2021.10.24 19:04 _Ghostvilla_ When's the next chapter coming out?
2021.10.24 19:04 -Captain_Midnight- I wish every important televised Football soccer game ended with the two teams fighting each other like in a bar brawl.
2021.10.24 19:04 DifficultCapital146 What would you ask for as a gift from the States?
I'm planning a trip to Dubai soon and want to buy some gifts for friends and family. I keep researching and most brands already exist and are widely available in Dubai. I want to get them something unique or uncommon and not sure what would that be.
So what would you ask for as a gift from the States that you can't buy/find in Dubai?
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2021.10.24 19:04 EgweneMalazanEmpire AWCF researcher Nkosilathi observed this pack in Gonarezhou Natiinal Park
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2021.10.24 19:04 Dankcoinco Invest In A Token Not Named After A Dog Breed! Invest With Dankcoin, The Next Level Meme Currency. 40K USD Market Cap, Large Supply, Tradeable, Fast And Affordable.
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2021.10.24 19:04 Annoyeddad81 [WTS] SBA4, Samson VertGrip, Kershaw Knives and some odds and ends. (AZ)
What’s up Gafs! Like the Title says,
Sba4 FDE Brace only with a Lunar Concepts split fix - $85.00
Samson Short Vert Grip - $29.00
2x Kershaw Leek 1660SWBLK - $45.00 each.
New small parts, KAK bolt catch and takedown pins with springs and detents, magpul polymer trigger guard and milspec charging handle - $23.00
Free Kershaw Groove knife w/purchase of Sba4.
All the goods.
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2021.10.24 19:04 Questionsasked987 Is my puppy normal?
Some background. I grew up on a farm where I had (in total) 13 dogs, 5 horses, 3 cats, 4 birds, and a mule. Most dogs at once was 6. I am very experienced with dogs and dog behavior.
However, with my pup, I’m an over-anxious, neurotic mess. Probably because it’s “my first dog” as the person responsible for training, etc.
To the point, he is a rescue puppy from Georgia where he’s got Labrador retriever, hound, and god knows what else in him. We met his litter mates and mother at the rescue and all were friendly, sociable pups. In fact, he was the calmest one! The vet from the rescue said he was a happy, friendly pup who was good with dogs but a little shy at times so needs socialization.
Cue to bringing him home this last Wednesday. He has been fantastic with us. Lovey, cuddly, sleeps through the night in his crate (11pm - 6 or 7am. I was surprised and took him out at 3am the first couple of nights but he refused to get out of his crate and barely peed before going back to bed. Now we’re doing the “if you whine, we’ll take you out, otherwise sleep away), and is generally great.
Some interesting things we’ve seen, and where my questions lay, are that he gave the vet he went to on Friday (2 days after coming home) a little growl and he has exhibited territorial barking at our neighbors dogs (who have both tried to bite me in the past so…. Maybe the pup is on to something).
With the vet, he was fantastic for the first 20min. Lovey with the techs, giving kisses and generally being a happy boy. Then he came to me, sat on my feet, and when the vet came to pick him up, he gave a little growl. The vet then gave him some cheese and he was all good again. She said that that was slightly abnormal but I’m wondering. He was in a new place, with new people, lots of smells, and was clearly tired of it all. Was it that abnormal?
Second is we had his first play date yesterday with a very energetic golden doodle. He was initially skittish and a little growling (no hackles raised though) and we gave him lots of positive reinforcement for 5-10 seconds and he started play growling/biting her. They then played with each other for over an hour and he was utterly fantastic.
Third, he met another dog today in the park and he was initially skittish but, again, after positive reinforcement, was play growling and biting again like a happy pup.
Is my puppy normal? Is he just a rough houser while playing? Is his barking/growling at our neighbors dogs through the fence (hackles are raised so he’s not playing) because he’s scared and still getting used to his new home?
Thanks! I just need an outside look. I’m pretty sure I’m just being a helicopter puppy parent but….
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2021.10.24 19:04 TheAnimeNugget Hmmm, I think I will…
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2021.10.24 19:04 DogNail My medication career depends on you editing and ripping this post apart.
Im a medical student who failed pediatrics after unfortunate miscarriage. It is my fault and I need to argue a point because I'm 0.3 percent away from passing. I do NOT want to repeat this and be forced to look at anymore baby photos. It is traumatizing.
POTENTIAL EMAIL BELOW:
My intentions with this email are not combative/argumentative. I just wanted to follow up incase Im asked in a future clerkship/exam and I could have the appropriate situations to support my statement. I'm also seeking advice for remediation due to a poor grade of 69.3%.
A questions asked on the Pediatrics Exam for the Fall 2021 class was worded similar to the question below:
What is the highest (common) relative risk of developing club foot?
I pulled up several articles spanning in the last twenty years. I was not able to find an article that strictly pointed to smoking as the highest relative risk. Rather the article acknowledges that smoking is a factor of a multifactorial etiology that contributes to the development of clubfoot. Please see below the pertinent information from the publications. I included the articles from which I found the information in-order to be one hundred percent transparent.
Earlier studies found no correlation between smoking and CTEV development. Cardy et. al. had conducted a meta analysis of 785 children with idiopathic CTEV. The authors found that “repots of associates between foot deformities, including CTEV, and maternal smoking during pregnancy are inconsistent” (4). Cardy et. al. “found no evidence of any interaction between family history and maternal (or paternal) smoking” (4). The Candy et.al study was published in 2011 and I think it would be a mistake to exclude smoking as a potential cause of CTEV. Multiple recent studies have concluded that smoking may contribute to the development of CTEV in conjunction with congenital predisposition.
Recently it has been widely accepted that “clubfoot is multifactorial in origin, genetic factors clearly play a central role” (6). A study by Bacino et.al supports the notion that smoking in conjunction with congenital malformation results in higher likelihood of CTEV. The study states that “heritability for clubfoot is estimated at 72%” (1). The same study found that “the concordance of CTEV among monozygotic twins is approximately 33% in comparison to 3% in dizygotic twins” (1). The article does acknowledge that smoking metabolism “were explored by studying SNPs in xenobiotic genes as they may increase susceptibility to clubfoot” and “may contribute to clubfoot”. The article acknowledges that smoking “is a strong environmental factor contributing to CTEV”. Overall, “CTEV is the result of interaction of multiple genes/developmental processes and environmental teratogens”. The article focuses on a multifactorial cause of CTEV rather than strictly smoking. The same sentiment was echoed by Smythe et. al. who’s publication pooled data from 1960-2015 with 13,962,989 children in 20 countries. Smythe et.al recognizes “risk factors such as smoking and maternal diabetes” are associated with CTEV but “a multifactorial etiologic model that involves both environment and genetic factors is likely” (5). A recent study conducted in 2021 looked at the annual number of newborns with congenital clubfoot born in Sicily from 1991 to 2004 with a total of 827 cases. Pavone et. al. demonstrated a total of 26 out of 827 cases in Sicily are linked to maternal smoking. Pavone et. al. data analysis indicated an odds ratio (OR) of 2.0 with smoking and 5.4 with familial history, were found to be independent predictors of clubfoot” (6). Even though the odds ratio is leaning toward a higher incidence of CTEV associated with congenital etiology the study does acknowledge “maternal smoking, and familial history of clubfoot were statistically significant” (6). The proposed etiology of smoking associated with development of CTEV is linked to vascular disruption resulting in fetal hypoxemia. However, smoking has steadily decreased in the last 20 years while congenital malformation associated with CTEV have been stagnant or increasing. A meta data study Bacino et. al. found that “prevalence of smoking during pregnancy decreased from 9.2% in 2010 to 6.9% in 2017” (2). On the other hand, congenital relative incidence has increased. A 19 year cohort study evaluated incidence of trisomy 21, 13, 18. As mentioned in the lecture, trisomy 13 and 18 are associated with development of CTEV. Loane et. al. found “the rise in average maternal age over time has brought with it an increase in the number of pregnancies affected by trisomies 21, 18, 13” (7). In conclusion, incidence of smoking has steadily decreased while maternal age has steadily increased. This leads me to believe that congenital malformation is the main relative risk factor associated with CTEV.
According to NIH congenital refers to a “conditions that are those present from birth” and “birth defects are described as being congenital can be caused by a genetic mutation, an unfavorable environment in the uterus, or combination of both” (8). Based on that definition I selected congenital as a higher relative risk. Considering smoking is only a partial factor of the multifactorial etiology of clubfoot. Much older publications identify zero to minor causation between maternal smoking and development of fetal clubfoot. Later studies Honein et.al. indicates “having a family history of foot anomaly was a strong effect modifier for clubfoot risk but the research found that material smoking in the absence of a positive family history was weak” (9). Current publications acknowledge that smoking is the strongest environmental factor but genetic factors resulting in congenital malformation are “estimated at twenty to twenty-five percent of clubfoot cases are associated with syndromic etiologies (1). Smoking is a strong environmental factor but it is not in isolation. Additional strong factors result in congenital development of clubfoot.
1) Bacino, C. A., & Hecht, J. T. (2014). Etiopathogenesis of equinovarus foot malformations. European Journal of Medical Genetics, 57(8), 473–479. https://doi.org/10.1016/j.ejmg.2014.06.001
2) Azagba, S., Manzione, L., Shan, L., & King, J. (2020, January 23). Trends in smoking during pregnancy by socioeconomic characteristics in the United States, 2010–2017. BMC Pregnancy and Childbirth. Retrieved October 22, 2021, from https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-2748-y.
3) Home. Global Clubfoot Initiative. (n.d.). Retrieved October 22, 2021, from https://globalclubfoot.com/clubfoot/.
4) Cardy, A. H., Sharp, L., Torrance, N., Hennekam, R. C., & Miedzybrodzka, Z. (2011). Is there evidence for aetiologically distinct subgroups of idiopathic congenital talipes equinovarus? A case-only study and Pedigree Analysis. PLoS ONE, 6(4). https://doi.org/10.1371/journal.pone.0017895
5)Smythe, T., Kuper, H., Macleod, D., Foster, A., & Lavy, C. (2017). Birth prevalence of congenital talipes equinovarus in low- and middle-income countries: A systematic review and meta-analysis. Tropical Medicine & International Health, 22(3), 269–285. https://doi.org/10.1111/tmi.12833
6)Pavone, V., Bianca, S., Grosso, G., Pavone, P., Mistretta, A., Longo, M. R., Marino, S., & Sessa, G. (2012, June). CONGENITAL TALIPES EQUINOVARUS: An epidemiological study in Sicily. Acta orthopaedica. Retrieved October 23, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3369158/.
7) Loane, M., Dolk, H., & Morris, J. (2011). Total & livebirth prevalence of down syndrome and other trisomies in Europe 1990-2007: Impact of increasing maternal age, prenatal screening and termination of pregnancy. Pediatric Research, 70, 85–85. https://doi.org/10.1038/pr.2011.310
8)Congenital. Genome.gov. (n.d.). Retrieved October 24, 2021, from https://www.genome.gov/genetics-glossary/Congenital.
9)Dickinson, K. C., Meyer, R. E., & Kotch, J. (2008). Maternal smoking and the risk for Clubfoot in infants. Birth Defects Research Part A: Clinical and Molecular Teratology, 82(2), 86–91. https://doi.org/10.1002/bdra.20417
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2021.10.24 19:04 WorthFickle Need comp Xbox 1 league with lots of users. Willing to pick up an orphan. Need quick sim and very active. Drop discord in comments
2021.10.24 19:04 Lord-Brevon Yeah, I hate those complaints too.
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2021.10.24 19:04 Cinephile94 How do I get this flame?
2021.10.24 19:04 munx_ I'm a really introverted adult and don't have a heap of friends - the friends I do have I have slowly lost touch with because of anxiety. Is it too late to repair my relationships with those people? Is it possible for me to make meaningful friendships as an adult, and how?
I've been feeling increasingly lonely lately. I feel as though I need friends, and I want friends, but I don't know how I go about making friends now that I don't have the crutch of school and the proximity it puts you in with people of similar ages and interests. I also feel as though I'm always the one reaching out to my friends to make things happen, no one tries to make plans with me despite them being keen when I do reach out. Can I change my relationships with my friends to make it more likely that they'll reach out to me for once?
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2021.10.24 19:04 Daniele86 cartolina-aforisma-andy-warhol-15
2021.10.24 19:04 Minimum-Alarm-1648 Day 21 how’re they lookin ?!
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2021.10.24 19:04 Suspicious_Jello9438 HAAS MOMENT
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2021.10.24 19:04 iamthefacetlayer Thought you guys would like a look at this recently retired rig.
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2021.10.24 19:04 HealthyAd6219 22 (yo) need advice
As the title said I'm 22 yo and I want to take advantage of my 20s to improve my skills like time management and planning such as that skills will help me in future to accomplish my goals.
I need advice from experienced people and if you could tell me one goal you are trying to reach to motivate me continuing 😁
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2021.10.24 19:04 KoretheWitch 🥺🥺🥺
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2021.10.24 19:04 Ok_Board9424 The American Shiba Tell a Friend Event ! 8600 Holders Strong
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2021.10.24 19:04 ZachTF My friend shared this with me.
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2021.10.24 19:04 MugShots DPS Alert
2021.10.24 19:04 hayafa Nice
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2021.10.24 19:04 Boo_Randy While the Fed Still Fuels the Fire, the Bank of Russia Throws Shock-and-Awe Rate Hikes at Raging “Persistent” Inflation, But US Inflation Not Far Below Russia’s
I wonder what it would be like to have a responsible central bank that acted to curb inflation and give savers a better return on their bank accounts, instead of Jerome Powell & his gang of counterfeiters and racketeers.
In another shock-and-awe move to douse raging inflation that is making no effort at being transitory, the Bank of Russia raised its policy rate by 75 basis points today, to 7.5%, its sixth rate hike, and the largest hike since the 100-basis-point hike on July 23. And it held the door open for more rate hikes.
“This is a significant increase and, obviously, this is not a fine-tuning exercise,” Bank of Russia Governor Elvira Nabiullina said in her post-meeting statement.
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2021.10.24 19:04 opinionated-dick ‘How can you play on the front foot…. with absolutely no structure to your team?’
No, that’s not a quote about Steve Bruce, but a quote by Ian Wright about Solskjaer.
He’ll be sacked now. And Man Utd will well be in their rights to according to the BBC and many other pundits. Because Man Utd are a big club and deserve an elite manager.
Newcastle fans on the other hands should have been thanking Bruce for the shit he shoved down our throat.
I hate the BBC. Hypocrites
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