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Caring for Babies During Winter
- instead of wearing one thick and heavy piece, opt for three to four layers of relatively thin clothing pieces – the outermost layer being the thickest
- when going out for a walk, never forget to protect the head and the extremities (i.e. feet and hands)
- keep her comfortably dressed when sleeping and avoid filling the crib with unnecessary blankets
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The feature set is good for smaller businesses, whereas bigger ones would most likely must upgrade eventually. My relationship wasn't extraordinarily abundant before I've joined up with this software program. What switched immediately while I registered and launched texting these I've appreciated on the location. Of course, some people declined me personally, however that's certainly not a problem. Usually, I've had gotten somewhat correct fits that granted me to supply numerous family members. Within a few weeks of speaking, all of us have our private initial date.
Individuals with malignant aims can register accounts with chat functions, regularly without the necessity of any character affirmation. Thus, it's ordinary to find many phony profiles on such administrations. Individuals holding these pretend profiles can bait blameless adolescents and grown-ups to share private information, which could be utilized to misuse them. At least, you'll find a way to see profiles of other members even without a paid subscription. Also, as the service is at present beneath development, a quantity of features are coming. It will allow you to confirm your account to access an extended part of E-Chat restricted only to verified folks. Zendesk Chat on the floor seems to be a simple and inexpensive chat widget that you can add to your website.
How Am I In A Position To Be Part Of A Chatroom?
The platform is nice to begin video chat, online chatting, and voice chat with other customers, as a end result of which it has turn out to be top-of-the-line chat rooms on the market. Badoo is amongst the hottest chat room apps in 2023 that lets you meet new and unknown people from proximity or from all around the world. It is a platform that constantly ensures its user's security and respect within the group in which we live. Band is a well-liked group chat app with a focus on common topics.
What can I use as a substitute of Omegle?
- ChatHub.
- CamSurf.
- Bazoocam.
- ChatRandom.
- Shagle.
- EmeraldChat.
- Tinychat.
- YouNow.
And you don't have to register yourself with the web site. All you must do is simply click on on the link to enter your name on this free chat site. There are varied chat rooms available in it like singles, USA, Australia, ladies, Indonesia, Africa, Portugal, and plenty of more like these.
What Is Free Live Chat Support?
When you join, the web site lets you choose which type of room you wish to enter. You may enter the primary room for normal conversations or go to an adult room for mature discussions. You can also select a particular gender should you wish to converse with solely women or males. Bigo Live is considered echat.live one of the most popular right now since it has plenty of customers. One cause it's well-liked is that the chatroom hosts can earn cash whereas they're streaming live. This one is decided by your level of courtesy, consciousness, and expertise. Technically, it's okay to speak to strangers, especially if you're an grownup.
- Connect with website visitors to convert leads, close offers, and supply assist.
- Right after I see characters which may be shady or unpleasant, we avoid them and transfer on.
- I haven't tested both of those integrations, but they usually work rather well and I expect it to be that way with Chatra.
- However, the positioning is beneath improvement now, and we're getting some thrilling upgrades.
- As to me, I procured enough matches preserve me energetic.
- Free chat apps permit people to communicate with their household, friends, shoppers, and more.
Using a screen recorder, you can also document Omegle chat. There will be times that you want conferences and even just a casual dialog with your mates. Being that stated, you want a software that may allow you to record and make a copy.
Hubspot's Free Live Chat
The site additionally has a profanity filter and offers a web-based transcript of all chats for lecturers and college students to review. I made the choice to publish the review on numerous reasons. For starters, I before confronted a quantity of scamming online dating websites, so I perceive how distressing and aggravating this encounter are. Hence, I do imagine that my private simple testimonial may help others break free comparable harm.
Many platforms restrict the flexibility to send direct messages to avoid this type of abuse. Why get slowed down with inconvenient registration pages if you don't have to? For free chat rooms options, wonderful online chat rooms, and cellular chat at the click of a mouse. Camgois a cam chat app that uses an intelligent live cam social network to match like-minded folks and filter out users who could additionally be unsafe. The Safe Search system makes use of artificial intelligence to weed out dangerous apples.
Chat Transcripts/chat History Performance
You can even invite your mates to talk in a personal room when you don't wish to speak to strangers. It has a walkie talkie feature with a push-to-talk type that permits you to communicate with basically anybody on the fly. However, this one also has a big selection of chat room type features as well. You can create public chat rooms or non-public ones with as a lot as 6,000 users directly and you should use the PTT operate to truly speak to them ham radio type.
What occurred to Yahoo chat?
Pager, launched on March 9, 1998 and renamed to Yahoo! Messenger in 1999. The chat room service shut down in 2012.
Tidio is a live chat software program solution for web sites that lets you connect with guests in actual time. If you need to set your chat widget to a eternally online mode, it's technically unimaginable to do it. The solely way to maintain your chat widget online when you're away out of your desktop is putting in the mobile app and preserving it open in the background.
I poised the analysis as indicated by my private preference and began acquiring photographs of really horny customers . We talk and swap images, take pleasure in, so I even obtained a few schedules. The characteristic set is fairly normal, however some features' availability is dependent upon the type of plan you choose. Chatra provides bots and automation features if you favor handing the communication over to the system. You can get primary and detailed details about your customers, as well as real-time visitor tracking and purchasing cart content preview. The standard agent productiveness options embrace notifications, notes, saved replies, team chats, invisible mode, business hours, and agent teams. Close webpages for online courting services, it doesn't matter utilization and methods.
Which app is best for chatting with lady free?
- Zoosk. Browse Free » Relationships: Casual Dates, Relationships.
- Match.com. Browse Free »
- EliteSingles. Browse Free »
- eharmony. Browse Free »
- OurTime.com. Browse Free »
- BlackPeopleMeet. Browse Free »
- Flirt. Browse Free »
- SilverSingles. Browse Free »
Additionally, you'll have the ability to defend your privateness by remaining nameless. Even if your webcam is not working, you'll have the ability to nonetheless start a video chat. With TinyChat, you can chat with anyone utilizing voice or video over the web.
The authentic concept was fun, however it's not well value the danger anymore. Still, there are web apps similar to the old chat rooms of yore if you know where to look. If you might have tried chat rooms before, you should strive completely different chat rooms. Maybe you'll discover a new favourite chat room the place you can discuss with many wonderful individuals. If you have by no means tried chat rooms, there isn't a cause to not strive them now. RubyChat began as an experiment in early 2022 and is constantly rising ever since.
You can begin online by simply getting into your gender, accepting the service terms, and following the steps! To prevent language barriers, you could also use a language filter. A consumer is rarely matched up with somebody they've already met through a particular filter, ensuring each match is completely different. The ChatHub interfaces are glorious for each video chats and text chats. Since you don't want a profile, you'll find a way to try without threat.
What is the oldest chatting app?
Believe it or not, chat apps really date again to the Eighties, when Compuserve launched CB Simulator, the first dedicated online chat service that was broadly out there to the public.
Besides, i favor that it app could be very convenient to work with, if it is about navigation or quantity. Price is actually strange, and I don't grudge bucks for since I even have the most effective benefits for charges they want. I've already met some reasonable people and discover very popular occasions.
Which is one of the best online chat site?
- Crisp. Chat.
- JivoChat.
- Chatra.
- OnWebChat.
- Userlike.
- MyLiveChat.
- Gist.
- Rocket. Chat.
You can chat with strangers from all over the world on this random chat site. Before you can begin video chatting, you only want to offer the site access to your webcam. Furthermore, it permits you to limit your conversation to only a particular partner you choose. Unlike many other sites which would possibly be open for everyone, ChatRad has some terms, together with that you must be no less than 18 years of age to use the service.

subset: commoncrawl


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Style Notes
Embracing a more-is-more aesthetic, our intricately beaded slip dress sparkles under the sun with sophisticated beading and slinky chain tassels. It features a feminine scalloped neckline, slimline straps and a swishy midi skirt that looks exceptionally elegant swishing around the dance floor at summer parties and balmy sunset soirees.
- Style: Slip Dress
- Design: Baroque
- Fabric: Woven
- Length: Maxi
- Neckline: V Neck
- Sleeve Length: Strappy
Details & Care
100% polyester. Gentle machine wash at 30 with similar colours. Model Height 5"10 – Model wears a UK 8/US Size 6. Centre back length of a size 10: 120cm


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CET History
Hall of Heroes - Leslie Edwards
Special | 19m 26s
Mr. Glenn Grundei, retired teacher from Winton Woods Primary North, began creating his tribute to American Veterans in the hallways of his school about ten years ago. What has resulted is an impressive display of picture frames containing letters, newspaper clippings, photographs, uniforms, and medals of honor, mostly from WWII. Here is an interview with Tuskegee Airman Leslie Edwards.
Aired: 11/07/07 |
More Specials
America's Voice
Special | 8m 17s
Hall of Heroes - Lynn Ashley
Special | 20m 28s
Hall of Heroes - Leslie Edwards
Special | 19m 26s
More History Shows
- Antiques Roadshow
ANTIQUES ROADSHOW is part adventure, part history lesson, and part treasure hunt!
- Finding Your Roots
Join Henry Louis Gates, Jr. in Finding Your Roots on PBS!
- Lucy Worsley Investigates
Lucy Worsley re-investigates some of the most dramatic chapters in British history.
- Tutankhamun: Allies & Enemies
Explore King Tutankhamun's life and legacy.
- American Experience
AMERICAN EXPERIENCE brings to life the compelling stories from our past!
- American Masters
Discover insightful profiles of important figures in America's artistic and cultural life.


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Location: Jitsi
Date and Time: Wednesday, March 8, 2023, 5:30pm-8:00pm
Scribe: You
Roll Call: TedBrunner,RussellSenior,JasonBergstrom,MatthewKlug,SteveTree
- Pick location for next weekly
- Node notes:
NodeBillyRays is down?
NodeFreshPot *still* needs a visit
NodeMississippi needs trying harder to get access to the Commons Building and wiring closet
- ARPA Grant application(s)
- State Legislative update (hearing carry over from a few weeks ago)
Your Item Here
- Node notes:
NodeBillyRays - was down, now back up, unknown intervention?
NodeFreshPot - down since July, but was non-critical
NodeMississippi - unknown power supply or closet switch, no contact from their end
- ARPA Grant - Russell and Ted will work up a grant proposal for APANO, Annapurna and Afro-Village (pods?)
- State Legislative session is tomorrow, but we have a conflict and need to meet with Afro-village instead
- Another hearing tomorrow, will have a recording
Russell will have a meeting with LewFrederick
Next week's meeting suggested to be at BookPub by Russell's


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10 Things to Know About How Teens Use Technology
Kristen Purcell discussed our teens & tech research at the ACT Enrollment Planners Conference
Kristen Purcell discussed our teens & tech research at the ACT Enrollment Planners Conference
Amanda Lenhart briefed the State of Maryland's Children's Online Privacy Working Group at the Attorney General's Office in Baltimore on the findings from the Teens, Social Media and Privacy report.
American teens have long been the country's most-wired age group. But contrary to the stereotype of hyper-connected teens, they say some things are better done in person.
Among the things teens choose to share on social media, their real name and photos of themselves rank the highest. What else do they share?
Explore what teens choose to share and keep private and with whom in this infographic.
Among teen social media users, percent who post the following to the profile they use most often
Size of Facebook network by gender and age
A list of some of the most revealing and interesting comments about how teens think about social networking sites and how they navigate issues of identity and privacy.
Youth are sharing more personal information on their profiles than in the past. They choose private settings for Facebook, but share with large networks of friends.
Yahoo! today confirmed that it's buying 6-year-old blogging service Tumblr for $1.1 billion in cash. Who uses Tumblr? We consulted the recent report on social media demographics from the Pew Research Center's Internet & American Life Project to find out: Only 6% of Internet users surveyed in late 2012 reported using Tumblr, versus two-thirds for Facebook. Three […]


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Season 7 is on a roll. Over the next 3 weeks the Education Department will be hosting 3 courses a week through season 7 in Ed3DAOs Learn-o-verse and MORE!!. Every Tuesday, Wednesday, and Thursday; join us in the #watercooler voice channel 15 mins prior to 2 PM UTC for Zep Onboarding.
Check out the Education Guild Live Sessions Calendar
Find the Events in the Sesh Bot #calendar & See what's New in the Bankless Academy App
Monday's New Joiner Session
When : 20th of March, 2023
Time : 1:45pm UTC
Venue: Zoom
Did you hear about the last one(totally awesome) but missed it? here's another chance…
Are you new and would like to get plug in right away?
Are you new and lost in the weeds of endless bee-like activities within the DAO?
Do you want to have a human-time with frenly DAO contributors to talk more about challenges you are facing as a new member and get some frenly advice?
Well. that's what the New Joiners Session is for. A human-frenly, no-bot-allowed chat session with you .
Let's have a great onboarding session
Check out the calender event and rsvp here, also don't forget to fill the sign up form.
RSVP and Sign Up Form
Tuesday 2 PM UTC RSVP
- How to Gitcoin
Learn About Gitcoin and Gitcoin Passport
Utilizes Gitcoin Grants as quarterly crowdfunding mechanism
Leverages Quadratic Funding to democratically allocate matching funds & make progress on important projects and causes
Whats Next?
Creating a decentralized +
Creating a decentralized + customizable Grants Protocol.
Join us in the watercooler 15 mins before event start for onboarding to Ed3DAOs Learn-o-verse in Zep. Its zoom + a metaverse!!
This event will be in the Auditorium
Wednesday 2 PM UTC RSVP
Join us for this Knowledge Session on Liquidity and Pools!
Join us in the watercooler 15 mins before event start for onboarding to zep. Its zoom + a metaverse!!
This event will be in Classroom 7
Thursday 2 PM UTC RSVP
Are you well balanced? Join us to learn about how to put your bank to use on the current and past DeFi Protocols.
This event will be in Classroom 7
Interested in helping to teach How To Sessions or need one for your DAO project? Connect with us in #the-edu-department (still in the Edu Guild Discord Category).
Looking for more Bankless Education? Check out the #leaerning-opportunities channel at the top of the DAO Discord. The place where All public DAO Educational Activities are welcome to share their events! Find learning opportunities in Design, AV, and DAOLationships Guilds, just to name a few.


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Jellyfiction 《Nanomancer Reborn – I've Become A Snow Girl?》 – Chapter 1017 Altar Within The Temple cooing crooked to you-p2
suite 269 pdf
Novel–Nanomancer Reborn – I've Become A Snow Girl?–Nanomancer Reborn – I've Become A Snow Girl?
Chapter 1017 Altar Within The Temple gold earn
Seeing that her time restriction was some day, s.h.i.+ro couldn't aid but pause for just a moment. Converting around, she saw that her exit have been closed.
Sensing that they was gone, s.h.i.+ro furrowed her brows prior to glancing again at Nan Tian.
Sighing in disappointment, s.h.i.+ro drawn your guide and began to compare several of the runes that her drones have examined throughout the city. She had ensured that that is in terms of they might to make sure they could take the full rune.
"I have done certainly. The G.o.d of recovery was my t.i.tle. After the new get older finished, everything was demolished. The native G.o.ds have been, sadly, addressed. I found myself no exception to this rule." The tone of voice sighed being the divine vigor washed out apart.
Refreshed from lightnovelpub[.]com
"It's easy enough. I wouldn't refer to it a routine but alternatively the act of declaring the motive to perform the trials." Silvia shrugged ahead of flaring her mana.
"I suppose we have to have a look now." s.h.i.+ro recommended with a look.
[One has found the Selection of your Gone G.o.d.]
"Realized. You may be talking the reality. My understanding of runes is absolutely not as strong as my comprehension of the careers that you simply talk about but I will grant you access to the library comprising the information of runes. Having said that, right before I allow you to go into the selection, I want you to produce a vow."
Choosing a serious breathing, she got one step ahead and glanced up with the crystal.
From what she could explain to, the component which has been missing was thoughts. Why you need to take the experiences? Have you considered the combat working experience? The identity? Why managed they just get rid of the memories but hardly anything else. Was there something to gain from your remembrances?
Suddenly, the signals converged towards her like a portal exposed prior to her.
Taking a serious breath, she grabbed the closest book and begun to browse.
"I'll give it a go." s.h.i.+ro explained soon after biting her lip.
torch novel
"It's reasonably easy. I wouldn't refer to it as a routine but instead the act of proclaiming the motive to undertake the trials." Silvia shrugged ahead of flaring her mana.
"I spent an instant discussing with him and so i need some reset." s.h.i.+ro scratched her cheek as Nan Tian couldn't support but chuckle.
Nanomancer Reborn – I've Become A Snow Girl?
The statues were definitely of armoured leaders positioning swords and had crimson capes behind them.
Recognizing a sterling silver platter with carvings at first, s.h.i.+ro a.n.a.lysed the terminology prior to launching her jaws.
"A demi G.o.ddess… It's already the modern age… But it's not the second half… How peculiar… Irregardless, respond to me this youthful G.o.ddess. What understanding should you get and that which you intention with regards to it?" A voice rang out as s.h.i.+ro believed that she was speaking with a G.o.d or relatively, what ended up being a G.o.d since this was left divine energy that is enclosed inside the crystal.
The origin on this content articles are lightnovelpub[.]com
Experiencing the portal flicker, she release Nan Tian's sleeve and stepped by means of.
"Silvia, Sage of Existence, wishes to attempt the trial offers of information." She termed out because the crystals started to flicker.
"Mn, all the best." s.h.i.+ro nodded her travel.
"It's just twenty four hours. It'll go by promptly, I've finished study beyond this ahead of." s.h.i.+ro muttered as she glanced again within the catalogue.
She could already actually feel her cardiovascular system defeating as one working day was far beyond her up-to-date reduce. Earlier, she was able to continue to be within Chronos' aspect for many years since her actual body was with Nan Tian.
"I am a departed G.o.d. There is not any want for you to know my label as this is the only area made up of my divine electricity."
The cause for this content articles are lightnovelpub[.]com
The sculptures had been of armoured titans holding swords and had reddish capes behind them.
"Mn, good luck." s.h.i.+ro nodded her mind.
New innovative chapters are released on lightnovelpub[.]com
Considering that her time limit was eventually, s.h.i.+ro couldn't support but pause for a second. Turning approximately, she observed that her get out of has been covered.
Normally, this procedure can be filled up with people today ever since the residents here used this temple being a place of wors.h.i.+p as well as a medium for getting information. Nevertheless, there were only deathly silence.
The sculptures were actually of armoured leaders grasping swords and had red-colored capes behind them.


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While starting to make your closure price, required one or two weeks from start to finish. And, for those who start the contract in the middle of 30 days, the representative could possibly get wait until the original of the the following month to finish the process. Then there are to provide how much time it will require you to obtain property that you want and that suits your need. Thus, this process might take any where from two months to per year.
Offering a house
When you're offering your residence, research has shown that it could grab anywhere https://worldpaydayloans.com/payday-loans-ar/ between thirty six in order to 70 days following the residence is noted to market. To acquire a precise imagine, you ought to contact a licensed realtor that knows the new business the place you residence is located. The home's position will additionally enjoy a giant part regarding how a lot of time they consist in the business earlier deal. And then make your house sell shorter, phase it before you could provides audience break through or take tips to solve right up one lesser circumstances.
Will cost you
- Settlement costs. You're requested to invest settlement costs on your household. These could is HOA fees, attorneys charges, and you may an escrow fee to mention a few.
- Commisson Commission. The true home agent becomes a fee payment, which might be as much as 5% otherwise six% of one's house's price point.
- Examination. There are even our home and you can inspection can cost you to provide in the. This could soon add up to more hundreds of dollars.
- Presenting. We need to offer buyers a sensible assumption on what this new house will just as in furniture. You may need to spend an expert stager to bring seats within the and you can work it.
- Resources. You should shell out the tools in your house up until they sells. This may cost a hundred or so a lot more dollars too.
- Rent or Financial. House vendors need certainly to alive someplace when you are their residence are upwards obtainable. This can imply briefly expenses rent somewhere else, remaining in a hotel, otherwise investing elizabeth go out.
Why does Real estate Progress Evaluate Against A lot of time-Name Inflation or Commodity?
Across the long lasting home speed have a tendency to change inside the-range with larger inflation. Occasionally a home cost may overshoot or undershoot, but considering a lengthy enough timeframe they typically song wider rising cost of living.A home purchasing for someone resident is more throughout the balance in place of gaining solid productivity.
When you're seeking to plan to put money into a residential property instead of brings to reach financing productivity, holds are usually the greater choice. He's more drinking water, plus they can be utilized much more flexible implies than antique real estate. And, it will be easy to market their carries rapidly in you need to without having to pay a great deal inside extra charge. Carries as well as generally have an ascending development, regardless of if they get rid of dramatically inside the sustain segments. Which general trend means they are a better selection for those who are able to help their cash material consistently before buying a great homepanies instance Revolutionary allow an easy task to put money into a beneficial varied profile inexpensively to help expand remove risk.
A citizen that have a 20% down-payment possess an excellent 5:1 leverage during the purchasing the home & if something lead southern area he has got not a chance to exit a part of the capital instead of leaving the entire resource. If one was laid off they are not in a position to help you re-finance their loan or score a home equity loan. And if the true house sector softens banking companies can be faster happy to lend up against the property.


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An electric vehicle starts from rest and accelerates at a rate of 2.1 m/s2 in a straight line until it reaches a speed of 19 m/s. The vehicle then slows at a constant rate of 1.3 m/s2 until it stops. (a) How much time elapses from start to stop? (b) How far does the vehicle move from start to stop
I will be glad to see your comment if you have any query and thumb up if you are satisfied. Thanks...
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Iranian protests should inspire us
Thousands of Iranian university students publicly protested Monday in a country that ranks as part of President George W. Bush's "Axis of Evil."
These students, along with a few professors, rallied against the death sentence imposed on a well-known professor for insulting Islam and questioning authority. History professor Hashem Aghajari, of Tarbiat-e-Modarres University in Tehran, encouraged contemporary interpretations of Islam; clerics in the hard-line government found him guilty of denying Islamic principles.
In America, citizens may worship as they choose or not worship at all. We can challenge our church's policies or abide by them without fear of intervention — much less punishment — by our government. We can criticize government policies and work actively to change them without fear of imprisonment. In Iran, religious and political rule are deeply intertwined. Denying Islamic principles can be punished by death. Aghajari knew this, yet during a speech last June advocated new, contemporary interpretations of Islam. Hard-liners protested and demanded Aghajari, whose political party supports Iranian President Mohammad Khatami's social and political reforms, be prosecuted.
Reformist parliament members and a few professors at the university are urging that the sentence be lifted. But the fact is that any challenge to Islam is a highly risky matter.
In Iran, student demonstrators took to the streets Monday in support of the condemned Aghajari, risking their own freedom and even their lives as they voiced objections to the sentence they termed "medieval." "You can cut our tongues ... you can take us to jail as you have jailed many other students and scholars, but you can't capture our hearts, you can't prevent freedom of expression and thoughts," Saeed Razavi, a student leader, said to applause.
Despite Americans' tremendous political freedom, most fail to exercise it by voting. Most Americans are so complacent that they seldom do more than complain to a family member when our government — of, by and for the people — does something they disapprove. Important mid-term elections took place here on Nov. 5, yet only a small percent of eligible voters turned out to play a role in determining the course of our country's future. Compare that to the passion of these students, who risked life and liberty for the sake of freedom of expression.
We admire those Iranians who have the courage of their convictions. In their own country, they embody the American principles of freedom of speech and freedom of worship.
Their whole-hearted dedication, and the very real risks they take in voicing them, rise above the level of a news story from the other side of the world.
They inform us that glimmers of democracy and freedom occasionally ignite even the darkest and most dangerous regimes, and should serve as inspiration to Americans not to take our own cherished freedoms for granted.


text: Expert consensus recommendations on the management of calcium channel blocker (CCB) poisoning in adults state IV calcium, high-dose insulin, and norepinephrine (and/or epinephrine) are first-line therapies. Dobutamine or epinephrine can be used in the presence of cardiogenic shock and atropine in the presence of symptomatic bradycardia or conduction disturbance. In patients refractory to first-line treatments, recommendations are incremental doses of high-dose insulin if there is myocardial dysfunction present, IV lipid-emulsion therapy, and using a pacemaker in the presence of unstable bradycardia or high-grade arteriovenous block without significant alteration in cardiac inotropism. [1] A 2020 systematic review evaluated various pharmacological interventions in managing beta-blocker (BB) poisoning. A total of 141 articles were evaluated for treatment and their effect on mortality and improvement in hemodynamic parameters. While the use of insulin for BB poisoning has been observed in several case series and case reports, no controlled human trials or observational studies were identified. Based on available evidence of high-dose insulin euglycemic therapy (HIET), mortality benefits were reported in 10 case series and clear hemodynamic improvement was observed in 2 case reports. The insulin dosing regimen ranged from 1 unit/kg/h up to 10 units/kg/h. Notably, in five case series, adverse effects such as hypoglycemia and hypokalemia occurred in 195 cases (42.6%). The majority of evidence that has observed an improvement in hemodynamic response for high-dose insulin euglycemic therapy is drawn from low-quality studies and is confounded by the use of multiple interventions and unclear treatment timelines and responsiveness. [2] A 2018 review discussing the use of HIET in BB and CCB overdose stated the major mechanism of insulin during these toxicities is to potentiate myocardial cells to uptake and effectively exploit glucose as a source of energy. Additionally, insulin also exhibits concentration-dependent inotropic effects on human myocardial cells. Compared to other clinical scenarios utilizing intravenous insulin, the most common insulin bolus dose in successful cases where HIET is utilized is 1 unit/kg, followed by infusion at 0.5 to 1 unit/kg/hour. Based on existing evidence, the authors recommended the reasonable maximum dose of regular insulin IV infusion to be 10 units/kg/hr titrated up every 10 to 15 min to clinical response. It is worth noting that this intense HIET requires continuous dextrose infusion and close monitoring of electrolytes, vital signs, blood glucose, and serial electrocardiogram. Ideally, the blood glucose should be maintained at greater than 100 mg/mL with an initial dextrose dose of 0.5 g/kg/hr. If blood glucose increases above 200 mg/dL, dextrose should be temporarily suspended. The duration of therapy typically depends on the achievement of hemodynamic stability. While there is no consensus on ideal efficacy targets in published literature, it is reasonable to target systolic blood pressure of ≥ 90 mmHg and heart rate of ≥ 50 beats per minute. If present at baseline, abnormalities in mental status and electrocardiogram readings should resolve. In a brief summary of case reports conducted by the authors, the maximal intravenous insulin infusion was initiated at 1.25 units/kg/hr and subsequently increased to 4.5 units/kg/hr in one patient with diltiazem overdose at 3,360 mg. [3] Symptomatic BB and CCB poisoning require supportive therapy through respiratory assistance and 1 to 2 liters of intravenous fluid to manage hypertension and avoiding fluid overload. The mainstay treatment of cardiogenic shock in beta-blocker and CCB overdose includes high-dose insulin euglycemia therapy loading dose 1 IU/kg then infusion rate of 1 to 10 IU/kg/hour with 50% glucose infusion to maintain euglycemia and catecholamine infusions titrated to effect to improve inotropy and chronotropy. Second-line therapies include phosphodiesterase inhibitors to improve contractility, glucagon to improve bradycardia, or intravenous calcium infusion specifically for CCB poisoning to increase cardiac output and vascular tone. [4] A review of articles from 1975-2010 for high-dose insulin therapy in relation to BB and CCB poisoning noted that human case reports of high dose insulin included insulin boluses ranging from 0.1 to 10 U/kg. Continuous insulin infusion rates ranged from 0.015 to 22 U/kg/h with the majority of patients receiving between 0.5 and 2 U/kg/h. Several case reports told of patients getting doses higher than 10 U/kg/h without having hypoglycemic effects. A dextrose infusion should be initiated at the beginning of therapy in order to prevent hypoglycemia. [5] High-dose insulin euglycemic therapy for CCB toxicity typically starts with a bolus dose of 1 unit/kg of regular insulin followed by an infusion of 1 unit/kg/hr. Animal data suggest increased insulin doses are associated with increased cardiac output. Despite expert recommendation of titration of insulin doses up to 10 units/kg/hr for refractory patients, a stepwise approach may be more beneficial to prevent volume overload and worsening vasodilation; however, stepwise approaches to insulin titration in CCB therapy are still being investigated. [6]


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Using the Internet, the text, or another reliable source such as a newspaper or periodical site, (not a scholastic or school site like Khan Academy and not Wikipedia), research some important data that has been presented in graph or table format. Make sure to cut and paste the chart or table; if that is not possible, paste a link to the webpage. (Check it to be sure it links correctly.) Present your graph and fully explain the information it is representing. Pose one question regarding the data and graph or chart for your fellow students to consider and respond to in your post.
Provide two replies to other student posts. These replies should be at least 2–3 sentences and should be written to further the discussion.
Discussion Best Practices
The Discussion Board is where you post your responses to the Discussion topics and share your experiences in completing exercises and applying the concepts of this course. You will need to post an initial response that thoroughly covers the topic(s). You will also need to respond substantially to at least two of your classmate's posts. These replies should be at least 2–3 sentences that further the discussion (remark on something specific from the post, tactfully point out mistakes, ask questions about the post, etc.). You should post throughout the unit to get assistance on problems with which you may be having issues. This will also to give your classmates the opportunity to respond to your ideas.
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text: Investment Strategies for Retirement The slideshow presentation that you would like to view is too large for your current screen resolution. Click here to view to view the slideshow at full resolution. Launch Presentation » Share | Have A Question About This Topic? Name Email Address Message Thank you! Oops! Related Content Emerging Market Opportunities What are your options for investing in emerging markets? Avoiding Cognitive Decline Try these activities to keep your brain sharp. Tax & Estate Strategies for Married LGBTQ+ Couples Learn how to maximize your tax and estate strategy as a married member of the LGBTQ+ community.


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Published: Friday 25th of January 2013
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