Self fish

Without the pursuit of love and happiness, breath is simply the sand of an hourglass pouring away to our time of passing. Love is the reason we are alive. To spend even a moment in misery is a moment wasted. Love is the goal of humanity. Everyone has or will experience love in its many forms over the course of a lifetime. Many, out of ignorance, habit, or sheer desperation, will fall in love with the wrong person. Most of us have or will have that one failed relationship, the one we reflect on as the relationship that taught us the most about who we are, what makes us happy, and what we seek or try to avoid in a mate. Through failure we learn what we can improve about ourselves. We learn that there are no perfect people and to try to make them that way is a losing battle, a never-ending, fruitless effort. Regardless, we will always try. Our happiness is dependent upon our honesty in defining ourselves. That is, if you are not happy, you cannot make yourself so simply by ignoring your own needs and catering to the needs of others. Additionally, you cannot make others happy by projecting your happiness upon them. When we are happy, we are being honest, even if only with ourselves. Unhappiness is wanting. If our needs are not being met, we seek to fulfill them, regardless of the consequences and often at the expense of our relationships and those we care about. In Self Fish, the hero has all that he needs, all except someone to share his life with. He is in search of a companion that he can love and who will love him in return. He is wary, as anyone would be, of welcoming someone into his world. Eventually He finds what he thinks will be a loyal, low-maintenance companion: the fish. We all know that in real life, fish are not a pet that one would typically consider affectionate. You can\u27t touch or pet a fish, and fish do not show loyalty or attachment. They can\u27t coexist in our environment without a substantial investment in special equipment. And, although fish owners insist on naming and assigning personality traits to their beloved aquatic friends, fish have but one facial expression, and are not capable of even simulating emotion. We are nothing to fish but a potential predators or potential prey. The fish character in my film is a metaphor for just this sort of emotional detachment. My fish character does emote; it shows significant discomfort, but does not reciprocate the love the hero has for the fish. It only admires its own reflection. Try as he might to please the fish, the hero cannot convince the fish to love him in return. His love turns to frustration, then to desperation, to resentment, and eventually to hatred. In the end he is helplessly trapped in an unreciprocated relationship where all amenities favor the fish. I have played the role of the main character depicted in my film many times in my life, but, more often than not, I have played the role of the fish. To those for whom I have been a fish, I sincerely apologize for my self-fishness. Please consider this story as an acknowledgement of guilt and an attempt to convey my regret for having treated you so cruelly. It seems one needs to be a fish before he can become a man. One needs to be a man before he can realize he has been a fish

1976: Abilene Christian College Bible Lectures - Full Text

FREEDOM IN CHRIST Being the Abilene Christian College Annual Bible Lectures 1976 Published by ABILENE CHRISTIAN COLLEGE Book Store ACC Station Abilene, Texas 7960

\u3ci\u3eProsopis glandulosa\u3c/i\u3e persistence is facilitated by differential protection of buds during low- and high-energy fires

Rangelands worldwide have experienced significant shifts from grass-dominated to woody-plant dominated states over the past century. In North America, these shifts are largely driven by overgrazing and landscape-scale fire suppression. Such shifts reduce productivity for livestock, can have broad-scale impacts to biodiversity, and are often difficult to reverse. Restoring grass dominance often involves restoring fire as an ecological process. However, many resprouting woody plants persist following disturbance, including fire, by resprouting from protected buds, rendering fire ineffective for reducing resprouting woody plant density. Recent research has shown that extreme fire (high-energy fires during periods of water stress) may reduce resprouting capacity. This previous research did not examine whether high-energy fires alone would be sufficient to cause mortality. We created an experimental framework for assessing the “buds-protection-resources” hypothesis of resprouting persistence under different fire energies. In July–August 2018 we exposed 48 individuals of a dominant resprouting woody plant in the region, honey mesquite (Prosopis glandulosa), to two levels of fire energy (high and low) and root crown exposure (exposed vs unexposed) and evaluated resprouting capacity. We censused basal and epicormic resprouts for two years following treatment. Water stress was moderate for several months leading up to fires but low in subsequent years. Epicormic and basal buds were somewhat protected from lowand high-energy fire. However, epicormic buds were protected in very few mesquites subjected to high-energy fires. High-energy fires decreased survival, caused loss of apical dominance, and left residual dead stems, which may increase chances of mortality from future fires. Basal resprout numbers were reduced by high-energy fires, which may have additional implications for long-term mesquite survival. While the buds, protection, and resources components of resprouter persistence all played a role in resprouting, high-energy fire decreased mesquite survival and reduced resprouting. This suggests that high-energy fires affect persistence mechanisms to different extents than low-energy fires. In addition, high-energy fires during normal rainfall can have negative impacts on resprouting capacity; water stress is not a necessary precursor to honey mesquite mortality from highenergy fire

The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions.

BackgroundIn 2018, the American Association for the Surgery of Trauma (AAST) published revisions to the renal injury grading system to reflect the increased reliance on computed tomography scans and non-operative management of high-grade renal trauma (HGRT). We aimed to evaluate how these revisions will change the grading of HGRT and if it outperforms the original 1989 grading in predicting bleeding control interventions.MethodsData on HGRT were collected from 14 Level-1 trauma centers from 2014 to 2017. Patients with initial computed tomography scans were included. Two radiologists reviewed the scans to regrade the injuries according to the 1989 and 2018 AAST grading systems. Descriptive statistics were used to assess grade reclassifications. Mixed-effect multivariable logistic regression was used to measure the predictive ability of each grading system. The areas under the curves were compared.ResultsOf the 322 injuries included, 27.0% were upgraded, 3.4% were downgraded, and 69.5% remained unchanged. Of the injuries graded as III or lower using the 1989 AAST, 33.5% were upgraded to grade IV using the 2018 AAST. Of the grade V injuries, 58.8% were downgraded using the 2018 AAST. There was no statistically significant difference in the overall areas under the curves between the 2018 and 1989 AAST grading system for predicting bleeding interventions (0.72 vs. 0.68, p = 0.34).ConclusionAbout one third of the injuries previously classified as grade III will be upgraded to grade IV using the 2018 AAST, which adds to the heterogeneity of grade IV injuries. Although the 2018 AAST grading provides more anatomic details on injury patterns and includes important radiologic findings, it did not outperform the 1989 AAST grading in predicting bleeding interventions.Level of evidencePrognostic and Epidemiological Study, level III

A comparison of 2 distal attachment mucosal exposure devices: a noninferiority randomized controlled trial

Background and Aims Endocuff and Endocuff Vision are effective mucosal exposure devices for improving polyp detection during colonoscopy. AmplifEYE is a knock-off device that appears similar to the Endocuff devices but has received minimal clinical testing. Methods We performed a randomized controlled clinical trial using a noninferiority design to compare Endocuff Vision with AmplifEYE. Results The primary endpoint of adenomas per colonoscopy was similar in AmplifEYE at 1.63 (2.83) versus 1.51 (2.29) with Endocuff Vision; p=0.535. The 95% lower confidence limit was 0.88 for ratio of means, establishing noninferiority of AmplifEYE (p=0.008). There was no difference between the arms in mean insertion time, and mean inspection time (withdrawal time minus polypectomy time and time for washing and suctioning) was shorter with AmplifEYE (6.8 minutes vs 6.9 minutes, p=0.042). Conclusions AmplifEYE is noninferior to Endocuff Vision for adenoma detection. The decision of which device to use can be based on cost. Additional comparisons of AmplifEYE to Endocuff by other investigators are warranted

Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy

Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy.BackgroundCritical illness leading to multi-organ dysfunction syndrome (MODS) and associated acute renal failure (ARF) is less common in children compared to adult patients. As a result, many issues plague the pediatric ARF outcome literature, including a relative lack of prospective study, a lack of modality stratification in subject populations and inconsistent controls for patient illness severity in outcome analysis.MethodsWe now report data from the first multicenter study to assess the outcome of pediatric patients with MODS receiving continuous renal replacement therapy (CRRT). One hundred twenty of 157 Registry patients (63 male/57 female) experienced MODS during their course.ResultsOne hundred sixteen patients had complete data available for analysis. The most common causes leading to CRRT were sepsis (N = 47; 39.2%) and cardiogenic shock (N = 24; 20%). Overall survival was 51.7%. Pediatric Risk of Mortality (PRISM 2) score, central venous pressure (CVP), and% fluid overload (%FO) at CRRT initiation were significantly lower for survivors versus nonsurvivors. Multivariate analysis controlling for severity of illness using PRISM 2 at CRRT initiation revealed that%FO was still significantly lower for survivors versus nonsurvivors (P < 0.05) even for patients receiving both mechanical ventilation and vasoactive pressors. We speculate that increased fluid administration from PICU admission to CRRT initiation is an independent risk factor for mortality in pediatric patients with MODS receiving CRRT.ConclusionWe suggest that after initial resuscitative efforts, an increased emphasis should be placed on early initiation of CRRT and inotropic agent use over fluid administration to maintain acceptable blood pressure

Trophic relation model in aquatic communities sockeye salmon model, Wood River Lakes, Alaska

The objective of this study is to develop a mathematical model to relate the production of juvenile sockeye salmon in the Wood River Lake system to parent stock size, primary and secondary production, population size of predators and competitors, and abiotic variables

Impact of a ring fitted cap on insertion time and adenoma detection: a randomized controlled trial

Background and Aims: Devices for flattening colon folds can improve polyp detection at colonoscopy. However, there are few data on the endoscopic ring fitted cap (EndoRings, EndoAid, Caesarea, Israel). We sought to compare adenoma detection with EndoRings with that of standard high-definition colonoscopy. Methods: A single-center randomized controlled trial of 562 patients (284 randomized to EndoRings and 278 to standard colonoscopy) at 2 outpatient endoscopy units in the Indiana University Hospital system. Adenoma detection was the primary outcome measured as adenoma detection rate (ADR) and adenomas per colonoscopy (APC). We also compared sessile serrated polyp detection rate (SSPDR), insertion times, withdrawal times, and ease of passage through the sigmoid colon. Results: EndoRings was superior to standard colonoscopy in terms of APC (1.46 vs 1.06, p=0.025) but there were no statistically significant differences in ADR or SSPDR. Mean withdrawal time (in patients with no polyps) was shorter and insertion time (all patients) was longer in the EndoRings arm by 1.8 minutes and 0.75 minutes, respectively. One provider had significantly higher detection with EndoRings and contributed substantially to the overall results. Conclusions: EndoRings can increase adenoma detection without significant increase in procedure time, but the effect varies between operators. EndoRings slows colonoscope insertion