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Although prominent physicians in the mid to late twentieth century announced with great fan- fare the end of infectious disease for all time such has not turned out to be the case. In fact infectious dis- ease is becoming more of a problem in the industrialized world every year. Resistant bacteria are making massive inroads in hospitals; one of the more common sentences in newspaper obituaries is "died of complications following surgery." They rarely say that in nearly all cases those "complications" are resist- ant bacteria the patient picked up in the hospital.
It has also become clear that many new infections, and others, simply not recognized as being infections (e.g. endocarditis from Bartonella infection or arthritis from Lyme bacteria), are emerging with greater frequency and virulence in the human population.
One major grouping of these types of infections are those that are often coinfectious with Lyme disease. This includes, but is not limited to, infections caused by Babesia, Bartonella, Ehrlichia, Anaplasma, Mycoplasma, Coxiella, and Rickettsia organisms.
Clinicians specializing in Lyme disease treatment have long been aware of the complex problems attendant with treating someone with multiple coinfections. Though slow on the uptake, as usual, this awareness is now becoming more common among researchers. In consequence, some good information is emerging on the synergy between coinfectious agents during active infections. This is a brief look at some of the factors that need to be taken into account when treating coinfections.
Studies on the complex interactions that occur between co-infectious bacteria are uncommon but, when combined with the experience of clinicians, they are revealing. Coinfective bacteria interact both in the vector that spreads them and then in the host they are transferred to and those interactions have a great deal of impact on patient out- comes.One of the first things to understand is the tremendous genetic flexibility of coinfectious organisms.
Genetic Flexibility and Evolution Among Bartonella
Bartonella organisms, like many related members of the proteobacteria (among whom are coinfectious agents such as Ehrlichia and Anaplasma), are undergoing rapid genetic alterations in response to environmental factors such as climate change, habitat damage, and human population increase.
As Bruno Chomel, et al, note in their paper, "Ecological fitness and strategies of adaptation of Bartonella species to their hosts and vectors":
“Massive natural or man made changes to historically stable ecosystems that result in alterations in vector biology and reservoir host density, increased international movement of a wide range of reservoir hosts across continents, recent human behavioral and societal changes that bring animals into increasingly close human contact, as well as medical interventions, HIV infection and an aging immunosenescent human population con- tribute to ongoing and dynamic interactions among Bartonella species and their hosts and vectors." (Chomel, et al, 2009)
Studies have found that Bartonella exists within infected hosts as a mosaic of different genetic variants. This kind of variation is not found during in vitro studies, only in living hosts. In response to the immune system of the host Bartonella, much like Lyme spirochetes, generate a number of genetic variants in order to maximize survival in the host. The various variants are able to live within different niches of the host more easily than others, e.g. the bone marrow or the lymph system, in order to maximize survival over time. It is not uncommon that several variants can be found within those niches, the several strains exchanging genetic material in order to stay ahead of the immune response. The outer membrane proteins on the exterior of the bacterial cell are often altered (as are many of the adhesion molecules such as BadA) which makes the variants harder to recognize by the immune system. Simple rearrangements of certain portions of the genome can create as many as 420,000 variants of a species of bacteria in a short period of time. As Chomel, et al, observe, "When the host produces antibodies targeted against the invading microorganisms, the infecting pathogen is usually killed. However, if the pathogen alters the protein expressed (antigenic varia-tion), or no longer expresses the protein on its surface (phase variation), the microorganism can survive and multiply in the host." (Chomel, 2009) In those with persistent or chronic Bartonella infection, both phase variation and anti-genic variation appear to be the norm, with the immune system unable to keep up. Study has found that the immune system is compromised in chronic cases, at least minimally.
All Bartonella species contain a very similar, fairly small, core genome and multiple accessory genome structures that they can weave into the core genome if needed. Most of the accessory genomes exist as genomic islands and were obtained through horizontal gene transfer from other bacteria. Some of these genomic islands are host specific, much as they are in Lyme spirochetes. Upon entry into a new host, the necessary genomic island can be incorporated into the core genome to facilitate host infection. As Chomel, et al comment, the horizontal gene transfer of so many genomic islands has "facilitated the remark-able evolutionary success of the modern lineage [of Bartonella] by conferring host adaptability" . . . and has stimulated "the adaptation of the generally host-restricted bartonellae to novel hosts." (Chomel, 2009)
The impetus for genetic rearrangement come from both the organ-ism itself and the immune environment in which it finds itself. Examination of the Bartonella genome has found a number of segments that are prone to rearrangement under environmental stress. In addition, Bartonella, like most bacteria, are able to both give and receive plasmids, strands of genetic material that can be woven into the genome to alter phenotype. Essentially, they can alter their physical form to make themselves more resistant to antibiotics, become more virulent, or more resistant to immune responses. Plasmids are exchanged with other bacteria, both inside of and outside the genus. In general, about 25 percent of the population of any mammal species, including humans, that can act as hosts for Bartonella will be infected, only a small portion of which will become symptomatic. Genetic variation in the mammal species is huge, over 22 genetic variants being found in one study.
Many of the arthropod vectors of Bartonella (i.e., ticks, fleas, and so on) contain multiple species of the bacteria, all of whom exchange DNA segments in order to facilitate their adaptation to new hosts. Variants develop in infected hosts such as humans, vectors take a blood meal, ingesting the new variants. The new variants, taken as blood meals from multiple species, interact in the gut of the vector, alter their genome structures, and then are injected into new hosts. There is a continual and very elegant genetic recombination occurring.
Research in 2007 found "that isolates responsible for human disease are not drawn randomly from the feline reservoir." (Arvand, 2007) In other words, there are specific human-infectious Bartonella held in the cats that are generated inside the cat to infect the human hosts that own the cats. (In fact, B. quintana, which is considered to be human specific, is an evolved off-shoot of B. henselae - a generally cat-specific species - that adapted itself to specialize in infecting humans. Research has found that B. henselae is still easily able to shift its outer membrane proteins to allow it to infect human red blood cells.)
Lindroos, et al, note, "the variable gene pool in the B. henselae population plays an important role in the establishment of long-term persistent infection in the natural host by promoting antigenic variation and escape from immune response. . . . the results suggest multiple sources of human infection from feline
B. henselae strains of diverse genotypes." (Lindroos, 2006) In spite of numerous comments to the contrary, Bartonella infec-tion of human beings is not a random or accidental event; we are not inadvertent hosts. All mammals are potential hosts for all Bartonella species and B. henselae (along with others that infect human companion animals) is not "accidentally" infecting humans. And the infection is wide spread, much more so than is commonly recognized among physicians or the CDC. As Mietze, et al note, in their research among Germans: "The prevalence of bartonellosis among humans in Germany appears to be high and severe clinical cases have been described." (Mietze, 2011)
There is tremendous genetic shifting occurring in response to multiple environmental factors. Coinfectious organisms that congregate inside ticks or other arthropod vectors are exchanging information with each other, including how to alter DNA in order to avoid both antibiotics and host immune responses. It should be assumed whenever a chronic case of Lyme or Lyme coinfections is encountered that multiple genetic variants exist and are being regularly generated within the infected per-son. This is becoming the norm rather than the exception. Treatment has to become more sophisticated in order to be successful. Looking at cytokine cascade is one way to get to a more sophisticated, approach.
Coinfections and Cytokine Cascades
One of the better articles on cytokine cascades is Andrea Graham, et al. "Transmission consequences of coinfection: cytokines writ large" that appeared in Trends in Parasitology, volume 23, number 6, in 2007. The authors propose a unique approach to understanding the dynamics of coinfections. Instead of focusing on the organisms them-selves, they suggest focusing on the cytokine cascades that the organisms produce in the body. They comment that "When the taxonomic identities of parasites are replaced with their cytokine signatures, for example, it becomes possible to predict the with-in-host consequences of coinfection for microparasite replication" as well as symptom picture, treatment approaches, and treatment outcomes.
Cytokines are small cell-signaling molecules secreted by the immune system and the glial cells of the nervous system that are important in intercellular communications in the body. They tend to produce unique forms of inflammation and alteration in the cell surface structure, depending on what is occurring during the infection. In practical terms, when a bacterium touches a cell, the cell gives off a signal, a cytokine, that tells the immune system what is happening and what kind of help that cell needs. Each type of infectious bacterium initiates a particular kind of cytokine cascade.
When treating a coinfection, it is important to take the time to under-stand the cytokine cascade that occurs from each organism. This determines many of the most effective approaches to treat the condition. For example, if the infectious bacteria, say Bartonella for example, stimulate high levels of interleukin-8 in the body, then reducing interleukin-8 levels through the use of phytomedicinals that have that particular action will in fact reduce many of the symptoms associated with Bartonella.
It is moderately easy to explore the cytokine cascade that one organism initiates but when you have two or more bacteria involved in an infection, each causing unique cytokine cascades, the dynamic becomes a great deal more complex. Most coinfectious bacteria have learned to work synergistically with each other. This means that the outcomes are not just additive; the bacteria actually work together and, just as with people working together, produce a much more powerful outcome than if merely one bacterial species is involved. As well, most bacterial species have learned how to use the host's own cytokine immune responses for their purposes.
As Graham, et al, note: "The influence of cytokines on effector responses is so powerful that many parasites manipulate host-cytokine path-ways for their own benefit," as is indeed the case with Lyme and its coinfectious agents such as Bartonella. Most crucially, they continue, "the magnitude and type of cytokine response influence host susceptibility and infectiousness. Susceptibility to a given parasite will be affected by cytokine responses that are ongoing at the time of expo-sure, including responses to pre-existing infections." In other words, if you are already suffering some inflammatory condition, however mild, the bacteria will use it to facilitate their spread in the body. If more than one microorganism is involved such spreading is enhanced considerably. As Graham, et al, put it "coinfection increases the reproductive number for the incoming parasite species and facilitates its transmission through the host population." While the immune system is often compromised by the cytokine dynamics initiated by one type of bacteria, multiple, simultaneously initiated cascades are even more potent in their impacts. In addition, you begin to get assaults on multiple body systems.
If Bartonella is a coinfection with Lyme, for example, what you then get is assault on and resultant degradation of the collagen systems of the body by the Lyme spirochetes and a simultaneous assault on red blood cells along with continual subversion and abnormalization of endothelial cells and their functions. Since Lyme spirochetes damage collagen tissues, for instance in the joints of the knee, the body will send CD34+ cells to that site to help repair the damage but some of those cells will be infected with Bartonella (which has a tendency to infect those precursor cells in the bone marrow). The Bartonella will take advantage of the local inflammation to establish a colony in that location that itself will contribute to collagen degradation the Lyme spirochetes are causing. If the person were to be already suffering with a preexisting inflammation in that joint location, the process is even easier for the bacteria.
If you add other coinfectious bacteria to the mix, the picture is even more complicated. For example, if Babesia are present, then the red blood cells are going to have two organisms infecting them (Bartonella and Babesia), thus increasing the deleterious impacts on the red blood cells. This is, as Graham, et al, comment, more common than not. "Hosts that are coinfected by multiple parasite species seem to be the rule rather than the exception in natural systems and some of the most devastating human diseases are associated with coinfections that challenge immune response efficacy."
The foundations of this are ecological more than anything else. As those researchers observe:
"Coinfections could, thus, increase vulnerability to the emergence of new parasites by facilitating species jumps if the coinfected portion of a population provides favorable conditions for an emerging parasite to adapt to a new host species." And research is bearing out that such adaptation is in fact occurring.
Another very fine paper on the dynamics of coinfections is by Telfer, et al, "Parasite interactions in natural populations: insights from longitudinal data," in Parasitology, volume 135, number 7, 2008. They echo Graham, et al, when they note, "in natural populations 'concomitant' or 'mixed' infections by more than one parasite species or genotype are common. Consequently, interactions between different parasite genotypes or species frequently occur. These interactions may be synergistic or antagonistic with potential fitness implications for both the host (morbidity and/or mortali-ty) and parasite (transmis-sion potential)."
There is mounting evidence from experimental studies that the outcome of interactions during co-infections (for either the host or the parasite) is context dependent, potentially varying with different host or parasite genotypes or environmental conditions. Perhaps most critically, outcome can depend on the timing and sequence of infections. . . .
Susceptibility is a property of an individual host at a given time. . . . The ability of a parasite to establish an infection successfully will depend on the initial immune response of the exposed host. On entry into the host, a parasite will experience an "immunoenvironment" potentially determined by both previous and current infections, as well as intrinsic factors such as sex, age, nutritional status and genotype. The immediate immunoeffectors in a naive host will be dominated by cells and molecules that comprise the innate immune response, and thus the efficiency of this arm of host immunity at reducing and clearing an infection will be influential in determining susceptibility.
In other words, attention to the health of the immune system is essential when dealing with coinfections. Resto-Ruiz, et al, emphasize this as well, as do so many other researchers, "The reduced ability of the host's immune response to control bacterial infection apparently results in a bacteremia of longer duration. . . people with intact immune function who become infected with B. henselae usually" do not experience severe symptoms. (Resto-Ruiz, et al, 2003)
The immune status of someone with coinfections must be addressed as part of any treatment protocol. Due to the synergistic nature of coinfections there is an inescapable truth: The weaker or more compromised the immune system, the more likely someone is to become infected and the more likely they are to have a debilitating course of ill-ness. Improving the immune status of those with chronic bartonellosis, for instance, allows the immune system, refined over very long evolutionary time, to do what it does best, which is to use very elegant mechanisms to control and clear infection. Eventually, the healthy immune system begins to identify the outer membrane proteins of the bacteria and creates antibodies to them. Due to the sophistication of the bacteria's sub-version of the host immune system this often takes any-where from 4-8 months with Bartonella infections. In those whose immune systems are compromised it may take longer, how long is directly proportional to the health of the immune system. Once the immune system creates the proper antigens, the bacteria are then eliminated fairly rapidly from the body. Reinfection is difficult as the antibodies remain in the body for some time.
The synergy of the coinfections' impacts on immune function has to be addressed as well. As Telfer, et al, comment, "Attempts by the immune system to simultaneously counter the multiple parasite species involved in a coinfection can lead to immunopathological disease and pathology that are more than the simple additive pathogenic effects of the different parasite species."
For example, infection with both Babesia and Bartonella are synergistically impactful on red blood cells and can reduced red blood cell counts up to 25 percent, leading to anemia, fatigue, breathlessness, and general weakness. (One positive note, because both bacteria are competing for red blood cells, longer studies have found that the Babesia, over time, tends to clear the Bartonella infection by outcompeting them. In the initial stages, however, the impact on red blood cells is immense.) Babesia are thought to sequester themselves in the capillary networks of the spleen and liver. Bartonella species sequester themselves in the endothelial cells of the capillary networks of the spleen and liver. Both then seed the blood stream from those locations at regular intervals. The impacts of infection with both para-sites on the spleen and liver are much greater than either alone and this has to be taken into account in any treatment approach.
Telfer, et al's, research also found that infection with Anaplasma for example made subsequent infection by Babesia much more certain, in fact, it made it twice as likely to occur. Reversing the order of infection found the same rate of increase. As well, animals infected with one Bartonella species who were also infected by other Bartonella species were much more likely to have long term infections. Coinfection with
Anaplasma and Bartonella (or Babesia and Ehrlichia), for example, are often more severe in the disease progression in that both white blood cells and red blood cells are infected. Specifically, Anaplasma and Ehrlichia infect neutrophils, the most abundant form of white blood cell in the body and an essential part of the innate immune system. Thus the immune system is fighting not only bacteria in the red blood cells and vascular tissues but bacteria inside itself.
In my experience, the technological medical community tends to down-play both the impact and occurrence of coinfections in the people they see while the alternative community tends to exaggerate it. Oddly, in spite of their training, most physicians don't really understand bacterial organisms very well, nor how to treat them. They usually tend to look for a pharmaceutical that is active for the bacteria in question and apply it, a fairly superficial approach that is increasingly failing in practice. If they have not definitively identified the cause of the condition they will generally prescribe a broad-spectrum antibiotic that will, as often as it helps, do more harm than good. The alternative community often fails at rigor of analysis and the focus, and courage, needed to confront deadly or life debilitating infections. Both make too much money off people's suffering though, in fairness, most (not all) of the alternative community tends to make much less. I just don't see that many herbalists with their own private airplanes.
In treating coinfections, the approach should be depth based with rigor of analysis. The bacterial infections need to be identified (and no, muscle testing is not reliable enough, but then, neither is Elisa -neither should be relied upon as diagnostically definitive) and then a treatment protocol initiated. In some cases antibiotics are very effective and with diseases as debilitating as Lyme and its coinfections they should be considered. However, if that kind of superficial approach fails, then a depth under-standing of the cytokine cascades and the likely interactions between the coinfections should be undertaken and a treatment protocol initiated that addresses it in depth. The most important thing in treating coinfections is to reduce the inflammatory processes the bacteria initiate and reduce the cytokine cascades that occur. That stops the majority of symptoms right there especially if treatment protocols are initiated that are designed to protect the areas of the body that are affected.
As Telfer et al, observe, "An immune response that effectively cleared the infection from endothelial cells would therefore ultimately control an infection [by Bartonella]." This applies as well to any intervention that will protect endothelial tissue from the bacteria. The bacteria can't survive if they are not able to initiate their particular form of inflammation in the body; it is how they make habitat and scavenge food. Enhancing immune function then allows the body to deal with the infection on its own. The addition of protocols to reduce the specific symptoms that are occurring (e.g. arthritis) and help restore quality of life are also important. Antibacterials can help but comprehensive treatment protocols that address these initial three conditions are essential:
1. Reducing cytokine cascade
2. Enhancing the exact immune function that is depressed
3. Addressing symptom picture
Relying on a "kill the invaders" approach is going to become increasingly ineffective as time goes on. In fact, it is already failing. The bacteria are evolving. We should, too.
Arvand, M. et al, Multi-Locus Sequence Typing of Bartonella hense-lae Isolates from Three Continents Reveals Hypervirulent and Feline-Associated Clones, PloS One, December 2007, Issue 12.
Chomel, B. et al, Ecological fitness and strategies of adaptation of Bartonella species to their hosts and vectors, Vet Res 40(29), 2009.
Graham, A. et al. "Transmission conse-quences of coinfection: cytokines writ large" that appeared in Trends in Parasitology, volume 23, number 6, in 2007.
Lindroos, H. Et al Genome rearrangements, deletions, and amplifications in the natural population of Bartonella henselae, Journal of Bacteriology 188(21): 7426-39, 2006.
Mietze, A. Et al. Combined MLST and SFLP typing of Bartonella henselae isolated from cats reveals new sequence types and suggests clonal evolution," Vet Microbiol 148(2-4):238-45, 2011.
Resto-Ruiz, S. Et al, The role of the host immune response in the pathogenesis of Bartonella henselae, DNA Cell Biology 22(6): 431-40, 2003.
About the author
Stephen Harrod Buhner (http://www.gaianstudies.org) is the award-winning author of 18 books of non-fiction and one of poetry. For the past 30 years he has taught throughout the U.S., Canada, and the Western European Isles (UK/EU) about medicinal plants and Earth relationship. Among other contributions, Stephen is one of the early pioneers in understanding the non-linear source of indigenous plant knowledge; has been instrumental in bringing to prominence unhopped, herbal beers and ancient gruit; developed the first depth understanding of systemic herbal antibiotics and plant synergists; created the first comprehensive exploration of the function of medicinal plants in ecosystem homeodynamis; initiated the development of phytoandrogens in herbal practice, published the first meta-analysis of the dynamics of Lyme spirochetes in the human body; developed the first under-standings necessary for the herbal treatment of cytokine cascades in disease complexes; generated the first comprehensive exploration of the use of heart field dynamics in human/plant relationships; created the first depth analysis and exploration of herbal antivirals; and is one of the foremost writers on the nature of emerging infections and ecosystem disruption. There is a reason that Rosemary Gladstar calls him one of the "plant genuises of our time."

domain: biology


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In total, the Department of Education has approved discharging $8.7 billion in student loan debt for more than 450,000 borrowers.
Click here to see if you are eligible.
That amount has included:
- $7.1 billion for borrowers who were eligible for relief because of “total and permanent disability.”
- $55.6 million in loan discharges for students who attended three trade schools that officials said misrepresented themselves to students.
- Another $1 billion for other students defrauded by their schools.
The Biden Administration has cancelled nearly $10 billion in student loan debt since January 2021, according to the U.S. Department of Education. The Department reported they have approved $9.5 billion in student loan discharges since January 2021, affecting approximately 563,000 borrowers. This has given borrowers the ability to tackle other debts, invest and increase savings.

domain: finance


Apologies if the flow of news in recent days has been a little stilted and even duplicated. Since we started the news round up we've used various tools to pull it all together but the main one has been google's reader to collate the various press release feeds. Google has decided to shut down reader on 1 July and since their announcement last month, along with many other reader users, we have been looking for alternatives. The problem is that google aggregator services are so good virtually all the alternatives use google as their source too. We've saved and transferred all our feeds to three different providers and are using one, Feedly, as our new main service. Last week they began transferring the data from google to their own servers and had a little bit of problem, they were even more popular than they had bargained for! so they hit a few snags but it looks like they have fixed the bugs and glitches. However, its possible that there may be more hiding in the system (the gremlins are exceptionally good at hide and seek!) so we're prepared for whatever happens - we think. With luck you'll never know and we're try to keep the stuttering to minimum.


Am Dienstag, den 30.01.2007, 14:37 +0100 schrieb Ralph Angenendt: > Nils Toedtmann wrote: > > > > Unpolished, incomplete and not intended as external reference: > > > > <http://nils.toedtmann.net/wiki/Native2Xen> > > Looks okay to me. If you're going to update it when (and if) 4.5 will > have Xen kernels }:-> Done ... should-work-[tm] with upcoming 4.5 if the packagename "kernel-xenU" won't change. Will delete the manual kernel install and "/lib/tls" stuff when 4.5 is out. > Anyone against inclusion? If not, I'll give you edit permissions for > that page "soonish". tnx, /n.


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Zaxcom STA150 Stereo Adaptor
Zaxcom has introduced a new addition to its professional audio equipment family, the STA150 stereo adaptor.
Now shipping, the STA150 is designed to allow ENG audio professionals to transform an existing single-channel Zaxcom TRX900 or TRX900AA wireless transmitter into a two-channel transmitter. With all connections mounted on the side of the unit, the STA150 is designed specifically for use in sound bags.
The STA150 stereo adaptor provides a balanced stereo audio input designed to eliminate ground loop problems. With a dedicated time code input, the new adaptor is designed to enable an exact match of audio recorded on the TRX and audio/video recorded on-camera by synchronizing the time code generator inside the TRX unit and supporting automated loading of audio onto the TRX's CompactFlash® memory card.
The new STA150 interface also features an output that can be used either as an audio monitor for playback from the memory card or as a time code output to jam other devices. The STA150 includes an external power input for connection to a 12-volt external power source.
More info at www.zaxcom.com.
Viewers of this article also read...
- Zaxcom TRX992 Wireless System Zaxcom has introduced the TRX992, a boom pole unit that performs the functions of an audio transmitter, monitor return receiver, backup recorder, and phantom power supply.
- Zaxcom Mix-8 Zaxcom's Deva Mix-8 Shipping October 2008.
- Zaxcom Fusion Zaxcom has introduced The Fusion High-Resolution Audio Mixer And Recorder.

domain: design


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The Coronavirus outbreak has been doing a lot more damage than the obvious. It has done more damage than causing many people to become ill to the point that a portion of them had succumbed to it. It has caused a lot more problems than forcing many people to lose their jobs and businesses. And it has also done a lot more damage than causing an increase in abuse, manslaughter as a result of abuse, and suicide rates as well.
This pandemic has revealed the true colors of people. Narcissists have shown up quite clearly as they have made it clear that their liberties are more important than human lives. Nasty behavior has also been at its worst, and I will not chalk it up to some of those people having a hard time coping with the situation. This is their true nature.
Another thing that the COVID-19 outbreak has revealed is hypocrisy at its finest. For instance, a publication that has been supportive of mental health for so long has shown its true colors. Those who are running it are all of a sudden invalidating the grief that others are feeling and experiencing who have not had their physical lives impacted by the virus.
The article was written by this publication, and it is called ‘Canceled Sports, Proms, And Graduations Are Disappointing — But Don’t Call Them ‘Devastating’. Therefore, their message basically is that if you have your health, then you have no business being devastated. Disappointed, yes, but devastation, no. That should only be saved for those who have lost loved ones or who have gotten ill from the Coronavirus.
Wow. Just wow. Hypocrisy at its finest. Now let me put in my two cents about this. Firstly, it is true that canceled events, trips, and other events cannot be put at the same level as someone’s life being in jeopardy from the virus or another condition. However, telling someone who had to cancel those important events to not feel devastated but to be disappointed instead is asinine!
No one tells anyone how to feel and how to process any type of grief they are experiencing as a result of the losses they experienced. And yes, canceled trips, canceled events, canceled graduation ceremonies are losses! Even though they are not life and death, they are losses. Losses that those who have to end those things before experiencing them have every right to grieve and be devastated over. How dare anyone that has the gall to invalidate the emotions, grief, and feelings that others have as a result of how the situation has affected them.
This is just as bad as telling anyone who goes to home hardware centers to grab ‘non-essential’ items that they are selfish for ‘endangering the lives of others’. Perhaps by denying these people access to those ‘non-essential- items are endangering their lives as well. That is if these ‘non-essential’ items are actually quite essential for their mental health. For instance, that guy who grabbed a bunch of cans of paint (non-essential items) who had the ‘nerve’ to go out and endanger others maybe did it so he could prevent himself from thinking suicidal thoughts?
Another great way to invalidate someone’s struggles and chastising them instead. Sure we know that curbside pickup is the right option to utilize. But that is not the point. The point is that no one has the right to judge others for what they do. And no one certainly has the right to judge others for how to feel about anything. The true colors of people have been slipping out from this and boy, they are awful.
You are correct. The point is that no one has the right to judge others for what they do. And no one certainly has the right to judge others for how to feel about anything.
Thanks for the more information about COVID-19. This disease is increasing and spreading day by day. To avoid this we have to follow all safety measures. Wash your hands with soap for 20-minutes, wear a mask when going outside, sanitize your hands after touching anything, keep social distancing, etc.
Very nice article.
I really enjoyed going through all the great information you’ve provided in this great article.
Keep up the great work.
Thank you so much for this amazing article. During this Covid-19 many people start work as a freelance. It helps them how to rank fiverr gig
Exactly! The true faces of people revealed. Who is friend of good times and who cares about and how much? Who is taking it as an opportunity to get profits and who is helping others.
Also, some so-called giant companies firing their permanent employee for is a short span of a pandemic.
Hello My name is Janet i am really very thank full that you have spoke up on this so intense topic as most of the people are suffering from anxiety and depression.
Keep up the good work.
Yes, sure. People were tested to be more and more confident to others. Nice post!

domain: psychology


Amazon is currently offering the Hisense 55-inch ULED 4K U7G Android Smart TV for $499.96 shipped. Normally going for $650 recently, this 23% discount marks a new all-time low we’ve tracked for this model. The U7G uses Hisense’s exclusive ULED technology to boost “color, contrast, brightness, [and] motion” with the Quantum Dot technology producing more vibrant colors than traditional LEDs usually do. The native 120Hz refresh rate of the TV means that the gaming experience will be unlike other similar TVs with it recognizing the HDMI signal coming from your console and adjusting settings accordingly. Dolby Vision and Atmos are also supported with the U7G alongside HDR10+ with full-array local dimming (90 zones) meaning darker darks and brighter brights. IMAX Enhanced and DTS audio technology combine to make playing digitally remastered HDR content a great experience. Android TV gives you access to streaming apps and even has built-in Assistant support. Learn more by checking out our announcement coverage.
If you want to save some cash but still get a 4K 55-inch TV, check out the VIZIO V-Series 4K LED Smart TV for $384. This TV is a step down with its lack of Quantum Dot technology but you retain support for Dolby Vision and HDR10+ for a better movie-watching experience. VIZIO’s own smart software runs on this TV with support for Apple HomeKit, Alexa, and Assistant integration as well as Apple AirPlay 2 and the built-in Chromecast for screen mirroring. The VIZIO SmartCast app allows you to control the TV with your phone being the remote as well. Variable Refresh Rate is present with this TV meaning modern consoles can have the gameplay being displayed be as smooth as can be.
Add some accent lighting to your entertainment center with Govee’s just-released Glide Smart Light Panels at $130, the first discount these lights have seen. You can also pick up a Bose Smart Soundbar 900 for $799 which features support for Dolby Atmos.
Hisense U7G 55-inch 4K ULED Android Smart TV features:
Sure, the Hisense U7G TV series is great for Netflix, the big game, and the real housewives of wherever. But the U7G is made for the gamers. It’s got our exclusive ULED technologies, 4K resolution, Quantum Dot Color, Dolby Vision HDR, Full Array Local Dimming zones and Android TV operating system. On top of all that, Hisense added a 120Hz Native panel for smoother, more fluid motion and HDMI 2.1, Variable Refresh Rate and Auto Low Latency Mode for gaming that looks sick, even if you suck. The U7G also has up to 1,000 nits peak brightness, which makes HDR ‘pop’ and means the picture is lit no matter how bright the room. All this looks great on paper. Now think how much better it would look on this TV.
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Dublin, Dec. 07, 2021 (GLOBE NEWSWIRE) -- The "Danyelza Patent, Sales & Clinical Trials Outlook 2028" report has been added to ResearchAndMarkets.com's offering.
As of now, the drug Danyelza has gained approval only in US. However, it is expected that in coming years the drug will gain approval in other regions also including China, Europe, and Japan.
For instance, CHMP has recently given positive opinon of the drug and thus, it is expected that Danyelza will gain approval in Europe by 2022, thus further boosting the growth of market. As per report findings, it is suggested that sales of the drug will follow trajectory growth rates during the forecast period and is expected to reach US$ 400 Million by 2028.
The overall Danyelza market will be mainly restricted by the high cost of therapy, lack of biomarkers, and the increasing investment in research and development sector. Currently, the drug is available as branded molecule and it will not face any competition from the generic drug during the forecast period.
The high cost of the therapy is generally unaffordable to majority of patients, thus restraining the growth of the market. To overcome this, several reimbursement policies have been developed which aim to reduce the out-of pocket cost by patients, thus decreasing financial toxicity. For example, y-Mab Connect co-pay program has been developed which provide a maximum benefit of US$ 15,000 per enrolment period.
The Danyelza market will witness high adoption rates of the drug during the forecast period. Owing to its superior mechanism of action, limited side effects, and ability to specifically target the receptors which are expressed on cancer cells, the drug Danyelza is expected show high adoption rates at a global level.
The report provides detailed analysis on Danyelza including its price, sales, dosage, and clinical trial insights. On the basis of this, the future sales of the drug have been forecasted and market opportunity of drug in neuroblastoma as well as osteosarcoma has been established.
Apart from neuroblastoma, researchers are also evaluating further indications s in children and adults include osteosarcoma and other GD2-positive cancers. Apart from this, ongoing clinical trials are also evaluating naxitamab in combination with allogenic natural killer cells and in combination with GM-CSF, irinotecan and temozolomide for the management of neuroblastoma.
The coming years will see a dominance of combinational therapy in neuroblastoma which will enhance the efficacy of treatment in cancer patients. The majority of clinical trials are present in phase-I/II clinical stage, suggesting that forecast period will see rapid approval of Danyelza as monotherapy or combinational therapy in wide range of GD2 positive cancers.
Danyelza Patent, Sales & Clinical Trials Outlook 2028 Report Analysis & Data Highlights:
Danyelza Patent Insight
Danyelza Dosage & Price
Danyelza Sales Forecast 2028: > USD 400 Million
Danyelza Role in Neuroblastoma & Osteosarcoma Therapy
Danyelza Structure & Pharmacokinetics Properties
Danyelza Ongoing Clinical Trials: 10 Clinical Studies
Danyelza Reimbursement Scenario
Key Topics Covered:
1. Danyelza (Naxitamab) - GD2 Targeting Antibody
1.1 Clinical Overview
1.2 Clinical Efficacy
2. Danyelza - Approval & Patent Insights
2.1 Orphan Designation & Approval
2.2 Patents & Assignees
3. Danyelza Commercial Insights
3.1 Pricing & Dosage Analysis
3.2 Sales Analysis
4. Danyelza Mechanism of Action
5. Danyelza Role in Neuroblastoma
6. Danyelza Role in Osteosarcoma
7. Danyelza - Supplementary Information
7.1 Pharmacodynamics & Pharmacokinetics Properties
7.2 Adverse Drug Reactions
7.3 Use in Specific Population
8. Global Market Analysis
8.1 Current Market Scenario
8.2 Future Market Opportunity
9. Danyelza Sales Forecast Till 2028
10. Danyelza Clinical Trial Insights
10.1 By Phase
10.2 By Region
10.3 By Status
10.4 Ongoing Clinical Trials
11. Danyelza Reimbursement Policy
12. Competitive Landscape
12.1 Autolus Therapeutics
12.3 Bellicum Therapeutics
12.4 Kurr Therapeutics
12.5 SciClone Therapeutics
12.6 Sorentto Therapeutics
12.7 Swixx Biopharma
12.8 Takeda Pharmaceuticals
12.9 United Therapeutics Corporation
12.10 Y-Mab Therapeutics
For more information about this report visit https://www.researchandmarkets.com/r/y0mvw5
CONTACT: CONTACT: ResearchAndMarkets.com Laura Wood, Senior Press Manager email@example.com For E.S.T Office Hours Call 1-917-300-0470 For U.S./CAN Toll Free Call 1-800-526-8630 For GMT Office Hours Call +353-1-416-8900

domain: medical


text:
Intuit faces billion-dollar blow
Published 4:00 am, Wednesday, February 15, 1995
Rejection of the proposed antitrust settlement between the government and Microsoft Corp. could deal a billion-dollar blow to Intuit Inc., the Menlo Park firm trying to complete a mega-merger with Microsoft.
In October, Intuit Chairman Scott Cook announced that Microsoft Chairman Bill Gates had offered $1.5 billion in shares to acquire his firm, whose popular Quicken software balances more checkbooks than any other program.
But critics told government antitrust lawyers that a merger of Intuit's financial know-how with Microsoft's market clout could create a digital colossus that would have a hand in the electronic purses and pocketbooks of the future.
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These antitrust objections to the merger gained credence Tuesday after Federal Judge Stanley Sporkin nixed a proposed out-of-court settlement between Microsoft and Justice Department lawyers that would have settled other allegations of monopolistic behavior by Microsoft.
Although the Intuit deal is a separate issue, the judge's decision is sure to cause government lawyers to scrutinize the merger proposal more critically, according to Maarten de Jong, an analyst with Bear Stearns & Co. in San Francisco.
He said Intuit's stock, which had been trading in the 30s to 40s before the deal was announced, shot up to the high 60s after the announcement. Intuit was down 4 to 64-1/4 at midday, as nervous investors wondered whether fallout from the Sporkin ruling might scuttle the merger.
"Intuit stock will collapse down to previous trading range or below" if the deal gets called off, de Jong said.
But Karl Wong, a software analyst with Dataquest in San Jose, said Intuit cannot afford the distraction and prolonged indecision of not knowing whether the merger will succeed.<

domain: law


text:
Like mother, like daughter!
Chrissy Teigen recently proved that her daughter, Luna, is ready to go into the family business… Modeling, of course!
The gorgeous infant made her debut and struck a pose wearing a piece from the Kardashian Kids collection. Too cute!
+Check out more of Luna’s cutest moments in the gallery!=

domain: celebrity


Your Stealth bar is consumed 50% slower.
Every 1.5s your inactive Weapon generates 2-10 Ammo.
Increase the ammo count of both of your weapons by 2-10.
Reduce maximum Side Arm inaccuracy by 8-40%
Reduce Side Arm recoil by 6-30%
Gain 10-50% Movement Speed for 2s when entering stealth.


text:
Temporary Water Shut-Off for Hoʻolehua Water System UsersPosted on Feb 2, 2023 in Department of Hawaiian Home Lands, Public Notice
FOR IMMEDIATE RELEASE
February 2, 2023
Temporary Water Shut-Off for Hoʻolehua Water System Users
(Hoʻolehua, Molokaʻi) – The Department of Hawaiian Home Lands (DHHL), through its contractor Goodfellow Bros., will install new valves on the Hoʻolehua Water System on Molokaʻi during the evenings of February 21, 2023 and February 23, 2023, weather permitting.
Water service is scheduled to be shut off from 10:00 p.m. to 6:00 a.m. on both dates for customers in the Hoʻolehua area, including businesses and Kualapuʻu School.
Affected customers are asked to store water and adjust schedules accordingly. In the event of technical difficulties or unforeseen conditions such as weather, potable water trucks will be placed near the Lanikeha Center and the DHHL baseyard for community use.
In addition, Kalama‘ula water customers are asked to conserve water the whole week of the scheduled work, as the entire system will be operating at decreased capacity.
The temporary water service interruption is a portion of DHHL’s $37 million capital improvement project to improve Molokaʻi’s 80-year-old Hoʻolehua Water System.
DHHL maintains four water systems statewide. Those water service areas are in Anahola, Kauaʻi; Hoʻolehua and Kalamaʻula, Molokaʻi; and Kawaihae and Puʻukapu on Hawaiʻi Island.
For more information, call (808) 620-9500.
About the Department of Hawaiian Home Lands:
The Department of Hawaiian Home Lands carries out Prince Jonah Kūhiō Kalanianaʻole’s vision of rehabilitating native Hawaiians by returning them to the land. Established by U.S. Congress in 1921, with the passage of the Hawaiian Homes Commission Act, the Hawaiian homesteading program run by DHHL includes the management of over 200,000 acres of land statewide with the specific purpose of developing and delivering homesteading.
Information and Community Relations Office
Department of Hawaiian Home Lands

domain: news


text:
- CRITTER TALK
- NEWS I FIND INTERESTING
by Burr Deming
I cannot claim to be diligent about exercise.
It has been years since I ran or even walked for any purpose other than getting some short distance away.
It isn’t a defiance of mild medical admonition, exactly. It’s more an issue of time. Sometimes what is most important is not what is most urgent. At least that’s the story I tell myself.
I still see folks as I commute. You can tell the people doing their daily obligation to health and wellbeing. They do the same thing I sometimes did in my less sedentary days. I carried a stick. It was for a couple of reasons.
It signaled to me that it was time to adopt a fitness persona. Tired? Keep running because I had the stick.
But it was also for early morning or late night protection. I’m pretty big and kind of dopey looking. So nobody is likely to bother me. And walking in most neighborhoods is safer than you might think. But why take chances?
So I see folks walking or running with their sticks in hand, and I know they’re exercising.
A few years ago, one early morning walker in Montgomery, Alabama, suddenly found himself surrounded by police. Officers from two patrol cars were joined by another on a motorcycle. They questioned the man. Did he just come from South Perry Street? As questioning went on, the reason became apparent. The police had a report of someone walking with a crowbar.
Walking with a crowbar?
After a bit, the man challenged the officers. Wasn’t it apparent that he was carrying a walking stick? And about that crowbar. Was it really illegal to walk with a crowbar?
The police were polite. No, they said. Crowbars are legal. So are sticks. But when they get that type of call, they have to check it out.
That type of call.
So they were prepared to stop any black man carrying anything at all because of a call saying someone saw a black man carrying something. The man was irritated at being stopped simply because someone was suspicious of a black man walking down the wrong street.
In this case, the man the police stopped was a Circuit Court Judge for the County of Montgomery. He showed them his badge, and that was the end of the interrogation. The police left and the Circuit Court Judge continued walking.
It was an experience shared by many black people. Those of us with black children know about “the talk.” Children must be taught that tragic consequences can come from an encounter with a malevolent officer, or with even a normally friendly officer having an abnormally bad day. Truly good officers provide safety, but there is no way to tell. No-one wears a badge that says “I’m one of the many good ones.”
If the officer is black, it is no guarantee of fairness. Neither abuse of authority nor fairness in the use of that authority is color-coded. Abuse can come at any time, and black citizens may become an inviting target.
So irritation must be suppressed. Argument must be avoided. Hands must always be visible. Make no sudden moves that might be seen as threatening. We want our children back home, alive and unbruised.
Fear of police abuse is a burden shared by police and many of the citizens they protect.
Judge Greg Griffen wrote of his experience in a post on Facebook. He mentioned the courtesy shown by the police, and later pointed out that one of the officers was black. But he described his irritation at being stopped for no apparent reason other than his race and the walking stick.
A few days later, he posted a separate Facebook entry with a photo of himself shaking hands with the Chief of Police. “We discussed the incident.”Then in caps, “WE ARE OK!”
Sometimes encounters with the police do not have a happy ending. When death results, and there is probable cause, an officer may become a defendant. Occasionally, a presiding judge may be black, perhaps even a black citizen who has been irritated by a police stop. It is not, after all, a rare experience.
Early last year, a 58 year old man was walking home from an after-work card game when he was stopped for questioning by a police officer. It was a high-crime area, and the officer later said he wanted to conduct a “field interview.” The officer testified that the man ran from him, then turned and attacked him with a long-poled paint roller.
The citizen’s version will be forever unknown. He was killed.
Medical evidence showed the deceased man had been tased multiple times, beaten with a baton, then shot 5 times. A baseball cap was still tightly clutched in his hand, making the described paint roller attack difficult. His fingerprints were not on the pole.
The shooting was investigated by the Alabama State Police. They reported the officer changed his story during their inquiry, eventually saying he was not sure about the roller attack. His cruiser camera and his body camera were both off during the fatal encounter.
The police officer was charged with murder.
It was already a politically charged case when it landed in the court of Judge Greg Griffen. Attorneys for the accused officer are demanding that Judge Griffen be disqualified. Their reasoning? official misconduct.
Judge Griffen had criticized his own early morning stop by police. The attorneys describe the incident as “eerily similar” to what happened to the deceased man on his way home from a card game.
This Honorable Court was so enraged by this incident that it wrote several comments pertaining to the same on a social media site proclaiming its disgust with the Montgomery Police Department…
The specific impropriety by the judge pertains to the case. Judge Griffen may have to decide:
…whether Mr. Smith, a white officer, was justified in stopping Mr. Gunn, a black mane(sic)
They meant a black man.
I suppose legal briefs must often be expressed in exaggerated terms. It is hard to find any part of social media in which Judge Greg Griffen “proclaimed” his “disgust with the Montgomery Police Department.” He did point out the courtesy of the police, but added that
it was aggravating to be detained when the only thing I was guilty of was being a black man walking down the street in his neighborhood with a stick in his hand.
Seems a reasonably restrained reaction. And the experience of being randomly stopped and questioned is more commonly shared by black citizens than is generally acknowledged.
It is common enough to make a common sense point:
If a black judge who has had a common black experience must be disqualified from deciding if “a white officer … was justified in stopping … a black mane” (that would be “man”) then we have moved to a place we hoped we had left. We have graduated to a challenge against any black judge in any case of alleged misconduct by an accused white officer.
It seems predictable that racial logic would begin the journey through our judicial system. We have had a clear warning.
I’ve been treated very unfairly by this judge. Now, this judge is of Mexican heritage.
Donald Trump, June 3, 2016
So what happens is the judge who happens to be, we believe, Mexican…
Donald Trump, May 27, 2016
Why, why did you refer to his ethnicity, Donald?
Well, because his heritage is Mexican.
Donald Trump, June 5, 2016
Some slopes really are slippery. The logic of ethnic determinism is pushing us into massive tragedy, and a national disgrace.
You know what I want? I want dreamers to come from this country … I want dreamers to come from the United States … We’re always talking about dreamers for other people.
Donald Trump, February 15, 2016
800,000 can seem like a statistic, until one or two appear before us. When individuals are seen for what they are – individuals – it becomes difficult to regard them as numbers, to be totaled up and sent away. One young adult fights back tears as she testifies to us on camera.
I have pledged allegiance to the flag for, like, 21 years.
Tania Breton, Morristown, NJ, on NJTV
We can multiply Tania Breton by hundreds of thousands.
I can’t change what my parents did.
800,000 Americans who have known no other life than that of an American are told to leave their country, to become, as it is put in Exodus, strangers in a strange land. Not knowing new local language, unfamiliar with new local customs, alien to new local people.
Some national leaders are speaking up in their defense:
Efforts to round up kids who have grown up here, and for all practical purposes are American kids, and send them someplace else, when they love this country.
President Barack Obama, January 18, 2017
The median age I think is six years old for those 800,000 when they came across the border. They should not be punished for the sins of their parents.
Senator Jeff Flake (R-AZ), September 3, 2017
The logic that would disqualify one judge because of common racial injustices, and condemns another because of the ethnicity of his parents, is now applied to teenagers and young adults. They are to be rounded up and exiled for the desperate sins of survival committed years ago by parents living on the edge.
We are shocked but not surprised, that this:
Now, this judge is of Mexican heritage.
can so easily become this:
Click here for reuse options!
We’re always talking about dreamers for other people.


text:
|LT George B. Dahl, USNRF
|11 June 1918 - 21 March 1919
Dictionary of American Naval Fighting Ships History: Santiago (ex-Tabaristan) was launched in 1906 by Wm. Hamilton and Co., Ltd., Port Glasgow, Scotland, and prior to her acquisition by the Navy was operated out of Havana, under Cuban registry, by the New York and Cuba Mail S.S. Co. She was taken over by the U.S. Navy on 3 June 1918 at New York for service in World War I; assigned the identification number 2253, and commissioned as a Naval Overseas Transportation Service vessel on 11 June 1918.
Refitted for Navy use, she took on general Army cargo and sailed in convoy for Brest on 18 June. Returning in ballast, on 30 July, she sailed again on 5 August; discharged her cargo at Verdon, and put into Hoboken, N.J., on the 22d. After completing her third eastward passage at St. Nazaire on 20 October, she carried out cross-channel runs between French and British ports until after the cessation of hostilities. She completed postwar duties in mid-February 1919 and sailed for the United States, arriving in Hampton Roads on 3 March. A week later she proceeded to New York where she was decommissioned on the 21st and turned over to the United States Shipping Board for return to her owner.
This page created by Joseph M. Radigan and maintained by David Wright

domain: history


The FBI and Wiretaps
To aid their Wall Street investigations, the FBI used DCSNet, their massive surveillance system.
Prosecutors are using the FBI’s massive surveillance system, DCSNet, which stands for Digital Collection System Network. According to Wired magazine, this system connects FBI wiretapping rooms to switches controlled by traditional land-line operators, internet-telephony providers and cellular companies. It can be used to instantly wiretap almost any communications device in the U.S.—wireless or tethered. In other words, you and I have no privacy. The government can listen in on any call made in the continental U.S. (This is all well and good if you trust every government employee. But what if an attorney general running for higher office will do anything to finger a high-profile target? Or what if a prosecutor has a personal grudge he’d like to fulfill? It seems to me it would be easy for this power to fall into the wrong hands.)


Fire & Rescue
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There's one thing that every stringed instrument around the world has in common. That is, obviously, that they all require a full set of strings to play them to their full potential. That said, every instrument has a wide variety of strings available, each impacting the way your instrument sounds. Choosing the right strings for your instrument can go a long way in helping you discover your perfect tone.
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text:
When I was first introduced to the possibility of adoption almost 15 years ago, I had longed to be a mother so bad that I was willing to do anything (well, almost anything) to get a child. I wore my rose colored glasses and persevered through every issue with a smile and determination. I didn’t think about what would happen in the future, how I would deal with adoption issues or even what issues might arise. The only fear I had at the time was that when my children turned 18 they would want to go back to their birth mother (so glad our adoption is open!).
There are many things I wished I would have known, could have prepared for, or could have been warned about.
But the real question is; if I had known these things, if I had known I would hurt and feel a loss for the things I didn’t have, would I have still adopted?
Even if I take my rose colored glasses off,
the view is still remarkable.
“If you are lonely, please know you can find comfort.
If you are discouraged, please know you can find hope.
If you are poor in spirit, please know you can be strengthened.
If you feel you are broken, please know you can be mended.”
Jeffrey R. Holland

domain: literature


text:
|Kurinobu T1, Sonoda A2*, Nitta N2, Otani H2, Kitamura S4, Nagatani Y2, Mukaisho K3, Tezuka N4, Nakano Y5, Takahashi M2 and Murata K2
|1Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, 464-8681, Japan
|2Department of Radiology, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga 520-2192, Japan
|3Department of Pathology, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga 520-2192, Japan
|4Department of Thoracic Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga 520-2192, Japan
|5Department of Respiratory Tract Medicine, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga 520-2192, Japan
|Corresponding Author :
Department of Radiology
Shiga University of Medical Science
Setatsukinowa-cho, Otsu, Shiga 520-2192, Japan
|Received April 08, 2013; Accepted May 21, 2013; Published May 27, 2013
|Citation: Kurinobu T, Sonoda A, Nitta N, Otani H, Kitamura S, et al. (2013) Lung Perforation by a Mediastinal Teratoma with CT Evidence of a Fistula between the Tumor and Bronchus-Case Report. OMICS J Radiology 2:129. doi: 10.4172/2167-7964.1000129
|Copyright: © 2013 Kurinobu T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Visit for more related articles at OMICS Journal of Radiology
|Patients with ruptured mediastinal teratomas perforating into the lung have been reported [1,2]. Usually these teratomas are associated with severe symptoms such as pleural effusion, pneumonia, fever, and hemoptysis [3-6] although some elicit no- or mild symptoms [1,7]. In such cases chronic infection such as concomitant pulmonary infection or tuberculosis may contribute to the differential diagnosis . The English language literature contains few reports of mediastinal teratomas perforating into the lung [1,2]. Because of their malignant potential their image patterns must be better understood.
|We present a patient whose mediastinal germ cell tumor perforating into the lung elicited mild symptoms. A teratoma-bronchial fistula was clearly demonstrated on CT images.
|This 53-year old man with a history of persistent hemosputum was admitted for mitral valve surgery. At the age of 32 he was diagnosed with a pulmonary abscess. His blood pressure, heart rate, and body temperature were 116/66 mmHg, 68 bpm, and 36.8°C, respectively. His breath sounds were clear, CRP was 0.74 mg/dl, WBC was 11400/ μl. Beta-D glucan and Aspergillus species antigen levels were normal. Other laboratory findings were also normal.
|A chest roentgenogram revealed a large mass with a cavity in the right upper lung (Figure 1). There was neither pleural effusion nor consolidation or ground glass opacity. A chest Computed Tomography (CT) scan showed a mediastinal mass measuring approximately 3.0 cm with a small air cavity (Figure 2A). There was some calcification at its periphery. The mass was enhanced heterogeneously and exhibited an unenhanced area suggestive of a fluid component (Figure 2B). No fatty component was identified. There was no pleural-or pericardial effusion near the tumor. The mediastinal mass was adjacent to a cystic lung lesion with a thickened wall in the right upper lobe. On axial CT images the air cavity of the mediastinal tumor was connected to the cystic lesion in the lung and tracheobronchial tree (Figures 2C-2I).
|Cardiac and thoracic surgeons performed plastic surgery to the mitral valve, mediastinal tumor resection, and partial right upper lobectomy in one operative session. Intraoperatively a mediastinal tumor in front of the superior vena cava was identified. It infiltrated slightly into the parietal pleura and pericardium. A tumor at the anterior mediastinum with tight adherence to the lung surface of the upper lobe was also observed. The right internal mammary artery fed the mediastinal mass.
|Histopathologically the mediastinal tumor with a fistula to the tracheobronchial tree was composed of hair, mature pancreatic- and intestinal tract tissue, endocrine-, exocrine-, and sebaceous gland tissue, thymic tissue, and skin (Figure 3). There were no immature or malignant components. The lung cystic lesion showed squamous and airway epithelia. Micro-inflammation and fibrosis were observed in the peribronchial area and bronchialectasis was identified. Perforation into the lung of the mediastinal germ cell tumor was confirmed and no immature components or malignancy were identified.
|Mediastinal germ cell tumors comprise 15% of anterior mediastinal tumors and 60% of mediastinal germ-cell tumors are benign teratomas in adults . They often rupture into adjacent organs and factors leading to their rupture are controversial. Proposed mechanisms of tumor rupture are autolysis by digestive or proteolytic enzymes released from glandular-type tissues within the tumor (e.g. pancreatic tissues, salivary gland tissues, intestinal epithelium), inflammation elicited by sebaceous gland secretions, ischemia secondary to rapid tumor growth, pressure necrosis, and superimposed infection of pulmonary or hematologic origin [3,7].
|As the tumor in our patient contained pancreatic tissues we posit that pancreatic enzymes were involved in its rupture. This hypothesis is supported by his harboring a lung abscess 20 years earlier. The abscess was the result of chemical pneumonitis or attributable to a tumor that had infiltrated the lung via digestive enzymes.
|Ruptured mediastinal teratomas may elicit various symptoms and critical complications. They produce pulmonary inflammation, pleuritis, pneumothorax, cardiac tamponade, and perforation of the greater vessels. Generally, ruptured mediastinal teratomas are associated with severe symptoms such as pleural effusion, pneumonia, fever, and hemoptysis [3-6] although in some instances the symptoms may be mild. In such cases the differential diagnosis involves chronic infection, for example concomitant pulmonary infection and tuberculosis . Radiographic findings may suggest rupture of a mediastinal teratoma. As ruptured teratomas have malignant potential, the image patterns of mediastinal teratomas perforating into the lung must be understood. Radiographically, anterior mediastinal teratomas are visualized as well-defined round or lobulated masses composed of a combination of calcification, fat, fluid, and attenuated soft tissue. In many unruptured teratomas these components are homogeneously enhanced. On the other hand, enhancement is inhomogeneous in the presence of a ruptured teratoma . Rupture results in chemical pneumonitis, pleural effusion, and sometimes abscess formation. The presence of specific components such as fat and calcification may be unclear. In our case we observed an inhomogeneously enhanced mass with calcification; no fat component was evident on CT images.
|We posit that the lung cystic lesion in our patient resulted from drainage of the abscess through the bronchus rather than from chronic pulmonary infection with a fungus or from tuberculosis. The image patterns of spontaneously ruptured mediastinal teratomas must be better understood and at the interpretation of radiographic images, the possibility of spontaneous rupture of a mediastinal teratoma must be considered even in the presence of only mild symptoms.
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Barrett Katz, Chief Medical Officer speaks for GenSight Biologics during the Innovative Showcase at OIS@ASCRS 2019.
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This presentation takes place at OIS@ASCRS at the Hilton in San Diego on May 2, 2019.
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Wednesday, September 4, 2019 10:23 am
Eden Hazard and his brother Thorgan will miss Belgium’s Euro 2020 qualifiers against San Marino and Scotland through injuries, the Belgian football association said on Wednesday.
The pair reported to the team camp in Tubize on Tuesday for medical checks which confirmed Eden is suffering from a muscle strain while his younger brother has a rib injury.
Eden has yet to make his league debut for Real Madrid since his move to Chelsea because of the injury.
No replacements have been named by coach Roberto Martinez.
Belgium, who have won their opening four qualifiers in Group I, play in San Marino on Friday and then Scotland at Hampden Park on Monday.(Reuters/NAN)


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This is according to an Umno supreme council member, who spoke to Malaysiakini on the condition of anonymity.
He said this indicates that it is highly likely that the prime minister will seek an audience with the Yang di-Pertuan Agong to advise him to dissolve Parliament this Friday.
In fact, the Umno leader did not rule out the possibility that the tabling of Budget 2023 would be delayed.


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Tuesday – Snippet Week, Day Two!
There was no one on the street, not that early in the day, but still A’ris walked with the gun at her side. She rushed into the inn, not bothering to look for Valeen and ran up the stairs, slowing only after she was safely in the room with the door locked. Riot bounced in irritation on the dresser, squawking at her in his nonsense version of the gypsy language.
As the bird cried for Hutch, A’ris struggled to keep herself from collapsing on the ground in a fit of tears. “We’re leaving, Riot. Be quiet and let me pack.”
After rinsing the blood from her hands, she tied her hair back from her face with a long ribbon. She threw the few items she had unpacked into her tote and dumped the rest of the loose belongings into Hutch’s satchel.
In the bathroom she paused to look at her reflection in the mirror. It wasn’t A’rissandra Brynx of the Roanarq’teve clan that stared back at her with sad eyes. That girl was gone, a scorned woman having replaced her. A woman with a mission only death itself could abolish. A’ris Brynx was going to start a war, and she knew that moment blinking into the mirror with red-ringed eyes that she would be on the right side of the battle. The winning side.
“There’s nothing left to see now,” she whispered to the mirror.
– The Dry Lands, a Hutch and A’ris novel

domain: artistic


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Why see an Audiologist at Ogden Speech & Hearing Center?
Audiologists are the most highly-trained professionals in hearing health care. They are the only hearing care professionals with advanced college educations and who are licensed by the state to perform comprehensive audiological hearing tests.
Our Audiologists work alongside the Ear, Nose and Throat Physicians at Mountain West ENT to give our patients the best hearing care possible.
Hearing Tests and Hearing Aids in South Ogden, Utah
Our audiologists will use a full hearing assessment to evaluate your hearing lifestyle and level of hearing loss to help you find the best fit in hearing aid solutions. Ogden Speech and Hearing Center’s board-certified audiologists are trained to recognize disorders and diseases related to hearing loss, tinnitus, ear infections and more, in addition to fitting hearing aids in South Ogden, Layton, Bountiful, and Draper, Utah.


This performance is great, but does the Model A’s feel reflect these results? In general, yes! In our experience, the bike can occasionally lock up and slide a little, but it doesn’t feel like it’s at all dangerous or out of control. Even when skidding, the Model A feels surprisingly stable.
With perhaps the most important safety feature of the bike covered, let’s unpack its other details. This bike, like all EBC models we’ve reviewed, is almost overflowing with small but significant elements that add up to an impressively safe ride; and in my opinion, this is where the Model A truly shines!
First – and speaking of shining – the bike includes an uncommonly thorough light package. The large 8” headlight has both a high and low beam setting for better illumination. It has three taillights for increased visibility from behind; the large taillight includes a brake light, and the two smaller lights on the seat stays function as turn signals.
Second, the Model A includes an electronic horn to better signal pedestrians, motorists, and other cyclists.
Third, each time the bike is turned on, its display requires the acceptance of a user agreement. This helps to protect families who lend their bikes to friends or companies who rent fleets of e-bikes in the event of any unfortunate circumstances. The bike also defaults to a setting that requires holding the minus button to engage the pedal assist system. While I personally kept forgetting about this, I appreciate the fact that it means the bike will never take off unexpectedly on you.
Next, the Model A uses 24”x3” puncture-resistant Rhino tires. These are a full 3mm thick, which helps to repel any sharp debris on the road and reduce the likelihood of getting a flat. We love this feature of the Model A, and would love to see thick tires used more often on other e-bikes!
Additionally, there’s an added level of safety from Electric Bike Company’s general approach to building their e-bikes. They make all of their wheels on-site, assemble all of their bikes by hand, inspect every component, and test each unit before shipping. All bikes even come with an authentication card that includes the name of its mechanic, its serial number, and its date of assembly. This allows for more personal ownership of the work by the EBC team members but also a more human connection between the company and the consumer; I was told by the company’s owner, Sean, that customers can speak directly with the mechanic who worked on their bike when they receive it if they have any questions or concerns.
I’m not currently aware of any other e-bike brand that offers such a comprehensive approach to safety or a similarly personal level of interfacing with their customers. Color me impressed with the company as a whole – but extending this degree of care to such an affordable bike as the Model A is certainly going above and beyond.


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Whenever people hear the names Katrina, Sandy, Charley, and Andrew they think of the storms that devastated this nation. Matthew is a popular name that means “Gift from God”, but over the past week it has become cringe worthy. Millions were left without power, winds exceeded 110 miles per hour with miles of destruction, death tolls reached nine-hundred and coastal roadways turned into roaring rivers, and storm surges flooded nations. Hurricane Matthew delivered some of the worst tragedies along its path as it started its slow crawl up the East Coast.
First, Matthew made landfall in Haiti on Tuesday as a Category 4 hurricane. It left behind widespread destruction. Haiti was struck with wind speeds up to 125 miles per hour and heavy rain that flattened homes, razed crops, swept away livestock, and flooded villages. After experiencing a 7.0 magnitude earthquake in 2010, it seems so unfair that the poorest nation in the Western Hemisphere should have to encounter another natural disaster. Also, fears of an even worse cholera outbreak and food shortages are something for the people of Haiti to be concerned about. Despite it all, Haiti’s positive spirit remains. However, Matthew had more to give.
After tearing through Haiti, Matthew began to set its sight on the United States East Coast. Matthew bore down on Florida Friday morning. Grocery stores were emptied and roads were jammed as 1.5 million Floridians were advised to evacuate. The storm surge caused massive amounts of erosion of the Florida beaches, portions of state roads were washed away, houses were surrounded by rising water, and thousands of trees uprooted. Many people are grateful that the damage was not worse, but there is still a lot of work to be done. Matthew continued to crawl up the coast towards Georgia and the Carolinas. The same conditions that battered Florida, occurred in Georgia and South Carolina. Curfews were even set until daylight to avoid looting. Carolina coasts braced for flooding as Matthew made its way north.
All were expecting Florida to be hit the hardest, but it turned out that North Carolina saw some of the worst conditions. Early forecasts predicted that Matthew would make its way out to sea before reaching North Carolina. The storm ended up staying longer than expected. The rain was dumped upon North Carolina all of Saturday, and Matthew became a flooding rival with Hurricane Floyd. The amount of rain was anywhere from six to eighteen inches across the state. Thousands of rescues carried throughout the night and next day. Along with the endless rain, North Carolina also experienced intense winds. Gov. Pat McCrory called the storm one of the worst floods he has seen since Hurricane Floyd in 1999. Something bizarre was the turnout at the North Carolina State University football game on Saturday. Fans still attended the game, even amongst the storm! Even after Matthew made its way out of North Carolina, there was still much turmoil. Parts of the state, such as Lumberton, are still witnessing ongoing floods. The water level has risen so high that you can only see the roofs of cars. River banks continue to burst, adding additional water issues. Eastern North Carolina is about to deal with some very serious circumstances. As the deluge rolls downstream towards the Atlantic Ocean, rescue teams follow. Flood waters continued to rise after Saturday, and threatened dams and those living around major rivers. The water is stuck with nowhere to go. Flood waters are not expected to crest until Friday. Wake County cancelled school on Monday and school is still being cancelled throughout many other counties this week. Universities, such as East Carolina University, cancelled classes for the remainder of the week. Millions are still without power and road conditions remain impassible. In some cases, families are not expected to have power anywhere from a few days to a week. Matthew’s death toll reached thirty-five as of Monday. Seventeen of these causalities were reported to be found in North Carolina. Cities are not expected to be drained for about another week.
Even though the storm has passed, Matthew is still impacting countless lives. Hurricane Matthew proved to be a destructive one, and states are now in recovery mode. The devastation of Hurricane Matthew has left tragedy, and the country will be working hard to alleviate the losses from Hurricane Matthew.

domain: geography


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If your Looker admin has enabled the IDE Metadata Sidebar Labs feature, users with
develop permission can view contextually relevant information about the objects in the Looker IDE metadata panel.
To view the metadata panel in the Looker IDE:
- Navigate to your project file.
- Click the information icon to open the quick help panel.
- Click the Metadata tab to open the metadata panel:
The metadata panel identifies the object with a name and an icon that represents the object type (see the Navigating Projects with the Object Browser Panel documentation page for all the possible object type icons):
For LookML objects that are used in multiple models, the metadata panel will provide a drop-down menu so you can select the model for which you want to see metadata:
The information displayed in the metadata panel depends on the type of LookML object selected and how the object is used in your project. You can use metadata to better understand many aspects of your project, as described in the following sections.
Metadata for models
If you click in a model file, the metadata shows you the Explores, views, and LookML dashboards that are included in the model, and provides links to where they are defined:
Metadata for views
New in Looker 21.0, the metadata panel shows the models that include the view and the primary key for a view.
If you click on a
view parameter, the metadata panel provides the filename and the line number where the view is defined in the file’s LookML. The metadata panel also shows you how the view is used in your project:
- Models that include this view
- Explores that use this view as their base view
- Explores into which this view is joined
- The view’s primary key
If the view has extensions or refinements, these will also be displayed in the metadata panel.
Metadata for Explores
New in Looker 21.0, the metadata panel shows the Explore’s base view.
If you click on an
explore parameter, the metadata panel provides the filename and the line number where the Explore is defined in the file’s LookML. The metadata panel also shows you how the Explore is used in your project:
- The Explore’s base view (the view used as the starting point for building the Explore)
- Other views that are joined into the base view
If the Explore has extensions or refinements, these will also be displayed in the metadata panel.
Metadata for fields
New in Looker 21.0, the metadata panel shows metadata for fields.
If you click on a field, the metadata panel provides a link to the filename and the line number where the field is defined in your LookML project. The metadata panel also shows you how the field is used in your project:
- Models that include this field’s view
- Views that use this field
Metadata for extensions
When you click on a
explore parameter, the metadata panel shows the object’s extensions. Here is an example of an Explore that has been extended:
You can click the link in the metadata panel to navigate directly to the LookML where the object is extended.
Similarly, you can use the metadata panel on extending objects to get contextual information about the extended object. Here is an example of an Explore that extends another Explore. In this case, the metadata panel provides information about the original extended object, such as which views are joined into the Explore:
In these examples, the extending and extended
explore parameters are next to each other in the same file, but this is not always the case. It’s not obvious by looking a parameter if it is extended, especially since the extended and extending objects can be in different LookML files. The metadata panel gives you context about the related objects, no matter where the objects are defined.
Metadata for refinements
The metadata panel makes it easy to see when a view or an Explore has refinements that have been added to the object. In this example, you can see that the view has more than one refinement, and you can use the links to navigate to the LookML for each refinement:
As with extensions, you can’t tell if an object is refined just by looking at the LookML, especially because the refinement LookML can be in a different file. The metadata panel allows you to see if an object has been refined, and lets you easily navigate to the LookML for the refinement.

domain: library


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After this I heard what seemed to be
the loud voice of a great multitude in heaven,
Salvation and glory and power to our God,
for his judgments are true and just;
whose justice knows no ends;
Convict us of our complicity
in oppressive systems.
Make us aware of how our actions
hurt the weakest of your children,
So that we may correct our ways
and work with you to make
your kingdom come to earth.
In the name of your son, Jesus,


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Developmental delay in children is a common reason for parents to get them at the Paediatric Neurology clinic and can be due to a large number of causes. There are several types of developmental delays in children and can affect a child’s cognitive, communication, social, physical, emotional, or behavioural skills. Developmental delays affect more than one area of a child’s development. When a child has delays in two or more or all of these areas, it is called global developmental delay.
Most developmental delays have an identifiable cause. Ascertaining the cause of developmental delay is crucial since the treatment plan and outcome will depend upon the underlying cause of delayed development, which is not a diagnosis by itself but rather a symptom of the disorder that is causing it.
Common causes of developmental delay (also known as cerebral palsy) include injury to the developing brain in-utero, or at the time of birth or immediately after birth due to a large variety of causes, accidental brain injury (including road traffic accidents, falls, etc.), as a result of severe brain infections (encephalitis or meningoencephalitis), genetic and chromosomal disorders, metabolic disorders, neuromuscular disorders to name a few.
Children may present as a motor delay only in neuromuscular disorders like myopathy, muscular dystrophy and hereditary neuropathy; as delay in language, communication and social spheres of development in autism spectrum disorders (see above), with or without additional delay in motor or adaptive developmental spheres. Children with cerebral palsy due to perinatal brain injury or genetic disorders usually have a global developmental delay.
Developmental delay requires a detailed evaluation by a paediatric neurologist who may, in turn, involve other necessary specialists depending on the child’s individual needs.
Treatment of developmental delay requires the management of the underlying cause and also neurodevelopmental therapy. Most children require a multi-disciplinary team approach for neurodevelopmental therapy. Such a team lead by a Paediatric Neurologist should also include Physiotherapist, Speech therapist, Occupational therapist, Audiologist, Child Psychologist, Child Psychiatrist, Geneticist, Paediatrician or Developmental Paediatrician, etc. With appropriate treatment and therapies, most kids with developmental delays improve over time.
Dr. Minal Kekatpure, Senior Consultant – Paediatric Neurology, Mazumdar Shaw Medical Center, Bangalore