bipolar disorder as well. 22 however, children sometimes respond differently to psychiatric medications than adults. before starting medication, your doctor will want to determine your child ' s physical and mental health. this is called a " baseline " assessment. your child will need regular follow - up visits to monitor treatment progress and side effects. most children with bipolar disorder will also need long - term or even lifelong medication treatment. this is often the best way to manage symptoms and prevent relapse, or a return of symptoms. 23 it ' s better to limit the number and dose of medications. a good way to remember this is to " start low, go slow. " talk to the doctor about using the smallest amount of medication that helps relieve your child ' s symptoms. to judge a medication ' s effectiveness, your child may need to take a medication for several weeks or months. the doctor or specialist needs this time to decide whether the medication is working or if they need to switch to a different medication. because children ' s symptoms are usually complex, they commonly need more than one type of medication. 24 keep a daily log of your child ' s most troublesome symptoms. doing so can make it easier for you, your child, and your doctor to decide whether a medication is helpful. also, be sure to tell your doctor about all other prescription drugs, over - the - counter medications, or natural supplements your child is taking. combining certain medications and supplements may cause unwanted or dangerous side effects. some of the types of medications generally used to treat bipolar disorder are listed below. information on medications can change. for the most up - to - date information on use and side effects of medications, see the u. s. food and drug administration ( fda ) websiteexternal link : please review our disclaimer.. you can also find more information about medications in the nimh mental health medications booklet. mood stabilizers, such as lithium are usually the first choice to treat bipolar disorder. lithium is approved for the treatment and prevention of manic symptoms in children ages 12 and older. 25 in addition, lithium might act as an antidepressant and help prevent suicidal behavior. 26 however, fda ' s approval of lithium was based on treatment studies in adults, not children. anticonvulsant medications, originally developed to treat seizures, are also sometimes used as mood stabilizers. they are not approved by the fda for treating bipolar disorder in children, but your doctor may prescribe one on an " off label " basis. they may be very helpful


, originally developed to treat seizures, are also sometimes used as mood stabilizers. they are not approved by the fda for treating bipolar disorder in children, but your doctor may prescribe one on an " off label " basis. they may be very helpful for difficult - to - treat bipolar episodes. for some children, anticonvulsants may work better than lithium. examples of anticonvulsant medications include valproic acid or divalproex sodium ( depakote ) and lamotrigine ( lamictal ). what are the side effects of mood stabilizers? lithium can cause side effects such as : - frequent urination - dry mouth - bloating or indigestion - joint or muscle pain - brittle nails or hair. lithium may cause other side effects not listed here. tell the doctor about bothersome or unusual side effects as soon as possible. if your child is being treated with lithium, it is important for him or her to see the doctor regularly. the doctor needs to check the levels of lithium in your child ' s blood, as well as kidney function and thyroid function. some common side effects of lamotrigine and valproic acid include : - mood swings - stuffed or runny nose, or other cold - like symptoms. children may be showing early signs of lithium poisoning if they develop the following : - muscle weakness - lack of coordination take your child to the emergency room if he or she is taking lithium and has these symptoms. the risk of lithium poisoning goes up when a child becomes dehydrated. make sure your child has enough to drink when he or she has a fever or sweats a lot during very active play or work. these medications may also be linked with rare but serious side effects. talk with the doctor or a pharmacist to make sure you understand signs of serious side effects for the specific medications your child is taking. in addition, valproic acid, lamotrigine, and other anticonvulsant medications carry an fda warning. the warning states that their use may increase the risk of suicidal thoughts and behaviors. people taking anticonvulsant medications for bipolar or other illnesses should be closely monitored for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. people taking these medications should not make any changes without talking to their health care professional. should girls take valproic acid? valproic acid may increase levels of testosterone ( a male hormone ) in teenage


or any unusual changes in mood or behavior. people taking these medications should not make any changes without talking to their health care professional. should girls take valproic acid? valproic acid may increase levels of testosterone ( a male hormone ) in teenage girls. it could lead to a condition called polycystic ovarian syndrome ( pcos ) in women who begin taking the medication before age 20. 27, 28 pcos can cause obesity, excess body hair, an irregular menstrual cycle, and other serious symptoms. most of these symptoms will improve after stopping treatment with valproic acid. young girls and women taking valproic acid should be monitored carefully by a doctor. 29 atypical antipsychotics are sometimes used to treat symptoms of bipolar disorder. those approved by the fda to treat youth with bipolar disorder are risperidone ( risperdal ), aripiprazole ( abilify ), quetiapine ( seroquel ), and olanzapine ( zyprexa ). short - term treatment with risperidone can help reduce symptoms of mania or mixed mania in children ages 10 and up. some research has indicated that risperidone is more effective in treating mania in young children than other medications. 30 aripiprazole and quetiapine are approved to treat mania symptoms in children 10 – 17 years old who have bipolar i, while olanzapine is approved for use in children ages 13 – 17. 31 what are the side effects of atypical antipsychotics? side effects of many atypical antipsychotics include : - dizziness when changing positions - blurred vision - rapid heartbeat - sensitivity to the sun - skin rashes - menstrual problems for girls - weight gain. atypical antipsychotics can cause major weight gain and changes in metabolism, especially in children. this may increase the risk of developing diabetes and high cholesterol. 32 while taking an atypical antipsychotic, your child ' s weight, glucose levels, and lipid levels should be monitored regularly by a doctor. in rare cases, long - term use of atypical antipsychotics may lead to a condition called tardive dyskinesia ( td ). the condition causes uncontrollable muscle movements that commonly occur around the mouth. td can range from mild to severe. sometimes people with td recover partially or fully after they stop taking the drug, but others do not. antidepressants


. the condition causes uncontrollable muscle movements that commonly occur around the mouth. td can range from mild to severe. sometimes people with td recover partially or fully after they stop taking the drug, but others do not. antidepressants, such as fluoxetine ( prozac ), paroxetine ( paxil ), and sertraline ( zoloft ) are sometimes used to treat symptoms of depression in bipolar disorder. doctors who prescribe antidepressants for bipolar disorder usually prescribe a mood stabilizer or anticonvulsant medication at the same time. if your child takes only an antidepressant, he or she may be at risk of switching to mania or hypomania. he or she may also be at risk of developing rapid cycling symptoms. 33 rapid cycling occurs when someone has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year. 34 however, results on effectiveness of antidepressants for treating bipolar depression are mixed. the step - bd study showed that, in adults, adding an antidepressant to a mood stabilizer is no more effective in treating depression than using a mood stabilizer alone. 35 what are the side effects of antidepressants? antidepressants can cause : - nausea ( feeling sick to your stomach ) - sleep problems, such as sleeplessness or drowsiness - agitation ( feeling jittery ) - sexual problems, which can affect both men and women. some antidepressants are more likely to cause certain side effects than other antidepressants. your doctor or pharmacist can answer questions about these medications. antidepressants carry an fda warning. although they are generally safe and popular, some studies have suggested that they may have unintentional side - effects in some people, especially teens and young adults. the fda warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. families and caregivers should report any changes to the doctor. the latest fda information can be found hereexternal link : please review our disclaimer.. unusual or severe side effects of any medication should be reported to a health care provider right away. your child may need a change in


the doctor. the latest fda information can be found hereexternal link : please review our disclaimer.. unusual or severe side effects of any medication should be reported to a health care provider right away. your child may need a change in the dose or a different medication. children and teens being treated for bipolar disorder should not stop taking a medication without talking to a doctor first. suddenly stopping a medication may lead to " rebound, " or worsening of bipolar disorder symptoms, or other uncomfortable or possibly dangerous withdrawal effects. sexual activity, pregnancy, and adolescents with bipolar disorder many teens make risky choices about sex. but having bipolar disorder is also linked with impulsive and risky choices. teenage girls with bipolar disorder who are pregnant or may become pregnant face special challenges because medications for the illness may have harmful effects on a developing fetus or nursing infant. 36 specifically, lithium and valproic acid should not be used during pregnancy. also, some medications may reduce the effectiveness of birth control pills. 37 for more information on managing bipolar disorder during and after pregnancy, see the nimh booklet bipolar disorder in adults. in addition to medication, psychotherapy can be an effective treatment for bipolar disorder. when treating bipolar disorder, psychotherapy is usually prescribed in combination with medication. studies in adults show that it can provide support, education, and guidance to people with bipolar disorder and their families. psychotherapy may also help children continue taking their medications to stay healthy and prevent relapse. some psychotherapy treatments used for bipolar disorder include : - cognitive behavioral therapy, which helps young people with bipolar disorder learn to change harmful or negative thought patterns and behaviors. - family - focused therapy, which includes a child ' s family members. it helps enhance family coping strategies, such as recognizing new episodes early and helping their child. this therapy also improves communication and problem - solving. - interpersonal and social rhythm therapy, which helps children and teens with bipolar disorder improve their relationships with others and manage their daily routines. regular daily routines and sleep schedules may help protect against manic episodes. - psychoeducation, which teaches young people with bipolar disorder about the illness and its treatment. this treatment helps people recognize signs of an impending relapse, allowing them time to seek treatment early, before a full - blown episode occurs. psychoeducation also may be helpful for family members and caregivers. other types of therapies may be tried as well, or used along with those mentioned above. the number, frequency, and type of psychotherapy sessions should be


. psychoeducation also may be helpful for family members and caregivers. other types of therapies may be tried as well, or used along with those mentioned above. the number, frequency, and type of psychotherapy sessions should be based on your child ' s treatment needs. a licensed psychologist, social worker, or counselor typically provides these therapies. he or she should work with your child ' s doctor to monitor care. in addition to getting therapy to help reduce symptoms of bipolar disorder, children and teens may also benefit from therapies that address problems at school, work, or in the community. such therapies may target communication skills, problem - solving skills, or skills for school or work. other programs, such as those provided by social welfare programs or support and advocacy groups, can help as well. 38 some children with bipolar disorder may also have learning disorders or language problems. 39 your child ' s school may need to make accommodations that reduce the stresses of a school day and provide proper support or interventions. you can find more information about psychotherapy on the nimh website. what can children and adolescents with bipolar disorder expect from treatment? there is no cure for bipolar disorder, but it can be treated effectively over the long term. you and your child ' s doctor should keep track of your child ' s symptoms and treatment effects to decide whether changes to the treatment plan are needed. one way to do this is by creating a mood or daily life chart, where you and the doctor can track your child ' s moods, treatments, sleep patterns, and life events. the chart can help you track and treat the illness more effectively. be sure to work closely with your child ' s treatment providers. talk openly and frequently with them about treatment choices. sometimes a child may switch from one type of bipolar disorder to another. this calls for a change in treatment. in the nimh - funded course and outcome of bipolar illness in youth ( coby ) study, researchers found that roughly 30 percent children with bp - nos later switched to bipolar i or ii. also, roughly 20 percent of children who started out with a diagnosis of bipolar ii switched to bipolar i. 40 because different medications may be more helpful for one type of symptom than another ( manic or depressive ), your child may need to change medications or try different treatments if his or her symptoms change. the coby study also showed that treatment helped around 70 percent of children with bipolar disorder recover from their most recent episode ( either manic


or depressive ), your child may need to change medications or try different treatments if his or her symptoms change. the coby study also showed that treatment helped around 70 percent of children with bipolar disorder recover from their most recent episode ( either manic or depressive ) over the course of about a year and half. however, within the next year or so, symptoms returned in half of the children who recovered. children with bipolar i or ii tended to recover faster than those with bp - nos, but their symptoms returned more frequently as well. if your child has other psychiatric illnesses, such as an anxiety disorder, eating disorder, or substance abuse disorder, he or she may be more likely to experience a relapse — especially of depressive symptoms. 41 scientists are unsure how these co - existing illnesses increase the chance of relapse. as we work to find ways to better understand and treat the disorder in children, nimh is also spearheading the research domain criteria ( rdoc ) project, which in an ongoing effort to map our current understanding of the brain circuitry that is involved in behavioral and cognitive functioning. by essentially breaking down mental disorders into their component pieces — rdoc aims to add to the knowledge we have gained from more traditional research approaches that focus solely on understanding mental disorders based on symptoms. the hope is that by changing the way we approach mental disorders, rdoc will help us open the door to new targets of preventive and treatment interventions. where can families of children with bipolar disorder get help? as with other serious illnesses, taking care of a child with bipolar disorder is very hard on the parents, family, and other caregivers. caregivers often must tend to the medical needs of their child while dealing with how it affects their own health and the health of their other children. the stress that caregivers are under may lead to missed work or lost free time. it can strain relationships with people who do not understand the situation and lead to physical and mental exhaustion. stress from caregiving can make it hard to cope with your child ' s bipolar symptoms. one study shows that if a caregiver is under a lot of stress, his or her loved one has more trouble sticking to the treatment plan, which increases the chance for a relapse of symptoms. 42 it is important to take care of your own physical and mental health. you may also find it helpful to join a local support group. if your child ' s illness prevents you from attending a local support group, try an online support group


symptoms. 42 it is important to take care of your own physical and mental health. you may also find it helpful to join a local support group. if your child ' s illness prevents you from attending a local support group, try an online support group. if you are unsure where to go for help, ask your family doctor. others who can help are listed below. - mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors - health maintenance organizations - community mental health centers - hospital psychiatry departments and outpatient clinics - mental health programs at universities or medical schools - state hospital outpatient clinics - family services, social agencies, or clergy - peer support groups - private clinics and facilities - employee assistance programs - local medical and / or psychiatric societies. you can also check the phone book under " mental health, " " health, " " social services, " " hotlines, " or " physicians " for phone numbers and addresses. an emergency room doctor can also provide temporary help and can tell you where and how to get further help. what if my child is in crisis? if you think your child is in crisis : - call your doctor - call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member to help you do these things - call the toll - free, 24 - hour hotline of the national suicide prevention lifeline at 1 - 800 - 273 - talk ( 1 - 800 - 273 - 8255 ) ; tty : 1 - 800 - 799 - 4tty ( 4889 ) to talk to a trained counselor - make sure your child is not left alone. 1. moreno c, laje g, blanco c, jiang h, schmidt ab, olfson m. national trends in the outpatient diagnosis and treatment of bipolar disorder in youth. arch gen psychiatry. 2007 sep ; 64 ( 9 ) : 1032 – 1039. 2. kessler rc, berglund p, demler o, jin r, merikangas kr, walters ee. lifetime prevalence and age - of - onset distributions of dsm - iv disorders in the national comorbidity survey replication. arch gen psychiatry. 2005 jun ; 62 ( 6 ) : 593 – 602. 3. nurnberger ji, jr., foroud t. genetics of bipolar affective disorder. curr psychiatry rep. 2000 apr ; 2 ( 2 ) : 147 – 157. 4. findling rl, youngstrom ea, fristad ma


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epilepsy. ann neurol. 1999 apr ; 45 ( 4 ) : 444 – 450. 28. joffe h, cohen ls, suppes t, mclaughlin wl, lavori p, adams jm, hwang ch, hall je, sachs gs. valproate is associated with new - onset oligoamenorrhea with hyperandrogenism in women with bipolar disorder. biol psychiatry. 2006 jun 1 ; 59 ( 11 ) : 1078 – 1086. 29. joffe h, cohen ls, suppes t, hwang ch, molay f, adams jm, sachs gs, hall je. longitudinal follow - up of reproductive and metabolic features of valproate - associated polycystic ovarian syndrome features : a preliminary report. biol psychiatry. 2006 dec 15 ; 60 ( 12 ) : 1378 – 1381. 30. geller b, luby j, josh p, wagner kd, emslie g, walkup jt, axelson da, bolhofner k, robb a, wolf dv, riddle ma, birmaher b, ryan nd, severe j, vitiello b, tillman r, lavori p. a randomized controlled trial of risperidone, lithium and divalproex sodium for initial treatment of bipolar i disorder, manic or mixed phase, in children and adolescents. arch gen psychiatry. 2012 may ; 69 ( 5 ) : 515 – 528. 31. u. s. food and drug administration. pediatric exclusivity labeling changes http : / / www. fda. gov / downloads / scienceresearch / specialtopics / pediatrictherapeuticsresearch / ucm163159. pdfexternal link : please review our disclaimer.. accessed on september 8, 2011. 32. lieberman ja, stroup ts, mcevoy jp, swartz ms, rosenheck ra, perkins do, keefe rs, davis sm, davis ce, lebowitz bd, severe j, hsiao jk. effectiveness of antipsychotic drugs in patients with chronic schizophrenia. n engl j med. 2005 sep 22 ; 353 ( 12 ) : 1209 – 1223. 33. thase me, sachs gs. bipolar depression : pharmacotherapy and related therapeutic strategies. biol psychiatry. 2000 sep 15 ; 48 ( 6 ) : 558 – 57


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adolesc psychiatry. 2005 may ; 44 ( 5 ) : 461 – 469. 40. birmaher b, axelson d, strober m, gill mk, valeri s, chiappetta l, ryan n, leonard h, hunt j, iyengar s, keller m. clinical course of children and adolescents with bipolar spectrum disorders. arch gen psychiatry. 2006 feb ; 63 ( 2 ) : 175 – 183. 41. perlis rh, ostacher mj, patel jk, marangell lb, zhang h, wisniewski sr, ketter ta, miklowitz dj, otto mw, gyulai l, reilly - harrington na, nierenberg aa, sachs gs, thase me. predictors of recurrence in bipolar disorder : primary outcomes from the systematic treatment enhancement program for bipolar disorder ( step - bd ). am j psychiatry. 2006 feb ; 163 ( 2 ) : 217 – 224. 42. perlick da, rosenheck ra, clarkin jf, maciejewski pk, sirey j, struening e, link bg. impact of family burden and affective response on clinical outcome among patients with bipolar disorder. psychiatr serv. 2004 sep ; 55 ( 9 ) : 1029 – 1035. for more information on bipolar disorder for information on clinical trials information from nimh is available in multiple formats. you can browse online, download documents in pdf, and order materials through the mail. check the nimh website for the latest information on this topic and to order publications. if you do not have internet access, please contact the nimh information resource center at the numbers listed below. national institute of mental health office of science policy, planning and communications science writing, press and dissemination branch 6001 executive boulevard room 6200, msc 9663 bethesda, md 20892 - 9663 phone : 301 - 443 - 4513 or 1 - 866 - 615 - nimh ( 6464 ) toll - free tty : 301 - 443 - 8431 or 1 - 866 - 415 - 8051 toll - free this publication is in the public domain and may be reproduced or copied without permission from nimh. we encourage you to reproduce it and use it in your efforts to improve public health. citation of the national institute of mental health as a source is appreciated. however, using government materials inappropriately can raise legal


or copied without permission from nimh. we encourage you to reproduce it and use it in your efforts to improve public health. citation of the national institute of mental health as a source is appreciated. however, using government materials inappropriately can raise legal or ethical concerns, so we ask you to use these guidelines : - nimh does not endorse or recommend any commercial products, processes, or services, and our publications may not be used for advertising or endorsement purposes. - nimh does not provide specific medical advice or treatment recommendations or referrals ; our materials may not be used in a manner that has the appearance of such information. - nimh requests that non - federal organizations not alter our publications in ways that will jeopardize the integrity and " brand " when using the publication. - addition of non - federal government logos and website links may not have the appearance of nimh endorsement of any specific commercial products or services or medical treatments or services. - images used in publications are of models and are used for illustrative purposes only. use of some images is restricted. if you have questions regarding these guidelines and use of nimh publications, please contact the nimh information resource center at 1 - 866 - 615 - 6464 or e - mail at email @ example. com. u. s. department of health and human services national institutes of health nih publication no. 12 - 6380


brush up on the facts : pets need good oral hygiene you and your pet have many things in common - one of which is the need for proper oral hygiene. without it, your pet could be in pain and you wouldn ' t know it. as a pet owner, you can help prevent periodontal disease in your cat or dog by learning proper brushing and making appointments for your pet to receive routine teeth cleanings. just like you, your pet has bacteria in his / her mouth. too much bacteria in the mouth can not only result in bad breath but can also lead to gum disease. this bacteria can then travel through the body and lead to serious infections involving your pet ' s major organs including the heart, lungs, kidneys, and liver. did you know that oral cancer is one of the major cancers affecting dogs and cats? by the age of 3, 70 % of dogs and cats show signs of gum disease. symptoms include yellow and brown buildup along the gumline, persistent bad breath, and red, inflamed gums. prevention of gum disease in your dog or cat is as simple as following a dental care regimen at home and following up with regular checkups with your pet ' s dentist - your family veterinarian. getting your dog or cat used to having its teeth cleaned at home should ideally be started when they are young. however, there are ways to make the experience pleasant if you have an adult dog or cat. be sure to use toothbrushes and toothpastes made especially for pets. human toothpaste contains fluoride which can be toxic in large amounts. be gentle when brushing, taking care to get the insides and outsides of all teeth. this process should be repeated approximately 2 - 3 times a week. to get your pet used to it, you may want to try using gauze wrapped around your finger and dipped in tuna water for cats and bouillon for dogs. some of the signs that your pet may be experiencing mouth or tooth pain may include : - - blood - tinged drooling - - difficulty eating / reluctance to eat - - swelling / redness of gums - - tipping / tilting the head when eating - - refusing to eat hard foods - - change in mouth odor your pet should also be examined regularly by your veterinarian. at times, a cleaning may need to be performed to eliminate excessive plaque build - up or extract infected teeth. for pets, these cleanings are considered surgical procedures because they are performed under anesthesia. pets cannot tell us


fox photos / getty images a happy - looking 1930s couple toasts. the act of toasting feels natural : you lift your arms in affirmation and drink in honor of an occasion or a loved one. it ' s what millions will do this week as they ring in the new year, but why? like shaking hands or saluting, toasting is a habit with incredibly foggy beginnings, so we here at the salt decided to dig into it, for the sake of science. " there ' s a thin line between history and folklore, " says historian paul dickson. he should know. he wrote a book about toasting called toasts : over 1, 500 of the best toasts, sentiments, blessings and graces. " but toasting definitely goes back to the ancient world. " ulysses drank to the health of achilles in the odyssey, he says. and in rome, drinking to someone ' s health was so important that the senate demanded that all diners drink to their emperor, augustus, before every meal. almost every culture — the hebrews, egyptians, persians, saxons, huns — had a pledging of honor with a glass, dickson says. but it wasn ' t always called a toast. the term didn ' t come about until the late 17th century. in the same way you throw a lime in tequila, it was customary to plop a piece of toast or crouton in a drink, dickson says. think of it as an early form of a cocktail snack. " it may have been a flavoring device, " he says. " the practice was common, and virtually anything found floating in a drink was referred to as toast. " origins of the ' clink ' and the clinking of glasses? dickson says that toasting flair didn ' t popularize until the early days of christianity. many believed the bell - like noise would drive off the devil — which was most dangerous in times of drinking and reveling. but that ' s just one theory. another legend contends that by adding the clink, toasters could get the greatest pleasure from a drink, dickson says. before the clink, toasts only satisfied four of the five senses. and there ' s a third theory. though dickson ' s research can ' t confirm or deny this one, many believe the clinking of glasses began as a way for nobles to avoid being poisoned. the tale goes that the clank would slosh liquid from one drink to the other, reassuring the guest that his or her drink


confirm or deny this one, many believe the clinking of glasses began as a way for nobles to avoid being poisoned. the tale goes that the clank would slosh liquid from one drink to the other, reassuring the guest that his or her drink was safe and untouched. the road to the american toast regardless of the reason, many in those early days drank to health, hospitality and honor. but every culture practiced different customs — some a bit strange. the irish tended to recite blessings, whereas young englishmen in the 17th century toasted sour drinks to profess their love. " the practice called for men to show their affection for a woman by stabbing themselves in the arm, mixing their blood in their wine, and drinking to the lady in question, " dickson explains. in scotland, it was customary to drink sparingly during the meal and then bring in a large punch bowl filled with whiskey, hot water and sugar after dinner. the drinking sometimes lasted eight to 10 hours, dickson says. and as for early americans — they adopted the tradition of toasting quite readily. but their ritual was largely directed to america as a patriotic gesture. they toasted to the new republic and the experiment of democracy. " after the [ revolutionary ] war, no official dinner or celebration was complete without 13 toasts, one for each state, " writes dickson. " for many years, the 13 toasts were obligatory at local fourth of july celebrations. " today, the ritual of toasting seems more popular than ever, perhaps a product of movies and cultural references, dickson says. toasts have also evolved into something of a verbal souvenir : " it ' s something you take home with you as sort of a remembrance of that time. " we ' ll certainly do that on monday night.


1. grammar - vietnamese grammar is not particularly any more difficult than to chinese ( mandarin ), but i feel as if there are many exceptions to those rules being taught in the language courses. for example, if you wanted to say : eg. ( because ) he was drunk, ( therefore ) i had to take him home. you could say : vi anh ay bi sin ruou, toi phai cho anh ay ve nha. but you could get rid of vi, or add tai or boi infront of it. also, you can remove bi, ruou and nha altogether and it would still make sense. if you take away vi, you must add either cho nen, vi the or so di... etc. 2. pronunciation - if you compare vietnamese pronunciation with chinese ( mandarin ), i think you ' d agree that the standard vietnamese ( northern ) pronunciation is quite hard enough to master, let alone the southern or central dialects. there are 6 tones in standard vietnamese and 5 in most of the others. the tones vary from extreme to extreme. the hardest tone to master is the nga ( ~ ) tone. even the southerners have merged this into the hoi (? ) tone. tone sandhi thankfully does not occur in modern vietnamese although there are traces of this in words such as cam on / cam on ( thank you ). 3. reading and writing - if you compared today ' s writing systems, then chinese would be far ahead for obvious reasons. the vietnamese script nowadays is 90 - 95 % phonetic. if, however, you compare chinese with chu nom. - firstly, in order to even read a nom character, you would have to learn at least 3000 chinese characters to be moderately literate. of course, many of those characters mightn ' t even be used that often. each of the characters has a corresponding vietnamised reading known as han - viet ( sino - vietnamese ). however, that just covers the sino - vietnamese words in vietnamese ( which do account for up to 60 % of all words ). what about the ordinary speech? in ordinary speech, vietnamese still use between 20 - 30 % chinese vocabulary without realising it. for those other 70 - 80 % of native vietnamese words, they must be transcribed using chu nom. but things aren ' t so simple. - the vietnamese phonology is similar but not an exact replica of that of chinese. therefore, there are many native words which do not have an exact sino - vietnamese


must be transcribed using chu nom. but things aren ' t so simple. - the vietnamese phonology is similar but not an exact replica of that of chinese. therefore, there are many native words which do not have an exact sino - vietnamese ( han - viet ) reading. as a result, the people who created chu nom used " rough borrowings of sound ". in other words, for those sounds that were present in vietnamese but not in chinese, they used similar sounds to do the job. note also that chu nom combines : original chinese characters with their exact pronunciations and meanings ( han - viet ), original chinese characters with a phonetic pronunciation and invented characters ( nom ). - an example is the character which is an old simplified form of the word dragon ( 龍 ). in han - viet is pronounced ' long ' and of course means dragon. however, is pronounced song ( river ), [ + ] is pronounced trong ( inside ) and [ + 目 ] is pronounced trong ( clear ). so just with those characters, you can see that the phonetic element is used mostly for its medial and final sound. of course, there are many more examples of this. however, what about the historic pronunciations? actually during the medieval period, song was pronounced somewhat like klong, and trong / trong were like tlong / tlong. as you can see, the long / long is actually there - the modern pronunciations just conceal that. some nom characters have phonetic components which are merely used for their medial or final sound. of course, vietnamese like most languages has changed a lot since the medieval ages. - as i mentioned just above, some original chinese characters are used simply as phonetic characters such as 女 can be read in han - viet as nu ( female ) or in nom as nua ( moreover, furthermore, also ). - i could go on, but as you can see, the han - nom writing system is not as simple as it sounds. it combines chinese characters with their original pronunciations and meanings, chinese characters used for phonetic purposes to represent a native vietnamese sound, invented characters ( mostly using a semantic and phonetic component ) and phonetic borrowings off invented characters. also, just as you may notice in modern chinese, the modern vietnamese pronunciations of certain characters with the same phonetic component is not always the same. this is obviously due to sound change, and semantic phonetic characters are a bit harder to learn because you ' d need


as you may notice in modern chinese, the modern vietnamese pronunciations of certain characters with the same phonetic component is not always the same. this is obviously due to sound change, and semantic phonetic characters are a bit harder to learn because you ' d need a fairly good understanding of chinese characters and their vietnamised pronunciations. ok, i should stop here. all i wanted to say was that chu nom would be harder to learn - not because the average character has more strokes, but because it combines three different types of characters ; original chinese character ( w / original meaning ) but pronounced with a nativised pronunciations ( han - viet ), original chinese character ( used phonetically to represent a native vietnamese syllable ), and an invented vietnamese character. also factor in the fact that although most chu nom characters are available to view online and many have been encoded into unicode, there has never been a full standardisation of nom characters, and even today, people can use their own variant of a character, and finally factor in the fact that there are modern words with no existing character but can be represented using an existing one. and yes, classical chinese will help you. with regards to original texts, most texts were written in classical chinese but there are many that were written in chu nom. these chu nom texts for the most part follow modern vietnamese syntax but use a lot of odd and no longer used native expressions. japanese writing sounds like a mess! all sounds in modern vietnamese may be represented in chu nom. to be considered " literate " you should aim to learn 3, 000 - 5, 000 chinese characters, and about 3, 000 - 5, 000 native characters ( ~ 6000 - 10, 000 ). me and a few others are currently transcribing texts for fun, but also aim to do our own standardisation for ourselves. oh and the average vietnamese in an informal situation will only speak 15 - 20 % words of chinese origin, everyday vietnamese would have about 20 - 30 % chinese ( or japanese ) derived vocabulary and in formal contexts, the media etc. then you can expect the amount to be 50 % at the least and even higher ( as much as 80 % ) in essays and documentation.


use of complementary and alternative medicine in radiotherapy patients - results of a german multicenter study reviewer : heather jones, md last modified : october 9, 2002 presenter : micke, oliver presenter ' s affiliation : department of radiotherapy, munster university hospital, munster type of session : scientific the use of complementary and alternative medicine ( cam ) is a frequent phenomenon among cancer patients. currently there is only limited knowledge about the patterns of use in patients undergoing radiotherapy for malignant diseases. in this study the german working ' trace elements and electrolytes in radiation oncology ' performed a multicenter evaluation in germany to evaluate the use of cam in cancer patients in addition to radiotherapy. materials and methods - a total of 1013 patients ( 476 female, 537 male ) from 5 institutions participated in the study - all patients were receiving radiation therapy for a biopsy proven malignancy - tumor parameters and the use of cam where evaluated as well as, the reason for the use, by what means did the patients received the cam medication, the source of cam information and the subjective self - assessment of patients personal conditions and quality of life was documented. - the most frequent histologies were : head and neck cancer ( 33 % ), breast cancer ( 29 % ), prostate cancer ( 18 % ) and lung cancer. - the overall cam use in this population was 56 % - of the patients using cam, 66 % were female patients and 34 were male. - cam use was most frequent in breast cancer patients ( 91 % ), followed by patients with hodgkin ' s disease ( 83 % ), other gynecologic malignancies ( 58 % ), renal cell carcinoma ( 50 % ) and rectal cancer ( 50 % ). - the most commonly used cam, in this population were : vitamin combinations ( 18 % ), treatment with mistle toe preparations ( 15 % ), selenium ( 10 % ), other trace elements preparations ( 7 % ), thymus preparations ( 6 % ) and homeopathy ( 4 % ). 6 % of patients used prayer as a complementary spiritual measure. - 60 % of patients younger than 60 years and 52 % of patients older than 60 years reported a cam use. - the most cited reasons for cam use were : ' supporting the conventional treatment ( 46 % ) and ' a better feeling ' ( 23 % ). - of the cam users 50 % purchased cam themselves the other 50 % use a prescription plan coverage - the cam medication was bought in


cam use were : ' supporting the conventional treatment ( 46 % ) and ' a better feeling ' ( 23 % ). - of the cam users 50 % purchased cam themselves the other 50 % use a prescription plan coverage - the cam medication was bought in majority of cases in drugstores ( 39 % ) and pharmacies ( 23 % ). - most the cam information in this population was obtained from the family physician ( 26 % ) and other patients ( 21 % ). more than half of all the patients in this patient population were using cam. every cancer patients should be asked about cam use. this frequent phenomenon should be documented and taken into account especially in clinical studies. the final conclusion of this study continues to underscore the need for physicians to be aware of cancer patients cam utilization. for the appropriate treatment recommendations to be made, a physician must be aware of all treatment modalities a patient is considering. also, important clinically is the theoretical concern that some of these cam therapies may interact with conventional cancer treatments and / or cause significant side effects. there is an ever growing body of evidence demonstrating the significant cam use in the cancer patient population and it highlights the need for prospective studies evaluating the commonly used cam therapies. oncolink ' s astro coverage made possible by an unrestricted educational grant from ortho biotech.


pressure is growing on educational institutions to increase the use of technology in the high school and college learning environment, according to the results of a new survey, which polled students, faculty, and it administrators. the “ learn now, lecture later ” survey was conducted by cdw - g, a technology product and service provider for business, government and education, and gathered responses from 1, 015 participants. the results highlight a mismatch between current educational instruction and the expectations of students. as technology has become more embedded in their out - of - school lives, students at both the secondary and post - secondary levels have begun to expect their learning experiences include laptops, smart phones, digital content, student response systems, and recorded lectures. learning management systems were a priority for college - level students. faculty members — whether high school or college instructors — said laptops, digital content, and tablets would aid the learning process, though budget constraints were cited as an obstacle. while slightly more than half of classes are lecture - based, fewer than 40 % of students wanted to learn through that model, according to the survey. only 23 % of students in the survey results said they were satisfied with how instructors utilized class time, while 69 % said technology should be leveraged to provide more learning tools in classes. nearly half of the faculty respondents indicated they had shifted from the traditional lecture model of teaching while 20 % indicated they were considering a change in the future. though students were more likely to opt for technology - driven modes of learning, 11 % reported they were being taught through hands - on projects but 17 % indicated they would prefer this method. the survey also reported 8 % were using distance and virtual learning as an educational tool, but 11 % would prefer it. a meager 3 % were being taught through one - on - one tutoring, but 8 % wanted more of the method. the survey also found that digital content – course material presented online – had reached high levels of penetration among the respondents. about 74 % of higher education students used digital content in comparison to 64 % of high school students. for learning management systems ( lms ), higher education student usage outnumbered high school student usage 72 % to 40 %, and the percentage comparison for recorded class lecture usage was 53 % to 30 %. at the instructor level, 80 % of college faculty members had used digital content in connection with a course compared to 66 % of high school teachers. it was 67 % to 49 % in the usage of lms in favor of higher education faculty. higher education faculty


the east of england has the fastest growing population in england and this is projected to continue. it has one of the highest total net migration rates of all the english regions. the total population was 5. 8 million in mid - 2010, 11 per cent of the population of england. the region had the highest percentage increase in population between 2001 and 2010 of all regions in england at 8. 0 per cent, compared with the england average of 5. 6 per cent. the 2008 - based projections suggest the region may have almost 7. 0 million residents by 2030 – 19. 5 per cent more than in 2010. this is the largest projected increase of the english regions, compared with the england increase of 14. 4 per cent. in 2009, the region had the highest total net migration rate of all english regions at 67 per 10, 000 residents. two - thirds of this was due to international migration. the region had the third highest net population increases due to both international ( 26, 000 ) and inter - regional migration ( 13, 000 ) in england. in mid - 2010, 17. 5 per cent of east of england residents were aged 65 and over, compared with 16. 5 per cent for england as a whole. the projections suggest that by 2030 these percentages will rise to 23. 2 per cent for the east of england compared with 21. 7 per cent for the whole of england. the population density of 300 residents per sq km in mid - 2010 was above the uk average of 260 but below the england average of 400. it was highest in luton ua with 4, 600 people per sq km and lowest in kings lynn and west norfolk and breckland local authority districts each with 100 people per sq km. source : office for national statistics the geography used reflects the changes which took place in april 2009. population estimates and projections are for 30 june each year. the mid - 2010 population estimates are those published on 30 june 2011 and the 2008 - based subnational population projections are those published on 27 may 2010. migration data are for calendar years and were published on 25 november 2010. you may use or re - use this information ( not including logos ) free of charge in any format or medium, under the terms of the open government licence, or write to the information policy team, the national archives, kew, london tw9 4du, or email : firstname. lastname @ example. org details of the policy governing the release of new data are available by visiting www. statisticsauthority. gov. uk /


fakir mohan senapati ( 13 january 1843 - 14 june 1918 ) born on january 13, 1843, at mallikashpur in balasore, played a leading role in establishing the distinct identity of oriya, a language mainly spoken in the indian state of orissa. fakirmohan senapati is regarded as the father of oriya nationalism and the morden oriya literaure. born to father, laxman charan senapati and mother tulsi devi senapatie, fakirmohan dedicated his life for the progress of oriya language in the later 19th and early 20th century. the story of fakirmohan is indeed the story of the ' renaissance ' of oriya literature. besides he was a social reformer and educator who used his pen to criticize and correct the aberrations prevalent in the society. he is called the father of oriya fiction. he is aptly called as thomas hardy of orissa. [ by whom? ] though he had translated from sanskrit, wrote poetry, and attempted many forms of literature, he is now known primarily as the father of modern oriya prose fiction. the four novels of fakirmohan, written between 1897 and 1915, reflect the socio - cultural conditions of orissa during the eighteenth and the nineteenth centuries. while the three novels, ' chhamana atha guntha ', ' mamu ' and ' prayaschita ' explore the realities of social life in its multiple dimensions. ' lachhama ' is a historical romance dealing with the anarchical conditions of orissa in the wake of maratha invasions during the eighteenth century. chha maana atha guntha is the first indian novel to deal with the exploitations of landless peasants by the feudal lord. it was written much before the october revolution of russia or much before the emerging of marxist ideas in india. fakir mohan is also the writer of the first autobiography in oriya, " atma jeevan charita " if either fakirmohan or his progeny had preserved his short story, “ lachhamania ” which he had written in the late 1860s, and which was published in the journal bodhadayini, edited by himself in balasore, fakirmohan would certainly been credited with having pioneered the genre in india. but as ill - luck would have it, except for a bare mention in his autobiography, the story cannot be traced, and thus his “ rebati ” ( 1898 ) is widely recognized as


certainly been credited with having pioneered the genre in india. but as ill - luck would have it, except for a bare mention in his autobiography, the story cannot be traced, and thus his “ rebati ” ( 1898 ) is widely recognized as the first oriya short story. “ rebati ” is the story of a young innocent girl whose desire for education is placed in the context of a conservative society in a backward orissa village, which is hit by the killer epidemic cholera. his other stories are “ patent medicine ”, “ daka munshi ”, ” adharma bitta ”, " randi pua ananta " etc. vyasa kabi fakir mohan senapati had one daughter from his first wife leelavati devi who had married to raghunath chaudhari elder brother of gagan bihar chaudhari. from his second wife krushna kumari dei ; fakir mohan had his only son mohini mohan senapati and daughter sarojini senapati. sarojini senapati married to gagan bihari chaudhari who was the then dist judge at cuttack. gagan behari chaudhari had three sons and one daughter they are bipin bihari chaudhary, saila bihari chaudhary, snehamayee devi. sneha mayee devi who married to surya mani jena a graduate from calcutta university who was the inspector of schools. even the senior advocate and former law minister late mr. ashok sen and his elder brother were the students of surya mani jena at sambalpur high school. surya mani had three sons and one daughter namely pratap chandra varma, ajay chandra and sanjaya chandra varma. prasanta varma, advocate supreme court of india is the son of late mr. pratap chandra varma and is one of the great great grand son of fakir mohan senapati. fakir mohan ' s great - grand - daughter monica das is a writer and economist based out of new delhi, india.


the divine liturgy / the byzantine rite eucharistic liturgies liturgy also known as the divine liturgy the institution of the eucharist, that is, of the mystic supper by the lord, is recorded by st. matthew 26 : 26 - 28 ; st. mark 14 : 22 - 24 ; st. luke 22 : 19 - 20, and the apostle paul, i corinthians. 11 : 23 - 25. what, was created at the eucharist the gathering of our lord jesus christ and his apostles was for our lord, “ to create the holy eucharist and leave his own being to the church. ” the term ( liturgy ) originally signified a public duty of any kind, including religious assignments. in the septuagint translation of the old testament, the term is used for the first time to denote services in the temple. in its orthodox usage the term denotes the eucharist as the chief act of public christian worship. in a derived sense, the term also denotes the text containing the words and order of the eucharist. there are three main orthodox liturgies ; st. chrysostom ’ s, st. basil ’ s, and presanctified,. another liturgy, that of, st. james, the brother of the lord. the liturgies of the orthodox church : the term liturgy in its orthodox usage denotes the work of the people that pertains to god. by the fourth century the term divine liturgy became the technical term for the mystery of the eucharist ( communion ), the crux of our liturgical celebration. the word eucharist is taken from the great prayer of the consecration ( the anaphora ) and in turn means thanksgiving. four liturgies have passed down through our sacred tradition : the liturgy of saint john chrysostom, the liturgy of saint basil, the presanctified liturgy, and the liturgy of saint james, the brother of our lord. the church commonly practices these liturgies, excluding that of saint james, today. each in turn offers the faithful a unique means towards the same climatic end, the celebration of the eucharist. the liturgy of saint james, the brother of the lord : ( the antiochian - jerusalem greek james ) the oldest orthodox liturgy, has its origin as the local liturgy of jerusalem before it went to antioch. today it is performed only 2 times a year, on the feast of st james the brother of the lord, and the sunday after the nativity ( the divine


orthodox liturgy, has its origin as the local liturgy of jerusalem before it went to antioch. today it is performed only 2 times a year, on the feast of st james the brother of the lord, and the sunday after the nativity ( the divine liturgy of st james, which was until recently only celebrated on the island of zakynthos on his feast on 23 october and in jerusalem on the sunday after christmas, is today celebrated in an increasing number of orthodox churches. it was the ancient rite of jerusalem, as the mystagogic catecheses of st cyril of jerusalem imply. it is still, in its syrian form, the principal liturgy of the syrian oriental church, both in syriac and, in the ancient syrian orthodox church of india, in malayalam and english. ) liturgy of st. james ( the antiochian - jerusalem greek james ) this is a very ancient liturgy existing in a greek and syriac form. it is traditionally ascribed to st. james, the lord ’ s brother and first bishop of jerusalem. it bears many common elements with the liturgy known to st. cyril, bishop of jerusalem who died about the year 386, and contains an apparent reference to the discovery of the cross of christ in jerusalem in the year 326. it was mostly used in the syriac, armenian, and georgian speaking provinces of the church. the fact that the syrian jacobites, separated from orthodoxy in 451, as well as by the orthodox themselves, used it proves that the liturgy cannot have been composed later than the middle of the 5th century. it is celebrated in the orthodox church on the anniversary of the death of st. james ( october 23 ) and at jerusalem on sunday after the nativity. the liturgy of st. james is an important specimen of liturgical antiquity reflecting the liturgical practices of the 4th century, if not earlier. there is little doubt that the rite of st. cyril of jerusalem was describing in the famous catechetical sermon was the liturgy of st. james in the form of that time. but around the 13th to 14th century this liturgy was phased out in favor of the byzantine rite that included, the other three, liturgies of st. john chrysostom, st. basil, and the presanctified. the liturgy of saint james, the brother of our lord : the liturgy of saint james is, probably the oldest of the eucharistic liturgies. it is still used, occasionally at jerusalem. and is used on saint james ’ s day, by many churches of the byzantine tradition. st. james


the liturgy of saint james is, probably the oldest of the eucharistic liturgies. it is still used, occasionally at jerusalem. and is used on saint james ’ s day, by many churches of the byzantine tradition. st. james was the bishop of jerusalem soon after the formation of the church on the pentecost. james was the son of joseph, by a previous marriage, and hence a brother of jesus. the liturgy reflects james understanding of the majesty of god. it is different for the more commonly used liturgies of ss. chrysostom and basil liturgy of st. basil ( the caesarian - byzantine basil ) the origin of the liturgy of st. basil is antiochian, specifically from cappadocia where st. basil was bishop. in all probability, st. basil was the celebrant, if not in its present form, at least in its essentials. and through we have ancient documents ascribing to st. basil a specific liturgical formula in the form of ‘ anaphora ’, the liturgy in its present form is obviously the collective work of many composers. but still, most of the important prayers in it are the work of st. basil on the strength of style, vocabulary and ideas. st. basil ’ s liturgy appears to be older than st. chrysostom ’ s perhaps by two centuries. the liturgy of st. basil is celebrated ten times a year, namely, the first five sundays of the great lent, before pascha - easter, on thursday and saturday of holy week ( vesperal liturgies ), the nativity feast of our lord, st. basil ’ s day ( january 1 ) and theophany - epiphany day ( january 6 ). the liturgy of saint basil : ( the caesarian - byzantine basil ) the liturgy of saint basil the great has its origins in cappadocia where saint basil served as bishop. the liturgy is most logically the collection of a number of composers, however, the chief prayers of the anaphora are attributed to him. in fact, saint basil was most probably the celebrant of this liturgy, if not in its present form, at least in its essentials. it is celebrated by the church on ten occasions each year : the first five sunday ' s of great lent, on thursday and saturday of holy week ( vesperal liturgies ), christmas day, the feast of saint basil, and epiphany. there also exist an “


occasions each year : the first five sunday ' s of great lent, on thursday and saturday of holy week ( vesperal liturgies ), christmas day, the feast of saint basil, and epiphany. there also exist an “ egyptian ” liturgy of saint basil, celebrated by monophysite copts., the diophysite orthodox celebrate the byzantine - basil liturgy ie. egyptian - basil, byzantine - basil liturgy of st. john chrysostom ( normal constantinopolitan liturgy ) st. john chrysostom liturgy is well known and very common in the eastern orthodox church. it may be celebrated every day of the year except the ones of st. basil and those of the presanctified gifts, and on good friday. it is shorter than that of st. basil and much reduced compared to st. james ’. st. chrysostom liturgy put an end to the free prayers and hymns in the officiating of the holy eucharist. the liturgy placed a seal on the free forms of the re - enactment of the mystic supper of the lord, depicting it in its finest form with a destiny of enduring far into the future. despite the addition of hymns at later times, the st. chrysostom liturgy remains the same majestic religious masterpiece with grandeur and dramatic appeal matching the human expression and the divine act. st. chrysostom ( 345 - 407a. d. ) was an eloquent preacher, writer and one of the fathers of the orthodox church, whose writings have been translated into many languages and have nourished the christian church throughout the centuries. < celebrated daily, sunday etc. > the liturgy of saint john chrysostom : ( normal constantinopolitan liturgy ) the liturgy of saint john chrysostom is most familiar to the faithful. it is dated two centuries later than the liturgy of saint basil yet bears an identical structure. as a liturgical reformer, saint john reshaped this liturgy, amongst other things, abbreviating prayers and shortening its length. for the most part the liturgy we celebrate today is that which the great saint celebrated himself, in the fourth century. presanctified liturgy ( lenten liturgy ) the liturgy of the presanctified gifts is in reality a religious service composed of elements drawn from hesperinos, the vespers service, and from the first part of the divine liturgy beginning with ‘ blessed be the kingdomgaƒæ ’ a¢a ‚ ¬a ¡


gifts is in reality a religious service composed of elements drawn from hesperinos, the vespers service, and from the first part of the divine liturgy beginning with ‘ blessed be the kingdomgaƒæ ’ a¢a ‚ ¬a ¡ aƒa€sa ‚ aª ’ and ending just before the cherubic hymn begins. it includes no consecration, but prepared believers can receive communion from the consecrated elements reserved from the liturgy of the previous sunday. a service of the nature of the presanctified can be traced back to pre - nicene times. st. sophronios, at jerusalem calls the presanctified in 646 an, ‘ apostolic ’ institution. the presanctified is attested as a lenten substitute for the eucharist in canon 52 of the trullan synod ( quinisext ) in 692. one should bear in mind, however, that the councils hardly introduced anything new ; either in faith or in the liturgical practice of the church ; rather, they verified and vested with universal authority teachings or practices that the conscience of the church had in sufficient measure already accepted. this means that the trullan canon in reality aimed at safeguarding an established practice within the church at large. the presanctified liturgy is attributed to st. gregory dialogos ( 540 - 604 ), but also to st. epiphanios ( 315 - 403 ), st. germanos, patriarch of constantinople ( about 634 - 733 ), and even to st. james, st. peter ; and in sinai it was ascribed to st. basil and st. chrysostom. obviously, the pre - byzantine core of the presanctified goes deeply back into the beginnings and only a little later than the ‘ synaxes ’ of the primitive church. its present byzantine form appears to be the work of more than one composer. parts obviously added to the ancient core are of different dates and different hands. the liturgy of the presanctified gifts : ( lenten liturgy ) the church during great lent and holy week celebrates the presanctified liturgy. it combines aspects from the vespers service and the divine liturgy. it contains no consecration, yet the faithful can receive communion from the gifts, sanctified the previous saturday or sunday. this service is the product of canons 49 & 51 of the synod of laodicea, ( about 365 ) that, prohibited the celebration of the eucharist in its common, non - penitential


sanctified the previous saturday or sunday. this service is the product of canons 49 & 51 of the synod of laodicea, ( about 365 ) that, prohibited the celebration of the eucharist in its common, non - penitential form, during great lent, apart from saturdays and sundays. the liturgy of the presanctified gifts is celebrated on wednesdays and fridays of the first six weeks of great lent, on thursday of the fifth week, when the great canon of st. andrew is commemorated, and the commemoration of hieromartyr haralampos ( february 10th ), on february 24th, the commemoration of first and second findings of the head of st. john the baptist, sometimes on march 9th, the day commemorating the forty martyrs of sebaste, and march 31st, the day commemorating saint innocent of irkutsk, if it falls on a fast day, and not a saturday or sunday ; and on the first three days of passion week ( great monday, tuesday and wednesday )., the presanctified liturgy can also be celebrated if the parish patronal feast falls within the lenten season, monday through friday. the presanctified is never celebrated on the annunciation ( march 25th ), when this great feast falls on any weekday during great lent, the liturgy of saint john chrysostom is prescribed to be celebrated., the celebration of the divine liturgy of the presanctified gifts concludes the day of commemoration. it does not open the day of commemoration. service celebrated by a bishop. when we gather as an orthodox family for the celebration of the divine liturgy we gather as unique individuals with unique responsibilities in the life of the church. each of us, by the virtue of our role in the church, is a member of the eucharistic community. in this light, each of us is an invaluable steward to the church, offering much with his / her ministry. early in the history, each community had a presiding bishop who was assisted in the services with the presbyters and deacons. after the churches began to increase to meet the needs of growing number of faithful within a particular diocese, the presbyter was appointed by the bishop, as the chief celebrant in a local community, the parish. even so the concept of the church is understood not in terms of the presbyter, but in terms of his diocesan bishop. when the bishop is in our midst, celebrating the divine liturgy it then becomes a hierarchal divine liturgy


parish. even so the concept of the church is understood not in terms of the presbyter, but in terms of his diocesan bishop. when the bishop is in our midst, celebrating the divine liturgy it then becomes a hierarchal divine liturgy, he is the chief celebrant of the assembly of the faithful. on account of his presence we add seemingly unique phrases and hymns making the service hierarchal. in the hierarchal divine liturgy, we commemorate the hierarch as celebrant. additionally, the celebrating hierarch commemorates his presiding bishop, demonstrating the local parishes unity to the greater orthodox community. and, ultimately as stewards with unique ministries, the presbyter ( s ) and the laity under the direction of the bishop, offer up all glory to god. also known, as “ patriarchal divine liturgy ”, if a patriarch / metropolitan or an archbishop is the main celebrant. the hierarchical divine liturgy : when we gather as an orthodox family for the celebration of the divine liturgy we gather as unique individuals with unique responsibilities in the life of the church. each of us, by virtue of our role in the church, is a member of a particular ' ordo ' within the eucharistic community. in this light, each of us is an invaluable steward to the church, offering much with his / her ministry. more often than not though, we gather without the president of our eucharistic assembly, that is, we celebrate the liturgy without the bishop! early on in our history, each community had a presiding bishop who was assisted in the service by a college of presbyters and deacons. shortly thereafter as the number of churches increased to meet the needs of the growing number of faithful within a particular diocese, the presbyter was then appointed by the bishop, as the chief celebrant in a local community, the parish. even so, the concept of the church is understood not in terms of that presbyter, but in terms of his diocesan bishop. when a bishop is in our midst, celebrating the liturgy of saint john chrysostom, the liturgy of saint basil, the presanctified liturgy, or the liturgy of saint james, the brother of our lord, he is the chief celebrant of the assembly. on account of his presence we add seemingly unique phrases and hymns making the service hierarchical. the phrases and hymns that we add may seem foreign to us or even unimportant because of


, he is the chief celebrant of the assembly. on account of his presence we add seemingly unique phrases and hymns making the service hierarchical. the phrases and hymns that we add may seem foreign to us or even unimportant because of their infrequency, yet these additions offer us the true flavor of the hierarchical liturgy. in the hierarchical divine liturgy, we commemorate the hierarch as celebrant. additionally, the celebrating hierarch commemorates his presiding bishop, demonstrating the local parishes unity to the greater orthodox community. and, ultimately as stewards with unique ministries, the presbyter ( s ) and the laity under the direction of the bishop. offer up, all glory to god., also known as “ patriarchal divine liturgy ” if a patriarch / metropolitan or an archbishop is the main celebrant the hierarchical divine liturgy : a " hierarchical divine liturgy " is a divine liturgy celebrated by the bishop ( who is also known as the " eparch " or " hierarch " ). the eparch is the ruling hierarch of an eparchy ( i. e. area over which he is pastorally responsible, a. k. a a " diocese " in the latin churches ). the hierarchical divine liturgy is served whenever the bishop is present. nowadays the eparch usually " visits " on special occasions in the parish, e. g. ordinations, a big parish anniversary, or the parish " praznyk " / ” yiorti ” ( the patronal feast day of the parish ). but, from a theological and liturgical viewpoint, the hierarchical divine liturgy is actually the basic and normal divine liturgy of the church. technically, it is only " by exception " that any divine liturgy is served without the eparch. since the bishop is the " shepherd " of his church, he should preside at all his church ' s celebrations. and he did in the early church when the christian community was small. nowadays it is impractical the bishop be present at every service in the eparchy. however, the eparch is still present at each service by means of various symbols, which remind us of our unity with the bishop, and through him the entire church both local and universal. e. g. any celebration of liturgy requires an " antimins ", a small cloth icon of the burial, which is signed by the bishop, representing his presence and thus the authorization of the entire christian community. just, as each, divine service should be served by a deacon


of liturgy requires an " antimins ", a small cloth icon of the burial, which is signed by the bishop, representing his presence and thus the authorization of the entire christian community. just, as each, divine service should be served by a deacon, and the service obviously " limps " without the ministry of the deacon. even more so does the service " limp " when the bishop is absent. clearly in the early church, the bishop presided at every divine service. and in cathedrals, esp. the cathedral of holy wisdom ( hagia sophia ) our mother church, where our liturgy developed, the presidency of a bishop was normative. when the bishop is present, the entirety of the church is present. the eparch represents in his office, the christian community ( both laity and clergy ) geographically in the local and particular church - being the representative of both laity and clergy ( cf. his election and the triple axios of clergy and laity ). by his apostolic succession, he also makes present the church historically stretching back to the apostles. and by his communion with : the patriarch, the college of bishops and all those with whom the patriarch is in communion, e. g. the other patriarchs, the eparch makes present the entirety of the catholic / orthodox communion. you may notice that every so often during the hierarchical services, suddenly the language will change into greek : e. g. : " eis polla eti, dhespota " ; " ton dhespotin... ", or " agios o theos... ". as rus ' - ukraine was evangelized by byzantine missionaries, the first bishops and metropolitans of our church were greeks. ( applicable, if in a russian / ukraine / carpatho - russian orthodox parish ) thanks to saints cyril and methodios, equal to the apostles and teachers of the slavic nations, the holy scriptures and liturgical texts, etc. were translated into the local vernacular. nevertheless, in gratitude to their missionary bishops who had to leave their homeland to minister to our church and in remembrance of our connections with our mother church, certain portions of the service will be taken in greek. according to local custom three other ancient liturgies, are also used by orthodox churches, on the occasion of the feast day of the saints to which their authorship is traditionally attributed. : the orthodox ( chalcedonian ) liturgy of saint james, the brother of the lord, of the greek orthodox patriarchate of jerusalem, used on october 23rd


the occasion of the feast day of the saints to which their authorship is traditionally attributed. : the orthodox ( chalcedonian ) liturgy of saint james, the brother of the lord, of the greek orthodox patriarchate of jerusalem, used on october 23rd, and the sunday after the nativity ( see entry above ) the orthodox ( chalcedonian ) liturgy of st mark, of the greek orthodox patriarchate of alexandria is another liturgy, that have been phased out in favor of the byzantine rite liturgies i. e., the st. john chrysostom, the st. basil and the presanctified. the orthodox ( chalcedonian ) liturgy of saint gregory the theologian - wonderworker, a ancient liturgy of cappadocia and alexandria if there is no divine liturgy, the typica is read which gives a sketch of the divine liturgy. ( a reader ’ s service ) divine liturgy : the eucharistic liturgy. the orthodox equivalent to the roman catholic mass or to the protestant service of holy communion. in the orthodox church there are four eucharistic liturgies used. the most common is the divine liturgy of st. john chrysostom, the liturgy used on all sundays except those which fall during the great lent, and all holy days on which a eucharistic liturgy is served except for the eves of pascha, christmas and theophany, holy thursday, and the feastday of st. basil the great ( january 1 ). the divine liturgy of st. basil the great, used on the sundays of great lent, holy thursday, the eves of pascha, christmas, and theophany, and the feast of st. basil the great. the liturgy of the presanctified gifts which is actually an extended vespers service at which holy communion which was consecrated on the previous sunday is distributed. the liturgy of presanctified gifts is used during weekdays of great lent when the full celebration of the eucharistic liturgy is prohibited. the liturgy of st. james, is served only in certain places on the feastday of st. james the " brother of the lord " and first bishop of jerusalem. “ the eucharist is our mystical food : without it, we starve spiritually. ”


zorba is fictitious, but the man who created zorba must have carried a tremendous dream of himself being in zorba ’ s place, because no novelist writes anything which is not actually a compensation for his life. the poets who write about love write about love because they have missed love. their beautiful poetry about love is a poor substitute. kazantzakis wanted to be a zorba but could not gather courage. he could not gather courage because of his christian heritage. in his novel zorba the greek there is a beautiful statement. zorba is working with his boss. the boss is always sad, long - faced, worried, and zorba is always enjoying the small things of life – food, wine, women. after a whole day ’ s work he would go to the seashore and would dance alone, would play on his musical instrument. the boss could not believe that he has nothing – a poor man, but he lives like an emperor. that night when he comes, his boss asks him, “ why am i so sad and why are you always so blissful? ” zorba says to the boss, “ boss, the only problem with you is you think too much. i am a poor man ; i don ’ t think, i simply live. ” in a small sentence – “ you think too much ” – he has given the whole insight of meditation. thinking too much is non - meditative. thinking less and less you become more and more meditative. the moment thinking ceases, you are in meditation. but nobody has even explored zorba ’ s life ; otherwise he would have found the possibility of his becoming a buddha. even before zorba, almost two thousand years ago, greece produced a tremendously beautiful man, very close to gautam buddha. the man ’ s name was epicurus, and he was not a fiction, he was a living zorba. his whole philosophy was just to live moment to moment and enjoy each moment as deeply as you can, because once it is gone, it is gone forever. he made a small commune in a forest which became known as the garden of epicurus. but even greeks have not paid much attention to epicurus or his teachings ; nothing much has survived … very few fragments here and there. it seems we feel ashamed of zorbas, and they are authentically real human beings. only on their solid rocks can we make beautiful temples of buddhahood, of enlightenment, of awakening. i


wednesday, 22 may 2013 06 : 56 malcolm x, born malcolm little on may 19, 1925, in omaha, nebraska, has been criticized by mainstream media and historians for his radical and violent rhetoric. now, however, many scholars are revisiting malcolm x ' s influence on the civil - rights struggles and concluding that his presence gave political leverage to the non - violent movement led by the rev. martin luther king, jr. " i always looked at malcolm as advocating an ' eye - for - eye, tooth - for - a - tooth ', " said james e. newton, chair of the african - american history department at the university of delaware. in 1946, malcolm x went to prison for burglary and served seven years of a 10 - year sentence. it was during his time in prison that he joined the nation of islam ( noi ) and upon release became the noi ' s chief spokesperson. the noi members were fervent advocates of a separate nation for blacks and whites, while advocating self - reliance for african americans. malcolm x later broke from the noi and denounced its separatist philosophy after his pilgrimage to mecca in 1964, where he witnessed for the first time, multiracial muslim brotherhood. although malcolm x denounced the separatist philosophy of the noi, he always maintained the option of using violence in seeking justice for african americans. in a speech at michigan state university in 1963, he gave the audience a history lesson in revolutionary thinking. " if patrick henry and all of the founding fathers of this country were willing to lay down their lives to get what you are enjoying today, then it ' s time for you to realize that a large, ever - increasing number of black people in this country are willing to die for what we know is due us by birth. " wednesday, 22 may 2013 06 : 47 the news made a big deal out of the fact that one dr. dre who made millions as a rapper gave 70 million dollars to the university of southern california to create a school dedicated to hip hop. all i could think of was that ' s just what we need, another class of rappers. i thought of the 70, 000 kids that will be kicked out of head - start as a result of the current federal budget crisis. with all of that, we need another group of rappers to rap to kids who can ' t read, write and reason. i thought of the preachers who take our money on sunday morning and use it for their personal wealth rather than for the good of the


of that, we need another group of rappers to rap to kids who can ' t read, write and reason. i thought of the preachers who take our money on sunday morning and use it for their personal wealth rather than for the good of the community. i thought of the charter school movement that takes our tax dollars to create a few schools for a few kids while the masses are forced to go to non - productive schools. it ' s as if you have 10 children and you decide to invest in two, and the rest are on their own. don ' t we owe it to all of the kids to treat them equally? that ' s what the taliban does, educate the boys and shoot the girls who have the audacity to want to go to school and get an education. the worst part is that the statistics are showing that charter schools are not producing a bumper crop of geniuses either. why not improve the whole school system? tuesday, 14 may 2013 20 : 16 a young black man came to my office to seek support of the journal for a position he was seeking. when the subject of his being a republican came up, he volunteered that his father had introduced him to a lot of republicans and they were nice to him. my response at the time was that he should look at the evidence to see who is a republican and who is a democrat. there are at least 40 black democrats in congress and no black elected republican congressmen or senators. if black politicians are to maximize their power, they will do it as a group. what if dr. king had decided that he would work alone? we who are black and proud would still be seeking the right to eat at a lunch counter, unmolested. we would not have civil rights laws outlawing discrimination in employment opportunities. thursday, 09 may 2013 06 : 22 as another mother ' s day rolls around, for me, it ' s different. my mother is gone. i have the mother of my children and the mothers of my grandchildren, and i can say, without hesitation, they are all great and wonderful women. each is different in motherhood, and while they don ' t hold my heart as my mother did, they hold the hearts of the greatest prizes my wife and i ever contributed to anyone - our three sons. in turn, they gave us seven grandchildren. fair trade is acceptable. wednesday, 01 may 2013 06 : 55 leave a future for your children! over the years we have travelled home to bakersfield for easter, but the traditions changed. when


gastrointestinal pathology cases how to use the cases for study : 1. these cases will guide you through the presentations and diagnoses of complex gi diseases. follow the cases part by part and answer the questions as you come to them in your small groups. 2. review the gross materials at your lab station during the first lab period. 4. groups of two students will be assigned one case to present at the next lab meeting. during the week between the first and second lab sessions review the comprehensive case materials linked to the last part of the case, complete your research on the disease entity being presented and look at the current literature in the field. answer the questions assigned in the last part of the case using both texts and current literature ; be sure to reference your work. prepare a 5 - 7 minute oral presentation as you would for attending rounds. ( this includes a brief summary of the chief complaint, pertinent history, labs, x - rays and hospital course ; pay close attention to how the diagnosis was made and the outcome. ) present the pathology using images on the computer ; you may use this program or any other format you wish. you will present your case to another group of students who did not originally see the case, so be clear and concise! 5. a written copy of the assigned questions from the last part of your case must be turned in to your facilitator during the second lab ; your report as well as your oral presentation will be graded. if you worked with other students in the class on one case, you may turn in one report with all the names and you will each receive the same grade. be sure to reference the material in your answers and use at least one piece of current literature from a medline search. goals and objectives : following the participation in lab sessions one and two the student will be able to : 1. compile a differential diagnosis based on the clinical presentation and findings, determine appropriate use of laboratory, and recommend modes of therapy. 2. use the library electronic reference system to research data on diseases, therapies and drugs 3. understand the basic pathology, presentation, and treatment of gi disorders including : disease and its complications and pancreatic pseudocysts d. hepatic cirrhosis and gi bleeding f. benign gastric and duodenal ulcers h. gastric carcinoma 4. compile data on a patient and present it in the form of a clinical pathological correlation.


promoting green and sustainable schools in pennsylvania! “ these award - winning schools serve as a model for all of pennsylvania by incorporating innovative technologies and strategies to use resources effectively and efficiently, ’ ’ corbett said. “ i congratulate them. ’ ’ the schools are : albert m. greenfield elementary school, philadelphia school district ; broughal middle school, bethlehem area school district, northampton county ; nazareth area middle school, nazareth area school district, northampton county ; and westtown school, chester county. lower merion school district, montgomery county, was awarded the first - ever district sustainability award for applying energy conservation initiatives across multiple school buildings throughout the district. albert m. greenfield elementary school - school district of philadelphia school district nominated was : additional green ribbon schools information : helpful grs resources - helpful links for grs 2012 - 2013 previous year winners! pathways to green schools... this pathways to green schools site is designed to provide school districts with helpful information in one location. it includes the latest information on state programs and grants available for your school, as well as best practices from districts around the state - - where schools and communities are making investments that help conserve natural resources and reduce energy costs. we believe that the entire educational experience should include green and sustainable practices. this includes the transportation to and from school, the buildings where our students learn, the energy being used in our schools, the food being served in our cafeterias, and the curriculum that is taught in the classrooms. there are many ways that schools can become more green and sustainable, and each step forward is a step in the right direction. we hope you will get started on the path, and we look forward to hearing about your success.


today, an increasingly alarming health problem within thai society is obesity, which is associated with a variety of related illnesses, including diabetes. overweight people, with a body mass more than 35 kg / sq. meter, are 20 - times more likely to suffer from diabetes than people with normal mass / area measurements. in addition, those with an enlarged abdominal area have an increased risk of diabetes, as the accumulation of fat cells around the waistline and abdomen cause insulin resistance. a recent study revealed that fat cells in overweight people release a hormone “ adiponectin ”, which is insulin resistant. diabetic patients have a higher level of this hormone than people of a similar weight. the level of “ adiponectin ” in those of average body mass is lower than in overweight people. in addition to the “ adiponectin ” hormone, fat cells also release other hormones resulting in a higher risk of developing diabetes and other blood vessel - related illnesses. overweight people tend to have a high - calorie / low fiber diet and either do not take enough exercise, or have insufficient body movement, in addition to having other health problems. those with a high risk of developing diabetes, especially overweight people, can prevent, or slow down the progress of diabetes - related illnesses by changing their diets and adjusting their lifestyles. they should consume more food with high fiber content, and adapt to low calorie foods that have lower saturated fat and sugar contents. regular exercise is required, aimed at reducing body weight by as much as 7 %. following this simple regimen will reduce the risk of diabetes by as much as 50 %, compared to the 30 % effectiveness of diabetic pills. to prevent acute and long - term side - effect illnesses developing and enable diabetic people with overweight problems to enjoy their lives, it is vital to keep diabetes in control by closely monitoring the body ’ s blood sugar level and other related symptoms. overweight people ’ s blood sugar levels can be kept within normal range through daily calorie intake calculations. a well - balanced diet is essential and each meal should avoid foods with high saturated fat and high carbohydrate contents, which cause high blood sugar levels. compulsory diet content includes vegetables and fruit, although sweet fruit should be avoided. regular exercise is highly recommended, as it also helps reduce blood sugar and cholesterol levels, besides relaxing the mind and boosting insulin efficiency in the body. with no warning symptoms, diabetes is not usually detected at its early stages


ginkgo may help tough - to - treat skin condition vitiligo affects 1 to 4 % of people worldwide, about half the time before age 20. the patchy loss of pigmentation commonly affects the face, arms, legs, and genitalia, and is often more noticeable in dark - skinned people. emotional distress over changes in body appearance caused by vitiligo can show up as sleep disturbances, anxiety, and even suicide attempts. recent research suggests that the condition may be related to some combination of autoimmune, genetic, biochemical, nervous system, and environmental factors, but no clear cause has been identified. current treatments for vitiligo are limited, as they don ’ t always restore the skin ’ s appearance and may in fact cause other problems. photochemotherapy ( administrating ultraviolet - sensitizing medications followed by exposure to ultraviolet light ) increases the risk of skin cancer and cannot be used by lighter skinned people. topical corticosteroids can help repigment the skin, but they can also cause it to thin. topical immunomodulators ( tacrolimus, for example ) can be used on smaller areas of depigmentation, but they may increase lymphoma and skin cancer risks. making the case for ginkgo before a treatment can be recommended for any condition, it has to go through a series of trials to establish its effectiveness and safety. early studies have suggested that ginkgo may be useful for treating vitiligo, but the herb has yet to be rigorously examined for this purpose. this study was a preliminary trial designed to determine if there is sufficient evidence to examine ginkgo in a larger, placebo controlled study. to this end, 12 people with vitiligo between ages 12 and 35 were given 60 mg of a standardized ginkgo extract two times per day for 12 weeks. their skin was examined for changes before starting the supplement and again every four weeks. blood tests were analyzed and adverse symptoms were recorded to screen for potential safety issues. after participants had been taking the ginkgo, researchers noted significant improvements in the size and degree of depigmentation, and found the spread of vitiligo was greatly inhibited. there were also trends towards improvements in the total area affected and the staging scores of the lesions ( a measure of vitiligo severity ). no adverse effects related to treatment with ginkgo were recorded. though these results are encouraging, the study


there were also trends towards improvements in the total area affected and the staging scores of the lesions ( a measure of vitiligo severity ). no adverse effects related to treatment with ginkgo were recorded. though these results are encouraging, the study authors advise that there is still much to be learned. “ it is recommended that any attempt to use ginkgo in the management of vitiligo should be carefully monitored by a healthcare practitioner, given that there are still many questions about the correct dose, its true effectiveness, interactions with other conditions or therapies, and possible adverse reactions, ” cautioned lead study author, orest szczurko. based on the positive results of the study, the authors recommend that larger scale studies be performed to confirm these promising findings. ( bmc complement altern med 2011 ; doi : 10. 1186 / 1472 - 6882 - 11 - 21. ) kimberly beauchamp, nd, received her doctoral degree from bastyr university, the nation ’ s premier academic institution for science - based natural medicine. she co - founded south county naturopaths in wakefield, ri, where she practiced whole family care with an emphasis on nutritional counseling, herbal medicine, detoxification, and food allergy identification and treatment. her blog, eat happy, helps take the drama out of healthy eating with real food recipes and nutrition news that you can use. dr. beauchamp is a regular contributor to healthnotes newswire.