When a (random) quantum event at the molecular level (DNA or RNA-DNA or RNA-protein or protein-protein) has consequences at the level of the phenotype, the somatic consequences may persist if they are compatible with the ecosystem and with the ever changing “coherence structure” of the organism as constructed along its history.

When a (random) quantum event at the molecular level (DNA or RNA-DNA or RNA-protein or protein-protein) has consequences at the level of the phenotype, the somatic consequences may persist if they are compatible with the ecosystem and with the ever changing “coherence structure” of the organism as constructed along its history. 

Biological evolution is a complex blend of ever changing structural stability, variability and emergence of new phenotypes, niches, ecosystems.

Biological evolution is a complex blend of ever changing structural stability, variability and emergence of new phenotypes, niches, ecosystems.

We wish to argue that the evolution of life marks the end of a physics world view of law entailed dynamics. Our considerations depend upon discussing the variability of the very ”contexts of life”: the interactions between organisms, biological niches and ecosystems. These are ever changing, intrinsically indeterminate and even unprestatable: we do not know ahead of time the "niches" which constitute the boundary conditions on selection. More generally, by the mathematical unprestatability of the "phase space" (space of possibilities), no laws of motion can be formulated for evolution. We call this radical emergence, from life to life. The purpose of this paper is the integration of variation and diversity in a sound conceptual frame and situate unpredictability at a novel theoretical level, that of the very phase space.

A healthy diet including plenty of folates is linked to lower depression risk, research finds. Folates include vitamin B9, folacin and folic acid.

A healthy diet including plenty of folates is linked to lower depression risk, research finds.

Folates include vitamin B9, folacin and folic acid.

P Hemophiliacs get SC vaxn

TIME X BODY Time and physicality are directly related. Time exists in your experience only because of your physicality.

Time and physicality are directly related. Time exists in your experience only because of your physicality.

TU 2018- HNY 2019 "In the New Year, never forget to thank your past years because they enabled you to reach today! Without the stairs of the past, you cannot arrive at the future!" -- Mehmet Murat ildan

"In the New Year, never forget to thank your past years because they enabled you to reach today! Without the stairs of the past, you cannot arrive at the future!"

-- Mehmet Murat ildan

N We tried using the Procalcitonin few years ago and compared with the CRP. It did not yield better prediction of neonatal sepsis. We use CRP some times. We perform CBC and blood c/s if needed and physical exam of the baby ; We use the Kaiser sepsis calculator for the management.

We tried using  the Procalcitonin few years ago and compared with the CRP. It did not yield better prediction of neonatal sepsis. We use CRP some times. We perform CBC and blood c/s if needed and physical exam of the baby ; We use the Kaiser sepsis calculator for the management. 

N Babies who appear not to be not responding to the initial wiping and dry before clamping cord are not given full 1 min of delayed cord clamping.

Babies who appear not to be not responding to the initial wiping and dry before clamping cord are not given full 1 min of delayed cord clamping. 

PARE X DTR COMMNCT - PARE

FRUIT WALK TO SMH CAR PARK , FRUIT WALK TO SMH OFFICE

UP

THE HIGH FRUCTOSE FACTOR Low income people used to be thin from lack of food. That has change

THE HIGH FRUCTOSE FACTOR

Low income people used to be thin from lack of food. That has change

D19842 OF OWN LYF DOOL 19842

HNY 2019 - DWM X BBD X STB DOCS

V SANKHARA

Saṅkhāra (Pali; Sanskrit saṃskāra) is a term figuring prominently in Buddhism. The word means 'that which has been put together' and 'that which puts together'.

EE People who eat in response to their emotional states find it particularly hard to lose weight, research finds.

People who eat in response to their emotional states find it particularly hard to lose weight, research finds.

OCZAP

TIME 301218 WELD	QT	REMRKS
0830 HNDOVR
0900 WR
0930 WR
1000 wr
1030 WR
1100 WR
1130 WR
1200 WR
1230 WR
1300 WR
1330 WR
1400 WR
1430 WR
1500 WR
1530 LNCH
1600 LP
1630 BRK
1700 brk
1730 BRK
1800 BRK
1830 TTO
1900 ORMRPH
1930 STRETCH
2000  BRK
2030 HO

Alcohol consumption is regularly linked to long-term brain damage by research. It can damage memory, problem-solving skills and the ability to read emotions.

Alcohol consumption is regularly linked to long-term brain damage by research.

It can damage memory, problem-solving skills and the ability to read emotions.

METAPHORS

descatres x objecty x machine metaphor

PAUSE X WHISPR

A pause gives you breathing space so listen to the whispers of the real you waiting to happen.” ~Tara Estacaan

EFFORT V SURRNDR LYF

“Life is a balance between what we can control and what we cannot. I am learning to live between effort and surrender.” ~Danielle Orner

PED PSYCHOSIS ADC

If only you can go through difficult times with inner Grace, every situation you face will be an opportunity to enhance your life.

I

f only you can go through difficult times with inner Grace, every situation you face will be an opportunity to enhance your life.

SUNYATA B

No system of thought can provide direct access to Empty Fullness for any-body. Experience is constructed via the mental thought system, that uses the mind of a body-mind, to convince that it is a separate individual entity that is uniquely individuated from every-body and every-thing else, when that is not what's happening.

🕉That is not what's happening, since there is not two of any-thing. There is no separation of every-thing as Empty Fullness. This and that is seemingly so, despite how the self-conjured constructs of duality prevent glimpses of the fact that there has been, is, and will always simply be this, as Empty Fullness.

🕉That is so, regardless of how a self-conjured self has be-come deluded by the manufacturing of its own self-conjured conjurings as dreamings of self-conjured humanly-based constructs, as it seemingly continues to deny that that is so.

🕉All this and that dualities, are seemingly not so, due to the delusional self-conjured conjurings from a self-conjured conjured self, that consistently self-perpetuates conjurings, despite how and why the separate sense of a self-conjured conjured self, cannot be so easily self-convinced, that it is a fallen victim of its own self-conjured conjurings, in denial of blindly accepting all self-conjured conjurings of ideas and human constructs, as a separate sense of self, that is reinforced by firm beliefs, as a self-perpetuated self-conjured conjured self, that is seemingly existing within a dream-like reality of self-conjured human constructs of its own design.

M T2DM: elevated triglyceride is an independent risk factor for chronic kidney disease

T2DM: elevated triglyceride is an independent risk factor for chronic kidney disease

B There is no evil greater than anger

There is no evil greater than anger

Be quiet, be still. Let the mind rest. Discover who you really are. —Nina Wise, “Sudden Awakening”

Be quiet, be still. Let the mind rest. Discover who you really are. —Nina Wise, “Sudden Awakening”

When you go to an Indian temple, it is just to behold an energy form. You want to take an imprint of the Divine within yourself.

When you go to an Indian temple, it is just to behold an energy form. You want to take an imprint of the Divine within yourself.

OCQDU

TIME 281218 TW	QT	REMRKS
1600	CRZ RV
1630	SPTM BLDS
1700	SPTM BL GS
1730	LGN
1800	SDHN
1830	RNNIE
1900	CRZ RV
1930	SMYH
2000	EVLNMRWH
2030	CRZ RV
2100	SBHN BLDS
2130	CRZ RV
2200	SPTM BLDS
2230	SPTM BL GS
2300	LGN
2330	SDHN
2400	RNNIE

ALO AMAR ALO OGO

Once your life is an expression of your blissfulness, you will not be in conflict with anyone.

Once your life is an expression of your blissfulness, you will not be in conflict with anyone.

Modern life has most people so preoccupied with anxieties about the future that they can't pay attention to the beauty that’s right in front of them.

Modern life has most people so preoccupied with anxieties about the future that they can't pay attention to the beauty that’s right in front of them. 

ekr

NW YR 2019 INTENTIONS BBD BK BDHA DTH

LYF X ANML X HUMN CONDN

SABOD X AFTR THE LYF DREAM IS OVER

LYF DREAM

LYF

RYOKAN

CBS

WSODB

WSODB

CNMA X WILLING SUSPENSION OF DISBELIEF

VOID

NOBODY

WHO AM I ? ARISING PASSING

EI PRITHIVI PANTHONIBAS

LYF IS BUT A DREAM

SKILL, TECH AND MAGICAL

N CR Ankyloglossum Superius Syndrome compromising a neonatal airway: Considerations in congenital oral airway obstructions. We report the case of a 37-week old newborn presenting on day 1 of life with an apparent congenital fusion of the tongue to the hard palate, consistent with Ankyloglossum Superius syndrome. Physical exam along with endoscopy showed apparent fusion of the floor of the mouth to the anterior hard palate..

Ankyloglossum Superius Syndrome compromising a neonatal airway: Considerations in congenital oral airway obstructions.

We report the case of a 37-week old newborn presenting on day 1 of life with an apparent congenital fusion of the tongue to the hard palate, consistent with Ankyloglossum Superius syndrome. Physical exam along with endoscopy showed apparent fusion of the floor of the mouth to the anterior hard palate..

P CR Central Diabetes Insipidus in an Infant with Pneumococcal Meningitis.

Central Diabetes Insipidus in an Infant with Pneumococcal Meningitis.

People who can predict the behaviour of others have higher personal intelligence, research finds. Two other signs of high personal intelligence are self-motivation and being able to anticipate desires.

People who can predict the behaviour of others have higher personal intelligence, research finds.

Two other signs of high personal intelligence are self-motivation and being able to anticipate desires.

Counter to guidelines, children with pharyngitis in whom non–group A strep is isolated commonly receive antibiotics.

Counter to guidelines, children with pharyngitis in whom non–group A strep is isolated commonly receive antibiotics.

A low carbohydrate diet promotes weight maintenance

A low carbohydrate diet promotes weight maintenance

THOUGHT STOPPING

P Fever greater than 39 °C (102.2 °F) in the unimmunized child is concerning when a focus for the fever cannot be found. I

Fever greater than 39 °C (102.2 °F) in the unimmunized child is concerning when a focus for the fever cannot be found. I

KEY FACT | Chest x-rays to evaluate for occult pneumonia should only be considered if the child has had fever for greater than 24 hours.

KEY FACT | Chest x-rays to evaluate for occult pneumonia should only be considered if the child has had fever for greater than 24 hours. 

KEY FACT | Over 60% of children with AOM will have resolution of their pain in one day whether treated with antibiotics or placebo.

KEY FACT | Over 60% of children with AOM will have resolution of their pain in one day whether treated with antibiotics or placebo.  

KEY FACT | Well-appearing, febrile children (3 to 36 months), who are fully immunized, with fever (> 39 °C) without an identifiable source, do not require automatic blood cultures and antibiotics.

KEY FACT | Well-appearing, febrile children (3 to 36 months), who are fully immunized, with fever (> 39 °C) without an identifiable source, do not require automatic blood cultures and antibiotics.  

P LBP

Box 10.2 Historical and physical examination red flags in children Red flags: history Red flags: physical • Prepubertal children, especially < 5 years • Functional disability • Duration > 4 weeks • Recurrent or worsening pain • Early morning stiffness and/or gelling • Night pain • Fever, weight loss, malaise • Postural changes: kyphosis or scoliosis • Limp or altered gait • Fever, tachycardia • Weight loss, bruising, lymphadenopathy, or abdominal mass • Altered spine shape or mobility • Vertebral or intervertebral tenderness • Limp or altered gait • Neurologic symptoms • Bladder or bowel dysfunction 

P URTICARIA

Common causes of acute urticaria Infections Viral (rhinovirus, rotavirus hepatitis A, B, C, Ebstein– Barr virus, herpes virus) Bacterial (streptococcal, mycoplasma) Foods, preservatives, dyes Medications, vitamins, supplements Transfusions Vaccines Stings, bites Contact allergies (i.e. latex) 

P KEY FACT | Necrotizing fasciitis has a mortality rate of 25% which increases to 70% in those patients who develop sepsis [

KEY FACT | Necrotizing fasciitis has a mortality rate of 25% which increases to 70% in those patients who develop sepsis [

P KEY FACT | The clinical hallmark of SJS and TEN is mucous membrane involvement with erythema and erosions of oral, genital, and ocular mucosa.

KEY FACT | The clinical hallmark of SJS and TEN is mucous membrane involvement with erythema and erosions of oral, genital, and ocular mucosa. 

P ####

Pearls for improving patient outcomes • Children with open growth plates are more likely to fracture through the growth plate than sustain a sprain. • Many buckle fractures of the forearm will only be visible on the lateral film. • Nurse maid ’ s elbow can be diagnosed clinically. If the typical history of being pulled with an outstretched hand, without any other trauma is present a hyperpronation maneuver may be performed without radiographs. • The presence of a posterior fat pad in the setting of traumatic injury to the elbow with otherwise normal radiographs is highly suggestive of occult fracture. • Normal x-rays are common in toddler ’ s fracture. Immobilization of the extremity should be based on clinical suspicion. • A normal white count does not rule out the possibility of septic arthritis. • Children frequently complain of knee pain, when in reality it is the hip that is the cause of the pathology. • Child abuse should always be a consideration when a child has a fracture or bruising in an infant. Rib, metaphyseal fractures, midshaft humeral and femur fractures in infant and non-ambulatory toddlers are high risk for abuse. 

P KEY FACT | While there is no one fracture type that is truly pathognomonic for abuse, one must have a high index of suspicion for abuse when a young child presents with a femur or mid-shaft humerus fracture.

KEY FACT | While there is no one fracture type that is truly pathognomonic for abuse, one must have a high index of suspicion for abuse when a young child presents with a femur or mid-shaft humerus fracture. 

P KEY FACT | The peripheral white blood cell count is normal in 80% of children with SA of the hip.

KEY FACT | The peripheral white blood cell count is normal in 80% of children with SA of the hip. 

FROG LEG X SCFE

KEY FACT | A frog-leg view of the hip should be ordered in addition to an AP view to diagnose SCFE.

P Pitfall | Not considering hip pathology when a young adolescent complains of distal thigh or knee pain

Pitfall | Not considering hip pathology when a young adolescent complains of distal thigh or knee pain 

P Pitfall | Missing a toddler ’ s fracture in a young child refusing to bear weight and negative x-rays

Pitfall | Missing a toddler ’ s fracture in a young child refusing to bear weight and negative x-rays


KEY FACT | Over 40% of children with toddler ’ s fracture will have negative initial radiographs. If clinical suspicion is high for toddler ’ s fracture, the child should be placed in a long leg cast and have repeat radiographs performed in 2 weeks.


   

P Pitfall | Missing a buckle fracture in a child with arm use and minimal pain after a fall

Pitfall | Missing a buckle fracture in a child with arm use and minimal pain after a fall 

P ORTHO KEY FACT | A child with point tenderness at his/her growth plate should be splinted and treated as if fractured, regardless of x-ray findings.

KEY FACT | A child with point tenderness at his/her growth plate should be splinted and treated as if fractured, regardless of x-ray findings. 

P ED KEY FACT | A urinary tract infection associated with a kidney stone is a urologic emergency

KEY FACT | A urinary tract infection associated with a kidney stone is a urologic emergency 

P ED PITFALLS HEENT

Pearls to improve patient outcomes • Patients with corneal abrasions, ulcers, and corneal foreign bodies are all treated with antibiotics and should see an ophthalmologist within 24 hours. • Contact lens wearers with corneal abrasions or patients with corneal ulcers (regardless of contact lens use) require antipseudomonal antibiotic coverage and should be advised to refrain from wearing their contacts until they are cleared to do so by an ophthalmologist. • Provide systemic corticosteroids to patients with severe throat pain due to GAS pharyngitis in order to hasten symptomatic improvement. • Consider peritonsillar abscess in patients with a sore throat affecting only one side. • When patients have throat pain that is out of proportion to the physical findings, consider retropharyngeal abscess and epiglottitis. • Admit patients with posterior and bilateral anterior packing for control of nosebleeds.

KEY FACT | Arterial hypertension does not cause epistaxis.

KEY FACT | Arterial hypertension does not cause epistaxis. 

P ED KEY FACT | Viruses account for the majority of cases of pharyngitis. Group A Streptococcus is responsible for fewer than 10% of cases.

KEY FACT | Viruses account for the majority of cases of pharyngitis. Group A Streptococcus is responsible for fewer than 10% of cases.


KEY FACT | The presence of all four Centor criteria confers a risk of Group A Streptococcus pharyngitis of 56%


KEY FACT | Corticosteroids improve severe throat pain and shorten the clinical course of GAS pharyngitis


  

P KEY FACT | All patients with corneal ulcers require antipseudomonal antibiotic coverage.

PED PITFALL Pitfall | Failure to ensure that patients with epithelial defects are treated with appropriate antibiotics and seen by an ophthalmologist within 24 hours

BLEEP 787

FREUD X EROS V THANATOS

REBEL

SUMMARY: REBEL
LIKELY STRENGTHS:
Independent-minded
Able to think outside the box
Unswayed by conventional wisdom
Willing to go his or her own way, to buck social conventions
In touch with his or her authentic desires
Spontaneous
POSSIBLE WEAKNESSES:
Likely to resist when asked or told to do something
Uncooperative
Inconsiderate
Has trouble accomplishing tasks that need to be done consistently, the same way, every time
Acts as though ordinary rules don’t apply
Restless; may find it difficult to settle down in a job, relationship, city
Struggles with routines and planning
May be indifferent to reputation


////////////////////////////////////////////////

SUMMARY: DEALING WITH A REBEL
They resist both outer and inner expectations
They put a high value on freedom, choice, identity, and self-expression
If someone asks or tells them to do something, they’re likely to resist.
They may respond to a challenge: “I’ll show you,” “Watch me,” “Y ou can’t make me,” “Y ou’re not the boss of me”
They may choose to act out of love, a sense of mission, belief in a cause
They have trouble telling themselves what to do—even when it’s something they want to do
They meet a challenge, in their own way, in their own time
They don’t respond well to supervision, advice, or directions
They tend to be good at delegating
If they’re in a long-term relationship, their partner is probably an Obliger

OBLIGER

SUMMARY: OBLIGER
LIKELY STRENGTHS:
Good boss, responsive leader, team player
Feels great obligation to meet others’ expectations
Responsible
Willing to go the extra mile
Responds to outer accountability
POSSIBLE WEAKNESSES:
Susceptible to overwork and burnout
May show the destructive pattern of Obliger-rebellion
Exploitable
May become resentful
Has trouble saying no or imposing limits


/////////////////////////////////////////////

SUMMARY: DEALING WITH AN OBLIGER
They readily meet outer expectations but struggle to meet inner expectations
They put a high value on meeting commitments to others
They succeed when given accountability, with supervision, deadlines, monitoring, and other forms of accountability,
such as the duty to be a good role model
They may have trouble setting limits on others’ demands
They may have trouble delegating, because they feel that some expectations attach to them personally
They must have systems of external accountability in order to meet inner expectations
They may be exploited by people who take advantage of them, and because of that…
They may feel resentful or burned out, in which case…
They may need managers or others to alleviate expectations, or they may rebel