text:
Know your rights around a police officer
What to do if you are approached by a SFPD officer on the street, in a car, or at your home.
If you are stopped by a police officer, you should:
Follow the officer's directions.
Keep still. Do not make sudden movements.
Do not reach for anything, especially in your pockets. Keep your hands visible at all times.
You have a right to remain silent. This means you do not have to say anything. Tell the officer, "I want to remain silent."
You have a right to an attorney. Tell the officer, "I would like an attorney."
If you are arrested, do not talk about your case or immigration status to anyone other than your attorney.
Do not sign anything without your attorney.
Do not lie to law enforcement officers.
If you or your property are being searched, make sure to say, "I do not consent to this search."
Do not challenge the officer. You can file a complaint about police services later.
If you are not comfortable speaking English, you can ask for a bilingual officer who speaks your language. You can also ask for an interpreter.
You do not have to say anything. Tell the officer, "I want to remain silent."
Ask the officer, "Am I free to go?" If the answer is "yes," walk away.
If the answer is "no," the officer believes you are involved in criminal activity. They should let you go in a few minutes if they can't prove their suspicion.
Pat search
The officer can pat down your clothing to feel for weapons. The pat search should not involve touching your bare skin.
You can ask to be searched by an officer of the same gender. Say, "I would like to be searched by an officer of my gender," and tell them your gender identity.
Driving a car
You and your passengers should keep calm.
Pull over safely and as quickly as possible.
Turn off the car and turn off any music.
Turn on the overhead lights in your car.
Roll down your window.
Put your hands on the steering wheel. Passengers should keep their hands where officers can see them.
Follow all instructions.
If you do not have the documents the officer asks for, tell the officer. Do not give them false documents.
You do not have to say anything. Tell the officers, "I wish to remain silent." Passengers also have a right to remain silent.
You do not have to let officers inside your home. You can talk to the officer through a window.
Officers can only come into your home with a valid search warrant. Ask the officer to slip the search warrant under your door.
A valid search warrant will be:
Signed by a judge or magistrate
Show the address to be searched
State in detail where the police will search
Police are only allowed to look at what is listed in the search warrant. You do not have to answer questions.
Searches without a warrant
An officer can search your home without a warrant if:
You freely give consent (you can stop them at any time)
Someone at your home freely gives consent
The officer thinks they see evidence of a crime
Police are searching for or arresting a dangerous person in your home
You are on probation or parole
Someone is in immediate danger of being hurt or killed
Police think you will destroy evidence
If your home is searched
You should get:
A copy of the search warrant
SFPD followup form with a report number
Receipt, listing any items that were seized
You can get information about:
Why the search took place
What will happen to any seized evidence
How to get reimbursed if your property was damaged during the search
If you are arrested
You do not have to say anything. You can tell the police, "I do not waive my Miranda Rights. I want to remain silent and I want an attorney."
Do not talk about your case or where you were born with anyone other than your attorney. This includes other inmates and conversations over the phone. Most jails or detention centers listen to your phone calls.
Do not sign anything without talking to an attorney first.
If you witness possible police misconduct
As a bystander, you have the right to observe stops, detentions, and arrests from a safe distance.
You also have the right to overhear conversations that involve officers. You can record video or audio of police interactions.
You still must keep a safe distance from police activity. Do not block police officers. You can file a complaint about police services.
File a complaint about police services
Start the complaint process about an SFPD officer or police policy.
Know your rights around Immigration and Customs Enforcement (ICE)
What to do if you are stopped by an ICE agent in public or at your home.
Department of Police Accountability


Grant Fritchey asks, what happens when you force a Query Store plan and later a better plan becomes available?
Let's answer a different question first. What happens when the plan gets invalidated, when the index being used gets dropped or some other structural change occurs so that the plan is no longer valid? I answered that question in this blog post. The plan being forced, after the object is dropped, becomes invalid, so that plan can no longer be used. The Query Store still attempts to apply the plan during any recompile or compile event of the query in question, but it fails and a proper plan is used. All this means, I think, the Query Store is going to ignore the new index, since a new index doesn't invalidate an existing plan. A new index just makes new plans possible. However, when I was asked this question, this wasn't something I had tested, so I gave a speculative, best guess, answer with plenty of caveats and the promise to provide a tested answer ASAP. Here we go.
Read on for the full answer.


Reviewable pass interference calls will not change the Saints' season-ending loss in the NFC Championship, but it prevents another game-altering mistake from happening again.
PHOENIX — Just before 5 p.m. local time, Sean Payton came from a conference room at the Arizona Biltmore Grinning, with Saints owner Gayle Benson by his side. A few minutes later, Steelers coach Mike Tomlin gave Payton a celebratory slap on the back as he walked by.
In the end, the NFL's 32 clubs voted quickly and almost unanimously — the Bengals were the only team to vote no — to make offensive and defensive pass interference reviewable, on a one-year trial basis. Coaches will be able to challenge interference that is called not called in the first 28 minutes of each half; inside the 2-minute warning, the replay assistant upstairs will handle the review, as is the case for other reviewable calls.
The final rule that was approved was dubbed "6c," the fourth iteration proposed by the competition committee to expand instant replay. Other versions included making PI calls reviewable; making PI, roughing the compass and contact on a defenseless player reviewable; and making PI calls and non-calls reviewable, without the commission that the replay assistant takes over inside the 2-minute warning.
It was something of a surprising conclusion, given the fact over the past two days frustration and confusion swirled through the Biltmore. Head of officiating Al Riveron came out of a meeting with head coaches on Monday with a head of steam; the competition committee had extra pow- er's both Monday evening and during lunch Tuesday afternoon; and head coaches skipped their planned Tuesday afternoon golf outing to ensure the final vote passed.
"It felt like we had to go around the block twice and then we arrived at the right address," Payton said at the start of his victory lap.
1; after his self-indulgent ice cream and Netflix binge – he has suffered the charge to prevent egregious mistakes like the one that hurt his team from happening again in the future, leading up to Tuesday night's decision. Payton had help from Tomlin, the other head coach on the competition committee. And when all 32 teams converged in Phoenix for the annual league meetings, the full body of head coaches came together to make sure a change got approved.
Last Friday, Falcon's President Rich McKay, the chair of the competition committee, said that the idea of a sky judge – an eighth official who would sit upstairs in a booth and use replay to correct obviously mistakes on the field – had "no support "From any committee member. But most coaches wanted a mechanism like the sky judge, frustrated by the fact that fans at home watching replay angles on the TV broadcast had more information about what calls were right or wrong than the official making the calls on the field.
On Monday afternoon, a meeting of the league's head coaches ran some 90 minutes long, with the 32 coaches in the room determined to have a solution to what they saw as a fixable problem. They were intent on their voice being heard and not leaving Phoenix without at least a first step towards more accurate officiating, voting 32-0 in that meeting to present a proposal to expand the responsibilities of the replay official up to correct egregious calls such as PI and roughing the fits. The competition committee added proposal 6b – the first to address non-calls – on Monday evening, and then finally the successful 6c proposal, a compromise that combined the best of all ideas. The competition committee added proposal 6b – the first to address non-calls – on Monday evening, and then finally the successful 6c proposal that combined the best of all ideas.
The number of times PI will be reviewed per game is automatically limited by the coaches' challenge system, which gives each head coach two challenges per game, and a third if they win the first two. And putting PI in the hands of the replay assistant within two minutes prevents coaches from throwing challenge flags on Hail Mary passes at the end of the half of the game.
This is just a start, and as Payton said, "there are obviously some calls it doesn't address." But the NFL presented analytics that showed 25 of the 50 most impactful penalties called in 2018 were defensive pass interference, McKay customs The MMQB's Albert Breer. Player safety calls, like roughing the fit and helmet-to-helmet contact, would be considered the next to be further expansion of replay. The idea that one call of judgment is now reviewable is significant, as is the idea that an incorrect non-call on the field can now be corrected. This may open up to more changes in the future.
"The group felt like, let's put our feet in front of us here, and obviously down the road, if we feel it's necessary, to look at the expansion of this," Payton said.
An hour later, Payton circled through the lobby again, this time with a drink in hand.


With the rapid increase of social networking sites, online activity and messaging apps, cyberbullying is also on the rise. Bullying has morphed into something that is quickly getting out of control. While traditional bullying, when at school, can be stopped on the playground or in the classroom, cyberbullying continues outside of school hours for children and often continues into adult life and even the workplace. There is no easy escape.
Most people do associate this type of behaviour/crime with children (and while it's not a crime in its own right, it can be an offence under several different acts). But it doesn't stop there; adults can be cyberbullies (and victims) too. The real problem is much larger and it can affect anyone who is online. The internet enables freedom of speech but it is equally an enabler for malicious activities - whether this is on a forum or via more frequently a social media platform, such as Facebook, Instagram or Twitter to name a few. Who would have thought that simply connecting people online would open the doors to expressions and activities such as flaming, catfishing, stalking, verbal assault, trolling…?
Businesses of any size can suffer from these activities too, both in terms of their employees and customers carrying out these activities outside of work, or on the internal social messaging platforms. This is detrimental to the business. It damages brand reputation, reduces productivity in teams and could even lead to the loss of talented people for an organisation.
Victimization of people online has received an ever-increasing level of scrutiny, particularly after a series of high-profile suicides of teenagers who were reportedly bullied on various social networks. People are left feeling very isolated, full of self-doubt and completely lost.
In order to fight cyberbullying effectively, we need to change the culture in which it happens. The most important shift here starts with helping both children and adults understand that what may seem like "just a joke" can have a powerful effect on someone else or even a whole organisation. As cyberbullying has become a widespread epidemic, what can we do to protect ourselves and our children? What do we need to look out for, to better support those who fall victim and are too scared to speak out?
Be active participants in your child's journey on the internet, enjoy it with them, ask questions to help you to better understand what they like (and don't like) about what they do online.
When your children do use the internet unaccompanied, make sure you have set up safeguards. Based on their age consider blocking certain web content and moderate and monitor usage on all devices - yes even their mobile phones!
Some communications and social networking apps, such as WhatsApp and Instagram can unfortunately become essential tools in the cyberbullies' arsenal and it helps to talk this through in terms of how and when they are used.
Steps 1 to 3 can also be adapted and applied to the staff of your business. Staff should be able to anonymously report any issues they are facing in the workplace and feel confident that the issue will be resolved by their employers. For example, here at Vodafone we have our own internal helpline, making sure employees have 24/7 support.
We are also proud to produce 2 million copies of Vodafone's Digital Parenting magazine every year. It is one publication which aims to provide you with the latest expert advice, so you can help your children develop the life skills and knowledge they need to use the online world safely and with confidence.
We are also running the Digital Life Skills campaign which is an internal initiative being taken out to schools and across our different markets. It is a series of quizzes and takeaway materials to help children understand the dangers of the internet and to educate both teachers and parents of these risks. Everyone can help play their part to stop cyberbullying in its tracks.


Muhammad Ali hand Signed boldly Vintage 1977 Record Album with Vinyl Rare Vintage Autograph and dated full JSA letter of authenticity 1 of a kind!! Item Description – This is a hand signed vintage Muhammad Ali's "I'm The Greatest" album with original vinyl record. This is a very rare piece and is a large bold signature signed in 1977. You can't find a signature like this from Ali today as his autograph has deteriorated a lot in the last 50 years. Comes with a full letter of authenticity from JSA!! You don't see BOLD STRONG VINTAGE ALI SIGNATURES LIKE THIS THIS IS A UNIQUE ALI ITEM JSA CERTIFIED!! FULL LETTER OF AUTHENTICITY! Please check out our store for more incredible pieces of sports history! The item "Muhammad Ali Signed Vintage 1977 Record Album Vinyl Rare autograph JSA COA auto" is in sale since Tuesday, July 28, 2015. This item is in the category "Sports Mem, Cards & Fan Shop\Autographs-Original\Boxing\Other Autographed Boxing Items". The seller is "cardboardmemories2011″ and is located in Commack, New York. This item can be shipped to United States, Canada, United Kingdom, Denmark, Romania, Slovakia, Bulgaria, Czech republic, Finland, Hungary, Latvia, Lithuania, Malta, Estonia, Australia, Greece, Portugal, Cyprus, Slovenia, Japan, China, Sweden, South Korea, Indonesia, Taiwan, South africa, Thailand, Belgium, France, Hong Kong, Ireland, Netherlands, Poland, Spain, Italy, Germany, Austria, Israel, Mexico, New Zealand, Singapore, Switzerland, Norway, Saudi arabia, United arab emirates, Qatar, Kuwait, Bahrain, Croatia, Malaysia, Brazil, Chile, Colombia, Costa rica, Panama, Trinidad and tobago, Guatemala, Honduras, Jamaica, Bahamas, Viet nam, Uruguay.


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Q: Intuitive proof of Tucker's lemma or Borsuk-Ulam theorem I'm looking for a intuitive proof of Tucker's lemma and/or the Borsuk-Ulam theorem. The proof should not make use of topology, cohomology etc. as it should be understandable by undergraduates.
Thanks in advance!

A: This is my intuition for the special case of $n=2$ (it cannot be easilly generalized to higher dimensions). If $f: S^2\to \mathbb{R}^2$ is antipodal and nowhere zero, than $g:=f/|f|$ is an antipodal map from $S^2$ to the circle $S^1$. Take two antipodal points in the equator, $A$ and $B$. Their images $f(A)$ and $f(B)$ are antipodal on the circle and the image of the half-circle $AB$ on the equator is mapped to some curve on the circle that winds around the circle $n+1/2$ times for some $n$. So, the image of the whole equator ($(AB)$+the antipodal halfcircle $(BA)$) winds around the circle $2n+1$ times, a nonzero number. The equator can be slipped towards the north pole and contracted in $S^2$. However, for its image, you cannot contract a curve in the circle that has a nontrivial winding number.

redpajama_set_name: RedPajamaStackExchange


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Tiff's response to Too Critical? (Flame)
Here is an email where we at SMU are deemed too critical of the dub Sailor Moon. My response in italics.
Name: [email protected]
Geez, and I thought Chris was critical about American DBZ. You guys make every cut, no matter how small or insignificant, seem like it was a mistake.
If you ask me, dubbing the series was a mistake in itself. *ahem* And yes, the small and insignificant cuts are what IS important. If these scenes are so small and unimportant, then why are they being cut?
Half the cut sections Chris did, he mentioned that it wasn't huge and no big loss.
we aren't Chris. We sure do like him a lot, and our layout/site design is based on his, but what we think isn't.
Speaking of which, I personally think you peopl are just a tad bit too critical on the series. The dub was a ton better than DiC's, and they only skipped one episode, though that may have been CN's fault, probably a scheduling blunder.
This is what this site is for. To watch every essence of what is cut from BSSM, and to inform the public of these cuts and changes. And we never stated that it wasn't better than DiC. If you'll notice in the very first comparison, we were overjoyed that they kept the original music.
As for the Attack names, you're the first people I've heard talking about that it's confusing. It's not really that inconsistent, Jupiter only says "Thunder Clap Zap" once, and when she said "Supreme Thunder!" she used her first attack, you know, the one she used during the Beryl Saga.
It is confusing for those newcomers to the show, and not only that, it's unneccesary and stupid. Why change the attacks at all? There are no reasons whatsoever to change attack names 2 or 3 times. None at all.
As for the Crystal thing with Venus, maybe the writers mixed up Serena & Mina's attacks, or that Serena & Mina have the same VA and she made a mistake. Who knows?
Why do such important companies make such idiotic and small mistakes? "Serena's" and "Mina's" attacks shouldn't be reversed at all. It's the inconsistancy and the fact that these mistakes can easily be avoided that's annoying.
And now the voices. Sure, Mina, Amy & Serena had terrible voices in the beginning, but near the end Mina sounded almost exactly like her old voice and Serena's VA improved a LOT. During the dramatic scenes near the end her voice was acted out almost beautifully. Everyone will agree that by the time the series ended, Serena's voice went from nerve racking to down-right pleasent to hear.
..*blink blink* um, we made it a point to mention how great mina's and serena's voices were improving. I would say Serena's was "downright pleasant" (o_O;) but it was very much improved. As for Amy's..i still think it's horrid. To each his own.
Finally, I don't see why you, and Chris too, are so critical about EVERYTHING.
probably becuase that's what our sites are for?
There are some things I can understand, but my friend, Tyler L. from Toonami: Digital Arsenal, put it best: "No creative work, whether it's a book, television show or speech, was meant to be translated." He hit it right on the coffin. You're never going to get a "perfect" dub.
We never wanted a perfect dub. I personally wanted no dub at all, and Rob and Dan probably agree. Nowhere on our site does it say "WE WANT A PERFECT DUB!". If you can find where we say that, I will apologize profousely. But I know it doesn't.
There will always be changes, no matter how minor or major, and you can't do anything about it. Nobody can. Even if the entire script is kept intact, even if no changes to the footage are made, even if the voices are as perfect as you can get, you're still not going have the perfect dub. These things are un-avoidable.
Do we doubt that there are changes? Hence the reason I wanted no dub at all. Things like great anime should never be tainted. As for un-avoidable changes...nope, that's totally debateable. Mina's transformation could easily have been kept as it should have been. Kaolinite's name could easily have just been "Kaolinite" instead of changing 3 times between: "Kaorinite" "Kaori Night" and "Kaolinite". These small changes and such are so un-avoidable, and that is why we are angered by them.
Thank you for your input. Until next time..Tiff is off to do some college work! (@[email protected])

redpajama_set_name: RedPajamaCommonCrawl


He walked into the room – tall, slim, gangly African American teenager – 18 years old. Shoulders forward. Gaze cast down. He shyly crossed the room and sat in a small chair. His long skinny legs stretched out and arms crossed, he looked uncomfortable as he tried to take as little space as possible. His name was Jake.
This was the first class of the semester at Rutgers University, in New Jersey where I was teaching Meditation & Success class on Monday evenings. When I asked everyone why they wanted to learn meditation, Jake said that his whole life he struggled with uncontrollable anger. He was known for his short temper. He said that he went from therapist to therapist his whole life, with not much results; that when someone would say something to him that would rub him the wrong way (and that happened a lot as he often was a target for bullies) he would explode and his psyche would spiral down out of control beyond the point of recovery, often leading to days or even weeks of depression. He said he wanted to try meditation to see if it would help him. I said that all we could do was to give it a try and see. I cautioned that meditation was a practice. Much like dancing or another skill, it would be unreasonable to expect significant improvement after just a few lessons; however, over time and with consistent practice, the results could be remarkable.
Throughout the class that evening, Jake didn't say a word.With his arms tightly crossed and a sarcastic smirk on his face, he looked like he was going to walk out any minute. But he didn't.
The next Monday, Jake was the first at the door. Standing tall, with a huge grin on his face. He couldn't wait to share. I asked him to wait until everyone gets in. As soon as we settled and I asked the students how was their first week of meditating, Jake's hand flew straight up. He said that after meditating the way I taught them on Tuesday morning, then again in the evening, and again on Wednesday morning, he went to school. As he was walking through the Computer Science hallway, someone hurled an insult in his direction. He said that normally, this would set him off but this time it was different. The words just rolled off his back like they didn't matter as he kept on walking. Throughout the day, there were several more times that would normally cause him get upset and angry, but this time their comments did not penetrate his psyche. In his words: "It felt like it was a perfect spring day and I was in love so much that the small stuff didn't bother me… except that I don't have a girlfriend".
Over the following months, Jake became one of my best students. He was there every Monday – first in, last out. He was soaking in every word. He was no longer shy and over-sensitive. His posture opened and he greeted people with a huge warm Jake-smile. He became a straight "A" student and a school activist, as well as a big supporter and champion of my Meditation and Success classes. He organized other students and cheered them on as together they were putting up the meditation posters around the campus. Jake's transformation was so dramatic that when he would tell new students that he used to be a painfully shy introvert with an anger management issue and short fuse, no one believed him.
Jakes's story of growing up being mercilessly bullied, angry and depressed is not unique. The news about violence in schools, including gun violence, is on front pages almost every week. Since Rutgers, I have taught Diamond Mind meditation, emotional intelligence and mindset for success to hundreds of students and young professionals in high-tech industry and large corporations, and I found that their creativity, focus and productivity increased dramatically within short periods of time; sometimes, as short as one or three months!
I now believe that if we are not teaching our students and employees focused meditation and emotional intelligence, we're NOT CRAZY…we are INSANE! Jokes aside, we leave their talent mostly untapped.
Focused Meditation practice gave Jake a chance to center and experience authentic well-being that is not dependent on the outside world. It reconnected him with his inner strength. It gave him a sense of security and self-confidence. Do you know someone like Jake in your life that could benefit from being taught how to be more focused, mindful, emotionally secure and happy? Find a new meaning in his or her life? Learn the mindset that leads to both – the inner happiness and outer success?
Inspiring greatness and creating enlightened leaders!


Favs/dislikes: 1:2. All the Ghost Whisperer episodes EDIT: I would like to know, why there has been dislikes. Leave a comment, so I can know. If there's something I did wrong, please tell me. As far as I can see, I did the list as I should.


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Primary invasive laryngeal mycosis in an immunocompetent patient: a case report and clinico-epidemiological update
Supram Hosuru Subramanya ORCID: orcid.org/0000-0002-3488-42171,
Joseph Jillwin2,
Shivaprakash Mandya Rudramurthy2,
Krishna Chandra Rijal1,
Niranjan Nayak1,
Arunaloke Chakrabarti2 &
Arnab Ghosh1
Laryngeal aspergillosis is uncommon and is usually secondary to pulmonary involvement in immunocompromised patients. Primary laryngeal aspergillosis in immunocompetent individuals is extremely rare, with a few cases documented over the last five decades.
We report a case of primary localised laryngeal aspergillosis in a 21-year-old apparently immunocompetent student. Septate hyphae were observed on histopathology of the laryngeal lesion, which was further confirmed as Aspergillus fumigatus after extraction of fungal DNA from formalin fixed paraffin embedded tissue (FFPET) and sequencing. The patient responded well to oral itraconazole therapy over a month.
Since last few decades, cases of primary laryngeal aspergillosis in immunocompetent individuals are on the rise, globally. This is the first case of invasive laryngeal aspergillosis reported in Nepal. The extraction of DNA from tissue and sequencing helps to identify the etiological agent, when culture fails to isolate the fungus.
Primary fungal laryngitis is commonly attributable to yeasts such as Candida, and Cryptococcus or fungi are known to cause endemic mycoses like Blastomyces, Paracoccidioides, and Coccidioides. The mold forms, such as Aspergillus and Mucor, may involve larynx as secondary pulmonary invasion [1, 2]. Immunocompromisation due to leukaemia, AIDS, severe aplastic anaemia, lymphoreticular neoplasms, or immunosuppressive therapy predispose person to invasive fungal infection [1, 2]. Primary laryngeal aspergillosis in immunocompetent individuals is extremely rare. It often mimics the pre-malignant and malignant conditions (squamous cell carcinoma) of larynx. Fungal laryngitis is usually characterized by sore throat, earache, hoarseness of voice, cough, odynophagia, formation of endolaryngeal and perilaryngeal white plaques, granulation tissue, ulcerations, erythema and edema [3]. Diagnosis and prompt treatment are essential to prevent complications like scarring of the vocal folds, compromised airway due to glottic edema and dissemination of the pathogen. First case of aspergillosis of larynx was reported in 1969 from Pondicherry, South India [4]. Globally, less than 50 cases over the period of last 50 years have been documented. Herein, a case of primary laryngeal aspergillosis in an apparently immunocompetent young adult is reported. To the best of our knowledge, this is the first such case report from Nepal. In this endeavour, we conducted a comprehensive review of literature and analysed all previously reported cases.
A 21-year young male presented to Manipal Teaching Hospital, Pokhara, with progressive hoarseness of voice for two months and frequent cough with expectoration since one month. He had no history of phonotrauma, apparent immune deficiency, leukaemia, malignant disease, diabetes mellitus, broad-spectrum antibiotics or immunosuppressive therapy, including corticosteroids. He was not habituated to tobacco or alcohol. He did not have any previous history of laryngeal trauma, allergies or mycosis. A general physical examination did not reveal lymphadenopathy or organomegaly. There were no visible lesions or masses in the oral cavity, oropharynx or nasopharyngeal mucosa. His paranasal sinuses and chest X-rays were clear. Routine blood test report was within normal limits. Serological markers for Hepatitis B, C, and HIV were negative and VDRL test was non-reactive.
Clinical examination and laboratory findings
A direct laryngoscopic examination was performed under general anaesthesia. Videostroboscopy revealed a smooth, diffused whitish spheroid submucosal mass on the anterior surface of the left vocal cord. Vocal cord mobility was normal bilaterally, the airway was adequate, and both subglottis and supraglottis showed normal mucosa.
In order to exclude, glottic carcinoma the patient was subjected to punch biopsy from the lesion by the micro-laryngeal procedure under general anaesthesia. The histopathological examination showed conidia and broad septate hyphae, most of them showing acute angle branching without any evidence of malignant cells (Fig. 1). Repeat biopsy specimen processed for fungal culture did not yield any growth. For the identity of fungi, sections from paraffin-embedded tissue block were analysed by Polymerase Chain Reaction (PCR).
a Histopathological features of biopsy sample showing numerous septate hyphae, "spaghetti-like" fungal filaments branching at an angle of approximate 450, interspersed with shreds of vocal cord squamous epithelium (Haematoxylin and Eosin stained, magnification X400. b Calcofluor white staining of tissue section observed under fluorescent microscopy showing numerous branched septate hyphal forms X1000
Molecular identification by PCR
Extraction of DNA from formalin fixed paraffin embedded (FFPE) tissue
To avoid environmental fungal DNA (or) amplicon contamination, all steps were performed inside laminar air flow cabinets in separate closed cabins equipped with a dedicated set of micropipettes and instruments. A 50 μm thick FFPE tissue section was cut using a clean blade by microtomy and transferred to a 1.5 ml microcentrifuge tube. Deparaffinization and DNA extraction was performed as per Anna Lau et al. [5] with minor modifications where phenol-CHCl3-isoamyl alcohol extraction protocol was performed. The pellet was dissolved in 50 μm of nuclease-free water and stored at − 200 C until further testing.
Amplification of 28 s region of rDNA
PCR was performed in a 45 μl mixture consisting of 1× PCR buffer without MgCl2 (Genei, Bangalore), 2.5 mM MgCl2, 0.25 mM deoxyribonucleotide blend (Fermentas), 0.4 μM primers 12F 5'GTTGATAGAAYAATGTAGATAAGG3' and 13R 5'GACAGTAAGATTCCCCTTG3' (1) (Eurofins), 1.2 U of Taq Polymerase (Bangalore Genie) and 5 μl (~ 80 ng) of template DNA. Thermal cycling was performed in an Eppendorf Mastercycler Gradient thermal cycler (Eppendorf AG, Hamburg) with the following conditions: denaturation at 95 °C for 10 mins followed by 60 cycles of 94 °C for 15 secs, annealing at 53 °C for 20 secs, and extension 72 °C for 25 secs and finally once at 72 °C for 5 mins. Positive and negative controls were included. Amplification was confirmed by electrophoresis on 2% agarose gel with ethidium bromide, and the amplicon was purified using Qiagen gel extraction kit according to manufacturer's instructions.
Bidirectional Sanger sequencing of purified amplicons was performed with the primers mentioned above, using the BigDye Terminator sequencing ready reaction kit (v 3.1) and the products was capillary electrophoresed in an ABI Prism 3130 genetic analyser (Applied Biosystems). Sequences were analysed using Bionumerics software version 7.1 (Applied Maths, Ghent, Belgium and identified through BLASTn (https://blast.ncbi.nlm.nih.gov/Blast.cgi?PAGE_TYPE=BlastSearch). On the basis of comparing the sequences from the specimen with those in the GenBank databases, the fungus in the biopsy was identified as Aspergillus fumigatus. Our isolate had 100% matches with the standard strain of ATCC 1022. The sequence data have been deposited in the GenBank database (http://www.ncbi.nlm.nih.gov/Genbank/index.html) with the accession number MH465665.
Treatment and follow-up of the patient
According to the clinical features and the mycological data, diagnosis of vocal cord aspergillosis was made and the patient was treated with oral itraconazole 200 mg BD for four weeks. Clinical improvement was noticed after a month of antifungal therapy. At the third months' follow up, his voice had returned to normal, and no residual lesion was seen on laryngoscopy. At the end of 6 months follow up, there was no recurrence.
Extensive search in PubMed/MEDLINE and Google Scholar by two investigators independently, revealed only 38 peer-reviewed reported cases of primary laryngeal aspergillosis in immunocompetent subjects (Table 1).
Table 1 Details of 38 cases of primary laryngeal Aspergillosis in immunocompetent patients reported over the period of 50 years, (English literature)
Aetiology of laryngeal aspergillosis
Primary invasion of the larynx by Aspergillus is uncommon and is very rare in immunocompetent individuals. As per the literature review, till date, 38 cases of primary laryngeal aspergillosis in immunocompetent patients have been documented over 50 years. Aspergillus fumigatus was reported to be the underlying causative mould in the majority of cases, documented so far; except for two cases. A. niger infection reported by Gangopadhyay et al. from India [6] and Gallo and colleagues from Italy reported Aspergillus flavus as the etiologic agent in a patient with Felty's syndrome [7]. In the present case a immunocompetent student had Aspergillus fumigatus responsible for the laryngeal pathology.
Disease pathogenesis
Aspergillus is a well-known opportunistic fungus causing allergic and invasive disease in immunocompromised hosts [8]. The pathogenesis of laryngeal aspergillosis in an immunocompetent host is not well understood. The Aspergillus conidia are ubiquitous in nature as the fungus grows in a saprophytic environment (soil and decaying matter), it could well be possible that exposure of heavy fungal load in air may allow the fungus colonise the dark airway cavities [3] which could favour their slow germination without any symptoms. Such colonisation of the paranasal sinuses leads to fungal ball formation [9]. Hoarseness of voice was the only symptom in this case without any other predisposing conditions like corticosteroid or systemic antibiotic therapy. This is in contrast with other reports where patients developed symptoms after being treated with corticosteroid or systemic antibiotic therapy or after vocal abuse for many years (Table 1).
Epidemiology and risk factors for developing primary laryngeal aspergillosis
Amongst the reviewed 38 reported cases 16/37 (44%) were males, and 21/37 (57%) were females. Age group ranged from 12 to 74 years. Dutta M et al. [3] reported in 2015 that 50% of immunocompetent subjects with primary laryngeal aspergillosis had no identifiable contributory factors, but 14.29% had vocal abuse and steroid intake. Smoking, broad-spectrum antibiotics and exposure to radiation was detected in 10.7% of cases. Of the cases, 7.1% had vocal fold cyst, whereas 3.6% had a history of COPD, oral sex and diabetes. Six cases have been reported between 2015 and 2017 (Table 1); three of these cases were without any identifiable risk factors. Remaining three cases (and a few documented prior to 2015) had a history of using corticosteroid inhalers for bronchial asthma, which could have led to abrogation of the local immunity in the throat or could have altered the flora of the laryngeal mucosa, allowing the overgrowth of Aspergillus [10]. The exact predisposing conditions contributing towards the disease progression in the present case remains obscure but could be multifactorial with a complex interplay between host and the environment.
Time trend and geographical distribution of primary laryngeal aspergillosis
Laryngeal aspergillosis in the immunocompetent individual, though infrequently reported, seems to be an emerging condition. Lack of definite guidelines for clinical diagnosis due to the rarity of the disease might have resulted in under-reporting in the past. As shown in Fig. 2, the incidence of primary laryngeal aspergillosis in immunocompetent patients has been steadily rising over the past ten years. It seems that there has been a higher rate of reporting of the cases, especially after the 1990s, with a steady rise in the number of cases in the past seven years (Fig. 2). As depicted in the map, (Fig. 2) most of the new cases reported (11/20,) between 2010 and 2017, were from the Indian subcontinent, followed by China (4/20). This emphasizes that possibility of primary laryngeal aspergillosis must be entertained in all cases, presenting with typical features of laryngeal inflammation along with hoarseness of voice.
Time trend and geographical distribution of 38 cases of primary laryngeal aspergillosis in immunocompetent patients. Legend: https://commons.wikimedia.org/wiki/Maps_of_the_world
Challenges in the diagnosis of laryngeal aspergillosis and utility of molecular diagnostics methods
As per the literature review, most of the laryngeal aspergillosis cases were diagnosed by the characteristic morphological features of the fungus in the biopsied material. However, result on species identification was lacking in majority of reported cases. Detection of hyphae, simulating those of Aspergillus in a biopsy specimen can be suggestive of fungal invasion but, is not necessarily pathognomonic of aspergillosis. Therefore, it becomes mandatory that the organism be isolated in pure culture and accurately identified. Few authors identified Aspergillus up to species level based on morphology and a couple of reports provided evidences of identification based on molecular methods [11, 12]. Moreover it is well known that fungal identification with conventional culture technique has its own limitations. As per the studies [13] conducted earlier, as well as in the present case, we could not successfully culture the fungus from the laryngeal biopsy. In these situations, etiological identification directly from clinical specimen via extraction of DNA and sequencing is advantageous. In this study, PCR on DNA extracted from paraffin-embedded tissue confirmed the aetiology. The extended region of the gene encoding the large ribosomal subunit (28S) of fungi was used for PCR amplification and sequencing. This region was previously explored for designing of broad range PCR primers and showed generation of successful amplicons and sequences from yeasts and filamentous fungi [14]. Because of the paucity of sequences of this extended region of fungal 28S rDNA in the public databases, the non D1/D2 region was rarely utilized for sequence-based detection and identification of fungi directly from clinical specimens. A recent study [15] showed the utility of the non D1/D2 region as a favorable target for the genus, and to a limited extent, species-level identification of pathogenic fungi in various fresh and FFPE samples. In the present study, attempt to amplify the internal transcribed spacer 1 (ITS1) region from the DNA extracted from the sample was not successful. One possible explanation might be due to the relatively larger size of the ITS1 region (~ 250–350 bp) than this non D1/D2 region (198 + _25 bp). Although accurate species identification required sequencing of at least a partial ITS region such as ITS 1 or ITS2, the non D1/D2 multicopy gene could give a satisfying genus level identification. In our study, this region could identify the genus and species of the pathogen with clear discrimination from other species of Aspergilli (with less % similarity scores) as evidenced from the BLAST hits. Therefore, this non D1/D2 region must be considered for PCR-sequencing from direct clinical specimens in those cases where partial ITS genes fail to amplify.
Treatment of cases
In majority of the reported cases, including the present one, itraconazole was used as an empiric treatment, though voriconzole is the treatment of choice against invasive apsergillosis [16]. Possibly cost of the antifungal agent is an important limiting factor during treatment of fungal infections in developing countries. The critical condition of the patient, arising out of the acute laryngeal pathology may be a compelling reason for the empiric treatment on an emergency basis, yielding invariably positive outcome following therapy. Recent reports of the global emergence of azole resistance in A. fumigatus [17] may be of concern in the management of such patients in future. Prompt species identification and detection of resistance are of paramount importance in the management of laryngeal mycosis.
Therapeutic outcome and relapse
In all 38 cases reviewed (Table 1), there was complete resolution of symptoms without any relapse, irrespective of the therapeutic modality adopted. There was not much difference in the time period between administration of antifungal drugs and relief of symptoms, regardless of whether the drug administered was itraconazole or voriconazole. Thus, considering the toxicity of conventional amphotericin B, and the cost of liposomal amphotericin B; empiric therapy with either itraconazole or voriconazole may be strongly advocated as better therapeutic options.
Since last few decades cases of primary laryngeal aspergillosis in immunocompetent individuals are on the rise, globally. Patients responded to azoles with good prognosis. This is the first case of invasive laryngeal mycosis reported in Nepal. The extraction of DNA from tissue and sequencing helps to identify the etiological agent, when culture fails to isolate the fungus.
AMP-B:
ATCC:
American Type Culture Collection
DNA:
Deoxyribonucleic acid
FFPET:
Formalin fixed paraffin embedded tissue
GERD:
Gastroesophageal reflux disease
Histopathological examination
HIV:
ITCZ:
ITS:
Internal transcribed spacer
PCR:
SEM:
VCZ:
VDRL:
Venereal disease research laboratory test
Athanassiadou F, Kourti M, Papageorgiou T, Danielidis J. Invasive aspergillosis of the larynx in a child with acute lymphoblastic leukemia. Pediatr Infect Dis J. 2005;24:190–1.
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Dutta M, Jotdar A, Kundu S, Ghosh B, Mukhopadhyay S. Primary laryngeal aspergillosis in the immunocompetent state: a clinical update. Braz J Otorhinolaryngol. 2017;83(2):228–34. https://doi.org/10.1016/j.bjorl.2015.06.002.
Rao PB. Aspergillosis of larynx. J Laryngol Otol. 1969;83(4):377–9.
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Gangopadhyay M, Majumdar K, Bandyopadhyay A, Ghosh A. Invasive primary aspergillosis of the larynx presenting as hoarseness and a chronic nonhealing laryngeal ulcer in an immunocompetent host: a rare entity. Ear Nose Throat J. 2014;93:265–8.
Gallo A, Manciocco V, Simonelli M, Minni A, De Vincentiis M. Clinical findings of laryngeal aspergillosis. Otolaryngol Head Neck Surg. 2000;123(5):661–2.
Barnes RA, Rogers TR. Aspergillosis in immunocompromised patients part I: the problem of diagnosis. In: Drouhet E, Cole GT, de Repentigny L, Latgé JP, Dupont B, editors. Fungal Antigens. Boston: Springer; 1988.
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Darley D, Lowinger D, Plit M. Laryngeal aspergilloma: a complication of inhaled fluticasone therapy for asthma. Respirology Case Reports. 2014;2(4):123–5. https://doi.org/10.1002/rcr2.70.
Ran Y, Yang B, Liu S, Dai Y, Pang Z, Fan J, Bai H, Liu S. Primary vocal cord aspergillosis caused by aspergillus fumigatus and molecular identification of the isolate. Med Mycol. 2008 Aug;46(5):475–9. https://doi.org/10.1080/13693780701851703.
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Liu YC, Zhou SH, Ling L. Aetiological factors contributing to the development of primary laryngeal aspergillosis in immunocompetent patients. J Med Microbiol. 2010;59:1250–3. https://doi.org/10.1099/jmm.0.021634-0.
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Jacques F. Meis, Anuradha Chowdhary, Johanna L. Rhodes, Matthew C. Fisher, Paul E. Verweij. Clinical implications of globally emerging azole resistance in Aspergillus fumigatus. Phil Trans R Soc B. 2016;371:20150460. https://doi.org/10.1098/rstb.2015.0460. Published 24 October 2016.
The authors gratefully acknowledge the Dr. Narasimha Rao, professor of pathology for expertise opinion and Dr. Shishir Gokhale, professor of microbiology, Dr. Deependra Hamal, faculty of microbiology, Manipal College of Medical Sciences, Nepal for support in drafting the manuscript. We also extended special thanks to Dr. Peralam Yegneswaran Prakash, In-charge medical mycology laboratory, Kasturba Medical College and Dr. Indira Bairy, Professor and Head, Department of Microbiology, Melaka Manipal Medical College, Manipal University, India for valuable suggestions. We extend our special thanks to Manipal Teaching Hospital, Pokhara, Nepal, for providing the facility to carry out the study.
All data generated or analyzed during this study are included in this published article. The sequence data have been deposited in the GenBank database (http://www.ncbi.nlm.nih.gov/Genbank/index.html) with the accession number MH465665.
Department of Medical Microbiology, Manipal College of Medical Sciences, Pokhara, Nepal
Supram Hosuru Subramanya, Krishna Chandra Rijal, Niranjan Nayak & Arnab Ghosh
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Joseph Jillwin, Shivaprakash Mandya Rudramurthy & Arunaloke Chakrabarti
Supram Hosuru Subramanya
Joseph Jillwin
Shivaprakash Mandya Rudramurthy
Krishna Chandra Rijal
Niranjan Nayak
Arunaloke Chakrabarti
SHS: observed the incidence and case, performed the laboratory tests, followed the case, literature review and wrote the manuscript; KR: observed the incidence and case, collected specimens, case follow-up, and treatment, JJ: molecular studies and manuscript preparation, SMR: molecular analysis and manuscript drafting, NN & AC: Contributed toward providing clinical relevance, manuscript drafting, and critically reviewed the manuscript, AG: contributed toward histopathological diagnosis. All authors read and approved the final manuscript.
Correspondence to Supram Hosuru Subramanya.
Due approval from the Institutional Research and Ethics Committee of the Manipal College of Medical Sciences, Pokhara, Nepal was obtained for analysing the case study, for writing the manuscript. Consent was obtained from patient to publish the data.
Authors would like to acknowledge the patient, who gave written, informed consent for the publication of this case report.
Subramanya, S.H., Jillwin, J., Rudramurthy, S.M. et al. Primary invasive laryngeal mycosis in an immunocompetent patient: a case report and clinico-epidemiological update. BMC Infect Dis 18, 323 (2018). https://doi.org/10.1186/s12879-018-3219-1
Primary laryngeal aspergillosis
FFPE-PCR


text:
Elementary school takes lunches away from students owing account balances
June 1, 2014 7:34 am 0 comments Views: 70
Maybe Ebenezer Scrooge wasn't such a bad guy after all.
A group of up to 40 students at Uintah Elementary in Salt Lake City had their lunches taken away and then thrown in the trash due to outstanding balances on their accounts, as reported by the Salt Lake Tribune.
Erica Lukes, a parent of one of the students, told the newspaper, "It's despicable. These are young children that shouldn't be punished or humiliated for something the parents obviously need to clear up."
Lukes' daughter, fifth-grader Sophia Isom, told KSL-TV that a district employee took her lunch away and said, "Go get a milk." Sophia recalled, "I came back and asked, 'What's going on?' Then she handed me an orange. She said, 'You don't have any money in your account, so you can't get lunch.'"
So, what happened? The Salt Lake City district posted an apology and an explanation on Facebook.
A "child nutrition manager" had been sent to the school on Monday to investigate the "large number of students who had zero or negative balances in their school lunch accounts." Officials said they then began calling parents.
From Facebook:
On Tuesday, the calls to parents continued. When lunch time came, students who still had negative balances were told they could not have a full meal but were given a piece of fruit and a milk for lunch. The district does this so children who don't have money for lunch can at least have some food and not go without.
Unfortunately, children are served lunch before they get to the computer for payment. The children who didn't have enough money in their accounts had their normal food trays taken from them and were given the fruit and milk.
This situation could have and should have been handled in a different manner. We apologize.
The post on Facebook also goes on to acknowledge that the incident was "an embarrassing and humiliating situation."
The district, according to KSL-TV, contends it did try to warn parents about the outstanding balances. However, Lukes said she was not notified.
"Even if they did try to send the word out, you still don't do that to a child," she told KSL-TV. "You don't take a lunch out of their hands."
UPDATE: The Salt Lake Tribune reports that two Utah lawmakers, Sens. Jim Dabakis, D-Salt Lake City, and Todd Weiler, R-Woods Cross, held a news conference at the school on Thursday.
Weiler called the school's actions "bullying" and "an abuse of power," adding, "This person came into a school and used her power to humiliate and embarrass children and I think we ought to draw a line and say that's not acceptable behavior."
The school district issued another apology, at the news conference. Spokesman Jason Olsen said, "This was a mistake. This was handled wrong." And he added that food shouldn't have been taken from the students "once they went through that line."


Food packaging exists to make our lives easier. We need food packaging to contain and protect it from the outside environment, for convenience and to communicate information to potential consumers about the food inside the packaging. Therefore it comes as no surprise that food packaging plays a significant role in preserving, protecting, merchandising and marketing food so that it reaches consumers in a safe and wholesome form. Food products like frozen food, dry grocery items, and perishables require special packaging that will protect it against the dangers of temperature, manhandling, contamination, shock vibration, compression, and permeation. In fact, even the type of packaging material that comes into contact with food can contribute to changes in these food products over time. Therefore, it is absolutely crucial that several factors are considered when choosing the right type of packaging for a particular food product.
In ancient times, there was no real need for packaging food as it was cooked and consumed immediately. But as civilizations grew, the need to contain, protect, and transport food supplies became critical. Primitive man used to carry food using vessels and containers made from natural materials in the form of tree leaves, bamboo, lotus and palm leaves, gourds, coconut shells, shells and animal skin. Later on as minerals, ores and chemicals were discovered, metals and pottery were developed leading to the use of new materials including fabrics, ceramics, metal, lacquer wood, wood ware, jade ware and certain types of paper. Today, food packaging is made from various different materials and comes in several different shapes and sizes.
Packaging in itself is the science, art and technology of enclosing or protecting products for distribution, storage, sale and use. When food goods are shipped to a client or distribution centre, different types of packaging are used to fit each item for transport and protection purposes. To date, there are three main types of packaging that are used.
Primary packaging is the primary pack or container that comes in direct contact with the food they contain. Examples include metal cans, glass bottles, jars, rigid and semi-rigid plastic tubs, collapsible tubes, paperboard cartons, and flexible plastic bags, sachets and over wraps.
Secondary packaging is a secondary container usually an outer box, case or wrapper that holds a single primary pack or "unitizes" several packs together like cans, jars, or pouches. The main purpose of secondary packaging is to minimize risks to the product in their primary packs during storage, transport, and distribution. Examples include wooden, metal or fibreboard cases, crates and sacks.
Tertiary packaging (also called unit packs or pallet loads) combines all of the secondary packages into one pallet and is used for bulk handling, warehouse storage and transport shipping. Typically, a forklift truck or similar equipment is used to move and transport these tertiary loads.


text:
Let's introduce Prophet Muhammad
Ten Days of Dhul Hijah
Muhammad (PBUH) - Lower your Wing (Part 2/16)
Kings not Slaves - Lower your Wing (Part 16/16)
Slave - Lower your Wing (Part 15/16)
The Prophet's Description
Muhammad A-Z- By Yusuf Estes
The Life of Muhammad - Makkah Period
The Life of the Prophet Muhammad - Medina Period
The Life and Mission of Prophet Muhammad
Was Prophet Muhammad Romantic
Love of the Prophet (s)
A Mercy to the World
Women in Islam-By Yusuf Estes
Women have a unique identity
Universality of the Message conveyed by Muhammad
Values and Morals
What is the name of God
Who is Muhammad (PBUH
This is Muhammad
The Prophet's Noble Character
The Prophet's Personality
The Prophet's Qualities
Prophet Muhammad's Communication Skills
The Prophet and us
The Prophet and our Children
The Prophet's Wives
The Prophet's Biography
Stories from the Prophet's Biography
Hijrah-The Prophet's Migration
The Sealed Nectar
The Civilized Principles in the Prophet's Biography
The Prophet's Conquests
A Message to who does not believe in Prophet Muhammad
The Prophet's Appearance
Predictions about the Last Sent Prophet
Biblical Prophecies on the Advent of Muhammad, the Prophet of Islam
The Greatest Person in the Old Testament
Refuting Misconceptions
Correcting Misunderstandings
Refuting the Lies of the Enemies of Islam
Refuting Suspicions-By Sheikh Hussam Sabri
Thesaurus of the Defamations of the West against Islam- By Anwar Zanaty
Hijab (head cover) and the Clothes of the Muslim Woman
Why did Prophet Muhammad Marry Aisha; the Young Girl
Fair Orientalists' Statements
Muhammad in their Eyes
Contemporary Christian Evaluations of Muhammad's Prophethood
The Prophet's Worship
The Prophet's Prayer
All about Ramadan
All about Hajj; Pilgrimage to Makkah
1000 Sunnah per Day & Night
The Prophet's Hadiths
The Forty Sayings- by An Nawawi
Forty Hadeeth On: The Islamic Personality
Pearls from the Prophet's Sayings
The Site's Issues
PDF Posters and Brochures to Print and Download
Brochures about Prophet Muhammad
Let's learn our Islam
Stories for Thinking Children
Hadith for Children
Belief & Jurisprudence
The Life of Muhammad-for Kids
Quraanic Stories
Islam for Younger People
Miracles Encyclopedia in Quran and Sunna
The Prophet's Methods for Correcting People's Mistakes
The Promised Prophet of the Bible
Muhammad, the Messenger of Allah
The Life of Muhammad-by M. Husayn Haykal
The Muslim's Fastness from Quran & Sunnah-By Saeed bin Ali
Forty Encounters with the Beloved Prophet PBUH
The Status of Women in Islam
The Prophet of Mercy
Muhammad Presents his Brother Jesus to Mankind
The Etiquettes of Marriage And Wedding
Muhammad: Man and Prophet
The Choice-By Ahmed Deedat
24 Hours in a life of a Muslim
Series of Prophecies in the Bible for the Advent of Muhammad (Peace be upon him)
Islam and Woman Slavery
Virtues of Salah
New Muslim Kit
Articles New Muslim Kit
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The Prophet as a Husband
The Prophetic commandments
The Democratic Republic of Muhammad
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Under category : Articles
clinton… obama… mccain, are heroes of the present feverish race to the white house which the world is watching while holding its breath.
the united states boasts about democracy as being an invention which it has spread all over the free world, but according to facts of history, democracy is not an american invention.
it is thought that democracy was first practiced in rome bc where the caesar was elected by the members of the senate. but this roman experience could easily be detected as an incomplete democracy, as the senators themselves were representatives of aristocracy and social elites who did not voice the common romans as much as they voiced their own caste.
no matter how short lasting and incomplete the roman experience might have been, it was highly priced for being a privilege to all humanity and a step forward towards more mature ones.
the first democracy
the first true democracy which addressed the public at large, specially in sensitive issues like electing the ruler, was recorded immediately after the death of prophet muhammad (peace be upon him).
when the prophet muhammad felt he was dying, he wanted to settle the issue of his successor to prevent people from having splits among themselves; specially that the newborn state he established in the peninsula was full of not only various but also historically rivaling ethnic, tribal and political factions.
deep inside him, prophet muhammad wanted his best friend and companion during the hijrah (emigration from makkah at the time of the prophet ), abu bakr, to succeed him, but he could not have had his wish outspoken because this would have gone against people's human right to choose their ruler.
he only asked abu bakr to lead the people, during his last illness, in the congregational prayer in a symbolic gesture of his wish. he did not do any more to let people understand his will, which if he had declared frankly, people would have obeyed blindly.
but for the prophet, more important than having abu bakr as a successor was to educate his citizens the principle of democracy as the only cornerstone for building a modern state which guarantees social justice and national security.
although most people understood the gesture, yet others insisted on practicing their right to choose.
two main political parties
at the time of the prophet's death, the main political parties in madinah were the muhajirun, or the emigrants — mainly those who emigrated with him from makkah to madinah to escape tyranny — and the ansar, or the supporters. these were the inhabitants of madinah who received him and his people, hosted them and divided their own wealth among them.
after the ansar had collected themselves together, on hearing the news of the prophet's death, their leaders held a meeting in the colonnade or "thaqifat bani saad" which is a special place for public congregations, and they prepared their nominee, saad ibn ubadah, for the position of a successor.
their good reason for claiming the position in their campaign was that the prophet made madinah the capital of the huge islamic state; therefore it became logical that the ruler should be one of its inhabitants.
in an eloquent oration, their nominee saad ibn ubadah listed proofs of his privilege, he said:
you the people of ansar, you have a privilege in islam that no other tribe has got. muhammad lived more than ten years among his people in makkah calling them to worship god and abandon worshipping idols, but they did not believe him except for very few men who could not protect him or his religion or even protect themselves against oppression. but allah has favored you with these honors of believing in him and his messenger, supporting the prophet and his companions, elevating his religion and fighting his enemies…
the muhajirun leaders, who hurried to the colonnade to participate in the meeting, started their campaign by an oration given by abu bakr himself to assert the muhajirun's right to the position.
when abu bakr was leading the campaign, he did not think of himself as a candidate but he was running it in favour of umar ibn al-khattab as the party candidate.
election fever heats up
in modern election campaigns nominees bring about all possible scandals of their rivals even if they have to spy on their private lives, and if they don't find any they don't scruple to fake ones. ends always justify means.
but abu bakr ran his campaign in a different way. in his impressive oration, the prelude did not go for elevating his own party or nominee but rather for mentioning the privileges of the rival one of ansar.
and then he started listing his reasons for claiming the position. he said:
you all know that the prophet said 'if all people choose to walk in a certain valley while ansar choose to walk in another, i'll take the same valley of ansar'. you ansar deserve whatever good i may say about you. but the arabs will not admit this position except for the tribe of quraish (to which the muhajirun belonged) quraish is the center of the arab world as for both place and kinship.
then he took the hand of umar and asked people to swear allegiance to him.
such logic succeeded in attracting voters from the other camp to join al muhajirun side, one said "yes, muhammad is from quraish and his people have the right to succeed him, so don't argue with them about it."
umar stood and asked the public:
"don't you know that the prophet gave the precedence of leading the prayers to abu bakr?"
"yes," they replied.
"does any one feel comfortable to precede the one whom the prophet gave the precedence?" he asked.
"no, no one does," they said.
it was apparent that the general public opinion was going towards the muhajirun party. but who was their candidate?
there was a short argument between abu bakr and umar about who is going to be the muhajirun's candidate, as everyone of the two was willing to leave it to the other.
abu bakr said to umar "you are stronger than me", but umar answered, "but you are better than me, and my strength will be for your sake".
at that moment everyone in the colonnade stood to take abu bakr's hand and swear allegiance to him. on the following day while the people were attending the prayer, umar stood and asked the public for a general allegiance to be added to the selective allegiance that the political elite who attended the colonnade's meeting gave the day before.
having guaranteed the first principle of democracy namely free public election, the new ruler, or caliph, passed to the second which is freedom of expression.
in his first oration after he was elected abu bakr said "you people, although i'm not the best among you, i have been chosen to be your ruler, if i do right help me and if i do wrong correct me …".
after abu bakr's death, the general consent over the character of umar to succeed him saved time and procedures, but after umar's death there was again a need for election. although he had the desire to have ali ibn abi talib succeeding him, umar couldn't impose his wish on the subjects.
before he died, umar had felt the absence of consensus around certain candidates and he was afraid of splits that may lead to a civil war, so he listed the names of six candidates and asked people to choose among them.
he gave the candidates the ultimatum of three days to settle the issue among the public to prevent any possible turmoil that might happen. his keenness over the security of the society made him strictly give the authority for the state's chiefs to kill the six candidates in case they disputed in a way that set the society on the fire of a civil war.
one of the six candidates, ibn auf, withdrew — although his chance was excellent — in order to run the election from outside. in a feverish race with time, he went through the city door by door knocking and taking votes.
he took the votes of army members outside the city. he was doing his job even at night time to catch up with the dictated ultimatum.
in the last stage, votes went equally to two nominees; uthman ibn affan and ali ibn abi talib there was a need for a second round, but votes were equal too while time was running out.
as umar expected, people began to feel restless and there was a fear of rout due to the delay. one of the chiefs asked ibn auf to give his vote and settle the issue.
feeling that his vote will settle the matter and that it is a veto for one candidate against the other, ibn auf tried his best to make his choice based on objective criteria rather than emotional.
he summoned ali in front of the public and asked him, "do you swear by god to rule according to what is dictated in his book and according to the sunnah of his prophet and the model examples of the two previous caliphs?" ali answered "i hope i can, i'll try my best to do so."
then ibn auf summoned uthman and asked him the same question and the latter answered "yes, i will". therefore, ibn auf swore allegiance to uthman and so did everybody.
this is the history of true and mature experiences of democracy which took place 1400 years ago. and still there are other lessons to inspire of how modern states could be built in the model of the democratic republic of muhammad (peace be upon him).
Explanation of Surah Al-Maa'oon
Sha'baan: A Blessed Month that People Neglect - I
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text:
Country Doctor: A Conclusion
Jeff Waggoner, M.D.
This series has discussed some of the reasons young physicians are reluctant to become "country doctors."
It defined and addressed the concept of professional isolation. A rural doctor can't pop next door for an opinion from an orthopedic surgeon about a difficult fracture; he can't grab a cardiologist and discuss a confusing cardiac arrhythmia.
As a young city-trained physician once said to me, "Man! You guys are really hanging out there."
It also described what it's like for a country doctor when the phone rings in the middle of the night. When that happens the doctor has no idea what's at the other end of the telephone line.
It could be a simple medication question on a hospital patient. It could also be a call alerting the doctor that an ambulance is incoming to the emergency room from a rollover auto accident.
The only thing the doctor knows for sure is that whatever cataclysm lurks at the end of the telephone line it's his to handl
. He lives in the kitchen and sometimes the kitchen is hot.
We noted that today's young doctors seem less comfortable with these challenges than their predecessors and considered the possibility that modern medical training plays a role in this lack of "frontier spirit." I animated this proposition with a description of 72 hours in my second year of family practice residency.
I can't envision a resident in any present day training program facing a situation similar to those 72 hours—the three days I spent caring for premature triplets.
I had a level of responsibility placed on my shoulders no present day family practice resident would even attempt to carry.
But then?
There was no one else to shoulder it.
The days of "see one, do one, teach one" are gone. The dogma explaining why this is so alludes to new modes of learning, an emphasis on "team approaches," and the legal risks to doctors and hospitals posed by the pervasive invasion of health care by litigious-minded lawyers.
Hospitals no longer regard interns and residents (housestaff) as cheap labor upon which patient responsibilities can be foisted. They have had to hire private specialists to do what housestaff did for decades.
This change has had consequences. Without doubt it has increased the cost of medical care.
The addition of "hospitalists," "emergency room doctors," and "hospital employed trauma surgeons" has added a layer of medical costs that did not exist 25 years ago.
It has also made medical training a much more passive experience. I have a friend who is an experienced, gifted specialist in obstetrics and gynecology (OB/GYN).
He had planned to retire five years ago.
Today he continues his practice primarily because he realized that the young doctors joining his OB/GYN group were not very good surgeons. They were too inexperienced.
He began an informal training program, serving as a preceptor, scrubbing in on their cases. His new partners did the cases but he was there for backup and to offer them the benefit of his vast surgical experience.
He did this instead of retiring.
He did this because he was committed to professional excellence—not just his own but also his associates'.
The moment when I stared—in "isolation"—at an unassembled respirator needed for a neonate crashing behind me who also needed intubation and umbilical artery catheterization and whose sibling was already on a respirator is irrevocably stamped on my professional soul.
It was a crucial part of the forces that created within me Doctor Ceriani's "frontier spirit."
But such moments can take a toll. One morning, the year after I was the NICNU (Neonatal Intensive Care Nursery Unit) chief resident, the doctor who took my place was in the middle of morning rounds.
He began looking rather grey and excused himself. When he didn't return a nurse went to find him.
She discovered him on the floor of the call room's bathroom. Blood was splashed over the tile walls and the toilet was filled with it.
He had perforated an ulcer. His survival required a transfusion of five units of packed red blood cells.
There is no doubt the stress of working as the NICNU chief resident caused the ulcer.
Had his near death occurred today there would have been a scandal and perhaps some form of intervention in the training program.
The doctor returned to the nursery three weeks after his bleed.
Is this right? This doctor had a wife and two children. What about them?
Of course it's not right. Medicine, unless it's on a battlefield, should not require life threatening experiences during training. But these sorts of experiences are rare for today's housestaff.
Hospitals are now run by employed doctors. Individual responsibility has been replaced by a "team approach."
If you doubt this is so talk to someone recently hospitalized in a large hospital. Most of them will tell you they saw a different hospitalist every day and that they had no idea who "their doctor" was.
I've spent five columns exploring why young doctors shun rural practices. I'd like to add a positive note.
While rural medicine is a daunting proposition there have been developments that make it a unique opportunity to integrate modern technology into an old fashioned and intensely personal doctor/patient relationship and rare opportunity for professional autonomy.
Because of the Internet, Google, Medscape, youtube and the digitalization of almost every medical journal, country doctors have virtually all medical knowledge at their fingertips. They can research any problem, review videos of surgical and orthopedic procedures, and even access the original studies from which standards of care are derived.
Country doctors may be geographically isolated but they are not isolated from the flow of current medical knowledge.
If their patients need higher levels of care transfers are increasingly easy to initiate and complete in ever shorter periods of time.
Further, flight crews who attend to patients during these transfers are well trained in emergency procedures like insertion of chest tubes and difficult intubations.
Modalities like telemedicine are now viable and dependable sources of real time specialty consultation and assistance. Locally, Syracuse, Kan. began a telemedicine program less than 18 months ago and it is already an essential part of that small town's health care.
Rural medicine may well be one of the few remaining venues where doctors can think independently and apply common sense to the practice of medicine.
My sister once asked me if I felt experiences like my 72 hours with the triplets were worthwhile and a necessary part of training or if instead, they were an example of misuse of an educational system and a perpetuation of something akin to hazing.
Since running the NICNU almost killed a friend and associate of mine I would never say this sort of experience was necessary.
But for me the triplet's 72 hours was worthwhile. It taught me I should carefully evaluate what I think is impossible.
There is an untapped part of me capable of more than I might imagine. It taught me about humility because even having done what I considered impossible, Mother Nature and fate annulled my efforts.
Finally, it taught me that because I am human and fallible, there will be moments when all I can do is whisper, "I am sorry, so very sorry" …and grieve.
Dr. Waggoner is a family practice specialist with Weisbrod Memorial Hospital and sees patients in Eads Colo.. His column appears on Fridays in The Lamar Ledger.