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Frosty weather, wind, and lower indoor humidity can turn even the healthiest of skin dry, itchy, and scaly. Misconceptions on how to pre-empt dry skin abound – taking hot showers, exfoliating, drinking more water – but they’re ineffective, says dermatologist Jonathan Silverberg, MD, PhD, MPH, director of clinical research and contact dermatitis at the George Washington University (GW) Medical Faculty Associates (MFA). Here, he explains how to treat your skin with gentleness and care to ensure that the wintry months are less severe.
Why do we get dry skin during colder months?
Silverberg: Several things happen during the colder months that can increase dry skin. Cold air can’t hold as much moisture, which results in lower outdoor humidity. Use of indoor heating, particularly central air heating, further reduces indoor humidity. During the colder weather months as well, there are often more gray skies and cloud cover, and we spend more time indoors due to the cold, which leads us to get less sun exposure. This in turn can lead to lower vitamin D levels and increased inflammation in the skin, which can aggravate eczema and dry skin.
What are common misconceptions about how to remedy dry skin?
Silverberg: There are many misconceptions:
- Certainly, if someone is dehydrated, their skin won’t be well hydrated. However, in most circumstances, drinking more water does not help dry skin.
- Most exfoliants are irritating to the skin, and many can worsen dry skin.
- Many patients like taking very hot showers to alleviate winter itch. The reason why hot showers feel so good when someone is itchy is that the hot water induces a pain response that temporarily decreases itch. The problem is that the hot water damages the skin barrier and leads to increased dryness and itchiness long-term. I recommend patients take showers or baths with warm water rather than hot water.
- Some patients think that lotions are more effective moisturizers than creams or ointments because they contain more water as an ingredient. However, the water in lotions evaporates quickly upon application and does not hydrate the skin. I generally recommend that patients use a thicker cream or ointment moisturizer for enhanced efficacy. Thicker creams and ointments act like a barrier for the skin and seal moisture into the skin.
What is an effective treatment?
Silverberg: There are many effective treatments for dry skin:
- It is important to identify and treat the underlying cause of dry, scaly skin, such as eczema or psoriasis.
- Gentle skin care approaches are often highly effective. These include taking shorter showers or baths (less than 15 minutes). Do not take multiple showers per day.
- Apply moisturizer at least once a day. The best time to apply moisturizer is after the shower or bath.
- Use personal care products that are free of fragrances and other irritating ingredients.
When should you see a dermatologist for dry skin?
Silverberg: People should consider seeing a dermatologist when their dry skin is itchy or painful or is not getting better with the above-mentioned treatment approaches.
Can patients do anything to prevent dry skin?
Silverberg: Many of the previously mentioned treatments, such as daily moisturizer and short shower durations, can be used to prevent dry skin. If someone knows that they are prone to dry skin in the colder months or other times of year, I recommend that they proactively use gentle skin care practices and regular moisturizer to prevent the dry skin from appearing in the first place.
What other resources do you suggest?
Silverberg: I chair an international conference on atopic dermatitis called Revolutionizing Atopic Dermatitis (RAD). Our next meeting will be held virtually due to COVID on December 11-13, and we will address many of these issues about skin care. If patients are interested in learning more about atopic dermatitis or how to best care for their skin, this event is a good option. (For more information, email firstname.lastname@example.org.)
To make an appointment with a dermatologist, visit GW Dermatology or call 202-741-2600.


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Intramolecular electrochemical dehydrogenative N–N bond formation for the synthesis of 1,2,4-triazolo[1,5-a]pyridines†
A metal- and oxidant-free intramolecular dehydrogenative N–N bond formation has been developed under mild and scalable electrolytic conditions. Various valuable 1,2,4-triazolo[1,5-a]pyridines were synthesized efficiently from the readily available N-(2-pyridyl)amidines. The reactions were conducted in a simple undivided cell under constant current conditions with nBu4NBr as both the redox mediator and the electrolyte. This protocol was applied to the efficient synthesis of key intermediates for anti-diabetic compounds.

domain: chemistry


The effectiveness of Black cohosh, a drug used to treat post menopausal women was checked by a federally funded study// and was proved to be no better than a dummy pill.
There was a marked decrease in the severity and frequency of symptoms by 30% in a year’s span irrespective of the fact whether women took Black cohosh or a placebo.
Black cohosh, a perennial herb member of the buttercup family, is the most widely used herbal remedy for hot flashes.
The Herbal Alternatives for Menopause Trial (HALT), was a one-year, double-blind, randomized, and controlled trial comparing the effects of three formulations of black cohosh with hormone therapy and placebo for relief of hot flashes and night sweats.
Researchers assigned 351 women aged 45 to 55 to one of five groups:
? black cohosh alone
? multi-herb pill with black cohosh and nine other ingredients
? the multi-herb pill plus counseling to increase intake of dietary soy
? hormone therapy (estrogen with or without progestin)
? placebo (dummy pill)
"About 80 percent of women who go through menopause experience hot flashes," said Katherine M. Newton, PhD, Associate Director for Research at Group Health in Seattle, and lead author of the study.”
"Many women are looking for alternatives to hormone therapy which is the most proven remedy for hot flashes, and many are using alternative medicines," Newton said. "The most commonly used alternative is black cohosh. But we found that black cohosh was no better than placebo in treating hot flashes."
The study found that hormone therapy gave women most relief, reducing symptoms by an average of about four symptoms per day more than placebo.
Hormone therapy was included in the HALT study because it is a well-known and proven treatment to reduce menopausal symptoms. The HALT study began in 2001 and stopped the hormone therapy arm of the trial after the Women's HPage: 1 2 Related medicine news :1
. AIDS toll set to exceed Black Death2
. Black tea said to lower cholesterol3
. Women and Black Patients have less chances to survive a Heart Attack 4
. Blacks decline Lung cancer surgery5
. Fewer Blacks Undergo Lung Cancer Surgery6
. Home Remedies More Used By Blacks And Native Americans7
. Black Actor Confesses Sex Cult Past8
. Malfunction Of Key Growth Factor Increases Mortality Rate From Pulmonary Fibrosis In Blacks9
. HRT elevates breast cancer risk in Black women.10
. The Naked Truth about AIDS. Advertisements Drive The Point Home in Black And White!11
. Blacks and East Asians Prone To Side Effects of Cardiovascular Drugs


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FRESNO — A captivating night of beautiful music of many styles performed by individuals whose musicality was beyond reproach. That’s just one way of describing the concert that was recently presented by the Armenian Museum of Fresno. Dr. Anna Hamre, of California State University (CSU) Fresno, the music director of Fresno Master Chorale and Fresno Community Choir described the performance as “Spectacular. All three artists were simply splendid.” Indeed, any audience member could tell you something similar.
On May 31, an audience of around 230 people — a significant number of whom were non-Armenians — was treated to a concert of duo-piano and soprano at CSU Fresno’s Concert Hall. The concert featured soprano, Anahit Nersessian, and pianists, Naira Shahsouvarian and Maria Amirkhanian. “This is our way of dedicating this program to the memory of all those who lost their lives during the Armenian Genocide,” said Maria Amirkhanian.
The two-hour performance was very well received by the audience. So familiar was some of the music that some audience members could be heard humming tunes that they recognized and connected with. At the end of each set, the performers received a standing ovation and the cheers of an excited crowd.
The first half featured Anahit Nersessian, with Naira Shahsouvarian as her accompanist. The first five pieces were classics of the soprano repertoire such as Cleopatra’s Aria from Handel’s “Julius Caesar”, Lehar’s “Giuditta” and Puccini’s O Mio Babbino Caro, while the rest of Nersessian’s set was dedicated to Armenian music from the folk, liturgical, and classical traditions. This included Gomidas’ Kele Kele, Yerginkn Ambele and Gakave Yerke and Doloukhanian’s Yeraz, among others. Especially remarkable was her dexterous melisma in her performance of Sayat Nova’s Kamancha, which traversed the entirety of her voice.
Nersessian has a rich and powerful voice, which does not falter in the extremes of her expansive register. Her fortes were breath-taking and so strong as to fill an entire room on a stage shared with a grand piano (and two at full volume). Her coloratura had such steadfast consistency as to make her highest notes incredibly magnificent, but without any sense of being forced or a strain on her voice.
The second half of the concert featured Maria Amirkhanian and Naira Shahsouvarian performing duo-piano with an emphasis on Armenian music. Their set included Bach’s Concerto in F Minor and suite from St. Matthew’s Passion, Avetisyan’s Cherry Tree and four pieces by Aram Khachaturian, notably Sabre Dance from “Gayane” and Aegina’s Dance from “Spartacus.” This magnificent evening was closed by a new arrangement of Rousinian’s Giligia for two pianos and soprano by Karine Gasparyan.

domain: entertainment


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Every professional displayed on Counselling Directory has been independently
verified by our team to ensure they have suitable credentials to practise.
Every professional displayed on Counselling Directory has been independently verified by our team to ensure they have suitable credentials to practise.
We all need help sometimes, and sometimes family and friends are not what we need.
Making the decision to seek help can be the start of a solution, or accommodation of the issues that we all have to deal with.
My personal and professional experience coupled with my training, means that I may be able to help you on your journey.
I am not easily shocked, and feel that confidentiality is very important..
My experience has informed me, that sometimes help is best given individually or within a group, but also in a combination of the two.
I also see couples to help with difficulties within their relationship.
We will discuss what you need and what will be most beneficial to you.
I can help you with difficulties to do with issues that come up at the different stages of life:e.g. leaving home, starting a relationship, family life, bereavement, work issues, depression, and sense of personal worth, children leaving home, retirement...
I am very much aware of the issues that come up with multi-cultural, multi-lingual experiences, which I have worked with, extensively.
In addition to my work in private practice, offering group, couple and individual consultations, I practiced for many years, within the context of mental health, such as Mind, the Richmond Fellowship, in Therapeutic Communities, and Day Centres settings, as well as ,in agencies offering psychotherapy to young people, such as the Crouch End Consultation Centre for Young people, the Hackney Counselling Centre for Young People.
I have also counselled adults and older adults, over 65.
Currently in addition to my psychotherapy work, I supervise counsellors and psychotherapists, both individually and in groups of therapists within organisations.
My therapeutic work has included sessions with people art activities (writing, drawing, painting etc..) or who might be helped to use art both to unblock their creativity, and to use these activities to explore their difficulties.
- How does counselling/psychotherapy help?
It gives you a safe space, for you to talk, on a regular basis, ie: once or more a week, with the assurance of confidentiality.
You will have someone- a therapist - and if we work together: it will be me, who, by listening with great care to you, to what you are expressing verbally, non verbally, will undertake to help you explore your feelings, and thoughts better understand them , as well as , think together, in some depth, with you, about the issues that have led you to seek help. This, hopefully., will enabled to find a resolution of your difficulties.: and in doing so, help you to feel better about yourself, and your life..
We will endeavour to help you become clearer, in your own mind, about the reasons for your difficulties, in order for you to feel, and to be gradually less burdened by them, and so ,begin hopefully, to realise your potential, more fully, as a person,. which would positively alter your outlook on yourself, and all aspects of your life.
This process of understanding yourself, helps because it gives you "a handle", on your life, a greater sense of your own agency, and strategies to cope better. with situations, and relationships
.It can also offer different non- destructive models of relating, than those, from your past,.
This in turn hopefully helps ease feelings such as : anxiety, panic, confusion, depression, or anger , and many more ...
I tend to work on a longer term basis, rather than shorter , with people who come to me for help, as difficulties that have arisen in a person s life, have not developed over night, but over years, often including childhood and teenage years .So if it has taken years to develop a problem, it cannot be fully resolved in a few weeks.
In my experience, I have found that therefore a longer period of therapy, can really maximise the chances of making a real difference to someone s quality of life, by tackling the roots of the difficulties..
However, I have practiced, and have therefore experience of short term counselling.
When we meet, for the initial consultation, we will ,of course, discuss together fully - and, with my guidance- decide on the most appropriate form of help,( and set up short term therapy if this is deemed to be the most helpful)
I might sometimes at first, suggest meeting twice , if a longer time would be helpful ,to ensure that I am providing you with the best possible way forward.
Training, qualifications & experience
I trained and qualified at the Westminster Pastoral Foundation, for four years, graduating in 1989 in psycho- analytic and psychodynamic Psychotherapy, later in psychoanalytic and psychodynamic Supervision, in 1993 and at the Tavistock, in the psychoanalytic study of the couples relationship, in 1994 .
I taught and supervised, trainees for a number of years, at the Westminster and at the Chelsea Pastoral Foundations, as well as, at the Highgate and the Enfield Counselling Centres, on Introduction to counselling courses, as well as the professional diploma trainings in individual psychodynamic counselling, and in group analytic psychotherapy, :supervising the clinical work of therapists in training, teaching on the theoretical seminars, and facilitating the experiential groups within these trainings.
I worked as a a supervisor as well as a psychotherapist/counsellor to adults and young people in the low cost clinical services, attached to these training institutions WPF, CPF, HCC, ECC.
For a number of years, as an external consultant, I facilitated staff sensitivity groups,within several mental health organisations , specialising in: offering services to people, with issues arising from::
- alcohol and drug dependancy/codependancy ,
-adolescence and young adulthood,
-young carers, adoptive families
-second generation jewish people
I helped the teams to think about their work, dynamics, and how to best deliver their service.
Later ,I managed a Therapeutic Community for young adults with a variety of mental health problems, leading its therapeutic team, (under the auspices of Mind) .
Later, again, I oversaw the management of four residential therapeutic centre ,run on TC lines(Therapeutic Community) both for young people,( 18 to 25 year olds,) and for adults (over 25 up to 70)
.These small centres offered help through group, one to one psychotherapy and reality therapy to individuals with severe mental health difficulties, giving the possibility of either preventing an admission to in-patient psychiatric service,or after a period of hospitalisation , supporting them, in going back into a functional life , having developed a greater understanding of their vulnerabilties, and of their strengths, but also acquiring the necessary life skills to manage things better and have as fulfilling a life as possible. (Richmond Fellowship).
For eight years , I worked as psychotherapist and group therapist in 2 centres,in Hackney,at Off Centre Counselling Centre for Young People, and in Crouch End, at Open Door, Hornsey Consultation Service for Adolescents and Young Adults
I have been offering counselling and psychotherapy for over 25 years, in my East London private practice There I also see qualified practising psychotherapists for the supervision of their case load.
- Fully Registered Member of UKCP (Psychotherapy/G)
- Now being renewed: Full Registered Member of UKCP/ British Association of Psychodynamic and Psychoanalytic Supervision( BAPPS).
- Member of Foundation for Psychotherapy and Counselling
- Member of Council for Psychoanalysis and Jungian Analysis College.
Registered / Accredited
Being registered/accredited with a professional body means an individual must have achieved a substantial level of training and experience approved by their member organisation.
UK Council for Psychotherapy (UKCP)
The UK Council for Psychotherapy (UKCP) is a leading professional body for the education, training and regulation of psychotherapists and psychotherapeutic counsellors. Its register is accredited by the government's Professional Standards Authority.
As part of its commitment to protect the public, it works to improve access to psychotherapy, to support and disseminate research, to improve standards and to respond effectively to complaints against its members.
UKCP standards cover the range of different psychotherapies. Registration is obtained by training or accrediting with one of its member organisations, or by holding a European Certificate in Psychotherapy. Accredited by the Professional Standards Authority.
Accredited register membership
Accredited Register Scheme
The Accredited Register Scheme was set up in 2013 by the Department of Health (DoH) as a way to recognise organisations that hold voluntary registers which meet certain standards. These standards are set by the Professional Standards Authority (PSA).
This therapist has indicated that they belong to an Accredited Register.
Areas of counselling I deal with
Other areas of counselling I deal with
- Work with older adults:
I have a particular additional interest in, and experience of offering help to older adults, over the age of 65 , as this time of life brings its then unavoidable issues; such as ones mortality, the loss of close relationships, family, friends, loss or decrease in potency, loss of one s familiar role in family or life or of social status.
- Work with young people
I also have helped people in their teens, late teens, and young adults, and have developed an in depth understanding of the particular issues facing people in that age group, and also, of the particularly intense pressures that are placed on young people now : an increase in tests, and exams, leaving home, going to university, and bearing the cost of studies, issues with sexual identity, sexual difficulties, starting a family, starting work, lacking confidence, being depressed, feeling alone, isolated, overwhelmed , anxiety states, panic attacks ..... it can often be a very difficult and anxious time of life, as there are many new changes, challenges, that a human being will be facing at that time, in their life, when still only very young..
- Work with codependancy
I have a great nterest and experience in helping individuals and couples with the difficulties that come up in codependant relationships and the specific therapeutic techniques needed to help with unhelpful entranched patterns of relating..
- Work with adopters/adopted
I have worked with the often very difficult and painful issues that adoption brings up, both for the adopter, and the adoptee.
- Trauma work
Emotional trauma is also an area of human experience that is of particular concern and interest to me, and the way in which whilst it may resemble and share some common points with psychosis, it is also very different
Its therapeutic treatment, in order to promote the recovery and healing from trauma requires some very distinct responses and techniques from the therapist.
.These are: An affirming response frequently more important than an interpreting one , bearing witness, offering a deep acceptance, a capacity and willingness to be in touch with ones own pain and terror and to then allow that of the patient to reach one emotionally, whilst not being phased, or unduly overwhelmed by it, and to compassionately offer ones own willingness to "feel with" the patient, his/her pain and dreadful isolation, and terrifying break down in trust.
The attunement is much the same than that of a mother, when she is being ordinarily "devoted" :willingly allowing herself to" be filled" with the cries of her young baby and letting herself feel the pain contained in those.. in order to understand and know what will best suit and help her baby.. what will make her baby feel comfortable, again, what will again and again be needed from her by the baby.
- Conjoint Group and Individual Psychotherapy
For over 25 years, I have been practising a form of group therapy which combines both individual and group sessions: Following an initial period of one to one sessions, and of preparation of an appropriate duration, on an individual basis, a person is then offered one( or two) individual sessions per week, as well as one ( or two) group therapy sessions per week.In experiencing both, they will have the opportunity to be supported in a specifically tailored way, thus receiving a very rounded and wholistic form of psychotherapeutic help that both these settings offer when combined, in this particular way.
How it works, and what are the benefits?
I have found this to be a very beneficial combination of "tools" resulting in a therapeutic method, which helps an individual in quite a unique way. The reason for this is that it is very close to "real life"! and to the reality that, we, human beings at the beginning of life, first in babyhood, and subsequently, in childhood, have to deal with, while we grow and are helped -in the best of cases- to develop the necessary close and intense trustful attachments first to our mother , then to our father and siblings, while receiving from her , all the support , protection and nurturing we all need to survive and thrive.
This more often than not, wont have been so, for a person who feels that they need help, often desperately so.
This early experience of being born, babyhood with a protective mother, then the gradual introduction into the family "group" then into the wider world, and entry into tyhe social group of school...is symbolically represented, by first a period of one to one sessions with the therapist- me, if I see you, followed by entry into the group, discovering family members, then school, teachers, peers etc.. which in therapy, is entry into the group, and the gradual making of relationships with various members of the therapy group . Often in the majority of cases, in fact, they will , in aperson s mind, remind them, and so, represent, members of their family, their siblings , or their mother and , or their father, or other care takers, followed by at a later stage:( when of school age):the second social group ie: school. Foe many this will have been a traumatic , or at least emotionally painful time, which by being reexperienced in the safe context of the therapy group, as well as having the space all throughout therapy, to have the sole attention, and focus, from the therapist, both in the group, and outside it, ie in the individual session.
Because the therapist is present in both settings, it offers the possibility to clients for being supported by them (the therapist) as well as by their peers in the group.
One of the many healing factors in a group setting, is to realise that other people have felt the same feelings... a patient is enabled to actively learn from others, eg: how another person has survived, that they've successfully faced and overcome difficulties.
Due to the therapist being there, with them , in both settings, the client through the back and fourth motion individual to group, group to individual, regular, reliable, is given a very valuable continuity of experience, which theyn have probably missed when a child..
They have the hope and opportunity to receive support, encouragement, validation, due to their individual time being reliably offered, and safeguarded, (with mother, in the past, here with therapist: me) unlike probably what they experienced in childhood.. It is a kind of "special time" which, in therapy is offered and secured. As well of course as is the group: this therapeutic symbolic " family" is solid, ongoing , reliable, safe, so can accept, contain and facilitate the expression and working through of the intense feelings , a person would often not have been able to express , and even to feel, in childhood, and therefore also, not in their adult life.
In my many years of practicing this conjoint form of therapy, I have found that it does
seem to be very helpful indeed for most people , from the least to the most troubled, suitable for very young adults to adults, in their sixties, or seventies, who are seeking help, for the whole range of emotional difficulties that can befall a human being.. In providing an ongoing,and as gradual as needed, an opportunity for in- depth explorations of feelings and of issues, through the rich variety of relationships , offered by their being a group, ie the presence and participation of members in the group ,( up to 8 to 9 ) the possibilty for safely re- experiencing the problematic relationships and situations that have motivated their request for help,but at a pace, that is, this time round, emotionally manageable .
it opens up possibilities for the working through of difficulties, and provides an individual with the opportunity of learning or ( re-learning) to make relationships, in a safe and holding envronment,whereby changing unhelpful lifelong patterns, as well as giving a" real life" comprehension as to he why and the how of the issues have come about and have become often disabling problems.
it enables a person to emotionally " take risks", ie try out new strategies, and that will foster change and emotional growth and health. A person may discover who they really are, feel greater self esteem, confidence in themselves and able to make use of their attributes, qualities and talents, which were hidden, or not available, because of anxiety, or depression.The combination of individual and group sessions in the same week, seem in my experience of the people that I have helped, to have promoted changes that a sole individual or sole group approach might not have offered, at least not in the way the combined |G and I does.
It might give a space to a person who could for instance, have been unable to get in touch with their needs , and so, to be helped over a period of time, to healthily meet those, as well as reducing guilt, and shame,strengthen the capacity to feeling entitled to do so.
Work with carers, and young carers
I have offered counselling to help adults, often elderly, who carry the weight of responsibility for caring for a handicapped child, or an ageing vulnerable spouse, or an elderly mother, and similarly young people, as young as 15 year olds, who look after an infirm parent, or younger siblings, or a handicapped or ill sibling or family member, or parent. These carer will often become exhausteds, because they cannot not carry the heavy weight oflookig after a loved one, depsite the fact that an adult owes anoither adult nothung in reality,but that carers will tend to feel in an intractable labirynth
I offer an initial 30-minute telephone/Zoom consultation free of charge.
Thereafter, my fees are:
£70 for individual sessions
£40 for group sessions
£90 for couple sessions
Both the fees, and the therapeutic framework for sessions will be fully explored, explained, discussed and agreed during the initial session first one or first two sessions.
When I work
- Monday to Friday: from 7am to 8pm - Saturday:from 9 am to 2pm
- Languages spoken:
As well as English, I offer psychotherapy and supervision in fluent French, and to a lesser degree in German
- Location of my Practice:
- a 15 mns walk from Walthamstow Central Underground station on the Victoria Line,
- a 5 mns bus journey: 212, 275 from Walthamstow Central Underground station, on the Victoria Line
- a 6 to 8 mns walk from Wood Street train station : from Liverpool Street Overground , Liverpool St -Chingford line: 16 mns by train.
- What will happen in the first session ?:
After having emailed me or left a message on my answerphone, I will contact you, and we will have a conversation on the phone, during which we will decide together whether or not you would like to book an initial face to face consultation and for me to see whether I can offer you any help.The first session will be an opportunity to talk together in greater depth about the difficulties that decided you to seek help, and to work out the best ways that I, may be able to help you. It will also be a time for you to see if you feel comfortable with the kind of therapist that I am and with the way that I work, It is important that you feel at your ease, and for both of us to see whether we can work together.
Having been a psychotherapist for many years, I have helped people with many different issues and difficulties.

domain: psychology


text:
Bronchoscopy is a vital diagnostic and therapeutic procedure that has become an indispensable tool in modern medicine.
This minimally invasive technique, which involves the insertion of a flexible or rigid bronchoscope into the patient’s airways, allows healthcare professionals to visualize and assess the trachea, bronchi, and bronchioles in real time.
The procedure plays a crucial role in diagnosing various respiratory diseases, such as lung cancer, chronic obstructive pulmonary disease (COPD), and infections, as well as guiding treatments like biopsies, removal of foreign bodies, and stent placement.
In this article, we will provide an overview of the bronchoscopy procedure, delving into its significance, purpose, and various techniques employed by healthcare professionals. We also compiled a list of practice questions that cover key aspects of this procedure.
Get instant access to 25+ premium quizzes, mini-courses, and downloadable cheat sheets for FREE.
What is a Bronchoscopy?
A bronchoscopy is a medical procedure that allows a healthcare provider to visually examine the airways of the lungs, including the trachea and bronchi.
This examination is typically performed by a pulmonologist or a thoracic surgeon using a bronchoscope, which is a thin, flexible tube with a light and a camera on its end.
The bronchoscope is inserted through the patient’s nose or mouth and is gently guided down the throat into the airways.
The procedure can be performed for various reasons, such as:
- Diagnostic purposes: Bronchoscopy can help identify various lung conditions, including infections, tumors, inflammation, bleeding, or other abnormalities in the airways.
- Collection of tissue samples: During the procedure, small samples of lung tissue (biopsies) or fluid (bronchoalveolar lavage) may be collected for further analysis and testing.
- Treatment: Bronchoscopy can be used to remove foreign objects, clear mucus plugs, control bleeding, or deliver medication directly to the lungs.
There are two main types of bronchoscopy:
- Flexible bronchoscopy: The most common type, which utilizes a flexible bronchoscope. It is usually performed under local anesthesia with sedation to keep the patient comfortable.
- Rigid bronchoscopy: Involves a rigid, metal bronchoscope and is typically performed under general anesthesia. It is less commonly used but may be necessary for certain situations, such as removing large foreign objects or controlling severe bleeding.
Overall, bronchoscopy is a valuable diagnostic and therapeutic tool for evaluating and managing respiratory conditions.
The procedure is generally considered safe, but some potential risks include bleeding, infection, or a reaction to anesthesia.
Read our other guide that explains more details about the differences between flexible and rigid bronchoscopy procedures.
Respiratory Therapist’s Role During a Bronchoscopy
The involvement of respiratory therapists in bronchoscopy procedures can vary depending on the specific healthcare setting.
Generally, their primary responsibilities are to assist in the procedure, ensure the proper functioning of equipment, and maintain the patient’s stable condition throughout the process.
Before the Procedure
Prior to the procedure, respiratory therapists help determine if a bronchoscopy is necessary by identifying potential indications, such as retained secretions or foreign body obstructions.
They verify the physician’s order or protocol, review the patient’s medical record for contraindications and potential hazards, and confirm informed consent has been obtained.
RTs are responsible for preparing and checking all necessary equipment to ensure it functions correctly. They also develop a plan to maintain adequate oxygenation during the procedure.
If necessary, RTs can evaluate patients for bronchospasm and administer aerosolized bronchodilators before the procedure begins.
During the Procedure
Throughout the bronchoscopy, respiratory therapists closely monitor the patient’s vital signs and promptly identify and address any adverse reactions. They continue to administer oxygen as required and assist with patient positioning for optimal results.
They also help with the utilization of accessories, such as bite blocks, oral airways, nasopharyngeal tubes, biopsy forceps, and brushes.
After the Procedure
Following the bronchoscopy, respiratory therapists provide essential post-procedure care, including assisting patients with deep breathing and coughing exercises to clear secretions, and administering supplemental oxygen as needed.
They continue monitoring the patient’s vital signs and promptly report any changes to the physician. Furthermore, they are responsible for documenting all aspects of care in the patient’s medical record.
Bronchoscopy Practice Questions
1. What is flexible bronchoscopy used for?
It can be used for diagnostic and therapeutic purposes; however, it is most often indicated to help with the diagnosis of pulmonary diseases.
2. What is the goal of sedation during a bronchoscopy?
It improves the patient’s comfort during the procedure.
3. The continuous monitoring of what is important during a bronchoscopy procedure?
The monitoring of oxygenation and hemodynamic stability is important.
4. What are the most commonly used diagnostic procedures in flexible bronchoscopy?
BAL, biopsy, and TBNA.
5. BAL obtains samples from what?
6. Needle aspiration has a role in sampling mediastinal lymph nodes to diagnose what?
Lung cancer, sarcoidosis, and some infectious processes.
7. A biopsy has value in the diagnosis of what?
Infiltrative pulmonary diseases
8. What is often used along with a flexible bronchoscopy?
Various thermal ablation techniques
9. When using thermal ablation techniques, what is the most important thing to remember?
You should ensure a low FiO2 environment before the use of any thermal ablative therapy.
10. When can airway stenting be used to maintain airway patency?
It is used after the dilation of any obstructed major airways, and it’s important to recognize the difference between silicone and metallic stents.
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11. What is bronchial thermoplasty?
It’s a novel bronchoscopic technique for patients with steroid-dependent asthma.
12. What is being studied in the management of patients with severe emphysema as a minimally invasive lung volume reduction therapy?
Endobronchial valves and coil placement
13. Who plays a vital role in assisting before, during, and after bronchoscopy?
14. How does a respiratory therapist help with a bronchoscopy procedure?
There are many aspects to this role, but they include ensuring appropriate documentation (e.g., physician’s order), preparing the patient and the equipment, patient monitoring, and responding to adverse events.
15. What special considerations should be made when performing a bronchoscopy on mechanically ventilated patients?
Patients on the ventilator are more susceptible to adverse events. These considerations include ensuring adequate ventilation and gas exchange before, during, and after the procedure.
16. What are the clinical situations where flexible bronchoscopy would be indicated?
Hemoptysis, wheezing and stridor, pulmonary infiltrates, unexplained lung collapse, suspected or known bronchogenic carcinoma, mediastinal and hilar lymphadenopathy, lung transplantation, endotracheal intubation, evaluation of foreign body aspiration, unexplained superior vena cava syndrome, unexplained vocal cord paralysis, suspected fistulas, and treatment of refractory asthma.
17. What are the absolute contraindications for flexible bronchoscopy?
Refractory hypoxemia, lack of patient cooperation, lack of skilled personnel, lack of appropriate equipment and facilities, unstable angina, uncontrolled arrhythmias, increased intracranial pressure, and uncorrectable bleeding diathesis.
18. What are the relative contraindications for flexible bronchoscopy?
Unexplained or severe hypercarbia, uncontrolled asthma attack, lack of patient cooperation, uncorrected coagulopathy, recent myocardial infarction, unstable cervical spine, impaired neck mobility, and the need for a large tissue specimen.
19. Is sedation important during a flexible bronchoscopy procedure?
Yes, the goal of sedation is to improve the patient’s comfort during the procedure. In addition to risks of arrhythmias and fluctuations in blood pressure related to the procedure, airway manipulation during bronchoscopy may lead to coughing, hypoxemia, vomiting, bleeding, laryngospasm, and bronchospasm. All of these responses can affect the outcomes of the procedure. Therefore, adequate sedation is an essential part of the procedure.
20. What is BAL, and when is it indicated?
BAL stands for Bronchoalveolar lavage. It is used to obtain specimens from the alveolar region of the lung.
21. When is rigid bronchoscopy indicated?
Although the role of rigid bronchoscopy (RB) has declined, it remains an invaluable tool for the control of a compromised airway, massive hemoptysis, silicone stent placement, and for removing asphyxiating foreign bodies. The primary indication for rigid bronchoscopy is for managing a central airway obstruction.
22. What is the difference between BAL and bronchial washings?
Bronchial washings are generally obtained for the cytological examination of cancer and for microbiological analysis to diagnose mycobacterial or fungal infections. Unlike BAL, bronchial washings are obtained from the large airways.
23. What should a respiratory therapist consider regarding oxygen delivery during thermal ablation?
During the application of “hot therapies” (thermal ablation) like a laser, electrosurgery, or argon plasma coagulation, the FiO2 should always be maintained below 40% to prevent endobronchial ignition.
24. What are endobronchial stents used for?
Stents are devices designed for internal splinting of the airway lumen. Airway stents have been used to help reduce airway obstruction from malignant or benign processes that compress the airway from the outside. Airway stenting can offer immediate relief of acute respiratory distress, allow successful extubation, and may prolong survival.
25. What is the definition of bronchoscopy?
It is the process of passing a bronchoscope into the airways for either diagnostic testing or therapeutic purposes.
26. What are the four types of bronchoscopy?
Flexible bronchoscopy (FB), Rigid bronchoscopy (RB), Diagnostic bronchoscopy (DB), and Therapeutic bronchoscopy (TB)
27. A rigid bronchoscopy is preferred under what conditions?
It is preferred when the patient is under deep sedation with muscle relaxation.
28. What are the risks of flexible bronchoscopy?
Arrhythmias, fluctuations in blood pressure, and airway manipulation during bronchoscopy may lead to coughing, hypoxemia, vomiting, bleeding, laryngospasm, and bronchospasm.
29. What maneuver is used if the patient becomes over-sedated during a bronchoscopy procedure?
The chin-lift and jaw-thrust maneuver may be used.
30. What is recommended to prevent the patient from slipping into deep sedation?
Capnography monitoring while performing flexible bronchoscopy under moderate sedation is recommended.
31. What does flexible bronchoscopy monitoring consist of?
You must keep track of patient responses to verbal commands or spontaneous movements. Their chest movement may continue despite a near-total obstruction of the airway. There should be continuous cardiac, blood pressure, and pulse oximetry monitoring. Capnography should be used to monitor and prevent the patient from entering deep sedation.
32. What are the types of therapeutic bronchoscopy?
Rigid bronchoscopy, thermal ablation of the endobronchial lesion, brachytherapy, cryotherapy, and endobronchial stents.
33. What is the major indication for rigid bronchoscopy?
Managing central airway obstructions
34. What are the three types of thermal ablation of an endobronchial lesion?
Endobronchial electrocautery, argon plasma coagulation (APR), and laser photocoagulation.
35. What are the risks of thermal ablation of an endobronchial lesion?
Improper use of thermal modalities can lead to perforation of the airway, vascular structures, or the esophagus.
36. What are the complications of thermal ablation of an endobronchial lesion?
Hypoxemia, pneumothorax, and bronchopleural or bronchoesophageal fistula.
37. What are the contraindications of thermal ablation of an endobronchial lesion?
Refractory hypoxemia and extrinsic compression of the airway without an endobronchial lesion.
38. What is the relation between flexible bronchoscopy and an endotracheal tube?
You can use a flexible bronchoscope to place an ET tube through the mouth or nose. It allows for awake intubations with topical anesthesia. It is used in patients with cervical injuries where immobilization of the neck is crucial. It may also help identify causes of acute hypoxia and help remove secretions from the airway. It is limited to the experience of the operator, and there must be patient cooperation.
39. What is the respiratory therapist’s role in bronchoscopy before the procedure begins?
Respiratory therapists help identify the potential need for bronchoscopy (retained secretions or foreign body removal). They verify the physician’s order or protocol and review the patient’s record for contraindications (excessive clotting times), hazards, and informed consent. They prepare/ensure the proper function of equipment. They outline a plan for adequate oxygenation during the procedure. They evaluate the patient for bronchospasm and administer aerosolized bronchodilators if required. They assist nurses in the application of topical anesthetics.
40. What is the respiratory therapist’s role in bronchoscopy during the procedure?
Respiratory therapists monitor the patient’s vital signs (including capnography). They help identify and respond to adverse reactions and administer oxygen as needed. They provide proper positioning of the patient and assist with the use of accessories (bite block, oral airways, nasopharyngeal tube, biopsy forceps, brushes, etc.) They set up instruments for rigid bronchoscopy and silicone stents and help place chest tubes or ET tubes in emergency situations.
41. What does a respiratory therapist do during a bronchoscopy of a patient who is receiving mechanical ventilation?
Respiratory therapists help determine the appropriate length and diameter of the ET or tracheostomy tube. They ensure that the bite block is in place to avoid equipment damage. They adjust ventilator settings for safety reasons and oxygenation purposes and then return settings back to the patient’s pre-procedure settings.
42. What are the main complications and risks of a bronchoscopy procedure?
Bleeding, infection, bronchial perforation, bronchospasm, laryngospasm, and pneumothorax.
43. The endoscope reaches what generation of bronchi?
44. What is a rigid tube?
It’s an open metal tube with a distal light source and port for oxygen/ventilating equipment.
45. Who uses the rigid tube?
Otorhinolaryngologists and thoracic surgeons
46. What type of bronchoscope do respiratory therapists most often assist with?
47. Which bronchoscope can access very small airways?
48. What are the channels in a flexible fiberoptic bronchoscope?
Light transmission, visualizing, and multipurpose open
49. Who uses the flexible fiberoptic bronchoscope?
The pulmonologist, along with assistance from a respiratory therapist.
50. What is the most common method of anesthesia during a bronchoscopy?
The use of a topical anesthetic is the most common.
A bronchoscopy is a critical procedure that has revolutionized the way we diagnose and treat various pulmonary disorders. Through this article, we aimed to provide a comprehensive overview of the procedure and its importance in modern medicine.
Additionally, the practice questions presented in this article are designed to reinforce key concepts and enhance understanding, allowing healthcare professionals and students to develop a strong foundation for performing this procedure.
By staying up-to-date with advancements in this field and refining one’s skills, practitioners can continue to improve patient care and contribute to the ongoing evolution of pulmonary medicine.
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
- Faarc, Cairo J. PhD Rrt. Mosby’s Respiratory Care Equipment. 10th ed., Mosby, 2017.
- Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019.
- Mahmoud N, Vashisht R, Sanghavi D, et al. Bronchoscopy. [Updated 2022 Sep 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
- Paradis TJ, Dixon J, Tieu BH. The role of bronchoscopy in the diagnosis of airway disease. J Thorac Dis. 2016.

domain: biology


Fiat Toro-based SUV (7 Seater) back on FCA´s Agenda
The long-rumored full-size SUV is reported as part of FCA´s “next wave” of products.
With Jeep Compass already launched, and Fiat Argo (Punto successor) and Argo-based X6S sedan on the making, FCA appears to have started pondering on next batch of new cars for the developing markets, Mercosur region (South America) in particular. This includes the replacement model for the aging Strada pickup and a 7-seat SUV based on the Toro pickup. The latter isn´t a new idea, the SUV was rumored long back and deemed dormant, but it is reported that the project is now getting some priority.
It is learnt that the company has already invested notable time and resources in developing prototypes for the Toro SUV project. The idea of having a full-size SUV is in sync with FCA´s vision of offering a diverse range of SUVs in the region. Further, the success of Toro pickup in this market strengthens the scope for an SUV, reports Autoblog Argentina, adding that the brand is in dire need of a new product like this SUV to replace the Fiat Freemont model, the rebadged Dodge Journey.
It is also reported that the Fiat engineers are reworking the Toro platform to ensure higher levels of refinement for the new SUV than the pickup. The car is expected to share components from the Jeep Compass, while offering enhanced interior space and seating for seven passengers with a wheel base of 2.75 metres. Design wise, the Toro SUV is likely to inherit the front fascia from the pickup but with added chrome and LED embellishments, thereby providing greater sense of exclusivity.
The Toro SUV is expected to carry on the pickup´s 170 hp 2.0-litre turbo diesel engine, paired either to a 9-speed automatic transmission or a low-spec manual gearbox. Front wheel drive will be the norm, with an optional four-wheel drive system tweaked for passenger application.
FCA may take up to 2019 to bring the SUV on road, by the time the new Strada Pickup using the existing Economy 326 platform (as Palio and Punto) will also be ready. Though these new product developments are strictly applicable only for the Latin American markets, there provide insights on the company´s approach on products for developing markets across the globe, including India.
Next, would you like to read more on Fiat?
H/T Autoblog Argentina


NHTSA Opens Investigation On Hyundai Palisade For Windshield Wiper Failures
On August 15th, Hyundai Motor America issued a 122,919-vehicle recall. More specifically, the 2020 to 2021 model year Hyundai Palisade was called back due to a windshield wiper motor that could function intermittently or fail when impeded by snow and/or ice accumulation.
Wipers that don’t work when you need them reduce driver visibility, thus increasing the risk of a crash. The root cause boils down to a sudden increase in wiper system load, which results in circuit breaker actuation within the motor. Wiper operation resumes once the circuit breaker resets or the windshield is cleared of snow/ice. The suspect windshield wiper motor assembly bears part numbers 98110-S8000 and 98110-G5000.


text:
KPN sees 50% jump in data roaming traffic in ski destinations
Dutch people have been using up to 50% more roaming data from European winter sports destinations compared to a year ago. Data traffic peaks during the Christmas and Carnival holidays from the Alps, with the second week of Carnival (25/2 – 4/3) being by far the busiest week. kpn roaming 2023
This is based on an analysis of mobile roaming traffic processed by KPN from popular winter sports destinations such as Austria, Switzerland, France, and Italy.
During the period from December ’22 to March ’23, KPN recorded around 50% more data traffic compared to last year, which is more than the annual growth of data traffic. This increase may be due to both increased data consumption and increased travel. Compared to the winter of 2019/2020, roaming traffic even doubled. Two years ago, almost no data traffic was visible due to the pandemic.
Austria is the most popular winter sports destination in Europe. We make about the same number of calls from the Alps as we did a year ago. An absolute peak is visible in the second week of Carnival when both the central and northern regions have holidays. On Wednesday 1, Thursday 2, and Friday 3 March, winter sports roaming records are being broken in Austria.
KPN publishes the Stand van het Netwerk (State of the Network) to report on trends and developments in the amount of internet traffic on the network in the Netherlands. This includes previous publications, such as the impact of a WhatsApp outage on SMS traffic, New Year’s Eve, and the rollout of fiber optic.

domain: news


text:
Six gold medals for Granadilla club
The Insular Championship of Rhythmic Gymnastics, with individual and joint categories, was held once again in the municipal pavilion of Granadilla de Abona.
The event, organised by the Tenerife Federation with the collaboration of the Department of Sports, counted on the assistance of the Mayor of the municipality, José Domingo Regalado; the first deputy Mayor, Marcos José González; councillor for sports, Sara Cano, and councillor for tourism, María Candelaria Rodríguez; among others.
The event saw 75 gymnasts participating and around 500 people in the crowd.
A total of twelve teams from Tenerife demonstrated their skills in rhythmic gymnastics: Taina, Intara, Ritmicod, Evangim, Anya, Ursel, Achinech, Tenesay, Damae, Corarenal, Batistana and, the host, Adoney.
The Granadilla club, Adoney Rhythmic Gymnastics won six gold medals. All the categories presented by the municipal group obtained first place in the insular competition. The benjamín section was first in the classification with Rosalía Cañizares; in alevín, Anira Padin took the podium; in children, Ainara Damas won the medal in the Children’s category; in cadet, Antonella Bracco was the main protagonist, and, in youth, Andrea Rodríguez, got the gold.
Laura Garcia, trainer and head of the Adoney Club Rhythmic Gymnastics, said the sacrifice and the hours of training have paid off.


text:
Heads-up: Huge Sports Tech Sale Underway – 20% Off All Smart Trainers!
There’s a massive sales on smart cycling trainers right now, plus plenty other sports tech. There’s 20% off the Wahoo KICKR, KICKR CORE, CLIMB, Headwind, 20% off the Tacx NEO 2T, Flux 2, and Flux S, 20% off Saris Hammer 3 trainer and Saris MP1 Motion Platform. Plus also 20% off the Elite Direto X and Suito too, even the new Sterzo. Plus even steeper deals including with the Kinetic trainers at 30% off.
As is usually the case for trips to the region, I was down here for work meetings. I actually rather enjoy going to Bahrain, it’s super easy to get around. It lacks the horrible traffic or sprawl of some of the other cities, and also lacks the “complexities” associated with time spent in Saudi. Plus, if things go poorly during your stay, you can drink here.
Next to the conference room that the offices were in, in a nearly 40-story building, there were windows that overlooked what appeared to me to be a prime swimming area. I was continually gazing out to the turquoise waters, trying to figure out how I could slide in a swim there.
I had meetings all day Wednesday, and then most of the day on Thursday. With Thursday being the start of the weekend for most Middle Eastern countries, it meant we ended a bit earlier. Just enough that by around 4:15PM I was able to do a quick change in the lobby bathroom and head on out for a run.
The Point to Point Run:
I decided to do a point to point run from my hotel to the area I wanted to swim out from. It was about 4 miles one way, which seemed like a nice, roughly 30 minute run. I figured I’d then do another 30 minutes swimming. Here’s the departure point.
From there, I basically followed one of the main highways that crosses Bahrain. I can’t say it was terribly scenic, but it was relatively simple to run along. There was a wide sidewalk along the side of much of it. As is common in many countries in the region, there are numerous posters/paintings of the royal family along the way.
I decided to run with the LifeBEAM optical HR sensor hat. This unit dual broadcasts both ANT+ and Bluetooth Smart, very much like their existing helmet that I reviewed last spring. Basically the same sensor technology that worked well there.
And, it seemed to work fairly well here too. For this run I only had another optical sensor on me at the time to compare against (the Epson Runsense 810 GPS watch), but the two seemed to match well. You can see the sensor at the front of the hat, and then the tiny little battery at the back. I completely forgot the battery or sensor was there about 4 seconds after putting it on.
As I kept running I passed a couple of makeshift fields of play, with lively games underway:
From a route standpoint, it was fairly easy for me to remember. I basically just followed the highway until I found a point I could cross it. In this case, a highway on-ramp from the other side of the street. It’s not the most perfect of pedestrian crossings, but I saw a few other people using it…but it worked just fine and even had a very tiny sidewalk.
From there it was just about a mile left, as a straight shot down the palm-tree lined route to the resort area I’d be swimming at. My camera struggled a bit here in the fading/hazy light:
Once inside the grounds, it was all super-green though, as one might expect I suppose.
For the swim I had worn my swimsuit below my running shorts. Then, in a very lightweight drawstring bag from the Paris Half-Marathon this past weekend, I stashed my swim goggles and swimcap. I probably could have found creative ways to attach these to my body and skip the bag – but I also threw a few bucks of cash into the bag and an ID. This resort offers a day pass for use of the facilities (gym/beach/pools), or…if you happen to know someone there, that solves the problem too.
Given the resort is well secured, I wasn’t terribly worried about leaving my shoes on the beach. There were ample beach/pool/resort boys around that seemed to want to help me at every turn. So I just left my bag with shoes and hat on one of the beach chairs.
The resort has quite a nice protected lagoon, with only a few entrances. The deepest part I could find was perhaps 1m (3ft) deep. So I could have stood up at any point. It’s used by one of the openwater swim clubs here in Bahrain, and as a testament to that there was another man swimming as I arrived.
Without much further ado, I simply set off. I initially had hoped I’d be able to leave the lagoon and do a longer loop of sorts, but it was made very clear by a dense structure of fenced nets that they really didn’t want anything going out or into the area. So, I instead just did loops.
The length of the lagoon was perhaps 350-400m long, and so I made a bit of a triangle out of it, getting it to about 900m per loop. Not too shabby. At the far end was a fortress-like tower, you know, just in case Hilton or Hyatt decided to attack the Ritz.
From that end, I’d zip back to the starting point and do it all over. There were no buoys, so my track lines aren’t quite exactly in the same spot – I was mostly just eyeing points on shore. For the second loop, sunset was just beginning.
The water was nice and warm throughout, and being clear and shallow (and perfectly flat) made it a really relaxing swim. Plus, there’s virtually no dangerous sea creatures living in this section of the Gulf – so it’s like swimming in a gigantic swimming pool. I saw precisely one fish.
I wrapped my swim up in just over 30 minutes, cruising through about 1,800y. Obviously not any sort of race pace, but rather out to enjoy swimming before a redeye flight back home.
I spent a few minutes relaxing on the beach chairs watching the setting sun color the sky and the city and resort lights come alive. Oh, by ‘relaxing’, I mean fixing my flights for the night after British Airways cancelled my flight home. Still, if I’ve gotta spend time on a phone with an airline – it’ll be sitting on the beach at sunset.
From there I grabbed a quick Uber ride back across the city to my original hotel where I used the fitness club to shower before heading off to the airport. By around 9PM I was boarding the first of two (replacement) flights back home.
After a relatively short 6-hour flight I’ll land back home in the 6AM hour in Paris, ready to start the weekend. Well, minus the whole working Friday thing. But it’s Friday…it’s always a good day!
I swim, bike and run. Then, I come here and write about my adventures. It’s as simple as that. Most of the time. If you’re new around these parts, here’s the long version of my story.
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You probably stumbled upon here looking for a review of a sports gadget. If you’re trying to decide which unit to buy – check out my in-depth reviews section. Some reviews are over 60 pages long when printed out, with hundreds of photos! I aim to leave no stone unturned.
I travel a fair bit, both for work and for fun. Here’s a bunch of random trip reports and daily trip-logs that I’ve put together and posted. I’ve sorted it all by world geography, in an attempt to make it easy to figure out where I’ve been.
The most common question I receive outside of the “what’s the best GPS watch for me” variant, are photography-esq based. So in efforts to combat the amount of emails I need to sort through on a daily basis, I’ve complied this “My Photography Gear” post for your curious minds! It’s a nice break from the day to day sports-tech talk, and I hope you get something out of it!
Many readers stumble into my website in search of information on the latest and greatest sports tech products. But at the end of the day, you might just be wondering “What does Ray use when not testing new products?”. So here is the most up to date list of products I like and fit the bill for me and my training needs best! DC Rainmaker 2019 swim, bike, run, and general gear list. But wait, are you a female and feel like these things might not apply to you? If that’s the case (but certainly not saying my choices aren’t good for women), and you just want to see a different gear junkies “picks”, check out The Girl’s 2018 Gear Guide too.

domain: geography


text:
We’ve asked 3 questions of the candidates for mayor and councillor at the current KI Council election:
Dear council candidate
The Art Museum of Kangaroo Island, is a visionary and adventurous proposal which would reveal Kangaroo Island art to the world and draw world art to Kangaroo Island. For more information about the value of AMKI for Kangaroo Island, please see the AMKI Business Case.
Arts and cultural tourism is the strongest growing sector of global tourism and tourism plays a major role in the Kangaroo Island economy. The wellbeing benefits of the arts in practice and consumption are also clearly documented – benefits the fire-affected community of Kangaroo Island will continue to need.
The Art Museum of Kangaroo Island committee would appreciate candidates’ responses to these questions:
1. Do you believe that Council should be an active supporter of and advocate for the arts on Kangaroo Island?
2. Do you support the community-based Art Museum of Kangaroo Island proposal?
3. Do you support AMKI being built near Kingscote on Lot 460 Seaview Road overlooking the Bay of Shoals.
Here is a summary of their answers. Their answers in full are here.

domain: artistic


text:
A late third period effort wasn’t enough tonight as the Boston Bruins fell to the New Jersey Devils 3-2 tonight at the TD Garden.
The first period and game got off to a slow start for the Bruins. It felt like the fastest and slowest period at the same time as the new line combinations had a hard time adjusting and defense couldn’t get the puck out of the zone. There was what, one stoppage of play in the first ten minutes, but a lack of anything getting started by both sides.
Although there were problems with the rollout of the top lines, Trent Frederic, Craig Smith and Charlie Coyle had the best chemistry and opportunities of the period. Frederic found Smith’s rebounds and they had a good sequence of chances in the first half of the period. They also had a nice play started by a rush from Charlie McAvoy.
The defense had their own woes in the first and the absence of Matt Grzelcyk and Jakub Zboril was apparent. Defensive zone coverage had its holes and the Devils found shooting lanes and won battles behind the net.
Shots were 7-7 in the first period and the game was scoreless heading into the locker rooms.
The Devils came out attacking in the second period and got on the board early.
The Devils got on the board first at 1:34 in the second period. Jack Hughes dropped a pass to Kyle Palmieri who at the hash marks beat Jaroslav Halak’s glove, making the score 1-0.
NSFW pic.twitter.com/OVBfFRG2Mx— New Jersey Devils (@NJDevils) February 19, 2021
Then came a huge break for the Bruins. While on four-on-four play, P.K. Subban was assessed a four-minute penalty for high-sticking and the Bruins would have three minutes of the man-advantage. But alas, nope.
The Devils then extended their lead with a shorthanded goal. Jasper Brett fed Palmieri the puck up ice for a breakaway and a five-hole goal on Halak, making the score 2-0.
Don’t worry about what happened after this. Just enjoy the moment.— New Jersey Devils (@NJDevils) February 19, 2021
: Severson pic.twitter.com/9r21AsaYnw
Jake DeBrusk netted his first goal of the season at 12:36 in the second period to bring the Bruins within one score. On the power play, DeBrusk intercepted an attempt by Palmieri to clear the puck and picked the top shelf over Mackenzie Blackwood’s stick, making the score 2-1.
Jake Debrusk responds on the power play, bringing Boston within one off of the turnover!#NHLBruins pic.twitter.com/quORG334UC— Hockey Daily 365 (@HockeyDaily365) February 19, 2021
But the Devils answered back and regained their two-goal cushion at 15:37 in the second period. On four-on-four play, skating into the slot, Pavel Zacha passed to Andreas Johnsson in the right face-off circle who then returned a pass to Zacha in the left circle where he put a wrist shot past the glove of Halak, making the score 3-1.
Big Z— New Jersey Devils (@NJDevils) February 19, 2021
: Butcher pic.twitter.com/Iy88PFfrbK
Lines were shuffled again in the second, as David Krejci left the game with a lower-body injury and the team continued to have a hard time connecting. The Bruins overpassed in the period and the most obvious was Pastrnak giving away an opportunity in the slot and passing to Sean Kuraly. WHY.
The Bruins got back to playing their style and pace of hockey in the third period, but it was too little too late. Blackwood got in their way and came up huge for the Devils.
The Bruins made it interesting at the end by capitalizing on a late power play and pulling Halak for a 6-on-4. Pastrnak sent a blast through traffic to put the puck past Blackwood’s right shoulder, making the score 3-2. Originally the goal was credited to McAvoy because it looked like he got part of his stick on it and redirected the puck. But official scoring gave the goal to Pastrnak.
Bruins make it a 3-2 game. pic.twitter.com/PfvUBMwZB2— Conor Ryan (@ConorRyan_93) February 19, 2021
With the net still empty and just over a minute left, the Bruins had a few additional chances to send the game to overtime. Within the final seconds, Pastrnak had the best shot to tie the game, but the team couldn’t get it past Blackwood and dropped their second regulation game in a row.
Their next game is on Lake Tahoe as they take on the Philadelphia Flyers at 2pm on Sunday. We’ll see you then.

domain: game


MPSC Communiqué - May 2015
7 May 2015
Notes from the Chair
The Marine Pest Sectoral Committee (MPSC) held its ninth meeting (MPSC09) in Wellington, New Zealand in May 2015. This meeting was preceded by the biannual Industry Consultation Day, presentations from New Zealand marine pest professionals, and the inaugural MPSC internal review session (‘MPSC review’).
I would like to extend my thanks to all who participated in MPSC09 and related meetings. I would especially like to thank our MPSC New Zealand observer and the staff at the National Institute of Water and Atmospheric Research for hosting the meeting. Both the MPSC review and Industry Consultation Day provided important guidance on future direction and goals for MPSC. We also received invaluable feedback from our industry partners on improving breadth and depth of stakeholder engagement.
At MPSC09, we progressed a number of MPSC priority tasks, and addressed issues raised at the Industry Consultation Day and the MPSC review. Highlights of the meeting included discussion of marine pest emergency preparedness opportunities, progress on drafting the MPSC Communications and Engagement Strategy, and agreement on a number of improvements to the format of the existing Industry Consultation Day.
I am looking forward to the next Industry Consultation Day where we can start to implement some of these changes and develop a stronger partnership.
As Chair, I would like to extend my thanks to MPSC members, observers and industry representatives for constructive and propulsive contributions to MPSC09 and associated meetings.
Dr Robyn Martin
MPSC Review —5 May 2015
At MPSC08, the committee agreed to undertake an internal strategic review of MPSC performance every two years. The inaugural review took place on 5 May 2015, and examined MPSC performance against the terms of reference and objectives. The review process consisted of a survey to gather results from MPSC members and industry stakeholders, followed by a face-to-face strategic review session.
Outcomes of the MPSC review identified the following future aims for the committee:
- Increase the involvement of existing stakeholders in identifying MPSC risks and priorities, and in the delivery of marine pest priority issues.
- Broaden stakeholder attendance at future meetings.
- Investigate marine pest emergency preparedness opportunities.
- Finalise the national marine pest strategy.
Industry Consultation Day—6 May 2015
The Industry Consultation Day was held on 6 May 2015.
The day began with an update on the Australian Government review of national marine pest biosecurity (‘national review’). The national review is currently being finalized, and review outcomes will be provided to government for consideration shortly. The Chair also provided an update on the Biosecurity Act 2015. This legislation aims to provide the Australian Government with a modern regulatory framework to better manage biosecurity risks in current and future trading environments, and is designed to be clear and easy to understand. The Biosecurity Act 2015 also contains a framework to manage the risks associated with ballast water. This allows Australia to meet its obligations under the International Convention for the Control and Management of Ships’ Ballast Water and Sediments when it is ratified. The Biosecurity Act 2015 passed through Australian Parliament on 14 May 2015, and will commence on 16 June 2016.
Additional information on the biosecurity legislation can be found at Biosecurity Act 2015 and supporting Acts.
The day also included a presentation on the results of the MPSC review and discussion regarding the future of MPSC Industry Consultation Days. Industry representatives emphasized the importance of allocating sufficient time for industry input into MPSC matters, and the value of demonstrating the impact of marine pests to industry executive officers and other stakeholders.
The day progressed with a number of presentations from New Zealand government and industry experts on marine pathway management, regional partnership approaches to marine biosecurity management, and marine science and taxonomic services in New Zealand.
There was some discussion regarding increasing information flow to industry, and MPSC agreed to circulate future milestone reports on the establishment of the Australian Testing Centre for Marine Pests to industry. There was also discussion regarding the Australian Priority Marine Pest List, which is currently being progressed, and the National Marine Pest Strategy, which will be progressed once the national review is completed. This strategy will apply to all marine pest stakeholders.
A highlight of the day was a visit to the New Zealand Marine Invasives Taxonomic Service, a centralised service that provides taxonomic identification and collection management of marine organisms relevant to marine biosecurity management in New Zealand. Attendees were able to view a number of preserved marine species and observe the online microscope and portable marine invasive species demonstration kit.
Future MPSC Industry Consultation Days
Following discussions at MPSC09, Industry Consultation Days will be undergoing a number of changes. The current discussion and presentation sessions will be replaced with a workshop, where MPSC members and stakeholders will work together to progress key priority items. When appropriate, additional stakeholders – such as environmental representatives – will also be invited to the workshop. Workshops may also be themed, to be more applicable to specific groups of stakeholders.
The first ‘MPSC Partners Workshop’ will be held in conjunction with MPSC10. The workshop will address the results of the national review, and progress both the MPSC Communications Strategy and the National Marine Pest Strategy alongside other key items.
MPSC is also currently considering removing restrictions on a number of ‘government only’ meeting papers to facilitate increased industry consultation.
MPSC09 Meeting Notes—7 May 2015
Jurisdictional ‘round up’
Key marine pest biosecurity activities reported at MPSC09 included:
- The Western Australian ‘VesselCheck’ software is currently available for international vessels. Software covering domestic vessels is under development.
The VesselCheck software is available at Department of Fisheries WA Vessel Check.
- The Queensland Biosecurity Act 2014 is expected to come into force in early 2016 and will provide stronger legislative support for dealing with marine pests in Queensland waters. Regulations to support the Act are currently under development.
- The Australian Government is currently progressing the marine pest Rapid Response Manuals, and aims to publish these by the end of the year.
- The New Zealand Craft Risk Management Standards for Biofouling have been implemented, with a four year lead-in period before enforcement commences.
MPSC high priority work items
There has been progress on a number of MPSC high priority work items.
- MPSC Communication and Engagement Strategy
MPSC is currently drafting a strategy outlining how the committee will communicate and promote marine pest matters to stakeholders. The aims of this strategy are to raise the level of support for marine biosecurity, and to maximise community and industry involvement in marine pest biosecurity management. It is expected that this strategy will be completed by the end of the year.
- Australian Priority Marine Pests List
- A recent workshop in South Australia further progressed the Australian Priority Marine Pests List. Once completed, this list will replace the now invalid CCIMPE trigger list.
- National Marine Pest Biosecurity Strategy Development
The national strategy is in the process of being redrafted to be more outcomes focused. The strategy will not be finalised until outcomes of the national review are released later this year.
- National Monitoring Network (NMN) Cost Sharing
Progress of the NMN cost sharing model is on track. MPSC has contracted the Australian Bureau of Agricultural and Resource Economics and Sciences to develop a location monitoring cost sharing model for surveillance.
MPSC members discussed the benefits of emergency preparedness simulation exercises. Members are currently looking into resourcing requirements, with the aim of conducting an exercise during 2015-16. This would involve industries and governments.
Update on activities in the aquarium sector
The main body of work in the aquarium sector is currently the noxious fish list. Consultation is now occurring on the fourth tranche of this list.
The New South Wales Department of Primary Industries is currently testing a South Australian Research and Development Institute methodology for assessing whether species should be included on the noxious fish list.
Further information is available on the Australian Government Department of the Environment website.
Upcoming MPSC meetings
The next MPSC meeting (MPSC10) will be held in Canberra in the latter part of 2015.
Future MPSC Communiqués
In line with other updates to MPSC processes, the MPSC communiqué is undergoing the following changes:
Focus on a single MPSC meeting
Focus on all MPSC activities for the past six months.
Published twice a year
Published twice a year:
These changes will be implemented from MPSC10 onwards.
Department of Agriculture
Department of Agriculture
Department of Fisheries
New South Wales
Department of Primary Industries
Department of Agriculture, Fisheries and Forestry
Department of Primary Industry and Fisheries
Department of Environment, Land, Water and Planning
Primary Industries and Regions South Australia
Department of Primary Industries, Parks, Water and Environment


text:
A Medical Device Daily
RaySearch Laboratories (Stockholm, Sweden) reported a long-term license and development agreement with Royal Philips Electronics (Amsterdam, the Netherlands) covering a suite of new products within the adaptive radiation therapy sector.
The agreement covers three products, the first of which will be launched during the second half of 2007.
RaySearch said that adaptive radiation therapy is considered to be the next technology shift within radiation to increase precision by taking into account changes in the patient’s anatomy during treatment, thus making it possible to deliver higher doses to the tumor and reduce side effects.
“This is one of the most important milestones in RaySearch’s history, said Johan L f, president/CEO of RaySearch. “We ... will jointly develop the next generation of treatment planning systems for adaptive radiation therapy. Given Philips leading position in the treatment planning market and that the cooperation within IMRT [Intensity Modulated Radiation Therapy] has been an important factor for RaySearch’s favorable development, we have great hopes that the joint efforts now being initiated will be just as successful.”
IMRT improves treatment quality, but to achieve an even better result, software is required to deal with problems that arise due to changes in the patient geometry over time. By taking, for example, X-rays during the course of treatment, and feeding back the information, the treatment can be corrected so that errors can be avoided or dealt with, RaySearch said, calling this approach adaptive radiation therapy.
With the agreement, three products within adaptive radiation therapy will be developed, it said: a tool for IGRT using strictly geometrical information about the patient’s anatomy; a product facilitating more advanced adaptation of the treatment and taking into account dosimetric aspects; and a product for delivering “full four-dimensional adaptive radiation therapy.”
RaySearch and Philips said they already are involved in research activities within adaptive radiation therapy, including cooperation with Princess Margaret Hospital (Toronto), that cooperation launched in 2000. The first product, RayOptimizer, was integrated in Philips’ Pinnacle treatment planning system and was introduced clinically in 2001.
Later, the supplemental products RayMachine and RayBiology were launched.
Philips claims the largest installed customer base in treatment planning technology, with about 1,500 RayOptimizer licenses sold to date.
RaySearch, a spin-off from Karolinska Institute (Stockholm), was formed in 2000. Since 2001, the company has sold its product, RayOptimizer, to more than 900 hospitals internationally through a licensing agreement with Philips, thus enabling, it says, more than 100,000 patients to receive improved radiation therapy.
Tumor radiation/surgery combo reported
Results of a long-term clinical study conducted in Salzburg, Austria, bolsters support for a change in radiation therapy for breast cancer patients, according to a report from Breast Center Salzburg , published in the International Journal of Cancer. The report says that radiation administered during surgery, directly at the site of the excised tumor (intraoperative electron radiation therapy, or IOERT), greatly reduces the incidence of same side (or ipsilateral) breast tumor recurrence.
The findings were presented by Felix Sedlmayer, MD, chairman of radiation oncology at the University of Salzberg , on Oct. 8 at a special meeting of the European Chapter of the International Society of IORT at the conference of the European Society for Therapeutic Radiation and Oncology (Brussels) in Leipzig, Germany.
The study compared 190 women who received IOERT during lumpectomy followed by whole-breast radiation, with the 188 previously treated women who received lumpectomy alone, followed by whole-breast radiation using an externally applied electron beam boost to the tumor bed.
After a median follow-up period of 51 months, no local tumor recurrence occurred in the IOERT group; after a median follow-up of 81 months, 6.4% of the control group had experienced local breast cancer recurrences.
Because it does not have to pass through healthy organs, IOERT can be delivered at higher and better doses. It may also shorten by as much as half the post-operative radiation cycle, depending on the protocol. Guided by the radiation oncologist’s clear view of the site as well as intraoperative ultrasound, IOERT also allows the electron beam to be more accurately targeted.
In addition, IOERT eliminates the traditional delay of external radiation therapy, which must be scheduled only after the surgery patient has healed. This can give cancer cells a chance to recover and spread.
A reduction or even a long delay in local tumor regrowth strongly predicts better survival rates, according to the report. Previous studies have shown that patients who develop local recurrences within two years fare much worse than those who develop such recurrences after more than five years.
A subsequent study conducted by Sedlmayer involved 541 breast cancer patients that were advised to have breast conserving therapy. As of March 2004, 541 patients received IOERT during surgery.
Ranging in ages from 23 to 89, with a median age of 50.4 years, only one patient had an in-breast recurrence after 36 months. This recurrence was due to a previously unidentified tumor and not at the original tumor site. Sedlmayer was able to achieve 100% local tumor control and an overall survival rate of 92.1% for his patients after five years.
Nearly all Austrian women live within a two-hour drive to radiation facilities, noted Dr. Felix Sedlmayer. But American hospitals are not as well equipped, or are strapped by the coverage constraints of private health insurance companies.
“Obviously, many women in the U.S. are simply forced to choose mastectomy for lack of nearby equipped radiation facilities or lack of healthcare coverage for IORT,” said Sedlmayer. “This takes an unacceptable psychological and physical toll. Given the lowered recurrence rates we are seeing, the estimated 216,000 new cases of invasive breast cancer per year in the U.S. and an estimated breast-conserving surgery rate of 70%, the U.S. alone could avoid 5,000 cases of local recurrence per year.”
IntraOp Medical (Sunnyvale, California) says it offers the first fully mobile, self-shielding intraoperative radiation therapy system, the Mobetron. The Mobetron delivers the same electron-based radiation therapy administered in dedicated, shielded operating rooms, without needing to move the patient or make structural changes to surgery suites.
“As a self-shielding, mobile device, the Mobetron represents a technology investment that comes in much lower and can be leveraged across many operating suites,” said Donald Goer, president/CEO of IntraOp.

domain: health


text:
Time certainly flies. Five years ago, Jennifer Lopez gave birth to twins Max and Emme, and this year the show-stopping mom proudly celebrated her twins' fifth birthday by baking cupcakes. Lopez shared a Twitter photo of her sweet treats with fans and followers, with a caption that read "Happy Birthday Coconuts!!!
(2 months and 23 days ago)
Good thing Jennifer Lopez is super rich ... 'cause she's learning the hard way -- a prep school education in L.A. costs a friggin' fortune ... and she's gotta spring for TWINS. Check out TMZ on TV -- click here to see your local listings!
(2 months and 11 days ago)
Marc Anthony and Jennifer Lopez's twins, Emme and Max, turn 5-years-old Friday, and it seems their mom went into traditional mom-mode to help them celebrate. Us Weekly shares the fun details of Lopez working...
(2 months and 25 days ago)
Jennifer Lopez is experiencing the kind of stress that hundreds of rich L.A. mommies endure every year -- getting their kids into exclusive, VERY EXPENSIVE private schools.We've learned Jennifer has been making the rounds in L.A., interviewing schools…
(2 months and 12 days ago)
Disneyland really is the happiest place on earth, especially for Marc Anthony! Jennifer Lopez's ex took his much younger girlfriend, Chloe Green, and his twins, Max and Emme, to the...
(2 months and 20 days ago)
Jennifer Lopez went from fabulous to frumpy yesterday (March 15) as she spent the afternoon with her 5-year-old twins Max and Emme. But J.Lo wasn't afraid to flaunt what she's got while chasing after her kids. The singer and actress, 43, had no problem flashing her sexy pink bra in a see-through white shirt, which read "Je t'aime." Lopez topped off her look with sunglasses,...
(2 months and 3 days ago)
Can Jennifer Lopez's kids get any more adorable? The Back-up Plan star's little ones took a trip to the Griffith Observatory in Los Angeles with their nanny Thursday,...
(27 days ago)
Jennifer Lopez has settled a lawsuit filed last April by her onetime limo driver, Hakob Manoukian, who claimed Lopez, her company Nuyorican Productions and her manager Benny Medina stiffed him out...
(2 months and 28 days ago)
More Entertainment news »


text:
After creating 12 different billion-dollar businesses and breaking dozens of world records, wouldnt you think youd done it all?
Not Sir Richard Branson. Having brought the Virgin brand to all corners of the globe, hes now reaching out to the stars as he prepares to launch commercial space travel with Virgin Galactic.
In this non-stop memoir, Richard takes you inside his whirlwind life: from reinventing his companies in the midst of the financial crisis and devastating personal losses, to tackling the planets biggest challenges, to the joys of becoming agrand-dude at 64.Discover the irrepressible spirit, ingenious vision and relentless drive that has made Richard the ultimate entrepreneur.
The iconoclastic Virgin founder is still changing the world. Next comes outer space.
Format : Soft Cover
Age Group : ADULT
Page Numbers :

domain: library


text:
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Marriott Hotels - Epitome Of Traditional Grace And type
Marriott Hotels - Epitome Of Traditional Grace Kind

domain: travel