9/18/2023 0 Comments Cough reflex vs gag reflex nerve![]() ![]() A more worrying statistic is that despite multiple visits to healthcare professionals, only half of patients receive a diagnosis to explain their debilitating symptoms ( Chamberlain et al., 2015). On the other hand, excessive chronic cough causes a major decrement in quality of life and is responsible for a large proportion of health care visits.Ĭhronic Cough (CC) remains one of the most frequent and onerous causes of patient morbidity encountered in healthcare and is estimated to burden 9–12% of the population ( Morice, 2008 Song et al., 2015). Impairment of the cough reflex is associated with aspiration and is a common mode of death in elderly, demented, and neurologically impaired patients. Dysfunction of this reflex may be crudely dichotomized into hypo and hyper-activation. The cough reflex is a vital defense mechanism that allows the body to expel inhaled foreign objects, potential pathogens, and endogenous secretions. ![]() The treatment and prevention of loss of the cough reflex, which has been largely neglected, is also discussed as novel low-cost interventions could help prevent a number of hospital and domiciliary deaths from both acute and chronic aspiration. We detail the physiological and pharmacological mechanisms involved in cough, and how the recent development of P2X3 receptor antagonists may lead to the first pharmaceutical agent licensed for chronic cough. In this review we discuss both hyper- and hypo-activation of the cough reflex and how airway reflux and chronic aspiration may be involved in the aetiology and sequalae of both disease states. In contrast, loss of normal functioning of the cough reflex is the cause of a significant proportion of mortality in the elderly, primarily through the development of aspiration pneumonia. Continual aberrant activation of the cough reflex, also known as chronic cough, can cause great detriment to quality of life and many of these patients are left misdiagnosed and undertreated. Similar to ancient Roman deity Janus, it often presents with one of two opposing “faces”. In clinical practice, we commonly face adversity when encountering dysfunction of the cough reflex.
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9/18/2023 0 Comments 40k space dreadnought ships pc![]() The years between 19 would see a frenzy of Dreadnought construction, ultimately leading to mile-long formations of Dreadnoughts in keel line affronting each other in the few larger sea battles of WWI.Ī clipper ship built in 1853 in Newburyport, Massachusetts. three knots more than usual) and less vibration. It was also turbine-powered, which meant higher speed (21 knots, i.e. Unlike ships-of-the-line before, which had a mix of many cannon of different calibers mounted in turrets all over the ship, with usually only four guns (the "main battery") being of the heaviest caliber, the Dreadnought had a main battery of ten 305 mm (12 inch) guns. ![]() Now, what was so special about the Dreadnought? It was the first "all big gun battleship". This German decision ultimately caused World War I. The German Empire realised that in the ensuing arms race, they stood a chance of overtaking Britain and, for the first time, becoming the leading naval power in the world. By building the Dreadnought, the British navy essentially forced all navies in the world to upgrade their fleets (this was much like an MS Office release). Building new ones could upset the international balance of powers. Their numbers were carefully regulated by written and/or unwritten treaties. "Dreadnought" quickly became the type name for all ships of her kind all older capital ships were soon to be called "pre-Dreadnoughts".īefore World War I, ships-of-the-line were what ICBMs are today: the biggest and meanest weapon system of all. It completely revolutionised warfare and rendered obsolete most if not all capital warships of the time. The launch of the British ship-of-the-line HMS Dreadnought, in 1906, was an event comparable to the first detonation of an atomic bomb in 1945. ![]() 9/18/2023 0 Comments Junk turret 7 days to die mods![]() ![]() Archers get explosive and flaming arrows/bolts. Hunting and Marksman Rifles can pierce even more enemies with AP rounds. Duckbill Choke shotguns can hit many enemies at once and shotguns also get slugs and explosive rounds. Armor piercing hits multiple targets and does about 15% increased damage to armored enemies. Hollow points do about 20% increased damage to non-armor. ![]() No access to specialized ammo types means turrets lose even more ground compared to other specializations. Unless you are really on the ball then Junk Turrets are unusuable against hordes with Demolishers. 2 fully modded turrets with 5/5 turrets syndrome take a Demolisher down to 50% at best before he booms. Just a few stray shots from an AK can completely destroy the full durability of a quality 6 Junk Turret.Įdited in after testing Junk Turrets will set off Demolisher's C4 charge. Combination of low DPS and single target damage makes this an exceptionally poor weapon vs anything more than 5 zombies.Įdited in after testing Junk Turrets can be damaged after the last update.Very low baseline DPS compared to all other ranged weapons.Can place multiple in a "breadcrumb" like fashion, which you can kite enemies over.Ammo is only iron, so you can always get more pretty easily.Zombie beats on door, you walk close to door to activate turret, turret kills zombie. Putting one outside your door can be nice at the right distance. Range activation happens regardless of LOS.Spare Turrets can be placed around you base, giving you early game sentries to help keep you safe while you farm.Noise warning alerts you to things sneaking up on you.Watches your back like the faithful metal buddy it is.Great stun/knockdown on single targets.Automated killing of weak to medium zombies.So Junk Turret is fantastic for clearing POIs early game, but as you get later game stage and you start facing more and tougher zombies junk turret starts to fall off alot even if you spec into it. Only one post per Let's Play series (This rule includes livestreams, such as on Twitch and YouTube Gaming).Do not advertise your server more than once per month.No Spamming the same message in multiple threads.If you feel you have been unfairly banned, message the moderators to discuss it. We ban people, not accounts if you evade bans, you will be banned again.Please refrain from misogyny, misandry, racism, homophobia or any other form of discrimination.Please contact a mod if your post accidentally got stuck in the spam filter!.If you've gotten the image from another subreddit, mark it as x-post.Promotion of piracy is prohibited here.The rules of reddit are always in effect do not dox users or post information that can lead to doxx do not call for brigades or witchhunts against subreddits or users do not post child pornography etc. ![]() 9/18/2023 0 Comments Spider solitaire arkadium 2 suits![]() While playing try to plan several moves in advance. To avoid that, prepare your mind to be in the game and only in the game. You will have to find a way to solve those locks that will unlock more tiles, giving you more moves to make.Īt first, it might look like it's going to be an easy game to play, but if you are not focusing and concentrating enough, you can get stuck in a few moves. Some of the matching tiles are going to be stacked upon each other. That's why it’s of greater importance to recognize the locks. Even if you reshuffle, sometimes you won't be able to match tiles. For example, eliminating only the top tiles is not a good idea because the other tiles will remain covered, and you can lose the game. The strategy while playing is to remove matching tiles while opening new possibilities to match. This game requires thinking, concentration, and planning. Any of those combinations will be accepted as a pair because there is only one of each. When you are playing, the only suit tiles that don't need to be matched are the Flowers and Seasons. In Mahjong, just like with playing cards, the tiles have suits: Character, Dot, Season, Dragon, Wind, and Flower. Also, you shouldn't have any other tile covering them. The tiles that you can pair need to be open from the left or right. ![]() If there are no more moves left, in some versions, you can reshuffle the tiles, often a maximum of 5 times per game. Only the tiles you can see can be paired, which means that first you need to pair the visible ones on the top and sides. ![]() The game's goal is to remove the tiles from the playing area by matching identical tiles. With our Mahjong game, you can:įrequently Asked Questions (FAQs) How do you play Mahjong? ![]() 9/18/2023 0 Comments Cashew plant photos![]() ![]() Coming into contact with urushiol can cause itching, blisters, and skin rashes. The drupe first develops on the tree and. Please Note: Cashews themselves aren’t toxic, but they are surrounded by a shell that consists of the toxic oil urushiol. The true fruit of the cashew tree is a kidney or boxing-gloveshaped drupe that grows at the end of the cashew apple. They are self-fertile, prefer full to partial sun, and are fast growing. Flowers Fruits Trees Vegetables Spices Basketry Colorants A to Z Index Reports by FLAAR Mesoamerica on Flora & Fauna of Parque Nacional Yaxha Nakum Naranjo Peten, Guatemala, Central America Share News Feeds: Cashew (maraon), Anacardium occidentale L. Mature Cashew Trees will reach a height of 12 feet, and a width of about 15 feet. You can also grow a Cashew Tree in a container if you are limited on space, or live in Zones 4 to 11. Technically, the cashew nut itself is the tree's fruit, so the fleshy cashew 'apple' is merely a byproduct. Turns out, each and every cashew nut grows attached to a 'false fruit,' the red, apple-esque object in the photo above. With care you can also harvest your own Cashew Nuts from the Cashew Tree.Ĭashew Trees can be grown in the ground in USDA Zones 9 to 11. Tier Und Naturfotografie J und C Sohns via Getty Images BRB, questioning everything. The bright red, juicy Cashew Apples are sweet and edible. The Cashew Apple, which appears above each Cashew Nut, is actually the swollen stem end of the branch where each nut grows. Most nuts are simply tree seeds, but Cashew Nuts are the seed and the fruit. The Cashew, more than any other widely consumed nut, is far more than it appears. ![]() HappyGrow Growing System – Never Re-Pot Your TreeĬashew Trees are extremely easy to grow, but that is where the straightforward nature of this unique tree ends. ![]() 9/17/2023 0 Comments Subchondral sclerosis![]() ![]() The base of the thumb (first carpometacarpal joint) is frequently involved in OA and can even become swollen and may be mistaken for wrist involvement. Hands can be involved, particularly the distal and proximal interphalangeal joints where bony enlargements can become quite dramatic and are referred to as Heberden’s and Bouchard’s nodes. Knees and hips are common sites (because they are weight-bearing joints). The distribution of joint involvement in OA is important as well. Notably absent in OA is the boggy synovitis seen in inflammatory arthritis (such as rheumatoid arthritis) or the intense, hot inflammation of crystalline arthropathies. Tenderness on palpation at the joint line and pain on passive motion are also common, although not unique to OA. SIGNS / EXAM FINDINGS: Physical findings in osteoarthritic joints include bony enlargement, crepitus, cool effusions, and decreased range of motion.Patients have pain which is generally worse at the end of the day compared to the beginning (because symptoms become worse with use / activity). Stiffness in the morning or following inactivity (“gel phenomenon”) rarely exceeds 30 minutes. Weight bearing joints may “lock” or “give way” due to internal derangement that is a consequence of advanced disease. SYMPTOMS: Patients with early disease experience localized joint pain that worsens with activity and is relieved by rest, while those with severe disease may have pain at rest.The American College of Rheumatology has set forth classification criteria to aid in the identification of patients with symptomatic OA that include, but do not rely solely on, radiographic findings. doi:10.OA is diagnosed by a triad of typical symptoms, physical findings and radiographic changes. MRI in osteoarthritis of the hip: gradations of severity. Li KC, Higgs J, Aisen AM, Buckwalter KA, Martel W, McCune WJ. OARSI Clinical Trials Recommendations: Hip imaging in clinical trials in osteoarthritis. Gold GE, Cicuttini F, Crema MD, Eckstein F, Guermazi A, Kijowski R, Link TM, Maheu E, Martel-Pelletier J, Miller CG, Pelletier JP, Peterfy CG, Potter HG, Roemer FW, Hunter DJ. Radiographic evaluation of osteoarthritis of the hip: an inter-observer study of 61 hips treated for late-detected developmental hip dislocation. (2018) Journal of hip preservation surgery. Influence of Tönnis grade on outcomes of arthroscopy for FAI in athletes: a comparative analysis. (2018) Clinical orthopaedics and related research. Classifications in Brief: Tönnis Classification of Hip Osteoarthritis. Atlas of standard radiographs of arthritis" UNESCO and WHO rapidly destructive osteoarthritis of the hip.grade 4: above criteria plus femoral head deformity.grade 3: criteria of grade 1 and 2 plus indistinct zone between femoral head and acetabulum subchondral signal loss due to bone sclerosis.grade 2: inhomogeneity with areas of high signal intensity in articular cartilage (T2WI) indistinct trabeculae or signal intensity loss in femoral head and neck (T1WI).grade 1: inhomogeneous high signal intensity in cartilage (T2WI).grade 5: femoral head deformity plus three of the above mentioned radiographic features.grade 4: three of the above mentioned radiographic features.grade 3: two of the above mentioned radiographic features.The Croft score uses different compositions of the following features for the grading of hip osteoarthritis: osteophytes, joint space narrowing, subchondral sclerosis, subchondral cysts 4,5. grade 3: severe joint space narrowing or obliteration, large subchondral cysts, severe deformity of the femoral head.grade 2: moderate joint space narrowing, small subchondral cysts of the femoral head and/or acetabulum, moderate loss of sphericity of the femoral head.grade 1: minor joint space narrowing, subchondral sclerosis of the femoral head and/or acetabulum, small osteophytes.The original Tönnis classification consists of three degrees of degenerative changes featuring osteoarthritis of the hip. Tönnis classification for osteoarthritis of the hip grade 4: gross loss of joint space with above features plus large osteophytes and increased deformity of the femoral head and acetabulum.grade 3: marked joint space narrowing, small osteophytes, some sclerosis and cyst formation and deformity of femoral head and acetabulum.grade 2: definite joint space narrowing, defined osteophytes and some sclerosis, especially in the acetabular region.grade 1: possible joint space narrowing and subtle osteophytes.Classification Plain radiographĭifferent grading schemes are described for plain radiographs of the hip: Osteoarthritis of the hip can be graded according to its severity. ![]() ![]() ![]() The following year publishes his most famous work: The portrait of Dorian Gray. The same year in which it publishes his first tests and Portrait of Mr. Although he would leave the direction of the magazine in 1889. Wilde would publish some of his first stories in this magazine. In fact, it is the same Oscar Wilde who suggests changing the name, because although at the beginning the magazine made publications of fashion items, home decoration and an occasional fiction of pink gender, what the magazine was looking for was vindicate the emerging role of women who were already being educated and had a role in the world. In 1887, Wilde would start directing The Woman’s World magazine, formerly called The Lady’s World. That is what the world calls a romance.” ― Oscar Wilde, The Picture of Dorian Gray “When one is in love, one always begins by deceiving one’s self, and one always ends by deceiving others. The following year the first of his sons, Cyril, was born and in 1886 his second son, Vyvyan. While in London he would meet Constance Lloyd, with whom he would get married on May 29, 1884. Thus began a series of conferences in England, France, and the United States. Because of this, Wilde left Ireland to return in the future only twice due to job issues. However, she preferred Bram Stoker, with whom she would marry in 1878. This book had an incredible reception in both the critics and the public because in a few weeks they managed to sell four editions.īack in Dublin, Wilde would fall in love with Florence Balcombe. In 1874, he would receive a scholarship with which he could enter the Magdalen College in Oxford, an institution from which he would obtain the title of Bachelor of Arts in 1878 with honors.Īlthough it is true that during his time at Trinity College he had already published in magazines such as Dublin University Magazine and Kottabos, and had won the Oxford Newdigate Prize in Oxford for his poem Ravenna, it was not until 1881 when he would publish Poems, his first book. Mahaffy, he would receive the most important prize of his Faculty, the Berkeley gold medal, for his work The social life in Greece. After high school, he would enter Trinity College in which, three years later, and thanks to the advice of J. Oscar would study at the Portora Royal School in Enniskillen between 1864 to 1871. He received education in his home until the age of nine, in which he demonstrated an ease in learning German and French. Oscar was the second of three children of one of the most important families of the Anglo-Irish society from the city of Dublin. Son of Sir William Wilde, Ireland’s most famous surgeon in Ophthalmology and Otology, and Jane Wilde, a sympathizer poet of Irish Nationalism. In addition to the controversies that caused his sexual orientation at that time. He was a well-known writer for his short stories, his essays, and his novel The Portrait of Dorian Gray. Oscar Wilde was born in Dublin, Ireland, on October 16, 1854, and died in Paris, France, on November 30, 1900. ![]() 9/17/2023 0 Comments Sparklers for wedding![]() These retailers must be certified by the North Carolina Department of Insurance’s Office of State Fire Marshal to sell Consumer Fireworks legally. Where Can You Purchase Fireworks in North Carolina?įireworks can only be purchased in North Carolina from licensed retailers. Additionally, any fireworks that explode or leave the ground are also prohibited for general public use. It’s essential to note that fireworks such as firecrackers, M-80s, and cherry bombs are illegal in North Carolina. The law also allows for the use of certain aerial fireworks, such as Roman candles and bottle rockets, but only if they comply with specific size and packaging requirements. These include sparklers, fountains, smoke devices, and novelties such as party poppers and snappers. In North Carolina, only certain types of Consumer Fireworks are legal for use by the general public. What Types of Fireworks are Legal in North Carolina? The office is responsible for issuing permits for professional fireworks displays and ensuring that all fireworks sold to the public comply with state law. The North Carolina Fireworks Safety Act is enforced by the North Carolina Department of Insurance’s Office of State Fire Marshal. Display Fireworks are those used by professionals for public displays, while Consumer Fireworks are those sold to the general public for personal use. The law classifies fireworks into two categories – Display Fireworks and Consumer Fireworks. North Carolina’s Fireworks Safety Act regulates the use, storage, and sale of all types of fireworks in the state. Overview of North Carolina’s Firework Laws and Regulations This comprehensive guide will provide you with everything you need to know about North Carolina’s fireworks laws and regulations, from what types of fireworks are legal to use to where you can purchase them, and how to use them safely. However, the laws surrounding fireworks in the state are not as straightforward as you might think. North Carolina Firework Laws and Regulationsįireworks have become synonymous with celebration, and North Carolina is no exception. ![]() Whether you live in Asheville, Charlotte, Raleigh, Winston-Salem or any other city in North Carolina, the best wedding sparkers in the state can be found at Direct Sparklers. Wedding sparklers provide easy distribution and cleanup.Instant crowd pleaser and make for stunning wedding photography.Available in a variety of lengths offering different burn times.Our #10 gold wedding sparklers, #20 gold wedding sparklers, #36 gold wedding sparklers and heart shaped sparklers give your special event the glitz and glamour in a safe and fun way. We provide North Carolina with premium wedding sparklers at affordable prices. At Direct Sparklers, we have the very best in wedding sparklers to make your wedding send-off one that’ll be remembered for a lifetime. From the wedding ceremony and dinner reception to the wedding grand finale, everything about your wedding should be exclusive and elegant. Your wedding day will be one of the most important moments in your life. ![]() 9/17/2023 0 Comments Facebook cover psd free![]() ![]() Ten More Free PSD Templates – Update Your Facebook Cover Photo.10 Free Facebook Timeline Cover Photo Photoshop PSD Template Sources.More Social Media 101 Timeline Cover Photo Articles: Gimp and Paint.Net are two other free alternatives to Photoshop. Don’t own Photoshop? Use online photo editor Pixlr to open and edit PSD files.Facebook’s photo compression is brutal, so save your finished design as a high quality png.Rick’s Tips for Editing Photoshop PSD Templates Decurz Design shares a fun bulletin board design that you can personalize to reflect your latest news and photos. Free PSD File Velvet Facebook Cover Template PSD features a beautiful designed organic background for your favorite photos.ġ0. The text is fully editable so you can customize the writing on the blackboard.Ĩ. DuckFiles blackboard template is perfect for fall back to school. This is a perfect time to use a sepia action or style on your photos.ĩ. My Digital Backgrounds free template is a beautiful blend of organic design with hand drawn frames. If that wasn’t generous enough, Jeff also has included 10 photo templates perfectly sized for posting on your Timeline.ħ. JHDoffers 23 free Photoshop Facebook collage templates for you to choose from. We love the use of the small photos to show close ups of flowers encountered on the trail.Ħ. Our favorite showcases a large full width photo with three small photos. Photodex has created two free PSD templates. Follow their design cue to making a group of photos harmonious by converting your photos to black and white.ĥ. PremiumCoding has designed a stylish 5 photo layout that is perfect for everything from business to weddings. ![]() We love her use of one section solid with text in the design example for the three photo collage template.Ĥ. Florabella shares three vintage frame templates and two collage Facebook Timeline cover photo templates. We’ve designed a free Facebook Timeline Cover Photo PSD Template inspired by rainy Portland Oregon days and the Duckfiles free Rainy Day Pattern.ģ. Download Artizon Digital’s Free Rainy Day template. Use the bonus marketing board to template to create a fun photo for a Halloween post.Ģ. Birdesign with Halloween just around the corner you will love this holiday cover photo template. 10 Free Facebook Timeline Cover Photo Template Sources and Our Downloadġ. I don’t quilt but love to create so I did a free cover photo template for you based rain drops. Each shop was participating in the Row by Row Experience by offering a custom quilting pattern they had created based of this year’s theme of water. I recently visited dozens of quilting shops with my quilter friend, Katie. I even got into the creative grove and put together a free template for based on our lovely Oregon rainy days. Just drag-and-drop your favorite photos into the template, change up the text and you have created your new personalized cover photo. We have gathered them from all over the web for you to choose from.Ĭreating a cover photo for your personal Timeline or Facebook business page is a snap. Make a successful choice!įree Fonts Download Links contained into the readme file.Check out our new collection of 10 great free Facebook Cover Photo Photoshop PSD templates. You are free to download this PSD template and modify it the way you wish. The template is fully layered and well organized. It was created exclusively for our website. This Free Construction Facebook Cover can be good for implementing a lot of designers ideas as well.Įnjoy this Facebook Cover from Free-PSD-Templates and follow us on Facebook! Use Photoshop to make all the customizations: Get Photoshop as part of a Creative Cloud single-app plan for just US$19.99/mo. Using this Free Construction Facebook Cover you can easily create a business page for your constructive business on Facebook in order to communicate with your current customers and keep them updated about your company. There are a lot of potential clients on Facebook and Twitter. Being present on social media is a must for any brand. ![]() ![]() ![]() “If we had the chance to do it all again, tell me, would we…?” sings Knight, which prompts someone in the audience to instantly fire back, “Hell, yes!”Īt Birmingham Symphony Hall, 19 June, then touring until 30 June. Watch the complete broadcast, featuring performances by Patti LaBelle, Ariana DeBose, Anna Deavere Smith, and more, by. There’s a lovely moment during The Way We Were. The 45th Annual Kennedy Center Honors aired December 28 at 8 PM ET on CBS. Knight has enough treasure in her own catalogue, and her touching delivery of the Jim Weatherly-penned Neither One of Us (Wants to Be the First to Say Goodbye), about a couple “living a lie”, brings the house down. Signature hit Midnight Train to Georgia, unaffected by rail disputes, has a sprightly new arrangement.Īn audience singalong of Hey Jude marks Paul McCartney’s birthday, although the show could perhaps lose the similar treatment of Queen’s We Are the Champions. M-People surely cribbed from 1978’s Come Back and Finish What You Started, while 1989’s Licence to Kill is a stellar Bond theme. ![]() Gladys Knight and the Pips also recorded I Heard It Through the Grapevine before her friend Marvin Gaye, while You’re the Best Thing That Ever Happened to Me and Baby Don’t Change Your Mind epitomise slinky, pre-disco 70s soul. ![]() The 1969 Motown single The Nitty Gritty segues into the Jackson 5’s Shake Your Body (Down to the Ground) – it was Knight, after all, who urged the label to sign them. “She’s incredible,” mutters the lady to my left, while numerous others film whole songs on their phones. “You may not know me personally but you’re all my friends,” she tells us. Few performers have such a warm rapport with their audience. Gladys Knight is currently touring across 1 country and has 10 upcoming concerts. ![]() |
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