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Organized labor is having a moment. Medicine has not been immune. In recent months, 75,000 Kaiser healthcare workers went on strike, and that was just one of 26 healthcare worker strikes in 2023. One of the biggest changes for medicine, though, is a significant uptick in the unionization of trainees. As of December 202... |
My individual house staff union at Stanford Hospital can't address the, you know, the structural issues that exist with the ACGME and the match process, nor can we address the structural issues that exist with American healthcare. So one union alone can't solve this problem, but it doesn't need to, right? If my union c... |
How that comes about, I think, can come about in a number of ways. And so when MGB offered substantial raises that made us the highest paid residents in the country, when they offered retirement benefits, when we had unlimited fertility benefits, and a whole host of kind of different improvements in our salary and our ... |
Though Jay recently decided to step down, he was still the program director during the resident's recent campaign and vote to unionize. So I started out by asking Jay about what he perceived to be the biggest changes in medical education in the last nine years. There were really a number of changes. The most important,... |
But those oftentimes from a program director point of view, we didn't have the levers of power to fix those. And I think that there was a growing realization amongst residents that program directors, even though they served as the direct supervisor of trainees in the graduate medical education space, lack the agency to... |
What were the pros? What were the cons? What are the things that I worried about and the like? It was a well-attended meeting, probably the best-attended noon conference we've had all year. I think that, unfortunately, what was a nuanced conversation got eventually framed up in ways that didn't really reflect the reali... |
Food was a currency of love, as it is in many cultures. And so for me, the idea that you would withhold food was the equivalent of withholding love, and it just didn't make a whole lot of sense to me. Ultimately, I do think that, you know, there was, even after the union vote did occur, there was, you know, a decision ... |
Welcome to the New England Journal of Medicine summary for the week of December 5, 2013. I'm Dr. Lisa Johnson. This week, we feature articles on APOL1 risk variants, race, and chronic kidney disease, targeted temperature management for cardiac arrest, bivalorudin during transport for primary PCI, and fertility treatmen... |
Few medical situations have enjoyed such absolute improvement over the same time period. Future studies can continue to refine protocols, define subgroups that benefit from individual therapies, and clarify how to best adjust temperature or other interventions to each patient's illness. By Val Arudin, started during em... |
With less than three years to go, these two MDGs are seriously off-target for many countries. Among the 75 so-called countdown countries that have 98% of all maternal deaths and deaths among children younger than 5 years of age, only 17 are on track to reach the MDG4 target for child mortality, and only 9 are on track ... |
Given obesity's numerous developmental determinants, it is logical that effective prevention would target multiple modifiable factors. In combination, two well-studied prenatal risk factors, excessive gestational weight gain and maternal smoking during pregnancy, and two postnatal factors, fewer months of breastfeeding... |
Hey folks, just a quick reminder that this episode is not meant to be used for medical advice, just good old-fashioned education. All patient information has been modified to protect their identity and the views expressed in our podcast do not necessarily reflect the opinion of our employers. Welcome back Clinical Prob... |
Is there anything better than learning about jaundice from the future Boss Lady GI fellow? That was awesome. Thanks, Lindsay. Yeah, so this patient's coming in with jaundice. And let's think a little bit about the other aspect of this case, abdominal pain, mostly what it seems like a postprandial pain that this patient... |
Dan, it is not too late to switch from ID to GI. Come on. He did say Moritzu syndrome. So I feel like that is a valid point. You know, I didn't even put that in the script. I like Dan Minter even more now than I thought I could. Well, there's a lot of biliary pathogens, you know, those flukes and whatnot. Oh, this is b... |
As a general rule, pulmonary opacities could be something that's within the alveolar space. That could be pus, water, blood. It could be something within the interstitium, or it could be a sort of tissue-based mass. So if these are pulmonary metastases or primary pulmonary cancer or something like that. Just because I ... |
The abdominal and pelvic portions of the CT scan showed dilation of the common bile duct up to 1.5 centimeters and no discrete stones, masses, or lymphadenopathy. All right. Who am I to get in the way of pulmonary nodules on ID fellows? So I'll leave that up to Dan and then focus with Lindsay's permission under the com... |
Beautiful, Jack. I kind of think that your discussion of epidemiology was put in there in part to just dissuade me from thinking about liver flukes and all the other wonderful parasites. It was not a fluke. I'm dying on the inside. Okay. Well, yeah. Charmaine wanted me to talk about pulmonary nodules as the other part ... |
Welcome to the New England Journal of Medicine summary for the week of February 28, 2013. I'm Dr. Michael Bierer. This week's issue features articles on high-frequency oscillation for ARDS, on dancitron and risk of adverse fetal outcomes, and an artificial pancreas versus sensor-augmented pump, review articles on idiop... |
Ondansetron taken during pregnancy was not associated with a significantly increased risk of adverse fetal outcomes. Nocturnal Glucose Control with an Artificial Pancreas at a Diabetes Camp by Moshe Philipp from the Schneider Children's Medical Center of Israel, Petah Tikva. This randomized crossover trial compared an ... |
Symptomatic perineurial cysts, such as those described by Tarlov, have been reported for more than 70 years. However, most physicians are either unaware of the existence of Tarlov cysts or believe that they do not cause symptoms. Radiologists do not always report visualized Tarlov cysts, or they may report an imaging s... |
Hey folks, just a quick reminder that this episode is not meant to be used for medical advice, just good old-fashioned education. All patient information has been modified to protect their identity and the views expressed in our podcast do not necessarily reflect the opinion of our employers. Welcome back, family. It i... |
We only question someone's sex when they don't fit our cultural expectations of what male and female should be. That's so true. For some people, the cultural expectations associated with their sex assigned at birth align with their gender identity. For example, for someone assigned male at birth may identify as a man a... |
Thank you for bringing that up. I would like to say also that assuming someone's pronouns, even if correct, can be harmful. And it's something that actually has happened to me. I assumed someone's pronouns and turned out to be incorrect. And that affected the relationship that I have with them, of course. So we would l... |
Welcome to the New England Journal of Medicine audio summary for the week of February 24, 2011. I'm Dr. Lisa Johnson. This week's issue features articles on environmental microorganisms and childhood asthma, heterogeneity of hemoglobin H disease, BMI and risk of death in Asians, perilipin deficiency and lipodystrophy, ... |
These results highlight the dynamically changing effect of globalization on public health, as genetic disorders indigenous to specific populations become more common in the countries to which they migrate and make a strong case for newborn screening for alpha-thalassemia, at least in states with a substantial increase ... |
Three days before admission, weakness, loss of appetite, fatigue, and diarrhea developed, followed by progressive shortness of breath. On the morning of admission, he awoke with dyspnea, which was worse when he was lying flat. He was taken to the emergency room. Tachycardia, hypotension, hypoxemia, and fever developed,... |
Welcome to Intention to Treat from the New England Journal of Medicine. I'm Rachel Gottbaum. For decades, scientists have tried to find effective ways to treat Alzheimer's disease, with very little success. But that could be changing. New medications may help slow the progression of the disease, and new diagnostic tool... |
My name is Carol Balmer. My husband, Jim, has been diagnosed with Alzheimer's disease. I started recording symptoms, things that I found unusual back in 2013, but it was not until 2017 that he was officially diagnosed. At that time, his condition was called mild cognitive dysfunction. Jim was doing peculiar things. He ... |
We have to make sure that our patients understand what's been accomplished here. And there's still a long ways to go. Patients have to think about taking these drugs, that they're willing to come in for whether it's every month or every two weeks for an infusion or eventually a sub-Q injection, whether they are willing... |
And we're starting the first combination trial of amyloid and tau where we will look at multiple tau therapies alone and in combination with amyloid because just like cancer, heart disease, diabetes, when people have symptoms, you're going to need more than one approach. So that's what I want to talk about is this path... |
What we have to learn is how to use them, because exactly how much earlier are they going to predict? How are they going to show us progression and dynamic range? There are so many interesting questions that are going to open the door for the use of these biomarkers. And that's where I think one of our biggest advances... |
This is the New England Journal of Medicine audio summary. The full text of all articles is available to personal subscribers on our website. We offer discounts on personal subscriptions to residents and students. Go to NEJM.org and click on subscribe. Welcome to the New England Journal of Medicine audio summary for th... |
The continuing evolution of H5N1 viruses and the clusters of human infections in Indonesia and Turkey raise important questions. First, can the source of H5N1 be eliminated? And second, is the increasing number of clusters of human infection an indicator of evolution toward consistent human-to-human transmission? Clear... |
The authors examine the evidence of possible causal relations to factors such as air pollution, obesity, diet, and exposure to infections, antibiotics, and allergens, including exposure at very young ages. The most strongly supported preventive measure is the avoidance of passive and active exposure to smoke. A 35-year... |
Welcome, my name is Devine. This is episode 494 of the Devine Intervention Podcast. In today's podcast, we're going to be examining thalassemia. It's a high-yield topic, frequently tested on all the USMLEs, so I just want to make sure that you kind of have it down. So, typically, let's start off with a question. So, wh... |
In this case, there's going to be chromosome 11 actually. So that's a high-yield thing to just come into memory especially for the step one folks i don't know the whole chromosome 11 business so chromosome 11 uh the one you the copy you have from your dad you have one beta globin gene on that the one from your mom you ... |
Now let's go into alpha thalassemia. Alpha thalassemia is also a hormone recessive, but this is more of a chromosome 16 problem. So here you have four genes. Four genes. Four genes. Four genes. You have two on each chromosome from your parents. So you have two on dad's chromosome 16, two alpha genes, and you have two o... |
They tend to be more symptomatic. And one thing I'm going to say is that people that have this alpha-thalassemia, especially people that have hemoglobin H disease, you may actually see, so you'll see target cells like you see for thalassemias. It's going to be a microcylic anemia. But you may actually see Heinz bodies ... |
While you're doing that complete blood count, you'll see the target cells. Again, if you see those Heinz bodies, that should tell you that, oh, wait, I'm probably dealing with alpha thalassemia, where these folks have lost three or four of those genes. But then after that, you're going to do some more specific testing.... |
So this will have brittle bones. They have a pretty high risk of osteoporosis. That's an association you certainly want to know for your exams. And then another association you want to know is you want to, if they tell you that, well, you see like crud upper cauldron pain and fever in one of these folks, it's because t... |
Hydrops, right? Means you're hydropic. That's fluid. Hydrops fetalis in the fetus. Now, another mechanism behind the hydrops fetalis that, again, many people do not kind of give credit for is this, right? So, again, remember I said that one of the things that happens in thalassemias is you have like extramedullary hema... |
Think of like hemochromatosis, right? You can develop liver failure. You can develop pancreatic failure, right? Because the iron, fentanyl reaction, free radical production, damage your pancreas. You can also damage these people's pituitary glands. So that can cause all these problems. You can have iron overload. So ma... |
Welcome to Intention to Treat from the New England Journal of Medicine. I'm Rachel Gottbaum. Today, part two of our examination of the journal's racist history and what we can learn now. There are still such deep legacies from the past in our present practices. And it's the past that's Historical Injustice series. And ... |
And so NIH got interested, and there was a research study that was established that ran for decades. And the real hope was that they would find the genes that determined who did or did not get diabetes. And decades later, you know, fast forward to the early 2000s, and they still hadn't found the genes that would explai... |
And that's why their health was compromised. And that's why they were getting tuberculosis at higher rates. And one of the letter writers really put a fine point on this. And they said, well, look, if you focus on these inherent differences, you're robbing us of the desire to intervene. Whereas if you said, look, this ... |
Hello, and welcome to this JAMA Editor's Audio Summary for our August 23, 2016 issue. This is Dr. Phil Fontanarosa, Executive Editor of JAMA. This issue of JAMA includes three research reports, a scholarly special communication article, and four interesting viewpoints. Let's start with the research reports. The value o... |
No population has been harmed more by the COVID-19 pandemic than patients residing in nursing homes and long-term care facilities. The mortality from COVID-19 infection has been extremely high in these places. Once COVID-19 vaccines became available, it was up to a small team at the CDC to determine how to get the vacc... |
So Pfizer and Moderna make a bunch of vaccines. What's the first step? Does somebody from the CDC call up their CEO and say, we've got to push this stuff out across the country. What do you recommend? We know that ultimately a couple of pharmacy chains were selected to facilitate this process. Did somebody call up the ... |
And so we were able to get the most vulnerable people in the pandemic to really get them vaccinated all at once as quickly as possible. And I think that was the big challenge that we designed the program to overcome. So we're talking about long-term care facilities. We're including so-called nursing homes. And nursing ... |
So we'll be pretty much done with the program. And what we saw, I think, was kind of as expected. Hesitancy was a real concern. We saw about 80% uptake in residents in these facilities, but unfortunately under 40% uptake in staff in the facilities. So definitely a lot of work to be done on the hesitancy side of things ... |
And it was quite an achievement. It's a big logistic problem that you overcame. It's really been a massive team effort, not just at CDC, but state and local health departments coordinating locally with the facilities. And I think it's been a really important step for the public to be able to get vaccinated. And I think... |
So it seems like that should be a they're not getting vaccinated. Yeah. So, you know, you mentioned historically staff in long term care have had lower rates of flu vaccination. So we knew, knew going in that this would be would be a problem. And I think, you know, there's a number of systemic barriers to vaccination a... |
Yeah, it's a great question. I think, you know, we can't overestimate the complexities of vaccine distribution in a country as large. And diverse as the United States. We look to other countries and certainly we've seen rollout in, for example, Israel and very high coverage very quickly. But of course, other countries ... |
From the JAMA Network, this is Conversations with Dr. Bauchner, interviews featuring researchers and thinkers in healthcare about their publications in the latest issue of JAMA. Hello and welcome to Conversations with Dr. Bauchner. I'm back after being away for a week and I'm here with probably my favorite guest, Zeke ... |
We have to get the rate of transmission down, the number of new cases down, and then we can talk about it. There are places in the United States where you can discuss reasonably reopening in-person education. You've come from one of them, Maine. I think there are over a seven-day period, there are like 11 cases of COVI... |
They got it up and running in March and quickly were able to generate thousands upon thousands of people randomized and get evidence right away of what's working, what's not working. And I do think in certain pockets of the country where the governors, the mayors have spoken with one voice, a consistent voice, I think ... |
And I'm feeling better about it. Knowing how much pressure there can be, I can't say that I'm 100% confident that there's going to be no shenanigans here. But with his hand on the tiller and being forewarned about what might happen if the science doesn't drive this, I'm hoping he's able to resist. If there are politica... |
You're going to need two doses separated by three to four weeks. And I think there could be a lot of bottlenecks there. And I don't think as far as we can tell, and we did a report for the Center for American Progress on this, that the administration has well worked out each one of the potential steps. So that worries ... |
And I think we need to have that expansive view on this vaccine issue because it really has to be a worldview. Remember, we can immunize the United States, but it ain't returning to normal if the rest of the world doesn't have vaccine. Right. I mean, you can see what's happened in New Zealand. Right. They were in some ... |
Like the AMA essentially is closed. You can't do it at work. No one's coming to work. And then you have 30 million unemployed. So workplaces aren't going to do it. You can't get to the doc's office without PCR testing. So that won't be an effective model. When you say a new system, what do you envision, Zeke? I'll make... |
And so the impact, you don't know how to understand it because how you decide or how it was decided when people get it is very subjective. And one of the subjective factors may be who's likely to do better and who's likely to do worse. And you can't control for that. And so I think the data are very hard to interpret. ... |
Welcome to the New England Journal of Medicine summary for the week of July 12, 2012. I'm Dr. Lisa Johnson. This week's issue features articles on MEK inhibition in BRAF-mutated melanoma, potassium channel as a target of immune response in MS, hydroxyethyl starch or ringer's acetate in severe sepsis, blockade of lympho... |
One patient in each group had end-stage kidney failure. In the 90-day period, 22% of patients assigned to hydroxyethyl starch were treated with renal replacement therapy, versus 16% assigned to Ringer's acetate, and 10% and 6% of patients, respectively, had severe bleeding. Patients with severe sepsis assigned to fluid... |
The patient reportedly stopped exercising but continued to lose weight. On examination, the patient was cachectic with bitemporal wasting. Marked abnormalities in liver function were noted, and chest imaging revealed pneumomediastinum. This young man has a progressive, severe, subacute illness affecting multiple system... |
How should that change medical education? Finland, Weinstein, and the Birth of Antibiotic Regret, a perspective article by Kent Sepkiewicz from Memorial Sloan Kettering Cancer Center, New York. In 1953, two pioneers in the field of infectious diseases, Maxwell Finland and Louis Weinstein, co-authored an article in the ... |
From the JAMA Network, this is the JAMA Editor's Summary, a review of important research and review articles appearing in the latest JAMA issue. Hello, and welcome to this edition of the JAMA Editor's Summary podcast for the November 8, 2022 issue. I'm Dr. Kirsten Bibbins-Domingo, Editor-in-Chief of JAMA and the JAMA N... |
Doctors Zieger, Vanden Bogard, and Vanderhoven provide the accompanying editorial. ECMO is associated with better survival rates among select critically ill patients, but half of patients who receive ECMO will die, and severe chronic diseases and severe chronic diseases will be reduced. The ART article includes a which... |
I'm Stephen Morrissey, managing editor of the New England Journal of Medicine, and I'm talking with Arthur Kellerman, a policy analyst at RAND and an emergency medicine physician. Dr. Kellerman has co-authored a perspective article on lessons from the Boston response to the Marathon bombing. Dr. Kellerman, in your arti... |
You have no time to prepare a ramp up. You may have just a few minutes before the first casualties roll in the door. So the most critical actions in many instances are in that lull before the storm. When the scene is chaotic, units are responding, the casualty count is often highly inaccurate and may be wildly inflated... |
In their perspective article about the response at Brigham and Women's Hospital, Goralnik and Gates also point to the specific experience of several individuals in the hospital, for example, in Haiti after the 2010 earthquake. What role do you think that sort of individual experience plays in these situations? It's cer... |
That's a very dangerous and misleading assumption. We have to give our medical staffs, our EMS providers, and the key people who are involved in preparedness at the community level sufficient resources to do their jobs and sufficient opportunities to hone and refine their skills. You're not going to get a second chance... |
Hey everyone, I hope that you are staying safe in the midst of pandemic world. I wanted to let you know that tonight we will be doing another live show on Twitter, a curbside quiz show with Hannah R. Abrams as host and me facing off against Chris the Chew Man Chew in a Curbsiders trivia. We hope that you'll join us ton... |
So we do not recommend a wireless or Bluetooth headset or mic for podcast recording. So get something with a wire, at least for the time being. We do recommend that before you ever put out an episode that people are going to hear or see, that you probably just do a couple practice runs and only show them to friends and... |
And I think that will sort of help shape the show and make your early experiments move a little bit more quickly. Yeah, I think that's absolutely true. And it does kind of go back to the, like, it's like making learning objectives when you're creating a talk. And you make sure, like, did I hit my learning objectives in... |
So like every day feels the same when you're, when you're stuck at home, at least for me right now. But the, we, we try to do Monday through Thursday after 8 PM Eastern time, because at that time kids are in bed. Most notes are done-ish for the day, and people are home. So we record on weeknights. That's what works for... |
In theory, you could just start off with just a laptop and a USB microphone and talk to your friend with a laptop and a USB microphone when they're at their house and you could record a podcast that's say a couple people are going to get together and record something at least six feet apart in the modern era, you can g... |
Okay. So I would recommend one of those. They're only like five bucks or something. They're not too expensive. You're not going to break the bank. And then some over the ear headphones, which like right now I'm monitoring how loud my voice sounds on the microphone and using these monitoring headphones. They can run you... |
And most of these programs, when you record an audio file, the non-compressed files are usually a .wav or a .aiff file, and they're very big files. And then you can pull those tracks into an audio recording software, make your edits, and then you kind of export them or bounce them out of that program as an mp3 or dot m... |
So you need to have keywords in the title. So if you wanted to make a show about alcohol use disorder, make sure that's in your title so that if people are searching for shows about alcohol, Perfect. how to set up your recording studio. I guess the Cliff Notes version there is you want to record someplace that's got ca... |
And then in Zoom, Zoom records everybody so I just go with whatever track sounds better either the one that the person sent me that they recorded or the one that I recorded on my end, merge them all together and then you send them out and it sounds like everybody was in the same room together. with both of us on it. An... |
I don't know if it's a scam, but it's definitely something that, it's definitely something I think, knowing the basics of it, if you're using a WordPress website, and I'm not sure if this plugs into Squarespace or Wix as well, but there's a program called Yoast, Y-O-A-S-T. And that basically gives me a grade at the end... |
Hello and welcome to the Annals of Internal Medicine August 21st, 2018 podcast. I'm Dr. Christine Lane, Annals Editor-in-Chief, with highlights of what's new in Annals since our last highlights podcast. Let's begin with articles published online first on August 14th. All women should be screened annually for urinary in... |
Clinicians from Vanderbilt University Medical Center treated a 26-year-old woman who developed confusion, lethargy, respiratory failure, and cardiac arrest after inhaling suspected 1,2-diifluoroethane, a common ingredient in household aerosol products. Difluoroethanes are inhaled for recreational purposes sometimes, kn... |
Hello and welcome back to Sharp Scratch. You're listening to episode 102, The Social Life of Medics. This is a podcast brought to you by the BMJ, where medical students, junior doctors and expert guests come together and discuss all the things you need to know to be a good doctor, but that you might not get taught at m... |
And I feel like I kind of went in. I literally, because I was coming from Ireland, so I stalled as long as I could. So like literally the day before the lectures was when I actually arrived on campus. And I feel like I wasn't told much about Freshers' Week. I didn't really know the culture around Freshers' Week. I thin... |
At the time I was open to it, but I think now I don't know if it was my sort of thing just because it was I don't know a bit sketchy like if you saw the venue it was a bit weird um for me that we had like we planned a barbecue for freshers um for the freshers coming in um and I think it was like end of August or someti... |
Like it was so nice. But yeah, that's kind of was my experience with flatmates. That sounds so cute, Judy. I really want to play that game now as well. That is like exactly like it's just so up my street. Like really want to play that no I love that I think that's such an important part of like starting uni like that w... |
In second year, when I was a bit more kind of sure of myself and sure of what I wanted to get involved in I was on the like college welfare team and there were three of us who like supported the kind of students throughout the whole of the college and it was really really hard, it was absolutely exhausting, I failed my... |
And yeah, there's definitely no time limit. It's not like you have to, you're going to meet so many new people all throughout uni. And that's another reason to take some of the pressure off first year, I think. So for me, for like getting involved in societies. So my year were like we were the pandemic year. Like we we... |
Yes. So when I was working as VP for the ACS um I would try a lot to plan things around when I knew I would have a formative um or summative exam um and this would just be like a matter of like looking at the dates and knowing that okay maybe this week I'm not going to be doing as many meetings or this week we're not g... |
Yeah, and I suppose it is easier to coordinate all of that if your friends are medics who are on the same course as you kind of doing the same things as you're doing um so it's a bit funny actually I don't have many non-medic friends like I actually in third year of fourth year when people graduated I didn't notice it ... |
But I think if we have like a realistic idea of like, OK, so I'm not going to be able to knock on your door it's not going to be as easy for us to plan things and just kind of understanding that just because they're a little bit further away doesn't mean that they've necessarily like that they necessarily care less abo... |
I'm Stephen Morrissey, Managing Editor of the New England Journal of Medicine, and I'm talking with Margaret Somerville and Nicola Biller-Andorno about their clinical decisions article on physician-assisted suicide. Dr. Somerville is an ethicist at McGill University in Montreal, and Dr. Biller-Andorno is an ethicist at... |
And I think we should actually respect that. What you're suggesting there, though, is what we call radical autonomy. And that's the value on which the case for physician-assisted suicide and euthanasia is based. And what that says is that my wishes dominate every other consideration. And the case against that is that w... |
I think the main problem is having physicians involved in people helping people to kill themselves or, in the case of euthanasia, killing those people. That's the main problem. What we're doing there is we're moving past a two-and-a-half-thousand-year-old absolute basic norm of medicine that I will always care, I will ... |
Also, disabled people are very, very worried because people who are then seen as a good act to help this person who's got a certain condition to kill themselves, disabled people say, well, I'm like that. I've got that condition. Do you think it's a good thing to help me to kill myself? I mean, those are the sorts of wo... |
🎵 Welcome back to the Curbsiders. This is the internal medicine podcast that uses expert interviews to bring you clinical pearls and practice changing knowledge. This is Paul Williams here by myself, plus or minus a couple of cats. I'm here to introduce an episode about primary care of the refugee patient. This is an ... |
So either a favorite failure or a patient complaint. I think we need to get your favorite patient complaint one of these days, Stuart. We're going to Tunisia now. I mean, the failure is very easy to remember because I don't think a lot will forget it. And this was when I was at MS3, a medical student, just starting my ... |
Dude, I would go with the Lego set. So I'll say a word about Terry Pratchett. The Terry Pratchett Discworld series is, it's like fantasy, mystery. It's also the main character, Sam Vimes, it becomes very more, he's a lovable curmudgeon. Maybe like someone sitting next to me right now, self-described curmudgeon anyway. ... |
But in the 1990s, as part of a nationalistic and ethnic conflict and cleansing in Bhutan. They were forced to leave Bhutan. Their rights to citizenship were taken away, and so they lived in Nepal in refugee camps. So most of our patients, the wait to get in or come to the U.S., which I think the U.S. started accepting ... |
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