RD BK THE JUNGLE X BORTN

In a hot land near the equator, where winter never comes, a new day is beginning. The climbing sun looks close enough to touch as it turns the sky pink. Out of the mist a vast ocean of leaves appears, splashes with yellow, orange, and violet blossoms. It is the roof of the jungle. Butterflies dip in and out of the blossoms. Macaws and parakeets feed and squawk in the treetops. They drop more berries than they eat. A vulture circles around and around overhead.

[…]

Under the leafy roof, it is dim and still. Time seems to have stopped in a wild summer world of long, long ago.

WALKING X THINKING

Bernhard writes:

If we observe very carefully someone who is walking, we also know how he thinks. If we observe very carefully someone who is thinking, we know how he walks. If we observe most minutely someone walking over a fairly long period of time, we gradually come to know his way of thinking, the structure of his thought, just as we, if we observe someone over a fairly long period of time as to the way he thinks, we will gradually come to know how he walks… There is nothing more revealing than to see a thinking person walking, just as there is nothing more revealing than to see a walking person thinking… Walking and thinking are in a perpetual relationship that is based on trust.

SHERIDAN Won't you come into the garden? I would like my roses to see you."

Won't you come into the garden? I would like my roses to see you."

EURIPEDES There is just one life for each of us: our own.

There is just one life for each of us: our own.

WILSON Science may never come up with a better office communication system than the coffee break.

Science may never come up with a better office communication system than the coffee break.

B DTHING

inally, we need to use our life to train in how to die. Just as water consistently flowing can eventually create grand canyons, so too our persistent training in how to die and take a controlled rebirth in the pure land will carve within our mind a spiritual Grand Canyon leading all of the waters of our mental continuum inexorably to the pure land when we die. There are three things in particular weshould do. First, is practice the yoga of sleeping every time we go to bed. Falling asleep and dying are very similar processes, so as we fall asleep we should strongly believe we are now going to die, generate the compassionate wish to take rebirth in the pure land so we can complete our training, engage in the yoga of sleeping, and then fall asleep with that mind. By gaining familiarity with this every night, we will know exactly what we need to do at death

HLTH

Less than 3% of human genome is protein-coding genes – the rest is control switches, structural elements, non-coding RNA, viruses & a lot of junk.

MORE ART THAN SC X MORE LUCK THAN SKILL

дух на гората dukh na gorata X BONODEVI A

Start taking more deep breaths, so you can mindfully collect more lessons for the long run. – It’s incredibly easy to overestimate the significance of a single decision, outcome, or event in the heat of the moment. But you must remind yourself to take a deep breath when things don’t go your way. Your results in the long run—good or bad—are always the byproduct of many small decisions, outcomes, and events over time. The truth is we all fail sometimes. The greater truth is that no single failure ever defines us.

  Start taking more deep breaths, so you can mindfully collect more lessons for the long run. – It’s incredibly easy to overestimate the significance of a single decision, outcome, or event in the heat of the moment. But you must remind yourself to take a deep breath when things don’t go your way. Your results in the long run—good or bad—are always the byproduct of many small decisions, outcomes, and events over time. The truth is we all fail sometimes. The greater truth is that no single failure ever defines us.

BORLAND If you would know strength and patience, welcome the company of trees."

If you would know strength and patience, welcome the company of trees."

SN CNMA GODFATHER 1972

The idealists and visionaries, foolish enough to throw caution to the winds and express their ardor and faith in some supreme deed, have advanced mankind and have enriched the world. -Emma Goldman, social activist (27 Jun 1869-1940)

The idealists and visionaries, foolish enough to throw caution to the winds and express their ardor and faith in some supreme deed, have advanced mankind and have enriched the world. -Emma Goldman, social activist (27 Jun 1869-1940)

DESCRIBE THE NEGATIVE EMOTION

A question that can help control negative emotions.

Understanding how you feel — and being able to describe it — can protect against depression, new research finds.

Young people who could describe their emotions in more precise ways were better at fighting off depression caused by stressful life events.

Differentiating emotions helps people to regulate them more effectively.

For example, identifying a feeling as frustration, rather than just ‘feeling bad’, can better help a person deal with it.

So, the simple question that may help protect against depression is: how do I really feel?

The study included 193 adolescents who reported their emotions four times a day over a week.

When they were were followed up 18 months later, young people better at differentiating their emotions were less susceptible to depression.

Dr Lisa Starr, the study’s first author, explained:

“Adolescents who use more granular terms such as ‘I feel annoyed,’ or ‘I feel frustrated,’ or ‘I feel ashamed’ — instead of simply saying ‘I feel bad’ — are better protected against developing increased depressive symptoms after experiencing a stressful life event.”

On the other hand, those who did not distinguish between being ashamed or annoyed, for example, were more likely to let stressful life events get them down.

Dr Starr said:

“Emotions convey a lot of information.

They communicate information about the person’s motivational state, level of arousal, emotional valence, and appraisals of the threatening experience

A person has to integrate all that information to figure out — “am I feeling irritated,” or “am I feeling angry, embarrassed, or some other emotion?”

It’s going to help me predict how my emotional experience will unfold, and how I can best regulate these emotions to make myself feel better.”

It may be possible to increase people’s sensitivity to their emotional states, Dr Starr said:

“Basically you need to know the way you feel, in order to change the way you feel.

I believe that NED could be modifiable, and I think it’s something that could be directly addressed with treatment protocols that target NED.

Our data suggests that if you are able to increase people’s NED then you should be able to buffer them against stressful experiences and the depressogenic effect of stress.”

“Pets are gifts to mankind.” Linda Blair

“Pets are gifts to mankind.”

Linda Blair

The more a thing tends to be permanent, the more it tends to be lifeless. ~ Alan Watts

The more a thing tends  to be permanent,  the more it tends to be lifeless. ~ Alan Watts 

A situation becomes stressful only when you compulsively react to it.

A situation becomes stressful only when you compulsively react to it.

A

Anger is considered a poison when it’s self-motivated and self-centered. But take that attachment to the self out of anger and the same emotion becomes the fierce energy of determination, which is a very positive force … Drop the self-orientation from ignorance, and it becomes a state of unknowing that allows new things to rise. —Roshi Bernie Glassman and Rick Fields, “Instructions to the Cook”

Anger is considered a poison when it’s self-motivated and self-centered. But take that attachment to the self out of anger and the same emotion becomes the fierce energy of determination, which is a very positive force … Drop the self-orientation from ignorance, and it becomes a state of unknowing that allows new things to rise.

—Roshi Bernie Glassman and Rick Fields, “Instructions to the Cook”

CSL

SINGER "Our knowledge is a little island in a great ocean of nonknowledge."

"Our knowledge is a little island in a great ocean of nonknowledge."

JOYCE A corpse is meat gone bad. Well and what's cheese? Corpse of milk."

A corpse is meat gone bad. Well and what's cheese? Corpse of milk."

BASHO The temple bell stops but I still hear the sound coming out of the flowers."

The temple bell stops but I still hear the sound coming out of the flowers."

The happiest is the person who suffers the least pain; the most miserable who enjoys the least pleasure. -Jean-Jacques Rousseau, philosopher and author (28 Jun 1712-1778)

The happiest is the person who suffers the least pain; the most miserable who enjoys the least pleasure. -Jean-Jacques Rousseau, philosopher and author (28 Jun 1712-1778) 

BIAS

People's motivations bias how they gather information

Posted: 27 Jun 2019 11:31 AM PDT

A new study suggests people stop gathering evidence earlier when the data supports their desired conclusion than when it supports the conclusion they wish was false.

“Silence was the cure, if only temporarily, silence and geography. But of what was I being cured? I do not know, have never known. I only know the cure. Silence, and no connections except to landscape.” – Mary Cantwell, Manhattan, When I Was Young

“Silence was the cure, if only temporarily, silence and geography. But of what was I being cured? I do not know, have never known. I only know the cure. Silence, and no connections except to landscape.”

– Mary Cantwell, Manhattan, When I Was Young

EMPED

VK SAS doctors are an important part of the paediatric workforce with nearly 800 whole time equivalents working across the UK

SAS doctors are an important part of the paediatric workforce with nearly 800 whole time equivalents working across the UK

AGING X PROTEIN

How Aging, Stress, and Depression Contribute to Vascular Disease: One Molecular Explanation

Anthony L. Komaroff, MD reviewing Zannas AS et al. Proc Natl Acad Sci U S A 2019 Jun 4

Elevated expression of FKBP5 protein promotes inflammation.

DWM FAV

Effects of Increasing or Decreasing Red Meat Intake

Paul S. Mueller, MD, MPH, FACP reviewing Zheng Y et al. BMJ 2019 Jun 12

Changes in red meat consumption directly affected 25-year all-cause mortality.

MISHTI DOI X NODIA

P

rebecca maybe not death, but something close do you have moments, where you can’t imagine a future? you’re lying there, staring at the same walls same ceilings same words with nothing but the same feelings- empty and pale, like there’s no reason to go on, when you can’t even do enough to fail. the future is coming, but you don’t want to be in it, can’t imagine yourself in it. where you just want to stop. everything. and just sit there for a while. maybe not death, as that’s too permanent, but something close to it. when you can feel the rope around your neck, the razor on your wrist, the way the pills taste. you can imagine it, and you aren’t sure if it’s what you want, or just the feelings you imagine it will give you

E MAJOR AND MINOR

JSLAMIST PROBLEM X DHINESE WAY - TRUSTWORTHY AVG UNTRUSTWORTHY TAU WAY

IF VIGHAR NALE BROKEN RULE THEN UNTRUSTWORTHY

Perhaps the most important thing we bring to another person is the silence in us. Not the sort of silence that is filled with unspoken criticism or hard withdrawal. The sort of silence that is a place of refuge, of rest, of acceptance of someone as they are. ~ Rachel Naomi Remen

Perhaps the most important thing we bring to another person is the silence in us. Not the sort of silence that is filled with unspoken criticism or hard withdrawal. The sort of silence that is a place of refuge, of rest, of acceptance of someone as they are. ~ Rachel Naomi Remen 

almond бадем badem A

iliamna riviolus

When we meditate, we relate to that unsettling, ineffable commodity: the present. We train in letting go of thoughts and feelings as they arise, and settle back into the present: that gap between two concepts—past and future—that don’t actually exist. —Pamela Gayle White, “The Pursuit of Happiness”

When we meditate, we relate to that unsettling, ineffable commodity: the present. We train in letting go of thoughts and feelings as they arise, and settle back into the present: that gap between two concepts—past and future—that don’t actuallyexist.

—Pamela Gayle White, “The Pursuit of Happiness”

CDS The best thing you can do is to keep going.

The best thing you can do is to keep going.

Every little struggle is a step forward.

Every little struggle is a step forward.

P MAROON X MECKEL

Meckel's diverticulum

A Meckel's diverticulum is an out-pouching (sack) that protrudes from the small intestine near the junction of the small intestine and the colon. It is present from birth and occurs in a small percentage of the population. Some Meckel's diverticula can secrete acid, like the stomach, and the acid can cause ulcerations in the inner lining of the diverticulum or the tissues of the small intestine adjacent to the diverticulum. These ulcers can bleed. Bleeding from a Meckel's diverticulum is the most common cause of gastrointestinal bleeding in children and young adults. Bleeding from a Meckel's diverticulum is painless but can be brisk and can cause bright red, dark red, or maroon stools

P KD

P KD DDX

P INCOMPLETE KD

P KD XCARDIAC

P KD

KD DDX P

KD SHOCK SYNDROME X KDSS X MAS P

Kawasaki disease (KD) is an acute febrile systemic vasculitis of unknown etiology and often occurs in children under 5 years old. During the acute phase, approximately 5% of children with KD develop hypotension and shock, a severe condition termed KD shock syndrome (KDSS). Macrophage activation syndrome (MAS), another life-threatening complication, has been reported to be associated with KD, although rarely. KDSS complicated with MAS is extremely rare. In this article, we present our experience in the diagnosis and treatment of KDSS complicated with MAS. Patient concerns: A 5-month boy with fever for 5 days was diagnosed with KD. After 2 doses of intravenous immunoglobulin and regular antiinflammatory treatment at a local hospital, the fever did not subdue. He was admitted to our department on the 10th day of illness. The boy developed KDSS on the 11th day of illness. In the mean time, the boy had hepatosplenomegaly, and laboratory tests showed hypertriglyceridemia, hypofibrinogenemia, decreased blood red cells and platelets, increased ferritin and soluble sIL2Rα, and reduced natural killer cell activity. Diagnosis: The patient had KDSS complicated with MAS. Interventions: Emergency antishock therapy along with high-dose steroid with a longer tapering course was carried out. Following these treatments, fever subsided and other symptoms and signs relieved, but progressive coronary dilatation occurred, warfarin was thereby administered. Outcomes: The patient was discharged 30 days after hospitalization. Echocardiography at the 2 month follow-up showed regression of coronary aneurysm. Lessons: Laboratory testing is critical for the diagnosis of MAS and we recommend that 2009 HLH diagnostic criteria be used for the diagnosis of MAS in KD. Emergency treatment of shock and a longer course of high-dose steroid anti-inflammatory therapy are vital for the management of KDSS complicated with MAS.

P M ESBL UTI

Significant potential risk factors for ESBL‐UTI were previous use of antibiotics in the last 3 months, previous hospitalization in the last 3 months, history of recurrent UTI, and presence of renal anomalies. On logistic regression analysis, history of previous hospitalization in the last 3 months (OR= 3.83, CI 1.49‐ 9.84) was identified as an independent significant risk factor for ESBL‐ UTI .There was a significantly higher resistance to amoxicillin‐clavulanate, amikacin, gentamycin and quinolones in cases compared to controls.

Painless PR bleed. Dark Meckel Bright Polyp

Painless PR bleed. Dark Meckel

Bright Polyp

PLAN B PLAN C "If the pieces do not fit into your puzzle... try a different picture." -- Cass van Krah

"If the pieces do not fit into your puzzle... try a different picture."

-- Cass van Krah

BHVRAL AD V PROPAGANDIST AD

SELIGION -A Successful Failure: Finding Faith in an Age of Fear and Falsehood

A Successful Failure: Finding Faith in an Age of Fear and Falsehood

M MACE X DM

• This study examined long-term cardiac mortality in a cohort of 1948 patients with stable coronary artery disease (CAD) according to glycemic status (normal, prediabetes, and type 2 diabetes). After 6.3 years of follow-up, the rates of cardiac death and major adverse cardiac events (MACE) were similar between the participants with a normal glycemic status and the participants with prediabetes. Participants with type 2 diabetes had higher rates of cardiac death and MACE than the other two groups.

• The findings of this study indicate that prediabetes glycemic status does not appear to confer an increase in risk for cardiac death or MACE.

DO ANY THING DAILY FOR 66 DAYS IE JUST OVER 2 MONTHS AND IT WILL TURN INTO A HABIT

DO ANY THING DAILY FOR 66 DAYS IE JUST OVER 2 MONTHS AND IT WILL TURN INTO A HABIT

LANDSCAPE ПЕЙЗАЖ PEĬZAZH

TOOK THE WRONG PATH

The truly creative mind in any field is no more than this: A human creature born abnormally, inhumanly sensitive. To him... a touch is a blow, a sound is a noise, a misfortune is a tragedy, a joy is an ecstasy, a friend is a lover, a lover is a god, and failure is death. Add to this cruelly delicate organism the overpowering necessity to create, create, create -- so that without the creating of music or poetry or books or buildings or something of meaning, his very breath is cut off from him. He must create, must pour out creation. By some strange, unknown, inward urgency he is not really alive unless he is creating. -Pearl S. Buck, novelist, Nobel laureate (26 Jun 1892-1973)

The truly creative mind in any field is no more than this: A human creature born abnormally, inhumanly sensitive. To him... a touch is a blow, a sound is a noise, a misfortune is a tragedy, a joy is an ecstasy, a friend is a lover, a lover is a god, and failure is death. Add to this cruelly delicate organism the overpowering necessity to create, create, create -- so that without the creating of music or poetry or books or buildings or something of meaning, his very breath is cut off from him. He must create, must pour out creation. By some strange, unknown, inward urgency he is not really alive unless he is creating. -Pearl S. Buck, novelist, Nobel laureate (26 Jun 1892-1973) 

MKPT TREE

BOABAB

FR

ATTACHMNT STATES OF MIND

4 ASHRAMAS

BGVS

WMBLDN

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 

DESIRE

The word desire comes from the latin Desiderare, or “away from the star.” Desire is intrinsic to our aliveness, yet when we have unmet needs, it can possess us. We become stuck in the grip of wanting or addictions.

ALL BHAGWAN BHAJANS ARE PARASYMPATHOMIMETIC

If you want to live strong, you need to be in touch with the five elements constantly.

If you want to live strong, you need to be in touch with the five elements constantly.

In our age there is no such thing as "keeping out of politics". All issues are political issues, and politics itself is a mass of lies, evasions, folly, hatred, and schizophrenia. -George Orwell, novelist (25 Jun 1903-1950)

In our age there is no such thing as "keeping out of politics". All issues are political issues, and politics itself is a mass of lies, evasions, folly, hatred, and schizophrenia. -George Orwell, novelist (25 Jun 1903-1950) 

FOUNDER FARMER TINKER THIEF

DHEU вълни vŭlni

va' fa Napoli

va' fa Napoli

BLOSSOMING FROM IDIOT TO IMBECILE

A СИНЯ ЦВЕТЯ SINYA TSVETYA

THE NAJ EFFECT

he real test always comes when you don't get what you expect from people. Will you react in uncontrollable emotion? Or will calmness be your superpower?

Nearly 1/2 of the world's population — more than 3 billion people — live on less than $2.50 a day. More than 1.3 billion live in extreme poverty — less than $1.25 a day. ... According to UNICEF, 22,000 children die each day due to poverty. 805 million people worldwide do not have enough food to eat.

Nearly 1/2 of the world's population — more than 3 billion people — live on less than $2.50 a day. More than 1.3 billion live in extreme poverty — less than $1.25 a day. ... According to UNICEF, 22,000 children die each day due to poverty. 805 million people worldwide do not have enough food to eat.

IS AKSHAY KUMAR THE DEAN MARTIN OF BOLLYWOOD

COSMIC AWE

N VIT K NUDGE

It's OK to Nudge for Vitamin K

Bates D. Moses 

 

Adam D. Borecky 

 

Alex Dubov

First published: 17 June 2019

 

https://doi.org/10.1111/apa.14905

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/apa.14905

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Abstract

Aim

To propose a theoretical framework of factors that are likely to influence parental refusal to administer an intramuscular Vitamin K injection in newborns to prevent Vitamin K deficiency bleeding

Methods

The literature was reviewed on the risks and benefits of Vitamin K prophylaxis, the pathophysiology of Vitamin K deficiency bleeding, the elements of a robust informed refusal, and the ways in which cognitive biases can prevent an informed decision. This information was then synthesized into an ethical framework for the clinician's use of nudging in the clinical decision‐making process.

Results

Cognitive biases involved in decisions about Vitamin K injections can be systematically addressed by nudges in the clinical setting to increase the rates of Vitamin K prophylaxis.

Conclusion

We conclude that repeated, yet careful and respectful nudging throughout pregnancy and birth, may help combat natural biases and empower mothers to make the healthiest decisions for their babies.

P BACK PAIN X CP

Back pain is more frequent in girls and in children with scoliosis in the context of cerebral palsy

Gunnar Hägglund 

 

Tomasz Czuba 

 

Ann I. Alriksson‐Schmidt

First published: 19 June 2019

 

https://doi.org/10.1111/apa.14909

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/apa.14909

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Abstract

Aim

To investigate the prevalence of general and back pain in children with cerebral palsy and the relationships between scoliosis and back pain.

Methods

Cross‐sectional register study based on data from the Swedish Cerebral Palsy Follow‐Up Programme. Descriptive analyses and logistic regression to regress age, sex, gross motor function, windswept, hip extension and source of report on the presence of pain.

Results

The study included 3783 children (58% boys) 1‐18 (mean 10.0) years of age. General pain was reported in 1538 (44% girls, 38% boys) and back pain in 226 (7% girls, 5% boys) children. The proportion of back pain increased from <4% prior to age 12 years to >12% from 16 years of age. Back pain increased from 4% in children without scoliosis to 16% in children with severe scoliosis. Moderate/severe back pain increased from 2% in children without scoliosis to 10% in children with severe scoliosis. Increased odds of reporting back pain were found for age, girls, low gross motor function and children with scoliosis.

Conclusion

The proportion of children with general pain increased with age and was more frequent in girls. Age, female sex, low gross motor function and scoliosis were significant predictors of back pain.

Does permissive hypercapnia carry increased risk for neurodevelopmental sequelae? N

Does permissive hypercapnia carry increased risk for neurodevelopmental sequelae?

Targeting a higher PaCO₂ did not decrease the rate of BPD or death in ventilated preterm infants and there were no significant differences in neurodevelopmental outcomes at 2 years. Permissive hypercapnia does not appear to confer any protection from severe lung disease or cause any adverse effect as a consequence. The risk factors for adverse neurodevelopment at follow-up remain in line with previous studies. In this study, higher PaCO2 levels seem to carry a potential risk of NEC.

WORK LYF BANK BALANCE

EU

COSMOS X CONSC

Why are we in a privileged position? Because we have consciousness?

Consciousness is clearly part of the picture. That raises a set of issues that are beyond my pay grade. It’s interesting of course that the universe has evolved creatures that have consciousness and observe the cosmos. It makes you wonder, What’s up with that? What’s the endgame? Is there one? And every one of those questions reflects the bankruptcy of the human brain. When you start asking questions like that, you think the big brain is able to know everything. In fact, it’s a device for filtering information, and its ultimate function is to help us survive. As long as it keeps doing that, I suspect, we’ll be around with these entertaining questions. But I can’t tell whether our big brain is just extra luggage or part of an essential commodity.

GALILEO X MOBILE PHONES

“If Galileo had never pointed a telescope to the sky we wouldn’t have cell phones.” What did you mean?

Galileo turns out to be one of those personalities who actually did stuff. He didn’t just talk about it. He experimented and didn’t take for granted the things that were said to be true. He tested. The heart of science is testing your knowledge. You understand your knowledge is limited. You understand that what you might successfully discern today could be overtaken by subtler discoveries later on. The scientific revolution is rooted in a mentality that doesn’t rely on authority. Galileo had that.

Every one of those questions reflects the bankruptcy of the human brain.

When Galileo made a telescope, he did this remarkable thing. Instead of using it like a military device to look at ships, he uses it to look at the sky. He points it to the moon and he sees the surface is irregular, there are features on it. He looks at Jupiter and he sees it’s accompanied by four other objects that are moving systematically around it, like planets in a solar system. He looks at Venus and sees it changes as it’s moving around the sun. He looks at Saturn, and his telescope isn’t good enough to make out the rings, but he sees that there’s something there. We take all of these discoveries for granted today, but at the time, it was like the universe was a whole new place. Galileo leverages that information, that sense of discovery, into a whole transformation of human endeavor.

Ultimately you have to link Galileo’s celestial observations to the laws of motion, to Kepler and Newton, who was able to define the mathematical way the forces work to make all this happen. So it’s really a short jump from Newton’s laws to putting satellites in orbit around the earth to smart phones.

ASTROLOGY TO ASTRONOMY

Today we make fun of astrology because it’s not science, but how did it lead to astronomy?

It’s certainly appropriate to say astrology was merged closely with astronomy. Even in antiquity, if you could separate them out, you would say both are just the basic gathering of the data and the manipulation of data to reach broader conclusions. People saw the seasonal behavior of the sun and stars, the tidal behavior of the moon. So it’s understandable that people in antiquity would come to the conclusion that what’s happening in the sky has an effect on Earth.

But this is what’s interesting. You can go to ancient Maya, whose people practiced astrology, to the Mediterranean, where astrology was rooted in Mesopotamia, which picks up stuff from Greece and Egypt, and then to China. Every one of those cultures puts astrological rules together in a different way. It’s the same sky but they read it completely differently. So if you could be a cross-cultural astronomer 2,000 years ago, you would know right away the jig is up because all these guys can’t be right. And they aren’t right. The rules of astrology are not physical laws. You have to recognize that for people today who invest in astrology, this is a matter of belief. Astrology is truly a matter of faith and I don’t believe terribly in criticizing people’s religion.

PROLONGED DISORDERS OF CONSC M

• The understanding of prolonged disorders of consciousness has evolved along with new clinical, imaging, and physiology data, raising the possibility of response to therapeutic interventions. The disorders included are coma, unresponsive wakefulness syndrome, minimally conscious state, and cognitive motor dissociation. Data on various therapeutic interventions are very limited. The authors of this review cover pharmacologic interventions, including amantadine, zolpidem, and intrathecal baclofen, as well as nonpharmacologic interventions, including transcranial direct-current stimulation, transcranial magnetic stimulation, low-frequency focused ultrasound, vagal nerve stimulation, and deep-brain stimulation.

Тези мезета са твърде солени. Tezi mezeta sa tvarde soleni. These appetizers are too salty.

Тези мезета са твърде солени.

Tezi mezeta sa tvarde soleni.

These appetizers are too salty.

Bulgaria is the oldest country in Europe that hasn't changed its name since it was first established. ... Sofia, the capital of Bulgaria, was founded 7000 years ago. This makes it the second oldest city in Europe. The gold treasure discovered in the Varna Necropolis is the oldest one in the world

Bulgaria is the oldest country in Europe that hasn't changed its name since it was first established. ... Sofia, the capital of Bulgaria, was founded 7000 years ago. This makes it the second oldest city in Europe. The gold treasure discovered in the Varna Necropolis is the oldest one in the world

A ОСВОБОЖДЕНИЕТО OSVOBOZHDENIETO

PREHISTORIC NIGHT SKY

How did people in prehistoric times relate to the night sky?

Our ancestors in deep prehistoric times had a human connection with the cosmos that is probably deeper, more abiding, and more deeply felt than we have today. People in antiquity saw the connections between things. They saw light from the sun but they didn’t know how it was formed. Nobody was talking about thermonuclear reactions in the core of the sun. But they realized the behavior of the sun had a big-time effect on the earth—on what the animals did, the plants did. The earliest calendars may have kept track of stars that appear in the predawn, or just after sunset. When a group of stars is visible, it means this animal is going to do this, the salmon are going to run, the deer are going to rut. Those are the connections that were in people’s minds. They had an integrated relationship with the cosmos. Now we’re at a greater loss. We’re trying to figure out how Earth fits into a cosmos that appears to have no limit. At the very least, it’s operating on physical laws beyond ordinary human experience; they don’t make intuitive sense and have to be examined mathematically. So maybe now we’re the ones with a far less integrated sense of our relationship to the cosmos.

ITLY

P TSS

Pediatric Toxic Shock Syndrome After a 7% Burn: A Case Study and Systematic Literature Review

Ankur Khajuria, Hauwa'u Hayat Nadama, Michael Gallagher, Isabel Jones, Joanne Atkins

Annals of Plastic Surgery 2019 June 11

INTRODUCTION: Toxic shock syndrome (TSS) is a life-threatening condition, which occurs in children after sustaining a burn. Often diagnosed retrospectively, many patients may not receive optimal treatment.The primary objective of this study was to evaluate a severe and complex case of TSS at our unit and subsequently conduct a Preferred Reporting for Systematic Reviews and Meta-Analyses-compliant systematic literature review, to identify cases of postthermal injury TSS and evaluate their presentation and management.

CASE REPORT: A 9-year-old boy with Down syndrome presented with a 7% total body surface area scald to his back and posterior head. Four days after discharge, he developed a fever. The following day, he deteriorated, becoming stridulous and unresponsive. A working diagnosis of TSS was made. The patient's intensive care stay was arduous with multiple complications, including 2 cardiac arrests.

METHODS: A Preferred Reporting for Systematic Reviews and Meta-Analyses-compliant systematic literature review was conducted. MEDLINE, PubMed, and Web of Science were searched using key terms "burns, thermal injury, scalds, paediatric, child, infant, neonate, toxic shock syndrome" to identify cases. Two authors independently checked each study against inclusion criteria.

RESULTS: The systematic literature search yielded 9 articles, identifying 40 cases. Ages ranged between 9 months and 8 years. The mean number of days' postburn patients presented with symptoms of TSS was 2.5 days (1-7 days). The most common presenting symptoms were fever (75%), rash (70%), and diarrhea, and/or vomiting (52.5%). Intravenous immunoglobulins were administered in 11 (27.5%) cases.

DISCUSSION: We have highlighted a case where a possible delayed diagnosis along with the immunodeficiency seen in Down syndrome may have impacted the severity of TSS. The literature review highlighted that a significant proportion of patients do not meet diagnostic criteria.