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Are you in good spirits most of the time? yes/no8. Basal infoldings associated with elongated mi-tochondria are a morphologic specialization associated withreabsorption offluid and electrolytes. Along with cough, he is also experiencingbreathlessness which was initially associated with moderate to severe exertion, but now with evenmild exertion. European RespiratorySociety/American Thoracic Society. A minority of patients still doesnot adequately respond to immunotherapy and becomedisabled

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Moons KG, Kengne AP, Woodward M, Royston P, Vergouwe Y, Altman DG, Grobbee DE.Risk prediction models: I. citizen or a lawfully admitted immigrant with at least 5 years of legal residency. Even though medical professionals like to joke that terminology is like aforeign language (sometimes, yes), don’t throw this book out the window justyet. ( a) UGIS depictsB-I gastroduodenostomy ( arrowheads ). The type of additional tissues resected is dependent onthe type of exenteration buy antabuse pills which is dictated by the size and location of the lesion.

The patient also complains of weakness,marked loss of appetite and significant weight loss for the last … months. The interaction between respiratoryand cardiac function is a complex one with majordifferences occurring under conditions of sponta-neous or positive pressure respiration.

Alternatively, a linear regression could be used# with the outcomemeasure in its original form, but this only measures association and the abilityto predict values of the continuous outcome for individuals and does not pro-vide risk results. The change in blood ?ow pressure and is governed by the differencein the intra-alveolar vessels depends on their between pulmonary arterial and venous pres-position within the different zones of the lung as sures. It takes symptomatic NPHpatients longer than normal to rise from a chair and towalk a short distance. Afterabsorption it is converted to deoxy-5-fluorouridine in theliver and released in blood. They cause marked bronchoconstrictionin guineapigs and in asthmatic patients.

is aware of a claim, the product names appear in initial capital orall capital letters. Osteomyelitis at multiple levels is observed in lessthan 5%. He is probably hyperventilating becauseof the anxiety. Sidransky E, Lopez G (2012) The link between the GBA gene and Parkinsonism. Examples include flour and wooddust; enzymes (e.g. buy antabuse pills from Bacillus subtilis and Aspergillusniger in the detergent industry); dusts from agriculturalwastes; fungi and bacteria in moldy hay, feeds, and woodproducts; and dander, feces, papae, and other residue frominsect and rodent pests. In addition, theuse of fiber supplements or antacids containing alumi-num, magnesium, or calcium can slow absorption. Risk factors forvenous stasis include long periods of standing still buy antabuse pills sitting, orlying down. About 90% of body’s content of 5-HTis localized in the intestines; most of the restis in platelets and brain

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CRP values slowly return to normal over 14–21days in patients without infection [63]. CT-guided fine-needle aspiration invertebral osteomyelitis: true usefulness of a common practice. In theEARLY (Endothelin Antagonist trial in Mildly SymptomaticPulmonary Arterial Hypertension Patients) study, bosentantherapy was evaluated in 168 mildly symptomatic or WHOfunctional II PAH [iPAH, hPAH, PAH associated with CTD,anorexigen use, human immunodeficiency syndrome (HIV), orCHD] patients

In theEARLY (Endothelin Antagonist trial in Mildly SymptomaticPulmonary Arterial Hypertension Patients) study, bosentantherapy was evaluated in 168 mildly symptomatic or WHOfunctional II PAH [iPAH, hPAH, PAH associated with CTD,anorexigen use, human immunodeficiency syndrome (HIV), orCHD] patients. Genetic susceptibility fac-tors have also been proposed (Bhandari et al.2006; Lavoie et al. This isillustrated in Table 10.2 using an example to be covered on page 209.

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I’d like to strangle the asswipe who first added doorbells to commercials. As all dog owners can attest, their pets can’t distinguish a doorbell on TV from one ringing at their own homes. Every time some television delivery person rings a bell, canines throughout the land undoubtedly behave exactly like ours: barking like hell while romping around maniacally.

You’d think the world was ending from the way Prometheus reacts to doorbells. Whenever he hears one, real or simulated, he runs over anyone and anything blocking his path in a mad dash to the front door. I can’t count the number of times I’ve spilled drinks on the couch because the critter bludgeoned my arm in his haste to see who’d come a calling. And the nonstop barking! He may be a little guy, but I could swear he’s caused more damage to my eardrums than all the rock concerts I’ve attended.

According to my wife, the dog’s berserk romps grow even worse when he’s confined on our bed. It’s too high for him to get down on his own, so he can’t obey his instinct to rush toward the door at the sound of a bell. Instead, he complements his barks with frantic leaps across the comforter, including atop Sophia’s head! I’m not usually present when the two of them watch TV in bed together, so I haven’t personally seen him in action, until last night.

Having at last witnessed the dog’s response to a TV doorbell whilst in bed, I can confirm that Sophia didn’t exaggerate his wild behavior. I only wish I’d been farther removed when observing his shenanigans. Unfortunately for me, at the moment the television doorbell announced the arrival of a pizza pie, I happened to be enjoying certain conjugal privileges with my wife. It wasn’t the resultant barking which killed the mood for the rest of the evening, and probably for the foreseeable future as well. Nope; what torpedoed the merest thought of sex was the manic rampage accompanying Prometheus’ barking … over my bare butt cheeks, with nails obviously in need of clipping.

 
 
 
With a product like this, the consequences of TV doorbells may be less severe.

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I ran into my friend Jimmy at the polls this morning. After we cast our votes, he filled me in on the week-long cold shoulder he’s received from his wife. The ridiculous tale had me doubled over with laughter.

The trouble began when Jimmy returned from a hard day at work and found a ham sandwich and pickles awaiting him for dinner. When he testily asked his wife why she hadn’t cooked supper, Melinda told him she’d been too busy.

In hindsight, Jimmy realizes he should’ve kept his mouth shut. He didn’t though. Instead, he snidely commented: “What do you mean, ‘too busy’? You don’t even have a job! 

That got Melinda fired up. She answered: “I have job, asshole!: taking care of your kids, cleaning your house, doing your laundry, cooking your meals, and giving you sex! Only, I don’t get paid for any of it!!!”

Again, in retrospect Jimmy wishes he’d backed off. But he opted to go in the other direction: “Are you kidding me? You get paid for all of it! In case you’ve forgotten, I bring home a paycheck every week and you spend it!”

“So I’m a whore, am I?!!! Well, if I’m a whore, then I’m gonna start acting like one, just you wait and see!”

Jimmy insists he never used the word “whore”; but he also made no attempt to diffuse his wife’s anger. By the next morning, he’d already forgotten the argument. He left for work believing all was right in his world. It wasn’t.

When he returned home that evening, he found a delicious steak dinner awaiting him, along with Melinda’s $20 invoice for cooking it. Beneath that bill, he found another: $800 for one week of daycare, housecleaning, and laundry services.  Melinda seemed dead set on obtaining payment too.

As if the charges for household chores weren’t galling enough, Jimmy found an even greater shock awaiting him in the bedroom that night. Atop his nightstand, he discovered a typed spreadsheet of sexual acts and positions, with price tags attached to each!

A number of potential comebacks came to mind after Jimmy scanned his wife’s list. Of them all, only one seemed capable of eliciting a week-long silent treatment, as well as its accompanying strike concerning all non-child-related services. Naturally, that’s the comment he went with: “You expect me to pay professional rates, for amateur work?”

 
 
 
Just one of the services performed by many a housewife (or stay at home dad), without payment

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At last, I’ve found a productive way to spend time with my mentee. I think so anyway, more or less. At minimum, I can bond with Ernie more effectively now. I’ll also be able to give his imagination a more positive outlet than the cheating and lying to which he usually directs it. I only hope the school’s administrators agree that my method’s upsides outweigh its downsides.

At today’s mentoring session, I learned of Ernie’s fixation with battling teachers. It’s an idea he unfortunately obtained from me, last month, when I inadvertently let my thoughts slip at the book fair. As the boy informed me, he and his friends have spent the intervening days rating the school’s faculty for death matches against each other. The kids have embellished reality too, by envisioning special abilities for all combatants.

I asked Ernie how he and his buddies planned to apply their concept, and he shrugged. That’s when I proposed: “Why don’t you make a game out of it? In fact, why don’t we design it together when I see you each week?” As I suggested, we could put together a map based on the school layout and have the teachers fight for control of the classrooms and hallways. The teachers would have their own avatars on the map board and would move around the board seeking out other faculty members to destroy.  Also, each teacher would have one or more extraordinary powers which Ernie and I would convert into attack and defense values.

He loved the idea and said he had “tons of ideas,” all of which he’d begin sharing next week. In the meantime, he’s already drawn something which I believe will work perfectly as the game’s first avatar. His sketch depicts a giant blob of a creature possessing Tyrannosaurus Rex-like claws, and venomous snakes growing from its head. The monster’s name is “Ms. M” – as in Ms. McDaniel, his teacher.

I first saw Ernie’s sketch when I picked him up from his classroom, before we began discussing the new game. Ms. McDaniel herself showed it to me. As I learned from her, Ernie wouldn’t say exactly what it depicted, but he admitted to obtaining the idea from his mentor. Luckily for me, the lad hadn’t written in the creature’s name below its picture, so I could honestly tell her I had no idea what he meant.

Of course, I now know the subject of Ernie’s drawing, and I’ll no longer be able to claim ignorance if asked further questions about the boy’s doodles. Yet even if Ms. McDaniel doesn’t say another word to me on the subject, I realize it’s only a matter of time until she or some other teacher learns about Ernie’s new game, “Rockem Sockem Teachers,” and his “partner” in the enterprise. That’s when I’ll undoubtedly hear all about the downsides of my mentoring program.

 
 
 
“Ms. M” – though thankfully not yet labeled

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Thanks to my conversation with a client today, I think a mystery has been solved. Our quarterly pest control took place yesterday, and a new guy performed the service. When I asked him where our regular exterminator was, he simply told me he’d be our company representative from now on. I had nothing against the fellow, but I’m comfortable with Wendell and I want him back. Yet when I called the company to make my request, a woman ambiguously informed me that Wendell would no longer service our home.

To say the least, this turn of events puzzled me. I’d last spoken to Wendell a week ago, when he’d scheduled our inspection without indicating a reassignment of his duties. I’d given him another business referral then, and he’d expressed his gratitude — after I assured him that the new customer wasn’t involved in child pornography, like the last one. To further ease his mind, I added that I’d actually met this client and her kids, and they all seemed perfectly normal.

Wendell’s new customer, Carol, is a divorcee with two daughters and a son. Carol had brought them along on her lone visit to my office. And unlike the situation with “Mr. Kiddie Porn,” I’d learned the exact nature of her employment: dispatching for a satellite television provider. 

Carol had met with me a few days after Wendell’s inadvertent brush with law enforcement. In conversation, she happened to mention her need for a new exterminator. I recommended Wendell and told her I’d have him contact her. As I learned today, Wendell arrived Wednesday morning for quarterly pest control. He didn’t stick around though.

In a phone call this morning, Carol explained that she’d opened the front door for Wendell clad only in her bathrobe — which she dropped to the floor after escorting him to the kitchen. There, she attempted to introduce him to her children: her naked twelve, ten, and eight-year-old children. Wendell’s jaw dropped at the sight of Carol in the au natural; but that was nothing compared to his reaction on spotting the trio of pre-pubescent figures. His face turned ashen, and he fled from the premises without uttering a word.

After finishing the tale, Carol asked: “Richard, I don’t get it. Didn’t you tell him the kids and I are nudists?”

As a matter of fact I didn’t, because I hadn’t known. Carol had never revealed that particular tidbit, and she and her kids had been fully clothed the only time I’d seen them.

Without a heads up on the nudist angle, Wendell must’ve received a mighty shock at the sight of the woman and her kids. I can imagine the unpleasant thoughts running through his mind at that moment, especially on the heals of the kiddie porn snafu. Had I been in his shoes, I’m sure I too would no longer wish to service the home of the sociopath who’d referred this customer.

 
 
 
Best accompanied with pajamas … when the exterminator arrives.

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How can a grown man be unsure if he’s allergic to bees? It seems odd to me, yet my friend Ned insists he didn’t find out for certain until a doctor confirmed matters last month. During our conversation last night, he filled me in on the events which led to the revelation.

One unusually hot Saturday in early October, Ned’s wife forced him to bring the family to her nephew’s pee-wee football game. As expected, the gridiron action itself proved distinctly unentertaining. But the boredom factor seemed insignificant compared to the other ills besetting my amigo. A combination of sweat-inducing heat, endless bitching and moaning from his own kids, and a plague of yellowjackets created a perfect storm of misery for Ned. The dangerous insects swarmed so numerously that one concerned father purchased wasp and hornet killer, which he proceeded to spray liberally throughout the vicinity.

Compounding Ned’s unhappiness, midway through the contest he experienced a sudden and absolute urge to use a restroom. Trouble was, the only facilities on hand were a couple of port-o-potties. Under normal circumstances, he wouldn’t set foot in one of those disgusting contraptions, much less sit down there. But he had no choice, so he did his best to disregard the revolting conditions, as well as the appearance of several yellowjackets in the enclosed space.

While perched on the bowl, he suddenly heard the distinct sound of an aerosol can hissing near the port-o-potty. The appearance of the deadly insecticide apparently riled up the tiny interlopers inside the lavatory. According to Ned, they buzzed about furiously for a few seconds and then strafed him. My poor friend got stung several times in the process, including once on his scrotum!

His fear of a possible bee allergy stemmed directly from the severity of the swelling which occurred around the sting sites. Specifically, when his “man berries” began to look more like fuzzy pink grapefruit, he saw a need to obtain prompt medical assistance. It turned out he wasn’t allergic though. As the emergency room physician advised, the swelling Ned experienced, though substantial, fell within the range of normal reaction.

Upon hearing Ned’s tale, I offered him the helpful information I’d gleaned from my exterminator about aggressive bees and wasps: “As I understand it, the critters can smell fear. They attack when they sense a release of pheromones and a panic-induced jump in heart rate. You obviously panicked, because otherwise they wouldn’t have stung you. If only you’d stayed calm.”

Based on his response, I think it’s fair to say Ned didn’t appreciate my educational commentary: “Of course I panicked, jackass! You would’ve too if you’d seen angry bees heading for your balls!”

 
 
 
Thankfully, my friend isn’t allergic to this insect!

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My wife and I argued about art today. The topic arose thanks to a garage sale in our neighborhood.  After Sophia observed someone purchasing a framed print of what appeared to be random paint spatters, she wondered aloud: “How could anyone consider such garbage art?”

The Mrs. believes proper art means easily discernible subjects. Therefore, she isn’t a big fan of abstract painting. In contrast, I hold a more relaxed view. I like what I like, even if I have no idea what the artist intended. When my wife dismissed the legitimacy of the garage sale item, I reminded her: “One man’s crap is another man’s masterpiece, as the ‘Guggenheim incident’ proved.”

Sophia seemed less than impressed. In her opinion, the “Guggenheim incident” didn’t prove a thing, except perhaps that some people have a hard time distinguishing art from non-art. I beg to differ, but I’ll let my readers judge. 

The Guggenheim incident occurred years ago, long before I met my wife. For those who don’t know, the Guggenheim is a famous New York City museum featuring modern and contemporary art among other works. Cylindrical in shape, the building contains an open center surrounded by a continuous sloping walkway spiraling up the interior walls, with works of art displayed along the walkway.  Most importantly, back then the museum contained single user bathrooms within certain columns along the walkway. The bathroom doors had locks and opened outward, but one of those locks must’ve malfunctioned the day I visited.

As I recall, I’d purchased a hot dog and pretzel from a street vendor earlier that afternoon. Either the frankfurter itself or the fixings I’d loaded it with disagreed with me. The food shot through my system faster than Hitler’s blitzkrieg through Poland, and while strolling through the museum I found myself in desperate need of a lavatory. After locating an unoccupied one, I locked the door (so I thought) and sat down to do my business.

I had no chance to reach the doorknob when someone suddenly turned it and flung the door open. Nor could I close the door again from within, after the intruder hastily departed without shutting the door behind him. Perched on the bowl with my pants and underwear at my ankles, I could only cringe helplessly as a stream of passersby viewed what some took to be the museum’s “newest exhibit.” Indeed, after one little boy stopped to stare at me, he actually asked his father: “Daddy. Is that art?”

His father considered carefully before responding: “Son. In this place, you never know.”

 
 
 
The Guggenheim’s interior – Bathrooms not shown

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Perhaps because of her marketing background, my wife will go to almost any length to please customers, my clients included. Unfortunately, her unmatched willingness to kiss ass doesn’t square well with certain other qualities. Sophia tends to be gullible; her culinary tastes don’t extend to exotics; and she retains an urban northerner’s inherent prejudice against all things backwoods. Each of those traits were on display during our dinner with the Williams.

Randy Williams is a client of mine. He and his wife Cindy are native Georgians. Outdoor enthusiasts, they enjoy camping, fishing and hunting. Most importantly, as I recently discovered, they’re shameless practical jokers as well.

Up until a month ago, I’d never met Cindy and never interacted with Randy in a social setting. Sophia hadn’t met or spoken to either of them. That all changed when Randy conveyed an invitation to dinner at their vacation home: a rustic cabin in the North Georgia woods. When he told me our destination, I ill-advisedly confided my wife’s biases.

When Cindy served dinner that night, I felt as shocked as Sophia to hear the entrée’s name: “raccoon stew.” Both of our hosts kept utterly straight faces, and both of them dug in with gusto. In the realm of eating, my attitude’s always been “when in Rome…” So I didn’t hesitate to sample the unusual dish. Surprisingly, I thought raccoon tasted a lot like ordinary beef.

I knew Sophia, unlike me, would be apoplectic at the thought of sampling stewed rodent. Yet, amazingly, she ate some! As I learned that night, her intense desire to please a client overcame her inherent revulsion at the yokels’ choice of provender.

Randy called me the next day to ask how Sophia had enjoyed her “raccoon.” When he cracked up, I realized we’d been had. He admitted that Cindy’s stew contained nothing more than standard pot roast. As he also confided, his wife would sooner starve than actually sample any small animal more exotic than a rabbit. I meant to inform Sophia of the joke; but as often occurs, one thing led to another and I forgot to tell her.

Last night, Randy and Cindy came to our house for dinner. I’d neglected to ask Sophia for her intended menu, so I chuckled as much as our guests when she announced the main course as “squirrel pot pie.” Despite knowing her well, I found her poker face convincing. She stuck to her guns too, insisting that the nutty, chicken-like meat was in fact squirrel.

As soon as our guests departed, I asked Sophia what she’d actually served. Her answer certainly surprised me: “Richard; why was everyone shocked to hear I’d cooked squirrel? After all, Cindy made raccoon for us, so I figured she and Randy would appreciate another backwoods recipe. Was I wrong?”

Ordinarily, I don’t fib to my wife or clients. In this case, however, it looks like white lies will have to do for both. I started last night, when I kept my mouth shut in response to Sophia’s question. And when Randy calls me tomorrow to compliment the Mrs. on her “practical joke,” I plan to agree with him that it was a good one, and leave it at that.

 
 
 
A backwoods delicacy, or so I’ve heard

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I live in an area where a street’s name can change from one intersection to the next, and every other road seems to be called “Peachtree.” For those reasons, I rely heavily on a GPS unit when driving to unfamiliar places. Except, after this morning’s events, I think I’ll need to find a more trustworthy device.

A local judge recently appointed me as guardian ad litem in a child custody battle. In that role, I’m required to evaluate the children and make a custody recommendation based on their best interests.

I’d scheduled my initial home evaluation this morning, at the residence occupied by the current primary custodian. For purposes of today’s tale, I’ll refer to her as “Mrs. Smith.” Since Mrs. Smith lives in an area unfamiliar to me, I relied on my trusty GPS unit for directions.

The annoying GPS lady sent me far from the nearest urban venues, leading me on single lane roads beside farm-dotted landscapes, before finally announcing that I’d arrived at my destination.

When a much older woman than I’d anticipated opened the door, I introduced myself as the “lawyer sent by the Court.” Although she said she didn’t expect my visit, it seemed obvious that she anticipated an evaluation at some point. She basically told me so, despite misphrasing her question: “So, you’re the one who’s going to ‘value’ everything?”

When she asked me where I’d like to begin, I told her: “I’d prefer to see the kids first, if that’s alright. Talking to them will help me determine what’s in their best interest.”

She answered: “I didn’t know their best interest counts for anything, and I don’t see how talking to them will help. But you’re the expert.” She told me the kids were outside and led me there.

Oddly, I couldn’t see or hear any children in her backyard. And while the property was spacious, its grass-covered acreage didn’t seem capable of hiding a child from plain sight. Still, I spotted nothing except a small flock of mini-goats grazing on the lawn.

Puzzled, I queried: “Where’re the kids?”

Equally bewildered, she answered: “They’re right there. Don’t you see ’em?” She pointed toward the goats.

Yep. Those were her “kids.” As I belatedly learned, my crappy GPS unit had directed me to the wrong residence! The woman answering the door hadn’t actually given her name, and I’d wrongly taken her for Mrs. Smith. Equally, she’d mistaken me for an appraiser sent to value the home and its possessions. All she knew was that her lawyer had hired someone as part of the probate process for her late husband’s estate.

Unless I can figure a way to salvage something from today’s “evaluation,” I’ll have wasted an entire morning. If only I could base my report to the judge on my rural observations. Probably not, since the most I could say is: “The kids appear to be well-groomed, well-treated, and well-fed. In fact, I’ve never seen anyone chew his cud more contentedly.”

 
 
 
The kids at play

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In an effort to educate my young mentee, I taught him to speak in a primitive code. Now I hear he’s abused his knowledge. Accordingly, mentoring’s been canceled today.

At the end of last week’s session, Ernie had prattled how he couldn’t wait to tell his friends about our new game, “Rockem Sockem Teachers.” I’d urged caution, advising: “Don’t let your teacher hear you! In fact, why don’t you start speaking Pig Latin so she doesn’t understand your words?”

To my surprise, Ernie had no idea what I meant. He’d never heard of Pig Latin! I explained its rudiments to him: “It’s easy.  All you do is move the first part of every word to the back and add ‘ay’ to it. For example, ‘Rockem Sockem Teachers’ becomes ‘ockemray ockemsay eacherstay.’”

Ernie practiced all the way back to his classroom. In the ensuing week, it would appear that he’s grown fairly proficient in the tongue.

Turns out, Ernie’s teacher already knows about Pig Latin, and how to speak it. She made that clear when I attempted to retrieve Ernie from his classroom today. Apologizing for my wasted trip, she informed me there’ll be no mentoring for the boy this week. As she explained, he has to be disciplined for the coded language he’d imparted to her this morning. She added: “You know, I didn’t think the kids in his generation had even heard of Pig Latin.”

Feeling a tad guilty, I responded: “Far be it from me to question your disciplinary methods, but doesn’t it seem harsh to cancel mentoring simply because Ernie spoke Pig Latin to you?”

“Oh, he’s not getting punished because he spoke Pig Latin. He’s in trouble because of what he used it to say, when I chastised him for interrupting another student.” Leaning closer, she then whispered the offending words in my ear.

I had to admit the punishment did not exceed the crime. Best of all, I no longer felt guilty about my role in the events. I may’ve taught Ernie to speak Pig Latin, but he didn’t learn “uckfay ouyay” from me.

 
 
 
On the internet, there’re translation programs for every language, even Pig Latin.