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If you want to watch Tyrant Season 2 Episode 3 Faith free episodes withal and high quality commercial the right website. Watch Tyrant Season 2 Episode 3 Faith and different scenes in amazing streaming free of charge. Stream Tyrant Season 2 Episode 3 Faith on the web. Taking after the resistance's assault on the public interview, Tariq dispatches sarin gas at a town to smoke out radicals, leaving Jamal and the Royal Family to manage the outcomes and make a concealment. Barry winds up in a Bedouin town (the same town at this very moment) and battles to keep his actual character a mystery, while stateside, Molly keeps on managing the transactions of Barry's bequest and finds Sammy has an extensive legacy.
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Community College of Aurora sororities
Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
Get the facts about Community College of Aurora sororities, and registering for elective lectures and seminars. As a student, your first stop should be the registrar's office, where you can pick up a free copy of both the academic calendar and course catalog, in order to find available credit classes that you may be interested in taking. Then get a copy of the schedule of classes, so you can plan a workable weekly schedule for yourself. Finally, check with your major department for assistance with prerequisites, tuition payment deadlines, and Community College of Aurora student life information. Please use the form above to request admissions info for Community College of Aurora.
If you decide to rush a fraternity or join a sorority, there are several factors you should take into account before you get overwhelmed by all the attention they are giving you. The brothers or sisters have their own agenda, and need to fill up the house with a new pledge class every year. Look at the clothes everyone is wearing, and especially their shoes. Are these the same clothes and shoes that you always wear? How do people talk? Do they make sense to you, and seem like the same crowd of friends you left back home?
Nobody wants to feel left out, so you may find yourself spending money you can't afford, and focusing more on fitting into your fraternity or sorority house, than concentrating on doing well in college. Alternatively, if you fit right in, the frats and sororities can be a great place to spend you college career, making life-long friendships, and having the time of your life. Beyond consideration for Community College of Aurora sororities, you may think about Northwest Mississippi Community College grade changes for complementary electives to your primary course of study.
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If I would have to write a letter to a 100 fictional characters, it would be CHANDLER BING, over and over again. Okay, give me the opportunity to first introduce him to all of you (stand this, friends lovers) Chandler Bing is a character of the all time famous TV series "FRIENDS". This man you…
Category: fun
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He's the king, what he fears is loss of his throne. If he survives, I get killed later to bury his top secret of priest's assassination order from him.
Best Indian Jugaad
Indians are way out of anyone's league. When it comes to our benefits, or the level of intelligence we show is not to be compared with any other individual of any other nation. Here are some damn cool Jugaads which you'll find nowhere else but INDIA. 2 in 1 Lock Who needs 2 coolers when…
What's going on in a guy's mind while hugging a girl?
A hell lot of crap. Believe me, there's a lot more going inside our heads that too, when hugs are so uncommon and overrated in India. A little insight of it is what I've mentioned below. (In view of hugging a close female friend/ a lover) Should I stoop down a bit more to hug…
What are the best ever Rahul Gandhi trolls?
Since the moment Rahul Gandhi has stepped into politics, he only has faced trolls and nothing else. Some of the funny memes I found on internet are here. Enjoy them. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Funny right?
My 15 School Classmates
School times are what we as a whole love to recall. Regardless of what is it about, it generally conveys back recollections which are unparalleled to some lovely parts of our pasts. Indeed, even the most noticeably awful of the gathering photos are apparently the best ones on the planet Earth now. The Class Photographs…
Can I kill an attacking wolf with just my bare hands?
The fact that you're sweating like a pig till now because of tiredness and high adrenaline levels in your body makes you more vulnerable to get caught. Your heavy breathing, the increased temperatures in your surroundings is more than enough to know your location. It will sooner or a little later than sooner hunt you down. Hunt you down for never to hide again.
Best Wishes
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An Engineer's life is full of ups and downs and they really don't know a possible way to improve upon it, don't know whether they really want to improve upon their conditions or not.
Engineering Ka Punchnama
Engineering……. sounds like the heaviest word on Earth. It's undoubtedly true that an engineer is the only person who has all kinds of possible 'Jugad' in this world.


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Using Unit Supply System (Manual Procedures)
This revision–
o Revises and changes COMSEC procedures throughout.
o Changes the address for submission of requests for clarification (para 1-6).
o Lists requirements to be included in Requests for Deviation (para 1-6).
o Excludes USAR units from submitting reports of supply constraints for unfinanced requirements, if the requirements have already been identified through budget submissions (para 1-8).
o Adds new information to show new time standards for requisitions with a specific RDD (table 2-2).
o Deletes instructions for requesting Modifications Work Orders (para 2-13).
o Changes the address for source of COMSEC materiel (througout).
o Adds status listings to the due-in status files (para 2-21).
o Allows the unit commanders' next higher headquarters to authorize turn-in or transfer of property no longer needed or authorized by VTAADS (para 3-5).
o Adds procedures for transfer of property among Army components (paras 3-14 and 3-15).
o Explains the procedure for the turn-in of IMPE equipment when instructed by the Software Management Support Department (SMSD) (para 3-15).
o Deletes the requirements to account for commissary store equipment (para 4-1).
o Adds the requirement to account for property that has been donated to the Army (para 4-1v).
o Adds the requirement to account for all abandoned property that is under the control of the Army (4-1w).
o Adds the requirement for "other on hand items" not otherwise authorized by paragraph 4-1 (para 4-2).
o Explains when the commander's assumption of command orders are used in lieu of the PBO appointment memorandum (para 4-4).
o Requires units to continue to report changes under CBS-X throughout wartime (para 4-28a).
o Changes the U.S. Army Central Vehicle Registry maintained by USAMC from MRSA to LOGSA (para 4-28).
o Explains how to account for support items authorized separately in authorization documents (para 4-35).
o Explains exemptions from property book accountability for copiers leased under a "cost per copy" contract (para 4-39).
o Changes requirements in accountability for the property book level accountable officer's statement (para 5-2).
o Adds procedures for loans of equipment among Army components (para 5-4).
o Deletes all reference to DD Form 1131 throughout.
o Adds procedures for loans of ARNG and USAR equipment (para 5-5).
o Lists class of supplies authorized under operational loads (para 7-1a(2)).
o Deletes definition of combat prescribed loads (para 7-1a(4)).
o Changes listed USAMC activities from USACDA/MRSA to LOGSA (chap 8).
o Clarifies the term Initial Mandatory Parts List (IMPL) (chap 8).
o Changes the prescribed number of days for the ARNG (para 8-1a).
o Adds the due-in status file to the PLL records (para 8-1g).
o Changes repair parts stockage codes at organizational level that agree with codes used at the SSA.
o Revises figures 8-3, 8-4, and 8-5 to shown new stockage codes.
o Adds figure 8-6 to show a sample of an Initial Mandatory Parts List.
o Specifies the number of DA Forms 3645/3645-1 copies required for USAR OCIE transactions (para 10-6a).
o Specifies what items can be summarized in the ARNG/USAR (para 10-7a).
o Authorizes the unit commander in the USAR, the issue of camouflage maternity uniforms (para 10-9a).
o Explains procedures for transfer of AAFA/AASF/AVCRAD OCIE issued to individuals in the event of mobilization (para 10-21c (3)).
o Changes office authority for ammunition procedures in chapter 11.
o Changes the date of the monthly POL inventory (para 12-21c).


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Frame Drumming on the West Australian coast.
A clip Sacha Fawkes shot on our trip down the Western Australian coastline 2012. I am almost finished my first year of the Master of Teaching course I am completing. More news on recordings, performances and workshops soon!
new release
Take a listen to my new ambient, piano, spoken word piece 'sound of everything' HERE
'The Sound of Everything'
'The Sound of Everything' installation/performance as part of my Artist in Residence at Thirning Villa: Sydney.
Thanks to Ruth Allen for the gorgeous back drop of 'permeable' and for the resonating vessels. Thanks also to the team of image makers. Nina Kourea, Suzie Wix, Selwyn Hunt and Carolyn Nowaczyk Film edited and sound by Me- M.Loucataris. For more information on my residency and on the project – see a number of posts below as well as my residency blog http://artistinresidencashfield.blogspot.com
The Sound of Everything
an ongoing project
music, dance, film, installation, sound design
creating spaces to trans – form in
7.30 pm : 24th of March : Thirning Villa : Ashfield, Sydney
sound- form- movement
ancient traditions – new technologies
improvisation – consciousness – integration
creative collaboration – shared visions- collective action
Phase 1 : installation mode : a number of different spaces will be set up with sound and vision- One of these will incorporate live sound and vision making featuring resonating vessels made by key collaborator installation/glass artist Ruth Allen.
Phase 2 : performance mode : the performance of a number of my songs and a piano piece, with accompanying projected images and special guest musicians, including the wonderful Noah Hampson and Kevin White.
Phase 3 : improvisation/ jam mode : with as many of my improvising collaborators who are in the mood : )
Read more on the project HERE
Betwixt : New album released
A compilation of instrumental works created for theatre, dance, film and installation works 2000-2010. Listen and buy from Bandcamp : ) Cleaning out the sonic cupboard feels good : )
I am Artist in Residence @ Thirning Villa
For more photos of Thirning Villa check out my Flikr sit here.
I am artist in Residence through Ashfield Council in Sydney at the historic house Thirning Villa until the end of March. If you have ever had a desire to chew the fat with me about art, music, dance, what it means to be an artist. If you have ever wanted to sing, dance, play and create in response to ideas about the relationship between sound, form and movement. If you are interested in improvisation, collaboration, performance as emergent epistemologies, traditional eastern performance modalities, contemporary media arts practice, creativity as a fundamental way of being for all not some……..then…. come and explore with me….. I am drawing up a plan now with a series of events…. atleast some of it will happen online so you can still participate from a distance…… Looking Forward to exploring 'The Sound of Everything'
mahri autumn's- ri-solv – released
My first album ri-solv under the project name Mahri Autumn is now officially OUT ! Available in Mp3 format for download (as a gift but feel free to donate so i can do more) Available at CD Baby in hard copy and Mp3 form and also at I tunes. If you know me you can also just grab a copy from me. (That's if you are old fashioned like me and like to hold things in your hand.) It comes with a 16 page booklet. Click here to go to Audio Narcissist which I have set up to distribute my music (and maybe some other peoples as time passes). There are also videos and bios, photos etc at www.mahriautumn.com
There are two more releases in the wings and about 20 in my mind so………. here begins….. release… release…. release… release
samsara & soundcloud
I joined soundcloud today. Yet another way of finding, listening to and downloading music. I mean really.. it does my head in how many music sites there are now. Soundcloud seems kinda cool, i like the players. It seems i now have yet another cyber identity, my label self, Audio Narcissist. I shall write more on ideas associated with being an audio narcissist soon. A sonically obsessed intermediary between form and sound… Silently exploring the inner crevices of my sonic frequencies. There is something very visceral to me about the idea. The mythology and history of the Narcissus story fascinates me. Solo digital recording is the sonic equivalent to looking at your reflection in a pool. There is much to be learnt from sonic reflection. Oh and this track ( Samsara below) in many ways marked the end of the process of creating the album ri-solv. It is made up of the beginnings and ends of tracks and is a meditation on death, life, acceptance – gain and loss, beginning and end, dualities of all kinds are quashed in ri-solv. There is no more either /or in ri-solv. Samsara the concept of the wheel of life, the fabric of human reality, the veil of illusion… reflects a similar notion. Everything is as true as everything else. or not………but then… (just kidding) : ) Oh and if you like this track feel free to download it, embed it, torrent it, have your wicked way with it in which ever way you choose. i'll be happy if you just give it a listen.
09 Samsara by audio.narcissist
Babelgum Metropolis Art Prize
My first video for" Jack" is being featured as part of the Metropolis Art Prize on Babelgum.
Check it out here and vote so they send me to New York : )
Mahri Autumn Gig in Autumn
Photo : Sound checking at Mt Kembla with little girls hanging close. Love that look in their eyes. The one that says " hmmmmmm women don't play drums like that on TV??? "
It was a warm sublime afternoon. The orange sun traversed the forest wrapped mountains and settled on our smiling faces as it gently dawned on us that perhaps we were indeed a community. A group of people with shared concerns, inspired by the creative juices that swim amongst us, jointly developing regular means of spending time together and collectively striving for a more sane, sustainable and meaningful existence. Of course later that week it was discovered that we hadn't drunk enough alcohol to make the pub happy with us. Ahhhhh well. Time to organise some gigs in local halls.


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Secrets of good science writing How to write a science news.
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Hello and thanks for visiting my blog. I'm Angela Pickett and I started this blog almost three years ago when we first arrived in the Barossa Valley. I've always wanted to write and I wanted to share my experience of my career change, our travels and our move to this beautiful wine region.
After 15 years as a diplomat in Canberra, Beijing, China and Hanoi, Vietnam, I decided it was time for a career and lifestyle change. In June 2014, my husband, two young boys and I left Hanoi and arrived in the Barossa with a dream of a more fulfilling lifestyle in one of Australia's premier food and wine regions. While my husband re-started his career in the wine industry after 3.5 years as the stay-at-home Dad to our boys, I completed a Masters in Arts and Entertainment Management and launched a trade consultancy helping small business to explore overseas trade opportunities.
As we have settled into our Barossa life, we bought a fantastic 1960s house and I started working with a local winemaker. I love working in the wine industry and it's great working in a small business where my job could be described as anything but making the wine.
In 2017, I decided to wind-up the consulting business and focus on learning as much as I could about the wine industry while also concentrating on writing – both on this blog and a memoir of our time in Vietnam.
This blog is an opportunity for me to share my writing – about everything from motherhood, to career change, fitness, travel and our vine-change/career change experience.
I hope you enjoy it!


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Attendance Grows at Sports Events
Wisconsin Lutheran College (WLC) wanted to strengthen support, attendance, and engagement at sporting events. The college prides itself on cultivating leadership skills and creating a strong sense of community. With no active mobile program in place, they decided to create a brand new
one that could be used to reward athletic fans.
Fans Win Points + Get Prizes
Moblico built a custom mobile engagement, loyalty, and monetization program from the ground up. Named the WLC Warriors Mobile App, it provides a variety of engagement channels -including QR code scanning, short codes, and location-based communications. The goal? Get fans to accumulate points—by attending games and participating in activities. They can earn more points throughout the game, then redeem them at the Pro Shop for sweatshirts and other Warriors gear.
Better Marketing Decisions
The Warriors app consistently demonstrates very detailed ROI, helping sponsors and participants alike to make solid marketing decisions and investments. It uses intuitive analytics to track progress and successes, allowing the college to modify and build on their current programs. The app can also be changed and adapted to accommodate the evolving needs of the fans, the athletic department, and the school.
Highly Detailed ROI
The Warriors app has now become such a core part of the WLC athletics experience that the school is rolling it out into a campus-wide initiative that will increase communications with students, staff, alumni, parents, and the general WLC community.


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University of Wolverhampton art dept
Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
Learn about University of Wolverhampton art dept, and registering for elective seminars and discussion sections. As a student, your first stop should be the registrar's office, where you can pick up a free copy of both the academic calendar and course catalog, in order to find available credit classes that you may be interested in taking. In-person class registration has largely been replaced with online sign-up, and many schools offer mobile apps that streamline the course registration process. Finally, check with your major department for assistance with prerequisites, tuition payment deadlines, and University of Wolverhampton Commercial Art information. Please use the form above to request admissions info for University of Wolverhampton.
Los Angeles employs the most graphic designers, while New York City runs a close second. It is estimated that the number of graphic design jobs will increase by 15 percent over the coming five years, with interactive media being the fastest-growing field. Because a strong portfolio is often the deciding factor among potential job candidates, students interested in graphic design should take basic courses in studio art, drawing, 3D animation, commercial art, and website design. The National Association of Schools of Art and Design accredits programs in studio art, computerized design, and graphics. Further, almost a third of graphic designers are self-employed, and work as freelance commercial artists.
Good graphic design stems from an understanding of page design, like you'd see in a magazine. If you break down the elements that make up website design, such as color palettes and mobile graphics, you'll end up with commercial art that works well. High-paying graphic design jobs demand proficiency in design software packages such as Adobe Photoshop, Illustrator and InDesign. Solidworks is 3D-modeling software that has become widespread after graphics-processing improved to the point of being able to render high resolution images. Beyond consideration for University of Wolverhampton art dept, you may think about Kutztown University continuing education courses for complementary electives to your primary course of study.
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Years of non-related college course work may be applied towards the total minimum. Experience in a highly selective college or university setting that practices..
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Starting medical school is one of the most exciting moments in a physicians career… but it can be a little daunting! This talk is one I gave recently to the college students in the Baylor College of Medicine Summer Surgery Program. In addition to talking about how medical school is different from college, I also included my top 10 tips for successfully making this important transition.
Category Archives: Studying
Why is there a battle going on about MOC … and why should you care?
Everyone hates exams. Most of us hate regulations. But, exams and regulations in medicine came about because of abuses in the past that led to the public distrusting doctors. It's a fascinating, and somewhat terrifying history that starts with changing "medical schools" from for profit (and horrible!) businesses into what we know today. As general doctors started doing ophthalmology, surgery, or obstetrics full time, it was became clear that defining what constituted a specialty, and demonstrating that practitioners were competent was important.
What does it mean to be "board certified"?
Being "board certified" means that one of the 24 specialty boards in the United States attests that you have met all the requirements and have passed rigorous exams to show that you are qualified to practice in that specialty.
Does the board certification last forever?
Short answer, no. Family Medicine was the first specialty (in 1970) to realize that initial certification was not enough. As the public continued to ask for evidence that physicians remained up to date, Surgery (1976), Emergency Medicine (1980) and Ob/Gyn (1986) added a recertification examination. As of 1990, the remaining boards became "time-limited" which means board certification expires after 6-10 years, unless physicians take and pass the recertification examination. So, many internists who are now in their 60s and 70s didn't have to do anything other than pass the initial examinations. (This is referred to as being "grandfathered").
Who makes up "the board" for the specialties?
The members of most boards are volunteer physicians in the specialty. In surgery, which I know the best, the board members are called "directors". There are 41 directors of the American Board of Surgery who represent a variety of organizations and specialties in surgery. These volunteer surgeons spend 20+ days a year away from their practices with no pay (although their expenses are paid) to give the oral examinations in surgery, and to design and validate the written examinations. They also have a variety of committees and projects which focused on one critical question: "What do we need to do to make sure we maintain the public trust in surgeons?"
How do the specialty boards decide if specialists are up to date?
Since 1990, boards have to be "maintained". If you don't maintain your board, you lose it. Hence the term, Maintenance of Certification (MOC). So what do you have to do for "MOC"? In addition to having a license, most boards have requirements to document hospital privileges and provide letters of reference. Here's a summary of the other requirements for four of the largest boards:
|Continuing Medical Education (CME)
|Recertification examination
|Practice Assessment
|Internal Medicine
|Must do some CME every 2 years.
Must get 100 MOC points every 5 yrs. (roughly 20-25 hrs/yr)
|Recertification examination every 10 years (counts as 20 hrs MOC points)
|Nothing required.
Can earn MOC points by QI or by teaching.
|$1940 ($194/yr) for General Medicine.
$2560 ($256/yr) for specialties.
|Read at least 30 of the 45 articles provided by the board annually and answer four questions/article (=25hrs CME credit)
|Exam every 6 years but may be exempt if excellence demonstrated by answers to articles. (pilot program)
|Completion of ABOG practice improvement modules
QI projects
Additional fee of $175 if exam is required.
|100 MOC points/5yrs. At least 40 in CME, 40 in practice assessment
"Question of the week" delivered by email. 20 questions = 10 MOC pts.
|Recertification examination every 10 years (counts as 60 hrs of CME)
|Institutional or practice QI projects
|$1300/5yrs ($260/yr)
|90 hrs in 3 yrs. (30 hrs/yr) of CME (lectures or online)
60 hrs (20/yr) have to be Level 1(test questions involved)
|Recertification examination every 10 years (counts as 60 hrs of CME)
|Participation in an outcome or quality improvement program
|$1600 ($160/yr)
What happens if doctors decide to not do MOC?
Being board certified is voluntary and so is maintaining a board. But, if doctors choose not to do MOC, they will lose their board certification.
Here's some of the possible implications if a doctor loses board certification:
- Hospital bylaws almost universally require staff members to be board certified. These bylaws will have to be rewritten for doctors who have lost their boards in order for them to work in these institutions.
- The ACGME requires that faculty that teach residents are board certified.
- The American College of Surgeons requires that all doctors are board certified who work in ACS accredited Trauma Centers or Children's Surgery Centers. .
- The American Academy of Pediatrics requires that all doctors in the NICU are board certified in order for the NICU to be verified prior to accreditation.
My bottom line on MOC
Since the new MOC requirements went into place I have increased both the quantity and quality of the materials I use to stay up to date, which I strongly feel has made me a better surgeon. I still don't like taking exams, but every time I do (I have three boards, so I take a lot of them!) I learn so much that I find the experience invaluable. (Yes, that's after the exam, not before or during… that hasn't changed since medical school.)
MOC isn't perfect, but it's evolving, and the reason it exists is a good one. Passing laws state by state to make MOC "optional" has the risk of hurting the public's trust in physicians – and the risk of creating quite a bit of chaos for hospitals, training programs, and others. For what? Saving $200 a year? Not having to take the test every 10 years? Not having to log the CME that is required by almost all state medical boards?
"Here's what's at stake: we physicians are granted an extraordinary amount of autonomy by the public and the government. We ask people to disrobe in our presence; we prescribe medications that can kill; we perform procedures that would be labeled as assault if done by the non-credentialed. If we prove ourselves incapable of self-governance, we are violating this trust, and society will – and should – step into the breach with standards and regulations that will be more onerous, more politically driven, and less informed by science. That is the road we may be headed down. It is why this fight matters." Robert Wachter, MD
How to Ace the NBME Shelf Exams, In-Training Exams and Your Boards.
Ok, now that I have your attention, let me share something with you. I'm going to show you how to maximize what you learn from the "school" we call rotations in medical school and residency so you can be an awesome master clinician. And, yes, it's going to help you with your exams, so stay with me.
Clinical rotations are a strange blend of learning and work. You learn from the work, but we all forget that the work is not the purpose of these clinical experiences. The purpose of rotations is to be able to "practice" medicine (as a student) and then master the art of your specialty (as a resident.)
There are six basic principles to learn medicine, and then learn your specialty …and on the way ace the exams:
- Remember it's school.
- At the beginning of each rotation, decide what topics you need to learn during the rotation and make a list.
- Take notes. All the time.
- Figure out how you will store your notes so you can find them quickly and organize them for review.
- Go through the notes you make every day to review them and then store them in your system.
- You can't learn medicine from a review book (yes, including UWorld)
Somewhere around the beginning of my third year of residency, I was sitting in the "dome" (the chief resident's "office" above OR 1 in our County Hospital) when Fred, one of my fellow 3rd years, walked in. He sat down and started to look through a stack of 3×5 cards so I asked him what he was doing. We all knew that he had scored the highest in our class on the ABSITE (the surgery in-service exam) and I was about to find out why.
Fred figured out from day one that there was no way he was going to be able to study like he did in college and during basic sciences. Instead of hours to sit and read, it had to be flexible "on the job" learning.
This mindset is probably the single more important thing to cultivate. It's the thing that drives you to constantly ask questions about why things are done the way they are and then go look up the answers.
Your list can be pretty simple, or more complex, but it needs to be enough.
First hint – There is a curriculum that has been defined for your rotations. Everything your professors have decided should be taught should absolutely be on your list. (By the way….If it's in the curriculum, it has to be part of an objective. If there is an objective, it has to be linked to a test question)
Second hint – There is no way in medical school that "surgery" (or any specialty) can be covered in 8-12 lectures. The same is true for your rotations in residency. You have to do more.
This is one time that an example may be better than a formula. Let's say I'm a brand new clinical student on my core surgery rotation….
Step 1. Find a textbook of Surgery and make a list of the topics from the chapters. A spreadsheet may be best for this, but any kind of list will do.
For example, our library has Sabiston's Textbook of Surgery (20th edition, 2017) on line:
Step 2. Breathe deeply. There are 72 chapters and no, you are not going to read all these pages.
Step 3. Create a schedule to SKIM every chapter during the rotation. Look only at the "big picture" i.e. headings, section titles, diagrams, tables. Your schedule should leave the last week or two free. So, for example, if your rotation is 2 months long, plan to SKIM 12 chapters a week to get them done in 6 weeks.
Step 4 – Now we get to the real deal (remember, this is graduate school and/or specialty training).
List the sections on your spreadsheet.
As a student, you won't read every section – unless they are very general (Acute Abdomen, for example) or if you have a patient with that particular problem. Here's what it might look like:
After I learned Fred's system, I always kept a stack of blank 3×5 cards in my pocket. Like him, for the last 3 years of my residency, I made notes ALL the time. Here's the kind of notes we are talking about:
- Reading textbooks or other curricular readings. Take the time to make the notes and make them well so you never have to go back to the chapter to review it.
- On rounds when someone teaches an important point (e.g. the 7 things that keep a fistula from closing)
- During Grand Rounds
- During conferences
- When you look up a paper to read about a patient
- And – most important – what you learn from specific patients. Do NOT put the name of the patient or their MRN (HIPPA). But, do put specifics that help you remember the patient (e.g. pt that always wore a red baseball cap and had a tattoo of a dragon)
As you can imagine, once I started this system, I was making 10-20 notes a day. It is remarkable how much you learn in a given day… and how it's almost instantly gone if you don't write it down. In three years I filled up two boxes with cards. These cards were the only thing I reviewed for my Board exams.
This is why using a notebook isn't the best way to keep notes on rotations. You'll take them chronologically and, unless you have an amazing index at the back with all the key words and pages listed, you'll never be able to find a specific note.
The key is being able to "file" the notes so you can find them. For the 3×5 system, leave a blank square at the top to put the topic you'll use to file them.
I used anatomy as the basis for my filing system. So I would use a pencil (so I could change it later if I needed to) to put the topic in the box. For example
Pancreas, pancreatitis
Appendix, neoplasms, carcinoid
This is very old-fashioned (but very effective) system.. I personally think there are better ways to do this now using scanning, cloud storage, key words and tags. For some ideas, check out this post.
What doesn't work well is to try to type notes on your phone. What REALLY doesn't work is to make notes and then decide to copy them, type them or somehow redo them later. (It never happens).
The key to learning (as opposed to memorizing for a test) is review. Simply filing the cards means you are reviewing them. Plan to pull them out to look at them (and all the work you accomplished!) every week or two.
More importantly, when you see a patient with pancreatitis 5 months from now on a different rotation, pull the cards you made on this rotation. You'll find you have 20 or so cards (or card equivalents) on pancreatitis … a review of the Surgery textbook, notes from Grand Rounds, the 3 patients you saw with pancreatitis that taught you about the disease and a few pearls you learned on rounds from your chief resident.
I'm really serious. Not only will you suffer when you are taking care of patients, you won't do as well on the tests (despite what the upper level students or residents tell you).
Remember the last two weeks of the rotation that you saved? Now's the time to pull out the review books. It's a wonderful way to review what you have learned from your skimming and patient oriented reading. It's also a great way to identify gaps and look up information.
p.s. Take more notes while you are doing this.
p.p.s Review all your notes, including the ones you make from the review books.
p.p.p.s Review them again.
How To Study in Medical School
Congratulations to all the first year medical students who are starting or getting ready to start medical school. As you will soon seen, from day one there will be an overwhelming amount of information to process and learn … much more than any you have seen during college. It's going to take a new strategy!
Unlike college, the information you learn during your preclinical studies will be important when you take the first part of your licensure examination (Step 1) and when you start your clinical rotations in 2 years or so, and when you start your residency.
It's not just about learning this information for your exams, it's also about creating a system to organize this information for the future.
What should an ideal system let you do?
- Hand write or type your notes
- Highlight and annotate notes to make them more easy to remember
- Import images, pdfs, powerpoint presentations or other digital information
- Review the notes on your phone or iPad as well as your computer
- Revise or reclassify notes as you learn more
- Make sure your notes can't ever be lost or destroyed
What "notes" should you use to study?
- Use the notes provided by your professors, usually in the form of a powerpoint presentation or pdf of the presentation. Many students download the presentations into OneNote and annotate the slides during the lecture. If you use this system, it will be very important to make a one page summary of the key points. Going back to review each slide is very time consuming and not a good "juice to squeeze ratio". (the effort you put into it is not worth what you get out of it).
- Take notes in class or to review like you did in college (highlighters and all!). If you choose to do this, use the SQR3 method or the Cornell note taking method to prepare i.e. don't come in cold to class. Write down the big topics to be covered, and come up with questions you expect to be answered in class. The key is active listening!
- Try mindmaps. Your brain doesn't organize things into bullet points. If you use colors, images and this more "organic" organization, it's amazing how much you can remember. Like mnemonics, the more outlandish the images and colors, the easier it is to remember. You'll find an example of a mindmap to learn about pilonidal disease below. Note, for example, that the image for obesity is a stick of butter surrounded by fat globules. It's creating your own images that makes this so powerful. Even though you can share mindmaps, or use software to create them, it's more effective to draw your own.
- Handwritten may lead to better learning…. Worth thinking about!
How should you organize your notes?
Here's where it gets fun. Organizing notes with Evernote is the best way I've found (ever) to do this. Evernote is an app for your computer and phone/iPad that allows you to store "notes". But, the notes can be a lot of different formats:
- New notes, typed directly into the software
- Imported notes from OneNote or a powerpoint presentation
- Scanned notes. Evernote has an amazing free app called Scannable that converts any document into a pdf using your phone. So. if you draw a mindmap, doodle about the anatomy of the rotator cuff or have a typed handout from someone, you can scan it into EverNote.
- Photos of whiteboards, paper notes, images.
- Videos, like your professor showing you how to examine the knee for instability.
- There is an Evernote "web clipper" that can be used on your computer to download any webpage.
- Audio notes. You can record a review for yourself and save it as a note.
Other advantages to using Evernote
- You can share notes with others
- You can find information by searching. Both typed and handwritten words will be recognized.
- When you store a link to a video it's active, so you can click and go directly to the site.
What should I do before I set up this system?
- Start the notes now – even though you don't have the system in place. Listen actively and take notes actively. Make sure you create one page summaries of every lecture. Keep these to scan in when you start your account.
- Download Evernote for your Life | A Practical Guide for the Use of Evernote in Your Everyday Life by Brandon Collins and read it before you create your system. This ebook is concise, easy to read and will explain why you can't think about EverNote as a "filing" system in the usual sense.
A few other words of advice
- Create your Evernote account with an email address that will follow you through your training. (By the way, if your personal email now is email@example.com, it's time to get a new and more professional address!)
- I'd create one huge notebook called "Everything I need to know to be a doctor" (just kidding.. but don't fall into the trap of creating a lot of different notebooks, either.)
- When you start, be very deliberate about your tags. You don't want to end up with "Penicillin", "penicillin" and "penicillinV" as three tags for penicillin… Decide how to standardize your tags before you start i.e. when to capitalize, generic names of drugs only, etc.
- Evernote is not HIPPA compliant. Don't EVER put any patient information (including photos) that could be identified.
- Go ahead and spend the money for Evernote premium. You'll be using all the storage and the bells and whistles.
What Big Magic Can Teach Those Who Serve
"Do what you love to do, and do it with both seriousness and lightness."*
On the flight home yesterday I finished Big Magic: Creative Living Beyond Fear by Elizabeth Gilbert (She's probably known to you for her NY Times Best Seller Eat, Pray, Love). For me, one of the overarching messages of her book was this – When you see what you do as your vocation (from Latin vocātiō, meaning "a call or summons"), and not just your job, it will transform how you view your work – a concept which I believe may be necessary (but not sufficient) to treat or prevent burnout.
As I read her thoughts on how to live a creative life, I realized that there were other ideas that applied to physicians, physicians in training and others who serve:
Just show up. Every day.
"Most of my writing life consists of nothing more than unglamorous, disciplined labor. I sit at my desk and I work like a farmer, and that's how it gets done. Most of it is not fairy dust in the least"
Learning and practicing medicine (or any other field) means showing up – really showing up – every day. Everyone in the first year of medical school learns that it is different than college. Cramming for exams is not only ineffective, it's just wrong. You are no longer studying for a grade on a test…. it's now about the patients you will take care of in the future. The same holds true during residency and when you begin your practice. It's not just when you are a trainee. Part of the "work" of medicine remains "unglamorous, disciplined labor"… keeping up with the literature, going to teaching conferences when you could be doing something else, finishing your hospital charts, being on call.
But the work of medicine is also about showing up every day in another sense, too – truly showing up for the people who rely on you – no matter what. That, too, can be "unglamorous, disciplined labor" when you are tired or stressed.
"Work with all your heart, because—I promise—if you show up for your work day after day after day after day, you just might get lucky enough some random morning to burst right into bloom."
"They are your patients… from the first day of medical school until you retire.
"Most of all, there is this truth: No matter how great your teachers may be, and no matter how esteemed your academy's reputation, eventually you will have to do the work by yourself. Eventually, the teachers won't be there anymore. The walls of the school will fall away, and you'll be on your own. The hours that you will then put into practice, study, auditions, and creation will be entirely up to you. The sooner and more passionately you get married to this idea—that it is ultimately entirely up to you—the better off you'll be."
Caring for others gives us joy but also gives us the responsibility to know the best thing to do for them. Whether you are a first year student, 3rd year resident or a PGY35 attending, we are all still learning. "Life long learning" is not just a phrase, it's the reality of what we do.
It's called the practice of medicine for a reason.
"It's a simple and generous rule of life that whatever you practice, you will improve at."
Learn the art of deliberate practice early. Deliberate practice, to use a musical analogy I learned in Cal Newton's fantastic book So Good They Can't Ignore You: Why Skills Trump Passion in the Quest for Work You Love, doesn't mean playing the piece from start to finish 20 times in an hour. It means spending 55 minutes on the small section that you struggle with, repeating it 100 times before you play the piece through once. It means instead of reading the comfortable material on the anatomy of the kidney, you deliberately tackle how the nephron works. It means that instead of doing the computer-simulated cholecystectomy 10 times you spend an hour tying intracorporeal knots in the trainer. Find the thing that is not easy and practice it over and over until it becomes easy.
There is Peril in Perfectionism
"There are only so many hours in a day, after all. There are only so many days in a year, only so many years in a life. You do what you can do, as competently as possible within a reasonable time frame, and then you let it go."
One of the greatest attributes of those who care for others is their devotion to the people they serve. But perfectionism, taken to its extreme, is dangerous. Extending your time to study for Step 1 beyond what is reasonable to try to get a higher score, revisiting decisions about patient care to the point of anxiety, worrying that your GPA has to be perfect are all counterproductive. The motivation to do well is like a cardiac sarcomere – a little worry will make you more effective, but stretched too far, there won't be any output at all.
Curiosity can overcome fear.
"No, when I refer to "creative living," I am speaking more broadly. I'm talking about living a life that is driven more strongly by curiosity than by fear."
It's something most students don't realize, but no matter how long you practice medicine, there are days when you are afraid. It takes courage to do what we do. Remember, being courageous is not an absence of fear, it's being able to do what's right despite the fear. I agree complete with Elizabeth Gilbert that curiosity helps. When you have something that doesn't go the way you expect or frightens you, instead of beating yourself up ("I should have studied more"…."I could have made a different decision"…etc…etc) become curious. If you are thinking about a complication, commit to finding everything you can about the procedure and how to prevent complications. If you didn't do as well on your test as you thought you should, look up different techniques to study, take notes, and remember information, and go back to make sure you really understood what was being tested.
Even more powerful than curiosity is gratitude. Fear and gratitude cannot exist at the same moment. Try it – the next time you are about to snap because your EMR freezes be grateful that you can see the computer, be grateful you have work, be grateful you have been trained to help other human beings …and see what happens.
"We must have the stubbornness to accept our gladness in the ruthless furnace of this world."
Your worth is not the same as your "success".
"You can measure your worth by your dedication to your path, not by your successes or failures."
Wow…. This one is so important.
It's not what you make on Step 1. It's not how many cases you do, how many patients you see or how much money you make. This concept is taught by every religion and philosopher I know – for a reason. Be devoted to doing the best you can and to forgiving yourself (and learning from it) when you fall short.
One last thing….for medical students trying to choose a specialty – forget about finding your passion.
This is a little longer quote than the others, and mirrors a similar message in So Good They Can't Ignore You: Why Skills Trump Passion in the Quest for Work You Love .
Find something, even a little tiny thing, that makes you curious (or fills you with wonder) and follow it. Dedicate yourself to following that curiosity and it will likely lead you to your career.
"May I also urge you to forget about passion? Perhaps you are surprised to hear this from me, but I am somewhat against passion. Or at least, I am against the preaching of passion. I don't believe in telling people, "All you need to do is to follow your passion, and everything will be fine." I think this can be an unhelpful and even cruel suggestion at times. First of all, it can be an unnecessary piece of advice, because if someone has a clear passion, odds are they're already following it and they don't need anyone to tell them to pursue it…..I believe that curiosity is the secret. Curiosity is the truth and the way of creative living. Curiosity is the alpha and the omega, the beginning and the end. Furthermore, curiosity is accessible to everyone…..In fact, curiosity only ever asks one simple question: "Is there anything you're interested in?" Anything? Even a tiny bit? No matter how mundane or small?….But in that moment, if you can pause and identify even one tiny speck of interest in something, then curiosity will ask you to turn your head a quarter of an inch and look at the thing a wee bit closer. Do it. It's a clue. It might seem like nothing, but it's a clue. Follow that clue. Trust it. See where curiosity will lead you next. Then follow the next clue, and the next, and the next. Remember, it doesn't have to be a voice in the desert; it's just a harmless little scavenger hunt. Following that scavenger hunt of curiosity can lead you to amazing, unexpected places. It may even eventually lead you to your passion—albeit through a strange, untraceable passageway of back alleys, underground caves, and secret doors.
*Italics are quotes from Big Magic: Creative Living Beyond Fear. Since I read this on my Kindle, I don't have page numbers!
It's the First Day of Medical School – What Should I Do?
I've written before about what to do before medical school starts, how to study in medical school and strategies for succeeding in the basic sciences. But how do you put this information about organizing your studying and your day into a system that works? Everyone will have variations on how they do this, but there are some fundamental principles that apply to all.
Don't get behind
From day one, the material matters and, from day one, it is voluminous. If you get behind, it's really hard to catch up.
Study, don't just read and reread.
You have to actively engage this material and review it (multiple times) to really learn it. You are no longer studying for a test, you are studying to take care of other people. The SQ3R method is used by many students, but there are other systems as well. What is important is to develop a system that works for you. One tool used by many students is Anki, software that allows you to create electronic flashcards to review key points.
Tips on active studying from UCSD
Tips on active studying from the University of Utah
Use going to class as time to "study"
One of the important components to active learning is to review the lecture material before it is presented. This is the opposite of what most of you experienced in college, but it's key. Survey the handouts or slides and make a list of the important points to be covered. Stay actively engaged.
p.s. You can't learn medicine if you are on Facebook in class.
Create a summary page for each lecture
Include the big concepts, and key points. Include specifics that are stressed by the professor, but avoid listing all the details. You may choose to hand write this, but most of you will come up with an electronic format and will organize the class notes, and your summaries using One Note, Growly or an equivalent software. Although your personal notes are fine on the cloud, don't put copyrighted material or your professor's slides where other people can see them (it's illegal).
Begin with the end in mind
In the long term, what you are learning (yes, all of it) will be applied to taking care of patients. In the slightly less long term, you will be tested on this information on the USMLE Step 1, a high stake exam and the first part of your medical license. Although some dedicated time to study for Step 1 is important, having a system to really learn the material in your basic science courses is by far the best way to do well on this exam.
Don't sacrifice sleep.
If you don't sleep you don't learn as well. Organize your schedule so you get at least 7, but preferably 8 hours of sleep every night.
Eat well, play hard and stay connected.
Clay Goodman,MD the Associate Dean of UME at Baylor, tells our first year class that the first year of medical school is a 60 hr/week job. They need to get up in the morning and "go to work", using the afternoon and evening to study. He then points out that if they work 60 hours and sleep 56 hours (8 hours a night) they still have 52 hours to work out, spend time with family and friends and do whatever else they want.
So, what should you do the first day of medical school?
Here's what your schedule might look like…
The night before – pack your breakfast for the morning break and lunch for the next day. Review any posted slides – survey them to understand the "big picture" and use them to start your summary of the lecture. Write down what you don't understand from the slides (yes, at this stage it may be every line… but that will get better!).
7am – wake up (If you prefer morning workouts, you can get up earlier and workout before class)
7:30 Grab a piece of fruit or a smoothie if you don't like to eat an early breakfast. (If you are ok with it, eat the full breakfast now, but whatever you do, don't skip breakfast)
8-12 Attend class – Stay engaged. Take notes, make sure the questions you asked yourself in the review are answered, raise your hand and ask questions if they weren't. Eat your breakfast or a snack at the 10 am break.
12-1 – Lunch with your classmates. Play foosball, talk, or just eat, but take a real break.
1-5 Study. One hour of studying for each hour of class is about right for most people. This may need to go until 6 or 7 if you have afternoon labs.
7 – Workout and then make and eat dinner. Working out is an important part of self-care. Exercise is essential to decrease stress and also will help you avoid the "freshmen 10". Your dinner should be healthy, not processed, and definitively not Ramen noodles. Make sure you have fruits and/or vegetables at every meal.
9-10 Look over tomorrow's lectures and start your summary pages for those lectures. Once you are a week or two into this, you'll be adding in reviews of material from previous weeks on a schedule.
10-11 Read a novel, watch TV, decompress.
11 Go to sleep!
You are starting on one of the most amazing journeys any human being can have… enjoy it! Don't forget to keep a journal and take photos (but not of patients). The first time you actually interview a patient, put on your white coat, hear a heart murmur or take a test in medical school are just that … the first time. Write about the experience.
Let me know in the comments what other advice you have for the students starting medical school this summer!
Top 10 ways to survive (and maybe even enjoy) being on call
Like our residents (but not nearly as frequently), my group has started taking "in house" call. For every one who is currently or has been a resident, this is an experience we all know…. and one that's hard to describe to those that haven't experienced it. Spending 24 hours on call in the hospital can be emotionally and physically draining, but it has moments that make it a special experience, too.
There are ways to make the experience easier. Here are my top 10 ways to survive (and maybe even enjoy) being on call:
1. Drink water. Put a water bottle in the lounge refrigerator, drink from every water fountain, put your water bottle next to your computer, or come up with other ways to stay hydrated. If you want more flavor, bring a zip-lock with cut up lemons or limes to put in your water or add a splash of fruit juice.
2. Be kind. No matter how stressed or busy you are, knock on every patient's door and enter their room with the intention to help. Sit down or put a hand on their arm when you are talking to them. Smile.
3. Take breaks. On purpose. No one really expects you to work non-stop for 24 hours and it's not good for your patients. Deliberately stop to do something else every few hours, even if it's just for 5 minutes. Go outside for a few minutes for a short walk to catch some natural light and breathe some fresh air. Get a good cup of coffee or tea, listen to some music or just sit. If you want something more active, climb a few flights of stairs, stretch, or even do a light workout.
4. Eat well and eat often. Do not rely on fast food or the hospital cafeteria. By far the best plan is to bring really good food from home. You need to have "comfort" food on call. If you don't cook, buy really good prepared food that you can look forward to. Make sure you have "plan B" ready if your call day gets completely out of control by having an energy bar (my favorite is Kind bars), peanut butter sandwich or other "quick" food in your white coat pocket.
5. Be part of the team. Notice and encourage the unique camaraderie you share with everyone else who is on call. It's a small "band of brothers" who find themselves in the hospital at 3am. Be kind to each other, help each other, and use this unique opportunity to get to know someone you might otherwise not get to know.
6. Wear good shoes. If you are in house for 24 hours, bring a second pair that's completely different (clogs and running shoes for example). Ditto socks. Buy really good socks and change them after 12 hours if you can.
7. Use caffeine wisely. It's practically essential for many of us at the beginning of the day, but beware trying to "wake up" with caffeine after 2pm. Not to mention that if you "caffeinate" all night, you'll have that sickly post-call-too-much-caffeine feeling in the morning.
8. Take naps. Any sleep is good sleep on call. If it's possible, 20 minutes will make you more alert and effective in your work.
9. Make your beeper a "Zen bell". Use your pager or phone as a tool for mindfulness. When it goes off, take a deep breath, relax the muscles in your face and shoulders and be present. This is a proven practice to decrease stress – try it, it works!
10. Learn. Take advantage of the unique educational opportunity of being on call. The fact that there are fewer people around at night and on the weekends has a real impact on how and what you learn on call. If you are a student or junior resident, you are more likely to be the first person evaluating new consults and admissions. You are also more likely to have one on one time with your senior resident or faculty as you care for patients together. If you are further along in your training, the "down time" on call (if there is any!) is a great time to catch up on reading.


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Original Article
Histopathologic Responses of Dog's Dental Pulp to Mineral Trioxide Aggregate, Bio Active Glass, Formocresol, Hydroxyapatite Ebrahim Jabbarifar DDS, MSc*, Sayed Mohammad Razavi DDS, MSc**, Neda Ahmadi DDS, MSC***
ABSTRACT Introduction: Bio Active Glass (BAG) is often used as a filler material for regeneration of dental bone defects. Mineral trioxide aggregate (MTA) is used as retrofilling agent, repair of root resorption and pulpotomy agent in primary dentition. Formocresol (FC) is old and standard fixation agent in pulpotomy procedures. Hydroxyapatite (HA) is a biologic constitute. It is used in ridge augmentation, bony defect repair and pulpotomy agent in teeth. The purpose of this study was evaluation of histopathologic responses of dog's dental pulp to MTA, BAG, FC and HA after three months follow up. Materials and Methods: For this experimental prospective study forty-eight teeth were randomly selected in four dogs. Animals were anesthetized and pulpotomized. Three months later, animals were anesthetized and sacrificed. Then, teeth were extracted and histologic sections were prepared. Histologic sections were observed by an oral pathologist. The sections were observed from the view of inflammation, hyperemia, necrosis, vitality, calcification and dentinal bridge. Relative frequency of histopathologic outcomes of dental pulp was analyzed and reported. Mean differences of four groups were analyzed by Kruskal-Wallis and Mann-Whitney tests. Results: Relative frequency of inflammation of FC, MTA, HA and BAG groups were 29.2, 25.9, 42.4 and 29.2 percent, respectively. Relative frequency of hyperemia of FC, MTA, HA and BAG groups were 75.1, 63.6, 59.2, 81.6 and 62.5 percent, respectively. Relative frequency of necrosis of FC, MTA, HA and BAG groups were 29.2, 11.1, 12.1, 0 percent, respectively. Relative frequency of calcification of FC, MTA, HA and BAG groups were 75, 51.9, 69.7 and 54.8 percent, respectively. Relative frequency of dentinal bridge of FC, MTA, HA and BAG groups were 29.2, 70.4, 30.3 and 29.2 percent, respectively. Conclusion: Histopathologic reactions of dental pulp to four materials (MTA, HA, BAG, FC) were different. Histopathologic outcomes of MTA was more proper than those of BAG, HA and FC. Considering these findings, use of mineral trioxide aggregate and bioactive glass in pulpotomy is more favorable than using Formocresol and Hydroxyapatite. Key words: Animal study, Bio Active Glass (BAG), Calcification, Dental pulp, Dentinal bridge, Formocresol (FC), Histopathologic Response, Hydroxyapatite, Necrosis, Mineral Trioxide Aggregate (MTA), Pulpotomy. Received: August 2006 Accepted: March 2007
Primary tooth pulpotomy procedures are based on the rationale that radicular pulp tissue is healthy or is capable of healing after amputation of the af-
Dent Res J 2007; 4(2): 83-87
fected pulp. Ideal pulpotomy procedure after extirpated coronal pulp should be bactericidal, harmless to pulp and surrounding structures, promote
* Associate Professor, Department of Pedodontics and Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. ** Assistant Professor, Department of Oral Pathologist and Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. *** Assistant Professor, Pedodontics, Hamadan Dental School, Hamadan, Iran. Correspondence to: E. Jabbarifar, Department of Pedodontics, School of Dentistry, Isfahan University of Medical sciences, Isfahan, Iran. E-mail: email@example.com
Dental Research Journal (Vol. 4, No. 2, Autumn-Winter 2007)
Jabbarifar et al
healing of the remaining pulp, not interfere with the physiologic root resorption in primary dentition, has no systemic distribution and hazard biologic and immunologic effects and has proper histologic and radiographic and clinical outcomes 1,2. The most commonly used pulpotomy agent is formaldehyde derivates 3. Calcium hydroxide with alkalinity exposed after one month leads to superficial necrosis of pulp zone, new area of coarse fibrous tissue likened to a primitive bone layer, odontoblastic like fibrous tissue zone, calcific bridge zone, vital and normal pulp tissue free of inflammatory cells zone 4. Glutaraldehyde dialdehyde (GA) has received attention as fixative and potential substitute in primary tooth pulpotomy. The superiority and advantages of GA vs. Formocresol as a pulpotomy agent is attributed to the irreversibility of histologic outcomes. Larger glutaraldehyde than formocresol molecules, less penetration to adjacent tissue and delayed distribution, require a longtime exposed for efficiency task than formocresol 5,6. Ferric sulfate more recently has been devoted to investigating its effectiveness as pulpotomy agent in primary dentition. Ferric sulfate (Astringedent 15.5 percent) agglutinates blood proteins and controls hemorrhage without clot formation 7. Tricalcium phosphate, pure calcium hydroxyl appatite, cholorhexidine gluconate (2%) and distilled water have been studied as pulp therapy procedure in animal and human case, but these materials have not been approved as satisfactory as calcium hydroxide and formocresol 7,8. Findings from pulpotomy experiments using frozen-dried bone, chlorhexidine 2%, feracrylum, calcium phosphate ceramic, bone morphogenic protein type 4, 7, platelet protein derivates, collagen, Portland cement, Argon CO2 laser, electrosurgery, powdered bovine dentin, Bio Active Glass and other biologic agents have been tested and the preliminary results were promising 9. More recently better histologic, radiographic and clinical outcomes have been obtained with white and gray mineral trioxide aggregate. Pulp canal obliteration has been detected in 91% of samples 10. Histologic, radiographic, clinical outcomes after various pulpotomy methods are attributed to a- previous pulpal health status, bsystemic condition of patient, c- biocompatibility and biophysical and immunologic properties of dressing material, d- different methodology and design studies, e- safety and innocency of
Histopathologic Responses of Dog's Dental Pulp to …
pulpotomy techniques and period of exposure. Common failure outcomes of pulpotomy procedures in primary dentitions are internal root resorption, dentoalveolar abscess, necrosis, granulation tissue substituted pulp of root canal, early exfoliation, over retained tooth, hypoplastic defect in succedaneous tooth, odontogenic tumor, narrow PDL space, delayed eruption and deflected eruptive route 11. The purpose of this study was comparison of histopathologic responses of dog's dental pulp to mineral trioxide aggregate, formocresol, hydroxyapatite and Bio Active Glass.
Materials and Methods
Four male dogs of Iranian mixed generation were obtained with the weight of 15-20 kg from animal house of Torabinejad research center of Isfahan dental school. Forty-eight teeth were randomly divided into MTA, FC, HA and BAG groups by throwing toss. The animals were examined, vaccinated and isolated for ten days. General anesthesia with intramuscular injection of 20 mg/kg of ketamine HCL (Alfasan, Netherland) and 12 mg/kg of xylazine (Alfasan, Netherland) was done. An infiltration injection of xylocaine 2% (Darupakhsh, Iran) was used for local anesthesia. Using a number 1 round bur in high-speed handpiece with copious water spray, access cavities were prepared in occlusal and lingual surface and pulp was exposed. Access cavity was completed. Coronal pulp was extirpated and bleeding was stopped with sterile moistened cotton pellets. Then, pulp stumps were covered with purry mixture MTA (Pro-Root MTA Densply, Tulsa USA), Hydroxyapatite (HA, Switzerland), Bioactive glass (Nova Bone, Germany), Tricresolformalin (PD, Brazil), which were prepared according to the manufacture's direction. Next, the cavities were restored with hard setting zonaline (PD, England) and Amalgam (SDI, Australia) Capsules. After 3 months, vital perfusion fixation was performed with 10% formalin solution (Merk, Germany). Then, animals' teeth were separated and dissected and placed in formalin solution for 14 days. Following decalcification, specimens were prepared for pathologic processing. Sections were stained with Hematoxylin and Eosin (H & E). Sections were observed under a light microscope (Zeiss, Germany) by an oral pathologist. Assessment of G coronal pulpal responses was performed according to the following criteria 12:
Dental Research Journal (Vol. 4, No. 2, Autumn-Winter 2007)
Jabbarifar et al
Histopathologic Responses of Dog's Dental Pulp to
1) Inflammation cell response scoring: Score 0: No scattered inflammatory cells in the pulp area corresponding to the pulp-exposed characteristic tissue. Score 1: Slight inflammatory cell infiltrate with PMNs or MNLs. Score 2: Moderate inflammatory cell infiltrate involving the coronal third of radicular pulp. Score 3: Severe inflammatory cell infiltrate involving the coronal third of radicular pulp. 2) Hard tissue formation scoring: Score 0: Absent Score 1: Modest hard tissue deposition beneath or lateral to the exposed area. Score 2: Moderate hard tissue deposition beneath or lateral to the exposed area. Score 3: Complete dentin bridge formation beneath to the exposed area. 3) Hyperemia scoring: Score 0: Absent. Score 1: Three blood vessels. Score 2: More than 5 blood vessels. Score 3: More than 8 blood vessels. 4) Necrosis scoring: Score 0: Absent. Score 1: Denaturation of proteins, autolysis. 5) Vitality scoring: Score 0: Abnormal cell, blood vessel, disintegration pulp tissue. Score 1: Natural dental pulp cell, blood vessel, intact pulp tissue. 6) Dentinal bridge scoring: Score 0: Absence of any dentinal structure. Score 1: Atubular and tubular dentinal structure. Frequency and relative frequency of histopathologic variables in MTA, FC, HA and BAG groups were analyzed by SPSS software version 11.5. Relative frequencies of difference in vitality, dentinal bridge, inflammation, calcification, hyperemia, necrosis between MTA, FC, HA and BAG groups were analyzed by Kruskal-Wallis and Man-Whitney tests included in SPSS software.
Based on light microscopic observations, no inflammatory reaction was seen in 70.8 Percent of BAG sections, 57.6 percent of HA samples, 70.8 percent of FC group and 74.1 percent of MTA cases (Table 1). Differences of inflammation reactions in four groups were not significant (Kruskal-Wallis, P=0.32). Relative frequency of inflammation in HA group was more than that in BAG, MTA and FC groups (Mann-Whitney test). Hyperemia was observed in 62.5 percent of BAG sections, 81.6 percent of HA samples, 75.1 percent of FC group and 59.2 percent of MTA cases. Mean differences of hyperemia in MTA, FC, HA and BAG groups were not significant. Pulpal necrosis was observed in 12.1 percent of HA samples, 29.2 percent of FC cases and 11.1 percent of MTA sections. Necrosis among four groups was significantly different (Kruskal-Wallis test, P=0.03) and average of necrosis in FC group was more than that in MTA, HA and BAG samples (Mann-Whitney test). 62.5 percent of the BAG, 57.6 percent of HA, 45.8 percent of FC and 40.7 percent of MTA group were vital in the remaining dental pulp after 3 months follow up. Averages of differences of vitality in four groups were not significant (Kruskal-Wallis test, P>0.05). Calcification loci as diffuse and irregular were observed in 54.2 percent of BAG, 69.7 percent of HA, 75 percent of FC and 51.9 percent of MTA samples. The differences in calcification between four groups were not significant (Kruskal-Wallis test). The formation of dentinal bridge was observed in 29.2 percent of BAG, 30.3 percent of HA, 29.2 percent of FC and 70.4 percent of MTA group. The formation of dentinal bridge in MTA group was more than that in BAG, HA and FC samples (Figure 1, 2). Average difference in formation of dentinal bridge in four groups was significant (Kruskal-Wallis test, P=0.006).
Table 1. Frequency and Relative frequency of histopathologic responses in 1/3 coronal root pulp to MTA, BAG, HA and FC. Pulpotomy
Dentinal bridge
25.9 (7)
40.7 (11)
51.9 (14)
59.2 (16)
11.1 (3)
70.4 (19)
29.2 (7)
62.5 (15)
54.2 (13)
62.5 (15)
29.2 (7)
42.4 (14)
57.6 (10)
69.7 (23)
81.6 (21)
12.1 (4)
30.3 (10)
29.2 (7)
45.8 (11)
75 (18)
75.1 (18)
29.2 (7)
29.2 (7)
Dental Research Journal (Vol. 4, No. 2, Autumn-Winter 2007)
Jabbarifar et al
Histopathologic Responses of Dog's Dental Pulp to …
B Figure 1. Histopathologic responses of dental pulp to MTA (Dentinal bridge formation) D= Dentin, DB= Dentinal bridge, P= Pulp (H&E stain, original magnification, A X40, B X10).
Figure 2. Histopathologic responses of dental pulp to MTA (Calcification foci) Cal= Calcification foci, P= Pulp (H&E stain, original magnification, X10).
Results of this study showed mild to moderate inflammatory changes in 32.3 percent samples of MTA, FC, HA and BAG groups 13,14. Average inflammatory changes in MTA group were less than that in BAG and equal to that in FC, less than that in HA samples. This may be an expected protective response from pulp to any foreign materials, manipulation and immunohistochemical events. Mild to moderate hyperemia in 27.8 percent samples of MTA, HA, FC and BAG groups was observed. This sign may be a transient outcome of dental pulp to these materials and pulpotomy procedures. 86.1 percent of MTA, FC, HA and BAG groups did not show any tissue necrosis and in 23.9 percent of four groups necrosis occurred. The reasons of necrosis may be attributed to hazardous effect of these materials, immunohistochemical events and reactions of dental pulp due to MTA, FC, HA or BAG. Diffuse irregular calcified loci were observed in 62.3 percent of MTA, FC, HA and BAG groups. This sign may be originated from biohistochemical properties of these materials and their reactions, chemical properties of these materials and reactions of dental pulp to theirs 15,16. In 70.4 percent of MTA samples dentinal bridge in the entrance of root canal pulp were observed. This may be from histochemicophysiological characteristics of dental pulp to these materials. Average dentinal bridge formation in MTA samples was more than those in HA and BAG but, was equal to that in FC groups. Histologic evaluation of pulp specimens after pulp capping is very important. Although it is important to have a calcific bridge under capping materials, making a calcification and dentinal bridge could be a sign of either healing or irritation 17. Authors have shown that healing pulpal reactions are more dependent on the capacity of capping materials to prevent bacterial microleakage rather than the specific properties of the materials themselves. MTA and BAG are insoluble materials and can provide tight seals, which could prevent bacterial access to pulp tissues. MTA and BAG do not appear to deteriorate and disintegrate with time, thus space for microleakage won't develop. The pulp responds favorably to the protection provided by a MTA layer. Nova bone won't be resorbed, so it remains on the pulp for long time and assists in reliability of under tissues 17,18. Inflammation and hyperemia can be harmless or helpful (depending on severity, acuteness and conDental Research Journal (Vol. 4, No. 2, Autumn-Winter 2007)
Jabbarifar et al
tinuity of reactions). All Specimens have shown mild to severe rates of inflammation. Necrosis, which is the improper outcomes of connective tissues to pulp capping agents, was observed in some samples of four groups.
Histologic reactions of dental pulp to MTA were more favorable than those in HA, FC and BAG groups. Findings of this study showed that MTA and BAG are more proper than Formocresol and hydroxyapatite as pulpotomy agents. Histopathologic reactions of dental pulp to BAG was more favorable than those of FC and HA. Considering the feasibility, cost, time, biocompatibility, long period of study, high success rate, conservative interpretation of the results of animal studies by other researchers, MTA and BAG can be used as alternatives in vital pulpotomy procedures in primary and permanent dentition.
1. Alacam A. Pulpal tissue changes following pulpotomies with formocresol, glutaraldehyde-calcium hydroxide, glutaraldehyde-zinc oxide eugenol pastes in primary teeth. J Pedod 1989; 13(2):123-32. 2. Stanley HR, Clark AE, Pameijer CH, Louw NP. Pulp capping with a modified bioglass formula (#A68-modified). Am J Dent 2001; 14(4):227-32. 3. Eidelman E, Holan G, Fuks AB. Mineral trioxide aggregate vs. formocresol in pulpotomized primary molars: a preliminary report. Pediatr Dent 2001; 23(1):15-8. 4. Schepers E, de Clercq M, Ducheyne P, Kempeneers R. Bioactive glass particulate material as a filler for bone lesions. J Oral Rehabil 1991; 18(5):439-52. 5. McDonald RE, Avery DR. Treatment of deep caries, vital pulp exposure, and pulpless teeth in children. In: McDonald RE, Avery DR, editors. Dentistry for the child and adolescent. 7th ed. St Louis: Mosby; 1999: 413-39. 6. Fuks AB. Pulp therapy for the primary dentition. In: Pinkham J, Casamassimo P, Fields HW, McTigue DJ, Nowak A, editors. Pediatric Dentistry: Infancy
Dental Research Journal (Vol. 4, No. 2, Autumn-Winter 2007)
Histopathologic Responses of Dog's Dental Pulp to
Through Adolescence. 4th ed. Philadelphia: Mosby; 2005: 341-53. 7. Smith NL, Seale NS, Nunn ME. Ferric sulfate pulpotomy in primary molars: a retrospective study. Pediatr Dent 2000; 22(3):192-99. 8. Torabinejad M, Hong CU, McDonald F, Pitt Ford TR. Physical and chemical properties of a new rootend filling material. J Endod 1995; 21(7):349-53. 9. Ford TR, Torabinejad M, Abedi HR, Bakland LK, Kariyawasam SP. Using mineral trioxide aggregate as a pulp-capping material. J Am Dent Assoc 1996; 127(10):1491-494. 10. Srinivasan V, Patchett CL, Waterhouse PJ. Is there life after Buckley's Formocresol? Part I -- a narrative review of alternative interventions and materials. Int J Paediatr Dent 2006; 16(2):117-27. 11. Patchett CL, Srinivasan V, Waterhouse PJ. Is there life after Buckley's formocresol? Part II - Development of a protocol for the management of extensive caries in the primary molar. Int J Paediatr Dent 2006; 16(3):199-206. 12. Salako N, Joseph B, Ritwik P, Salonen J, John P, Junaid TA. Comparison of bioactive glass, mineral trioxide aggregate, ferric sulfate, and formocresol as pulpotomy agents in rat molar. Dent Traumatol 2003; 19(6):314-20. 13. Jabbarifar E, Khademi AA, Ghasemi D. Clinical and radiographic evaluation ferricsulfate pulpotomy with Formocresol in primary molar teeth. J Res Med Sci 2001; 9:60-3. 14. Eskandarzadeh A, Parirokh M, Eslami S, Asgary S. A comparative study between MTA and Calcium hydroxide as pulp capping agents in dog's teeth. Dent Res J 2005; 2:88-97. 15. Norton MR, Wilson J. Dental implants placed in extraction sites implanted with bioactive glass: human histology and clinical outcome. Int J Oral Maxillofac Implants 2002; 17(2):249-257. 16. Stoor P, Soderling E, Salonen JI. Antibacterial effects of a bioactive glass paste on oral microorganisms. Acta Odontol Scand 1998; 56(3):161-165. 17. Shoji S, Nakamura M, Horiuchi H. Histopathological changes in dental pulps irradiated by CO2 laser: a preliminary report on laser pulpotomy. J Endod 1985; 11(9):379-384. 18. American Academy of Pediatric Dentistry. Guidelines. Pediatr Dent 1997; 19(7):28-85.
Published on Apr 7, 2011
Histopathologic Responses of Dog's Dental Pulp to Mineral Trioxide Aggregate, Bio Active Glass, Formocresol, Hydroxyapatite


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Author: LCIF Admin Leave A Comment
Social-emotional learning has been proven to decrease problem behaviors such as bullying and substance use and increase positive behavior patterns such as self-discipline and conflict resolution. Lions Quest is LCIF's social-emotional learning program (SEL), and the Lions of Multiple District (MD) 107 in Finland have successfully implemented Lions Quest. The Finnish government has recognized MD 107's program as a leader in educational curricula for children, and the Ministry of Education and Culture even awarded MD 107 a grant to conduct teacher training workshops.
Local Lions' involvement is key to Lions Quest's success, and over the last 20 years Finnish Lions have raised more than US$6 million to support and grow Lions Quest. Since the first workshop in 1991, more than 16,000 teachers have been trained to implement the program in Finland. Eight certified trainers host teacher training workshops throughout the country. Teachers are trained to work in multicultural classrooms, focusing on diversity and addressing the educational needs of refugee children.
Finnish Lions have expanded Lions Quest beyond the traditional classrooms to focus on youth sports. Trained in much the same way teachers are, coaches encourage good sportsmanship, teamwork and conflict resolution.
Understanding that the needs of today's students are ever-changing, the Lions also created a guide to Internet safety and cyber-bullying prevention. "Responsibility is Mine" teaches children not only how to keep themselves safe online but also discourages them from hurting others.
Taking the program even further, Finnish Lions have become global leaders in the research of SEL. In collaboration with the University of Helsinki, MD 107 conducted a study that showed that Lions Quest training is effective at building teachers' ability to develop social and emotional skills in their students. This research was published in the European Journal of Social and Behavioural Sciences.
Lions leaders in Finland work with local Lions on Lions Quest, serving as an example of what can be achieved when Lions are committed to a goal.
This article originally appeared in the May 2016 issue of LION Magazine.
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Lions and LCIF have greatly contributed to reducing the global burden of measles and rubella, but there is still work to close the remaining gap. There are more than 20 million children worldwide who have not yet received vaccination against measles and even more who have not received vaccination against rubella. Donate today and together we can reach out to help close this gap.
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April is Leo Club Awareness Month! To celebrate and recognize Leo clubs, the Lions Blog will feature stories about Leo service projects around the world. Today's story features the Penang City Leo Club in Malaysia. This Omega Leo Club was sponsored by Penang Host Lions Club over 30 years ago!
Each month, the Penang City Leo Club prepares and distributes food and drinking water to 50 homeless people. The Leos' sponsoring Lions club (Penang Host Lions Club) finances the project.
"We intend to create awareness to the public to concern our society and people around us especially those are marginalized and neglected. Not everyone is lucky to be born into a stable home.We want homeless people feel that they are a part of our society. We share our project on social media, such as Facebook, every month and sometimes it gets people's attention to chip in sponsorship for food."
The Leo Club Program gives young people the opportunity to serve their communities, develop leadership skills, make new friends and have fun! Learn more about the Leo Club Program and find out how to start a Leo club in your community.
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Every child should be vaccinated against measles and rubella, but progress on eliminating these diseases has stalled. Everyone should play a role in closing this gap – governments, health workers, parents, civil society and international organizations. The World Health Organization (WHO) is promoting the importance of immunization for all throughout life.
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Lions have been planting trees to help save the environment since the organization's earliest days. But in 2011 International President Wing-Kun Tam of Hong Kong, China, challenged the association to join in the effort as never before by asking Lions to plant 1 million trees within one year. "We want to wrap the earth in greenery," Tam told members in LION Magazine.
Lions, known for going above and beyond expectations when presented with a challenge, took Tam's goal and blew it sky high.
Multiple District 324 in Southern India played a large role in the initiative's success. On August 25, 2011, more than 100,000 Lions from 2,855 clubs coordinated with local governments, schools, police, family and friends to plant 3.4 million trees in just 12 hours—a world record. In total, from July 2011 to June 2012, Lions worldwide planted 15 million trees.
The challenge helped address a critical environmental problem. Due to human activity, the Earth's forests have been disappearing at alarming rates, especially since 1980. Deforestation impacts the whole planet. Converting carbon dioxide to oxygen, trees provide fresh air and stabilize many ecosystems. At the same time, they give shade from the sun, provide a livelihood for millions and beautify the landscape. Trees are the breath of life.
Lions' monumental effort took much preparation. In fact, Multiple District 324 had been planning the event ever since hearing then-Second Vice President Tam mention the idea at Lions Day at the United Nations in 2009. The Lions of Southern India took time to identify locations—such as school campuses, private farms, major roads and protected forests—where trees were needed and worked with the Indian government to obtain some of the saplings for free.
India's Lions put just as much effort into what would happen to the young trees after the big event. For about two years, the saplings would need to be cared for by volunteers. In many cases, the Lions turned to the students who had assisted in planting the trees for help. For example, students in a village near Hyderabad took charge of 1,450 saplings, making sure the trees had enough water and care to thrive. In return, the youth received an education in ecology and experienced the joy of watching their trees grow.
Lions in India helped take Tam's tree planting to new heights in 2011. By sharing the excitement of helping the environment with the next generation, they also planted seeds of stewardship and volunteerism that will grow for years to come.
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Tompaulin : It's A Girl's World
Boy/girl vocals tell of teenage troubles in northern towns...
They deserve better. They deserve not to have the words 'Belle'
and 'Sebastian' woven into every single review. Especially since this cracking song sees Tompaulin stepping out from under the shadow of their Glaswegian peers. But,
as comparisons go, they're still
in the neighbourhood, sharing a love for '60s pop and a knack
for sharp-eyed lyrics. Anyway: boy/girl vocals tell of teenage troubles in northern towns. Incidentally, fact fans, this song
was inspired by a girl the 'Paulin used to see outside a disco.
Kitty Empire


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Milwaukee journalist Dan Egan tell the complex story of the one of the world's most important freshwater ecosystems.
There is no Plan B for humanity and our fellow species if we fail to keep our waters alive and clean.
Promise (for farmers) and peril (for shrimp) at a new aquaculture outfit in rural Newton.
The Latino Earth Partnership (LEP) initiative of the University of Wisconsin-Madison (UW-Madison) Arboretum Earth Partnership program promotes collaborat
Recently, the Wisconsin Center for Investigative Journalism (WCIJ) began publishing a series titled Failure at the Faucet, examining state water quality and supply issues.
Before I joined the Wisconsin Academy staff last fall, I believed it was rare to witness an individual experiencing an epiphany—a profound moment of insight, or the connection of dots that leads to a new way of looking at a problem.
Several weeks ago a colleague asked me, "Can a person have an intimate relationship with water?" The question took me by surprise. "Well, of course a person can!" was my reply.
Waterways features three Wisconsin artists--Sarah FitzSimons (Madison), Marsha McDonald (Milwaukee), and John Miller (Madison)--whose work investigates the essential nature of water.
Have you ever stood along one of those rivers that flows with such beauty and power that you can't help but stop and watch?
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Here at Rusnak BMW, we want to provide you with the perfect vehicle for you and your family. The X3 may be that vehicle.
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If you would like to learn more about the X3, or any other vehicles we have in stock, stop by Rusnak BMW in Thousand Oaks, CA. Our team of friendly professionals would be more than happy to answer any questions you may have and set up a test drive.


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