0.24 to 0.43)	High
Guanfacine	Children and adolescents with ADHD, with or without ODD	Oppositional behaviour	2	678	SMD 0.43 (0.18 to 0.68)	Moderate
Clonidine	Children and adolescents with ADHD, with or without ODD or CD	Oppositional behaviour and conduct problems	6	545	SMD 0.27 (0.04 to 0.51)	Very low
Risperidone	Children and adolescents with average IQ and ODD or CD, with or without ADHD	Disruptive and aggressive behaviour	4a	429	SMD 0.60 (0.31 to 0.89)	High
Risperidone	Children and adolescents with low IQ and ODD or CD, with or without ADHD	Conduct problems and aggression	5a	398	SMD 0.72 (0.47 to 0.97)	Moderate
Quetiapine	Adolescents with CD, with or without ADHD	Conduct problems	1	19	SMD 1.6 (0.9 to 3.0)	Very low
Haloperidol	Children with CD	Aggression	1	61	Magnitude of effect was not reported, but a significant difference from placebo was found on some measures	Very low
Valproate	Children and adolescents with ODD or CD, with or without ADHD	Aggression	2	50	OR 14.60 (3.25 to 65.61) for response	Low
Lithium	Children and adolescents with CD	Aggression	4	184	OR 4.56 (1.97 to 10.56) for response or remission	Low
Carbamazepine	Children with CD	Aggression	1	24	No significant difference	Very low

While we pursue happiness, we flee from contentment. - Hasidic Proverb

While we pursue happiness, we flee from contentment. - Hasidic Proverb 

LYME X CHB

patient suspected of Lyme disease has 1st degree heart block on ECG, consider admission as many of these patients will go on to develop 3rd degree heart block.

CORE HABITS

core indispensable habits:

1. Working regularly on things I care about.
2. Reading and writing.
3. Simple daily exercise.
4. Getting a good night’s sleep.
5. Eating a relatively healthy diet.
6. All substances in moderation.
7. Creating things I’d love to see in the world.
8. Doing useful and/or enjoyable things.
9. A little meditation or mindfulness most days.
10. Making time for loved ones.
11. Noticing ambiguity to stop living reactively.
12. Believing nothing absolutely.
13. Noticing, admiring, and revering the subtle majesty of nature.

BUFFET The chains of habit are too light to be felt until they are too heavy to be broken.”

The chains of habit are too light to be felt until they are too heavy to be broken.”

We’re all caught up in this game, working every day to find a way out of the hell of soulless hedonism into the light of a more meaningful, noble, purpose-driven existence.

We’re all caught up in this game, working every day to find a way out of the hell of soulless hedonism into the light of a more meaningful, noble, purpose-driven existence.

CONSUME

It’s okay. Everything is good. Who needs real goals and dreams? Who needs real health and physical vitality? Just let go. Sit back, be lazy, soak in this HD entertainment, chase that fleeting high, buy more shit you don’t need, lather, rinse, repeat.”

neurobhvr

Boredom is actually a very positive sign. It is an indication that your meditation is beginning to wear through its entertainment value — ego is having a hard time finding fuel. Nevertheless, boredom is also a subtle or not so subtle manifestation of aggression. It is a dissatisfaction with the current situation and a desire for change. My teacher talked about two forms of boredom — hot boredom and cool boredom. Hot boredom is the irritable, wanting to jump out of your skin feeling that beginning meditators sometimes get. Over time, this can settle. Then cool boredom might arise. Cool boredom has an aware quality, a more subtle sense of lack of entertainment with highs and lows, less identification with “good” or “bad” meditation experiences. The best approach is to surrender to boredom. Let yourself be completely and utterly bored. Without giving you too much to look forward to, I will say that there are experiences beyond boredom. But you might have to give up hope.

Boredom is the perfect example of subtle duḥkha. Even when all our needs are met, still we crave for something more, and due to this craving we suffer in boredom. We seem to think that life is soluble, and that if only X then we'd be satisfied. But life is insoluble - life is duḥkha. Boredom is one head of this hydra. The only true solution is the complete abandonment of craving. In the meantime, I guess we should fill that boredom with a practice that leads to the abandonment of craving.

Boredom is the perfect example of subtle duḥkha. Even when all our needs are met, still we crave for something more, and due to this craving we suffer in boredom. We seem to think that life is soluble, and that if only X then we'd be satisfied. But life is insoluble - life is duḥkha. Boredom is one head of this hydra. The only true solution is the complete abandonment of craving. In the meantime, I guess we should fill that boredom with a practice that leads to the abandonment of craving.

I'm sure there is a teaching somewhere that explains his experiences under the bodhi tree post buddhahood, but he certainly did not need to sustain a fabricated state with effort or anything of that nature. As I wrote before on here: One of the characteristics of nirvana is that it is "permanent" because it is defined as a total cessation of cause for rebirth in the three realms. Since there is no possibility of cause for "re-arising" nirvana is said to be "permanent." Buddhahood is irreversible and permanent. Nirvāṇa is the total exhaustion of one's ignorance regarding the nature of phenomena, and for that reason nirvāṇa is described as a cessation. What ceases is the cause for the further arising and proliferation of delusion regarding the nature of phenomena, which is precisely the cessation of cause for the arising of the cyclical round of rebirth in the three realms we call "saṃsāra." For this reason, nirvāṇa is said to be 'permanent', because due to the exhaustion of cause for the further proliferation of saṃsāra, saṃsāra no longer has any way to arise. Tsele Natsok Rangdrol: You might ask, 'Why wouldn't confusion reoccur as before, after... [liberation has occured]?" This is because no basis [foundation] exists for its re-arising. Samantabhadra's liberation into the basis [wisdom] itself and the yogi liberated through practicing the path are both devoid of any basis [foundation] for reverting back to becoming a cause, just like a person who has recovered from a plague or the fruit of the se tree. He then states that the se tree is a particular tree which is poisonous to touch, causing blisters and swelling. However once recovered, one is then immune. Lopon Tenzin Namdak also explains this principle of immunity: Anyone who follows the teachings of the Buddhas will most likely attain results and purify negative karmic causes. Then that person will be like a man who has caught smallpox in the past; he will never catch it again because he is immune. The sickness of samsara will never come back. And this is the purpose of following the teachings. and from Lopon Kunga Namdrol: Buddhahood is a subtractive process; it means removing, gradually, obscurations of affliction and obscurations of knowledge. Since wisdom burns these obscurations away, in the end they have no causes for returning; and further, the causes for buddhahood are permanent leading to a permanent result.

I'm sure there is a teaching somewhere that explains his experiences under the bodhi tree post buddhahood, but he certainly did not need to sustain a fabricated state with effort or anything of that nature.

As I wrote before on here:

One of the characteristics of nirvana is that it is "permanent" because it is defined as a total cessation of cause for rebirth in the three realms. Since there is no possibility of cause for "re-arising" nirvana is said to be "permanent."

Buddhahood is irreversible and permanent. Nirvāṇa is the total exhaustion of one's ignorance regarding the nature of phenomena, and for that reason nirvāṇa is described as a cessation. What ceases is the cause for the further arising and proliferation of delusion regarding the nature of phenomena, which is precisely the cessation of cause for the arising of the cyclical round of rebirth in the three realms we call "saṃsāra."

For this reason, nirvāṇa is said to be 'permanent', because due to the exhaustion of cause for the further proliferation of saṃsāra, saṃsāra no longer has any way to arise.

Tsele Natsok Rangdrol:

You might ask, 'Why wouldn't confusion reoccur as before, after... [liberation has occured]?" This is because no basis [foundation] exists for its re-arising. Samantabhadra's liberation into the basis [wisdom] itself and the yogi liberated through practicing the path are both devoid of any basis [foundation] for reverting back to becoming a cause, just like a person who has recovered from a plague or the fruit of the se tree.

He then states that the se tree is a particular tree which is poisonous to touch, causing blisters and swelling. However once recovered, one is then immune.

Lopon Tenzin Namdak also explains this principle of immunity:

Anyone who follows the teachings of the Buddhas will most likely attain results and purify negative karmic causes. Then that person will be like a man who has caught smallpox in the past; he will never catch it again because he is immune. The sickness of samsara will never come back. And this is the purpose of following the teachings.

and from Lopon Kunga Namdrol:

Buddhahood is a subtractive process; it means removing, gradually, obscurations of affliction and obscurations of knowledge. Since wisdom burns these obscurations away, in the end they have no causes for returning; and further, the causes for buddhahood are permanent leading to a permanent result.

Nirvana is a complete cessation of a specific cause. Once that cause ceases there is no longer fuel for its re-arising. Which is to say upon actualizing the release we call "nirvana" that condition is permanent and you will not be affected by so-called meditation or a lack thereof.

Nirvana is a complete cessation of a specific cause. Once that cause ceases there is no longer fuel for its re-arising. Which is to say upon actualizing the release we call "nirvana" that condition is permanent and you will not be affected by so-called meditation or a lack thereof.

CAVETT "If your parents never had children, chances are... neither will you."

"If your parents never had children, chances are... neither will you."

MOST PPL WILL NOT BE SUCCESSFUL

SMONE "The great advantage about telling the truth is that nobody ever believes it.

"The great advantage about telling the truth is that nobody ever believes it.

Since the dawn of recorded history, and likely before, humans strived to understand the world into which they are born and from which they ultimately pass.

Since the dawn of recorded history, and likely before, humans strived to understand the
world into which they are born and from which they ultimately pass.

BPD

In 1967, Northway et al described the clinical and histologic features of lung injury and repair in infants with prior histories of respiratory distress syndrome and coined a new term, “bronchopulmonary dysplasia,” to describe these findings (N Engl J Med 1967;16:357-68). Since that time, the age of viability has decreased, and management has evolved with increasing use of non-invasive ventilation. Although we now recognize a broader spectrum of pulmonary problems in preterm infants, children, and adults, we continue to define chronic lung disease as the need for supplemental oxygen at a single point in time.