text:
Label: RIBAVIRIN powder, for solution
Packager: Bryant Ranch Prepack
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USE OF AEROSOLIZED RIBAVIRIN FOR INHALATION SOLUTION, USP IN PATIENTS REQUIRING MECHANICAL VENTILATOR ASSISTANCE SHOULD BE UNDERTAKEN ONLY BY PHYSICIANS AND SUPPORT STAFF FAMILIAR WITH THE SPECIFIC VENTILATOR BEING USED AND THIS MODE OF ADMINISTRATION OF THE DRUG. STRICT ATTENTION MUST BE PAID TO PROCEDURES THAT HAVE BEEN SHOWN TO MINIMIZE THE ACCUMULATION OF DRUG PRECIPITATE, WHICH CAN RESULT IN MECHANICAL VENTILATOR DYSFUNCTION AND ASSOCIATED INCREASED PULMONARY PRESSURES (SEE WARNINGS).
SUDDEN DETERIORATION OF RESPIRATORY FUNCTION HAS BEEN ASSOCIATED WITH INITIATION OF AEROSOLIZED RIBAVIRIN FOR INHALATION SOLUTION, USP USE IN INFANTS. RESPIRATORY FUNCTION SHOULD BE CAREFULLY MONITORED DURING TREATMENT. IF INITIATION OF AEROSOLIZED RIBAVIRIN FOR INHALATION SOLUTION, USP TREATMENT APPEARS TO PRODUCE SUDDEN DETERIORATION OF RESPIRATORY FUNCTION, TREATMENT SHOULD BE STOPPED AND REINSTITUTED ONLY WITH EXTREME CAUTION, CONTINUOUS MONITORING AND CONSIDERATION OF CONCOMITANT ADMINISTRATION OF BRONCHODILATORS (SEE WARNINGS).
RIBAVIRIN FOR INHALATION SOLUTION, USP IS NOT INDICATED FOR USE IN ADULTS. PHYSICIANS AND PATIENTS SHOULD BE AWARE THAT RIBAVIRIN HAS BEEN SHOWN TO PRODUCE TESTICULAR LESIONS IN RODENTS AND TO BE TERATOGENIC IN ALL ANIMAL SPECIES IN WHICH ADEQUATE STUDIES HAVE BEEN CONDUCTED (RODENTS AND RABBITS) (SEE CONTRAINDICATIONS).
Ribavirin is a synthetic nucleoside with antiviral activity. Ribavirin for inhalation solution, USP is a sterile, lyophilized powder to be reconstituted for aerosol administration. Each 100 mL glass vial contains 6 grams of ribavirin, and when reconstituted to the recommended volume of 300 mL with Sterile Water for Injection, USP or Sterile Water for Inhalation (no preservatives added), will contain 20 mg of ribavirin per mL, pH approximately 5.5. Aerosolization is to be carried out in a Small Particle Aerosol Generator (SPAG®-2) nebulizer only.
Ribavirin is 1-beta-D-ribofuranosyl-1H-1,2,4-triazole-3-carboxamide, with the following structural formula:
Ribavirin is a stable, white crystalline compound with a maximum solubility in water of 142 mg/mL at 25°C and with only a slight solubility in ethanol. The empirical formula is C8H12N4O5 and the molecular weight is 244.21.
In cell cultures the inhibitory activity of ribavirin for respiratory syncytial virus (RSV) is selective. The mechanism of action is unknown. Reversal of the in vitro antiviral activity by guanosine or xanthosine suggests ribavirin may act as an analogue of these cellular metabolites.
Ribavirin has demonstrated antiviral activity against RSV in vitro1 and in experimentally infected cotton rats.2 Several clinical isolates of RSV were evaluated for ribavirin susceptibility by plaque reduction in tissue culture. Plaques were reduced 85-98% by 16 mcg/mL; however, results may vary with the test system. The development of resistance has not been evaluated in vitro or in clinical trials.
In addition to the above, ribavirin has been shown to have in vitro activity against influenza A and B viruses and herpes simplex virus, but the clinical significance of these data is unknown.
Immunologic Effects
Neutralizing antibody responses to RSV were decreased in aerosolized Ribavirin for Inhalation Solution, USP-treated infants compared to placebo-treated infants.3 One study also showed that RSV-specific IgE antibody in bronchial secretions was decreased in patients treated with aerosolized Ribavirin for Inhalation Solution, USP. In rats, ribavirin administration resulted in lymphoid atrophy of the thymus, spleen and lymph nodes. Humoral immunity was reduced in guinea pigs and ferrets. Cellular immunity was also mildly depressed in animal studies. The clinical significance of these observations is unknown.
Assay for Ribavirin for Inhalation Solution, USP in human materials is by a radioimmunoassay which detects ribavirin and at least one metabolite.
Ribavirin for Inhalation Solution, USP, when administered by aerosol, is absorbed systemically. Four pediatric patients inhaling Ribavirin for Inhalation Solution, USP aerosol administered by face mask for 2.5 hours each day for 3 days had plasma concentrations ranging from 0.44 to 1.55 μM, with a mean concentration of 0.76 μM. The plasma half-life was reported to be 9.5 hours. Three pediatric patients inhaling aerosolized Ribavirin for Inhalation Solution, USP administered by face mask or mist tent for 20 hours each day for 5 days had plasma concentrations ranging from 1.5 to 14.3 μM, with a mean concentration of 6.8 μM.
The bioavailability of aerosolized Ribavirin for Inhalation Solution, USP is unknown and may depend on the mode of aerosol delivery. After aerosol treatment, peak plasma concentrations of ribavirin are 85% to 98% less than the concentration that reduced RSV plaque formation in tissue culture. After aerosol treatment, respiratory tract secretions are likely to contain ribavirin in concentrations manyfold higher than those required to reduce plaque formation. However, RSV is an intracellular virus, and it is unknown whether plasma concentrations or respiratory secretion concentrations of the drug better reflect intracellular concentrations in the respiratory tract.
In man, rats, and rhesus monkeys, accumulation of ribavirin and/or metabolites in the red blood cells has been noted, plateauing in red cells in man in about 4 days and gradually declining with an apparent half-life of 40 days (the half-life of erythrocytes). The extent of accumulation of ribavirin following inhalation therapy is not well defined.
Animal Toxicology
Ribavirin, when administered orally or as an aerosol, produced cardiac lesions in mice, rats, and monkeys, when given at doses of 30, 36 and 120 mg/kg or greater for 4 weeks or more (estimated human equivalent doses of 4.8, 12.3 and 111.4 mg/kg for a 5 kg child, or 2.5, 5.1 and 40 mg/kg for a 60 kg adult, based on body surface area adjustment). Aerosolized ribavirin administered to developing ferrets at 60 mg/kg for 10 or 30 days resulted in inflammatory and possibly emphysematous changes in the lungs. Proliferative changes were seen in the lungs following exposure at 131 mg/kg for 30 days. The significance of these findings to human administration is unknown.
Ribavirin for Inhalation Solution, USP is indicated for the treatment of hospitalized infants and young children with severe lower respiratory tract infections due to RSV. Treatment early in the course of severe lower respiratory tract infection may be necessary to achieve efficacy.
Only severe RSV lower respiratory tract infection should be treated with Ribavirin for Inhalation Solution, USP. The vast majority of infants and children with RSV infection have disease that is mild, self-limited, and does not require hospitalization or antiviral treatment. Many children with mild lower respiratory tract involvement will require shorter hospitalization than would be required for a full course of Ribavirin for Inhalation Solution, USP aerosol (3 to 7 days) and should not be treated with the drug. Thus the decision to treat with Ribavirin for Inhalation Solution, USP should be based on the severity of the RSV infection. The presence of an underlying condition such as prematurity, immunosuppression or cardiopulmonary disease may increase the severity of clinical manifestations and complications of RSV infection.
Use of aerosolized Ribavirin for Inhalation Solution, USP in patients requiring mechanical ventilator assistance should be undertaken only by physicians and support staff familiar with this mode of administration and the specific ventilator being used (see WARNINGS and DOSAGE AND ADMINISTRATION).
RSV infection should be documented by a rapid diagnostic method such as demonstration of viral antigen in respiratory tract secretions by immunofluorescence3,4 or ELISA5 before or during the first 24 hours of treatment. Treatment may be initiated while awaiting rapid diagnostic test results. However, treatment should not be continued without documentation of RSV infection. Non-culture antigen detection techniques may have false positive or false negative results. Assessment of the clinical situation, the time of year and other parameters may warrant reevaluation of the laboratory diagnosis.
Description of Studies
Non-Mechanically Ventilated Infants
In two placebo-controlled trials in infants hospitalized with RSV lower respiratory tract infection, aerosolized Ribavirin for Inhalation Solution, USP treatment had a therapeutic effect, as judged by the reduction in severity of clinical manifestations of disease by treatment day 3.3,4 Treatment was most effective when instituted within the first 3 days of clinical illness. Virus titers in respiratory secretions were also significantly reduced with Ribavirin for Inhalation Solution, USP in one of these original studies.4 Additional controlled studies conducted since these initial trials of aerosolized Ribavirin for Inhalation Solution, USP in the treatment of RSV infection have supported these data.
Mechanically Ventilated Infants
A randomized, double-blind, placebo-controlled evaluation of aerosolized Ribavirin for Inhalation Solution, USP at the recommended dose was conducted in 28 infants requiring mechanical ventilation for respiratory failure caused by documented RSV infection.6 Mean age was 1.4 months (SD, 1.7 months). Seven patients had underlying diseases predisposing them to severe infection and 21 were previously normal. Aerosolized Ribavirin for Inhalation Solution, USP treatment significantly decreased the duration of mechanical ventilation required (4.9 vs. 9.9 days, p=0.01) and duration of required supplemental oxygen (8.7 vs. 13.5 days, p=0.01). Intensive patient management and monitoring techniques were employed in this study. These included endotracheal tube suctioning every 1 to 2 hours; recording of proximal airway pressure, ventilatory rate, and FlO2 every hour; and arterial blood gas monitoring every 2 to 6 hours. To reduce the risk of Ribavirin for Inhalation Solution, USP precipitation and ventilator malfunction, heated wire tubing, two bacterial filters connected in series in the expiratory limb of the ventilator (with filter changes every 4 hours), and water column pressure release valves to monitor internal ventilator pressures were used in connecting ventilator circuits to the SPAG®-2.
Employing these techniques, no technical difficulties with Ribavirin for Inhalation Solution, USP administration were encountered during the study. Adverse events consisted of bacterial pneumonia in one case, staphylococcus bacteremia in one case and two cases of post-extubation stridor. None were felt to be related to Ribavirin for Inhalation Solution, USP administration.
Ribavirin for Inhalation Solution, USP is contraindicated in individuals who have shown hypersensitivity to the drug or its components, and in women who are or may become pregnant during exposure to the drug. Ribavirin has demonstrated significant teratogenic and/or embryocidal potential in all animal species in which adequate studies have been conducted (rodents and rabbits). Therefore, although clinical studies have not been performed, it should be assumed that Ribavirin for Inhalation Solution, USP may cause fetal harm in humans. Studies in which the drug has been administered systemically demonstrate that ribavirin is concentrated in the red blood cells and persists for the life of the erythrocyte.
SUDDEN DETERIORATION OF RESPIRATORY FUNCTION HAS BEEN ASSOCIATED WITH INITIATION OF AEROSOLIZED RIBAVIRIN FOR INHALATION SOLUTION, USP USE IN INFANTS. Respiratory function should be carefully monitored during treatment. If initiation of aerosolized Ribavirin for Inhalation Solution, USP treatment appears to produce sudden deterioration of respiratory function, treatment should be stopped and reinstituted only with extreme caution, continuous monitoring, and consideration of concomitant administration of bronchodilators.
Use with Mechanical Ventilators
USE OF AEROSOLIZED RIBAVIRIN FOR INHALATION SOLUTION, USP IN PATIENTS REQUIRING MECHANICAL VENTILATOR ASSISTANCE SHOULD BE UNDERTAKEN ONLY BY PHYSICIANS AND SUPPORT STAFF FAMILIAR WITH THIS MODE OF ADMINISTRATION AND THE SPECIFIC VENTILATOR BEING USED. Strict attention must be paid to procedures that have been shown to minimize the accumulation of drug precipitate, which can result in mechanical ventilator dysfunction and associated increased pulmonary pressures. These procedures include the use of bacteria filters in series in the expiratory limb of the ventilator circuit with frequent changes (every 4 hours), water column pressure release valves to indicate elevated ventilator pressures, frequent monitoring of these devices and verification that ribavirin crystals have not accumulated within the ventilator circuitry, and frequent suctioning and monitoring of the patient (see Description of Studies).
Those administering aerosolized Ribavirin for Inhalation Solution, USP in conjunction with mechanical ventilator use should be thoroughly familiar with detailed descriptions of these procedures as outlined in the SPAG-2 Instructions for Use.
Patients with severe lower respiratory tract infection due to RSV require optimum monitoring and attention to respiratory and fluid status (see SPAG-2 Instructions for Use).
Clinical studies of interactions of Ribavirin for Inhalation Solution, USP with other drugs commonly used to treat infants with RSV infections, such as digoxin, bronchodilators, other antiviral agents, antibiotics or anti-metabolites, have not been conducted. Interference by Ribavirin for Inhalation Solution, USP with laboratory tests has not been evaluated.
Carcinogenesis and Mutagenesis
Ribavirin increased the incidence of cell transformations and mutations in mouse Balb/c 3T3 (fibroblasts) and L5178Y (lymphoma) cells at concentrations of 0.015 and 0.03-5.0 mg/mL, respectively (without metabolic activation). Modest increases in mutation rates (3-4x) were observed at concentrations between 3.75-10.0 mg/mL in L5178Y cells in vitro with the addition of a metabolic activation fraction. In the mouse micronucleus assay, ribavirin was clastogenic at intravenous doses of 20-200 mg/kg, (estimated human equivalent of 1.67-16.7 mg/kg, based on body surface area adjustment for a 60 kg adult). Ribavirin was not mutagenic in a dominant lethal assay in rats at intraperitoneal doses between 50-200 mg/kg when administered for 5 days (estimated human equivalent of 7.14-28.6 mg/kg, based on body surface area adjustment; see Pharmacokinetics).
In vivo carcinogenicity studies with ribavirin are incomplete. However, results of a chronic feeding study with ribavirin in rats, at doses of 16-100 mg/kg/day (estimated human equivalent of 2.3-14.3 mg/kg/day, based on body surface area adjustment for the adult), suggest that ribavirin may induce benign mammary, pancreatic, pituitary and adrenal tumors. Preliminary results of two oral gavage oncogenicity studies in the mouse and rat (18-24 months; doses of 20-75 and 10-40 mg/kg/day, respectively [estimated human equivalent of 1.67-6.25 and 1.43-5.71 mg/kg/day, respectively, based on body surface area adjustment for the adult]) are inconclusive as to the carcinogenic potential of ribavirin (see Pharmacokinetics). However, these studies have demonstrated a relationship between chronic ribavirin exposure and increased incidences of vascular lesions (microscopic hemorrhages in mice) and retinal degeneration (in rats).
The fertility of ribavirin-treated animals (male or female) has not been fully investigated. However, in the mouse, administration of ribavirin at doses between 35-150 mg/kg/day (estimated human equivalent of 2.92-12.5 mg/kg/day, based on body surface area adjustment for the adult) resulted in significant seminiferous tubule atrophy, decreased sperm concentrations, and increased numbers of sperm with abnormal morphology. Partial recovery of sperm production was apparent 3-6 months following dose cessation. In several additional toxicology studies, ribavirin has been shown to cause testicular lesions (tubular atrophy) in adult rats at oral dose levels as low as 16 mg/kg/day (estimated human equivalent of 2.29 mg/kg/day, based on body surface area adjustment; see Pharmacokinetics). Lower doses were not tested. The reproductive capacity of treated male animals has not been studied.
Ribavirin has demonstrated significant teratogenic and/or embryocidal potential in all animal species in which adequate studies have been conducted. Teratogenic effects were evident after single oral doses of 2.5 mg/kg or greater in the hamster, and after daily oral doses of 0.3 and 1.0 mg/kg in the rabbit and rat, respectively (estimated human equivalent doses of 0.12 and 0.14 mg/kg, based on body surface area adjustment for the adult). Malformations of the skull, palate, eye, jaw, limbs, skeleton, and gastrointestinal tract were noted. The incidence and severity of teratogenic effects increased with escalation of the drug dose. Survival of fetuses and offspring was reduced. Ribavirin caused embryolethality in the rabbit at daily oral dose levels as low as 1 mg/kg. No teratogenic effects were evident in the rabbit and rat administered daily oral doses of 0.1 and 0.3 mg/kg, respectively with estimated human equivalent doses of 0.01 and 0.04 mg/kg, based on body surface area adjustment (see Pharmacokinetics). These doses are considered to define the No Observable Teratogenic Effects Level (NOTEL) for ribavirin in the rabbit and rat.
Following oral administration of ribavirin in the pregnant rat (1.0 mg/kg) and rabbit (0.3 mg/kg), mean plasma levels of drug ranged from 0.10-0.20 μM [0.024-0.049 μ/mL] at 1 hour after dosing, to undetectable levels at 24 hours. At 1 hour following the administration of 0.3 or 0.1 mg/kg in the rat and rabbit (NOTEL), respectively, mean plasma levels of drug in both species were near or below the limit of detection (0.05 μM; see Pharmacokinetics).
Although clinical studies have not been performed, Ribavirin for Inhalation Solution, USP may cause fetal harm in humans. As noted previously, ribavirin is concentrated in red blood cells and persists for the life of the cell. Thus the terminal half-life for the systemic elimination of ribavirin is essentially that of the half-life of circulating erythrocytes. The minimum interval following exposure to Ribavirin for Inhalation Solution, USP before pregnancy may be safely initiated is unknown (see CONTRAINDICATIONS, WARNINGS, and Information for Health Care Personnel).
Ribavirin for Inhalation Solution, USP has been shown to be toxic to lactating animals and their offspring. It is not known if Ribavirin for Inhalation Solution, USP is excreted in human milk.
Information for Health Care Personnel
Health care workers directly providing care to patients receiving aerosolized Ribavirin for Inhalation Solution, USP should be aware that ribavirin has been shown to be teratogenic in all animal species in which adequate studies have been conducted (rodents and rabbits). Although no reports of teratogenesis in offspring of mothers who were exposed to aerosolized Ribavirin for Inhalation Solution, USP during pregnancy have been confirmed, no controlled studies have been conducted in pregnant women. Studies of environmental exposure in treatment settings have shown that the drug can disperse into the immediate bedside area during routine patient care activities with highest ambient levels closest to the patient and extremely low levels outside of the immediate bedside area. Adverse reactions resulting from actual occupational exposure in adults are described below (see Adverse Events in Health Care Workers). Some studies have documented ambient drug concentrations at the bedside that could potentially lead to systemic exposures above those considered safe for exposure during pregnancy (1/1000 of the NOTEL dose in the most sensitive animal species).7, 8, 9
A 1992 study conducted by the National Institute of Occupational Safety and Health (NIOSH) demonstrated measurable urine levels of ribavirin in health care workers exposed to aerosol in the course of direct patient care.7 Levels were lowest in workers caring for infants receiving aerosolized Ribavirin for Inhalation Solution, USP with mechanical ventilation and highest in those caring for patients being administered the drug via an oxygen tent or hood. This study employed a more sensitive assay to evaluate ribavirin levels in urine than was available for several previous studies of environmental exposure that failed to detect measurable ribavirin levels in exposed workers. Creatinine adjusted urine levels in the NIOSH study ranged from less than 0.001 to 0.140 μM of ribavirin per gram of creatinine in exposed workers. However, the relationship between urinary ribavirin levels in exposed workers, plasma levels in animal studies, and the specific risk of teratogenesis in exposed pregnant women is unknown.
It is good practice to avoid unnecessary occupational exposure to chemicals wherever possible. Hospitals are encouraged to conduct training programs to minimize potential occupational exposure to Ribavirin for Inhalation Solution, USP. Health care workers who are pregnant should consider avoiding direct care of patients receiving aerosolized Ribavirin for Inhalation Solution, USP. If close patient contact cannot be avoided, precautions to limit exposure should be taken. These include administration of Ribavirin for Inhalation Solution, USP in negative pressure rooms; adequate room ventilation (at least six air exchanges per hour); the use of scavenging devices; turning off the SPAG-2 device for 5 to 10 minutes prior to prolonged patient contact; and wearing appropriately fitted respirator masks. Surgical masks do not provide adequate filtration of Ribavirin for Inhalation Solution, USP particles. Further information is available from NIOSH's Hazard Evaluation and Technical Assistance Branch and additional recommendations have been published in an Aerosol Consensus Statement by the American Respiratory Care Foundation and the American Association for Respiratory Care.10
The description of adverse reactions is based on events from clinical studies (approximately 200 patients) conducted prior to 1986, and the controlled trial of aerosolized Ribavirin for Inhalation Solution, USP conducted in 1989-1990. Additional data from spontaneous post-marketing reports of adverse events in individual patients have been available since 1986.
Deaths during or shortly after treatment with aerosolized Ribavirin for Inhalation Solution, USP have been reported in 20 cases of patients treated with Ribavirin for Inhalation Solution, USP (12 of these patients were being treated for RSV infections). Several cases have been characterized as "possibly related" to Ribavirin for Inhalation Solution, USP by the treating physician; these were in infants who experienced worsening respiratory status related to bronchospasm while being treated with the drug. Several other cases have been attributed to mechanical ventilator malfunction in which Ribavirin for Inhalation Solution, USP precipitation within the ventilator apparatus led to excessively high pulmonary pressures and diminished oxygenation.
In these cases the monitoring procedures described in the current package insert were not employed (see Description of Studies, WARNINGS, and DOSAGE AND ADMINISTRATION).
Pulmonary and Cardiovascular
Pulmonary function significantly deteriorated during aerosolized Ribavirin for Inhalation Solution, USP treatment in six of six adults with chronic obstructive lung disease and in four of six asthmatic adults. Dyspnea and chest soreness were also reported in the latter group. Minor abnormalities in pulmonary function were also seen in healthy adult volunteers.
In the original study population of approximately 200 infants who received aerosolized Ribavirin for Inhalation Solution, USP, several serious adverse events occurred in severely ill infants with lifethreatening underlying diseases, many of whom required assisted ventilation. The role of Ribavirin for Inhalation Solution, USP in these events is indeterminate. Since the drug's approval in 1986, additional reports of similar serious, though non-fatal, events have been filed infrequently. Events associated with aerosolized Ribavirin for Inhalation Solution, USP use have included the following:
Worsening of respiratory status, bronchospasm, pulmonary edema, hypoventilation, cyanosis, dyspnea, bacterial pneumonia, pneumothorax, apnea, atelectasis and ventilator dependence.
Cardiac arrest, hypotension, bradycardia and digitalis toxicity. Bigeminy, bradycardia and tachycardia have been described in patients with underlying congenital heart disease.
Some subjects requiring assisted ventilation experienced serious difficulties, due to inadequate ventilation and gas exchange. Precipitation of drug within the ventilatory apparatus, including the endotracheal tube, has resulted in increased positive end expiratory pressure and increased positive inspiratory pressure. Accumulation of fluid in tubing ("rain out") has also been noted. Measures to avoid these complications should be followed carefully (see DOSAGE AND ADMINISTRATION).
Although anemia was not reported with use of aerosolized Ribavirin for Inhalation Solution, USP in controlled clinical trials, most infants treated with the aerosol have not been evaluated 1 to 2 weeks post-treatment when anemia is likely to occur. Anemia has been shown to occur frequently with experimental oral and intravenous Ribavirin for Inhalation Solution, USP in humans. Also, cases of anemia (type unspecified), reticulocytosis and hemolytic anemia associated with aerosolized Ribavirin for Inhalation Solution, USP use have been reported through post-marketing reporting systems. All have been reversible with discontinuation of the drug.
Rash and conjunctivitis have been associated with the use of aerosolized Ribavirin for Inhalation Solution, USP. These usually resolve within hours of discontinuing therapy. Seizures and asthenia associated with experimental intravenous Ribavirin for Inhalation Solution, USP therapy have also been reported.
Adverse Events in Health Care Workers
Studies of environmental exposure to aerosolized Ribavirin for Inhalation Solution, USP in health care workers administering care to patients receiving the drug have not detected adverse signs or symptoms related to exposure. However, 152 health care workers have reported experiencing adverse events through post-marketing surveillance. Nearly all were in individuals providing direct care to infants receiving aerosolized Ribavirin for Inhalation Solution, USP. Of 358 events from these 152 individual health care worker reports, the most common signs and symptoms were headache (51% of reports), conjunctivitis (32%), and rhinitis, nausea, rash, dizziness, pharyngitis, or lacrimation (10-20% each). Several cases of bronchospasm and/or chest pain were also reported, usually in individuals with known underlying reactive airway disease. Several case reports of damage to contact lenses after prolonged close exposure to aerosolized Ribavirin for Inhalation Solution, USP have also been reported. Most signs and symptoms reported as having occurred in exposed health care workers resolved within minutes to hours of discontinuing close exposure to aerosolized Ribavirin for Inhalation Solution, USP (also see Information for Health Care Personnel).
The symptoms of RSV in adults can include headache, conjunctivitis, sore throat and/or cough, fever, hoarseness, nasal congestion and wheezing, although RSV infections in adults are typically mild and transient. Such infections represent a potential hazard to uninfected hospital patients. It is unknown whether certain symptoms cited in reports from health care workers were due to exposure to the drug or infection with RSV. Hospitals should implement appropriate infection control procedures.
To report SUSPECTED ADVERSE REACTIONS, contact Cameron Pharmaceuticals at 1-888-767-7913 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
No overdosage with Ribavirin for Inhalation Solution, USP by aerosol administration has been reported in humans. The LD50 in mice is 2 g orally and is associated with hypoactivity and gastrointestinal symptoms (estimated human equivalent dose of 0.17 g/kg, based on body surface area conversion). The mean plasma half-life after administration of aerosolized Ribavirin for Inhalation Solution, USP for pediatric patients is 9.5 hours. Ribavirin for Inhalation Solution, USP is concentrated and persists in red blood cells for the life of the erythrocyte (see Pharmacokinetics).
BEFORE USE, READ THOROUGHLY THE BAUSCH HEALTH SMALL PARTICLE AEROSOL GENERATOR SPAG-2 INSTRUCTIONS FOR USE FOR SMALL PARTICLE AEROSOL GENERATOR OPERATING INSTRUCTIONS. AEROSOLIZED RIBAVIRIN FOR INHALATION SOLUTION, USP HAS NOT BEEN TESTED WITH ANY OTHER AEROSOL GENERATING DEVICE.
The recommended treatment regimen is 20 mg/mL Ribavirin for Inhalation Solution, USP as the starting solution in the drug reservoir of the SPAG-2 unit, with continuous aerosol administration for 12-18 hours per day for 3 to 7 days. Using the recommended drug concentration of 20 mg/mL the average aerosol concentration for a 12 hour delivery period would be 190 mcg/L of air. Aerosolized Ribavirin for Inhalation Solution, USP should not be administered in a mixture for combined aerosolization or simultaneously with other aerosolized medications.
Ribavirin for Inhalation Solution, USP should be delivered to an infant oxygen hood from the SPAG®-2 aerosol generator. Administration by face mask or oxygen tent may be necessary if a hood cannot be employed (see SPAG-2 Instructions for Use). However, the volume and condensation area are larger in a tent and this may alter delivery dynamics of the drug.
The recommended dose and administration schedule for infants who require mechanical ventilation is the same as for those who do not. Either a pressure or volume cycle ventilator may be used in conjunction with the SPAG-2. In either case, patients should have their endotracheal tubes suctioned every 1-2 hours, and their pulmonary pressures monitored frequently (every 2-4 hours). For both pressure and volume ventilators, heated wire connective tubing and bacteria filters in series in the expiratory limb of the system (which must be changed frequently, i.e., every 4 hours) must be used to minimize the risk of Ribavirin for Inhalation Solution, USP precipitation in the system and the subsequent risk of ventilator dysfunction. Water column pressure release valves should be used in the ventilator circuit for pressure cycled ventilators, and may be utilized with volume cycled ventilators (see SPAG-2 INSTRUCTIONS FOR USE FOR DETAILED INSTRUCTIONS).
Ribavirin for Inhalation Solution, USP is supplied as 6 grams of lyophilized powder per 100 mL vial for aerosol administration only. By sterile technique, reconstitute drug with a minimum of 75 mL of Sterile Water for Injection, USP or Inhalation in the original 100 mL glass vial. Shake well. Transfer to the clean, sterilized 500 mL SPAG-2 reservoir and further dilute to a final volume of 300 mL with Sterile Water for Injection, USP or Inhalation. The final concentration should be 20 mg/mL. Important: This water should NOT have had any antimicrobial agent or other substance added. The solution should be inspected visually for particulate matter and discoloration prior to administration. Solutions that have been placed in the SPAG-2 unit should be discarded at least every 24 hours and when the liquid level is low before adding newly reconstituted solution.
Ribavirin for Inhalation Solution, USP is supplied in a one-pack count containing 100 mL glass vial with 6 grams of Sterile, lyophilized drug which is to be reconstituted with 300 mL Sterile Water for Injection, USP or Sterile Water for Inhalation (no preservatives added) and administered only by a small particle aerosol generator (SPAG®-2).
NDC: 63629-2149-1: One 6 g glass vial
Vials containing the lyophilized drug powder should be stored in a dry place at 25°C (77°F); excursions permitted to 15° to 30°C (59° to 86°F). Reconstituted solutions may be stored, under sterile conditions, at room temperature 20° to 30°C (68° to 86°F) for 24 hours. Solutions which have been placed in the SPAG-2 unit should be discarded at least every 24 hours.
Hruska JF, Bernstein JM, Douglas Jr., RG, and Hall CB. Effects of Virazole on respiratory syncytial virus in vitro. Antimicrob Agents Chemother 17:770-775, 1980.
Hruska JF, Morrow PE, Suffin SC, and Douglas Jr., RG. In vivo inhibition of respiratory syncytial virus by Virazole. Antimicrob Agents Chemother 21:125-130, 1982.
Taber LH, Knight V, Gilbert BE, McClung HW et al. Virazole aerosol treatment of bronchiolitis associated with respiratory tract infection in infants. Pediatrics 72:613-618, 1983.
Hall CB, McBride JT, Walsh EE, Bell DM et al. Aerosolized Virazole treatment of infants with respiratory syncytial viral infection. N Engl J Med 308:1443-7, 1983.
Hendry RM, Mclntosh K, Fahnestock ML, and Pierik LT. Enzyme-linked immunosorbent assay for detection of respiratory syncytial virus infection J Clin Microbiol 16:329-33, 1982.
Smith, David W., Frankel, Lorry R., Mather, Larry H., Tang, Allen T.S., Ariagno, Ronald L., Prober, Charles G. A Controlled Trial of Aerosolized Ribavirin in Infants Receiving Mechanical Ventilation for Severe Respiratory Syncytial Virus Infection. N Engl J Med 1991; 325:24-29.
Decker, John, Shultz, Ruth A., Health Hazard Evaluation Report: Florida Hospital, Orlando, Florida. Cincinnati OH: U.S. Department of Health and Human Services, Public Health Service, Centers for NIOSH Report No. HETA 91-104-2229.1
Barnes, D.J. and Doursew, M. Reference dose: Description and use in health risk assessments. Regul Tox. and Pharm. Vol. 8; p. 471-486, 1988.
Federal Register Vol. 53 No. 126 Thurs. June 30, 1988 p. 24834-24847.
American Association for Respiratory Care [1991]. Aerosol Consensus Statement-1991. Respiratory Care 36(9): 916-921.
Copies of the Report may be purchased from National Technical Information Service, 5285 Port Royal Road, Springfield, VA 22161; Ask for Publication PB 93119-345
SPL UNCLASSIFIED SECTION
Cameron Pharmaceuticals
Louisville, KY 40245 USA
Hospira, Inc.
McPherson, KS 67460 USA
SPAG is a trademark of Bausch Health Companies Inc. or its affiliates.
© 2019 Bausch Health Companies Inc. or its affiliates
Rev. 07/2019
Ribavirin 6 gm Powder for Solution, #1
ribavirin powder, for solution
Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:63629-2149(NDC:42494-423)
Route of Administration RESPIRATORY (INHALATION)
RIBAVIRIN (UNII: 49717AWG6K) (RIBAVIRIN - UNII:49717AWG6K) RIBAVIRIN 6 g
NDC:63629-2149-1 1 in 1 CARTON 02/15/2021
1 in 1 VIAL, GLASS; Type 0: Not a Combination Product
Labeler - Bryant Ranch Prepack (171714327)
Registrant - Bryant Ranch Prepack (171714327)
Bryant Ranch Prepack 171714327 REPACK(63629-2149) , RELABEL(63629-2149)
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1 312818 ribavirin 6 GM Inhalation Solution PSN
2 312818 ribavirin 20 MG/ML Inhalation Solution SCD
3 312818 ribavirin 6 GM Inhalation Solution SY
https://dailymed.nlm.nih.gov/dailymed/labelrss.cfm?setid=1ca2a558-2989-4e16-94de-ebe0dd801267
1 63629-2149-1


Here is what might be one of the most important outfits anyone needs to pick out in their lives, the job interview look. This look was for last Friday, the day I had my interview for the Córdova and Fernós Congressional Internship Program in Washington, D.C. I wore a Banana Republic blouse, Anne Taylor crop pants, Charlotte Russe pointed toe pumps, Shoedazzle Blanca purse, and though I did not show it here I wore a Forever 21 blazer as well. I thought this blouse was perfect because blue is the business color (although for a government job this may mean a political party, so careful with that), the print was very feminine and perfect for a day look even though the colors were dark, and the neckline looks very chic. After choosing a top the rest of the outfit was very easy and simple. The hair and makeup was simple as well, hair down and sleek, and makeup concentrated on the eyes with black eyeliner and a little blue eye shadow. I think the interview went well, but I'm still keeping my fingers crossed!


For fall conditions across the state call 515-233-4110 or check the current report online.
Interested in reducing energy bills and adding beauty to your landscape? Residential Tree Programs.
The Emerald Ash Borer is a small invasive wood-boring beetle that attacks ash trees.
The Iowa DNR works to help Iowans expand and care for the state's roughly 3 million acres of trees and forests. We use professionally trained foresters and natural resource technicians to provide forestry assistance to private landowners, to sustainably manage our state forests, to operate the State Forest Nursery at costs of production, and to protect, utilize and enhance the state's forest resources for today and tomorrow.
Forestry services include the State Forest Nursery, forest health, urban forestry, landowner assistance, fire management and prescribed fire, educational opportunities, Iowa's wood industry and logging and fall color reporting.
Foresters and forestry staff are happy to assist you with your private, public, urban, forest health, fire-related, and tree-planting needs.
The State Forest Assessment and Resource Strategy, titled "Iowa's Forests Today," was completed in 2008 for the purpose of providing an in-depth analysis of the past, present, and future conditions of the state's forest resources, as well as to offer analysis, identify historical trends and patterns, and make suggestions for improving management practices going forward.
The assessment was completed as a USDA Forest Service requirement for states applying for forestry-related federal funding.
For questions, comments, or more information, please contact Jeff Goerndt, Forestry Supervisor, at (515) 725-8452.
PLEASE NOTE: Due to personnel and funding shortages, DNR staff are currently unable to check trees nominated for the Big Tree program; however, dedicated volunteers are checking nominations as they are able to do so. To assist our volunteers, please consider donating to the program using the donation form provided below.
The DNR is responsible for managing Iowa's wildlife for all of Iowa's citizens. One of the DNR's responsibilities is to provide private landowners with the guidance and assistance they need to effectively deal with wildlife damage.
Find out more regarding wildlife damage identification and management.


It's New Music Friday! This week we have several new releases from a variety of country music artists. The list goes from new albums to new singles!
Here's a list of some of the new country music that is available now!
Spencer Crandall released a brand new album entitled, More! Listen to one of the featured tracks, Better, on YouTube below or click HERE to find out where you can listen to the full album!
Maren Morris has a new song available that was released on the Game Of Thrones' new album entitled, Kingdom of One.
Timmy Dunn released a new single, In A Hurry!
Alissa Griffith has released a new single entitled, Unfold!
Sarah Beth released a new single entitled, Something Blue!
Elise Hayes released a new single, Giving Up!
Abi has released a new single, Boomerang!
Sarah Spencer has a new single, Little One Bedroom!
Leaving Austin released a new EP entitled, Southern Gold! Listen to one of it's featured tracks below, Nothing But You!
Dennis Quaid & The Sharks released their debut record, Out Of The Box, today on vinyl for Record Store Day tomorrow! You can listen to the title track below on YouTube!
Which new music release are you excited to listen to today? I'd love to hear your thoughts, so leave me a comment below or on social media!


text:
Q: After splash screen, display white screen long time after killing the application and launching again in ionic ios I have an ionic application with both the platforms in android and iOS. The problem is that when the iOS application is launched for the first time it works smoothly but when we kill the application or launch the application again after coming from the background the white screen is shown and the application seems to get freezes there after showing the splash screen.
What is the problem and how to resolve it?
I am a native developer in iOS so in the case of native iOS we have an app delegate method for handling the application while coming from background like:

  applicationDidBecomeActive(_:)
  applicationWillEnterForeground(_:)

Is anything similar to these in ionic please have some light on this issue.

redpajama_set_name: RedPajamaStackExchange


text:
Machelonové (: მახელონები, Machelnebi; , Machelônes) byli starověkým kolchidským kmenem, který sídlil daleko na jih od přístavu Fasis v dnešní západní Gruzii. Tento kmen byl blízce spřízněn se sousedním kmenem Makronésů, o kterých se věří, že byli prapředky dnešního gruzínského subetnika Mingrelců.

Na tento kmen se odkazuje několik starověkých kronikářů. Například Plinius starší ho nazýval "Machorones" a umístil ho mezi říčky Ofis a Prytanis.

Reference

Starověké národy
Vymřelé etnické skupiny
Dějiny Gruzie

redpajama_set_name: RedPajamaWikipedia


text:
Q: Why golang container in k8s show linear memory leak, but htop shows no leaks? I have a microservice written in golang.
It processes images and do other stuff.
In k8s it shows linear memory grow
But in htop, it has stable memory usage. I tested it locally - also stable.

I understand, k8s shows some different memory usage, but what is it? And how to release/free this memory from golang?
There is no large heap. GC runs normally and I even run debug.FreeOSMemory() every 10 seconds from Go.
# cat /sys/fs/cgroup/memory/memory.stat
cache 3095613440
rss 189210624
rss_huge 0
shmem 0
mapped_file 1548288
dirty 15630336
writeback 0
pgpgin 7268911
pgpgout 6466952
pgfault 6519532
pgmajfault 15
inactive_anon 0
active_anon 189140992
inactive_file 628293632
active_file 2467319808
unevictable 0
hierarchical_memory_limit 8589934592
total_cache 3095613440
total_rss 189210624
total_rss_huge 0
total_shmem 0
total_mapped_file 1548288
total_dirty 15630336
total_writeback 0
total_pgpgin 7268911
total_pgpgout 6466952
total_pgfault 6519532
total_pgmajfault 15
total_inactive_anon 0
total_active_anon 189140992
total_inactive_file 628293632
total_active_file 2467319808
total_unevictable 0


Founded by entreprenuer Ignacio Coca, the Hotel Los Monteros was inaugurated in 1962 with 35 rooms. However, the high demand meant that it was enlarged on three occasions until it became a Grand Luxury hotel with 68 rooms, 20 luxury villas and more than 440 members of staff.
Celebrities of all kinds have been guests at the hotel, such as Queen Ingrid of Denmark, Michael Jackson, Julio Iglesias, Camilo José Cela, Baroness Von Thyssen, Lola Flores, Sean Connery, Antonio Banderas, Melanie Griffith or Carlos Herrera.
The hotel complex was a valuable asset to Spain's tourism, and it was made up by: Hotel Los Monteros, Río Real golf course, tennis club, La Cabane beach club and the horse-riding club.
It had the first golf course in town, the current Río Real golf course; today it offers green fees in more than 20 golf courses of the area.
And it is responsible that today we have something which back then was quite strange: the palette to serve fish sauce.
In 1965 you could already enjoy this space by the sea, a place that was later imitated by others due to the huge success of La Cabane. The former king and queen of Spain,(Mr Juan Carlos and Mrs Sofia), prince and princess back then, were among the first ones to visit it.


California is in the midst of a four-year drought. Despite the several days of heavy rain in mid-December 2014, rainfall and snow pack water content are way below normal. As of January 6, 2015 (with no rain in the forecast for the next 10 days), the water content of the Sierra snow pack is at 43% of normal for this time of the year, and only 17% of the average for April 1.
Trees are beginning to die across the state and even revered redwoods are showing signs of illness.
Indeed, one of California's most famous theme songs California Here I Come will be giving way to the Cowboy ballad Cool Water.
Unlike oil and gas, there is no national market for water. California's water supply is a mixture of federal, state, and private sources, some of which derives from out of state. The politics of water is extremely partisan, with cities electing Democrats and farming areas Republicans.
The water bond approved by the state legislature in 2014 will have little impact on short-run water supplies.
If high pressure off the coast continues to block the moisture-laden winter jet stream this year and beyond, more of the state will revert to desert, fire danger will worsen, and both oaks and redwood will die in large numbers.
You can follow the situation on the first link above.


text:
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You are at:Home » Receptive Language Disorder Strategies to Improve Speech
Receptive Language Disorder Strategies to Improve Speech
By ghisellerousso January 16, 2023 No Comments11 Mins Read
Children are born ready to learn a language — and, by age 5, most people can easily express themselves and understand others. However, for people with language disorders, communicating with others is a challenge that can lead to difficulties at school and work, during social interactions, and in overall well-being. One type of language impairment is receptive language disorder.
Receptive language is the ability to comprehend other people's words and actions. People with receptive language disorder often find it difficult to understand questions, follow directions, and participate in conversation. Receptive language disorder is often a lifelong condition, but early recognition of its symptoms and quick action to address them can yield improvements.
Also, read more: profiledefenders
What Is Receptive Language?[/anchor}
Language has two components: expressive and receptive. Expressive language is the language a person produces, and receptive language is what a person understands. The term "receptive language" refers to processing the five domains of language:
Morphology — Understanding how small changes in words change their meaning
Phonology — Distinguishing between different speech soundsPragmatics — Recognizing the meanings and feelings the written and spoken words express
Semantics — Comprehending vocabulary
Syntax — Following the order of words in spoken or written communication
Use of Receptive Language
Receptive language is at work in processing a wide variety of spoken and written communication as well as behavior. It relies on an understanding of concepts related to shape, size, time, color, and grammar. Following are some examples of the use of receptive language:
Following a routine for performing actions
Listening and understanding when someone speaks
Deciphering what behavior, words, or sounds signify
Reading and comprehending written materials and signs
Identifying pictures and objects
What Is Receptive Language Disorder?
Language disorder is a learning disability related to communication. The three types of language disorder follow:
Receptive language disorder, sometimes called language comprehension deficit, can make it difficult to understand what others are saying or doing and to form social connections.
Expressive language disorder is a condition in which a person has difficulty communicating a message when speaking.
Mixed receptive-expressive language disorder is a condition in which a person has difficulty with understanding others and expressing themselves.
Receptive language disorder can occur in toddlers, children, and adults. The exact cause of the issue is unknown, but it can be the result of genetic factors, such as autism or birth defects, and environmental factors, such as lack of exposure to speech because of neglect. Receptive language disorder in children is more likely to occur if a parent or sibling experiences the condition.
The following issues can also lead to receptive language disorder:
Vision impairment — Inability to see visual cues
Hearing impairment — Decreased ability to listen to language
Attention disorders — Lack of focus on conversation
For people who lose the ability to understand language in adulthood, the disorder is often the result of a brain injury or tumor. This condition is called receptive aphasia. Receptive language disorder generally isn't linked to intelligence, and it often doesn't fade away on its own.
How Do You Identify Receptive Language Disorder?
No one set of behaviors always indicates receptive language disorder. Some potential signs exist, however. These behaviors may occur before children start kindergarten, but they often appear later than signs of expressive language disorder.
Identifying Receptive Language Disorder in Children
Some key behaviors can point to issues with receptive language in children. Following are some actions that may be difficult for children of various ages who have receptive language disorder:
Identifying Receptive Language Disorder in Adults
Adults with receptive language disorder can have problems with social interaction. Activities such as the following can be difficult for adults with this condition:
Following conversations
Answering questions about conversations that just occurred
Understanding the language others use
Responding to others' questions
Completing word-finding problems
Comprehending the meaning behind statements
Interacting with others
Participating in social events
Strategies to Improve Receptive Language Disorder
Individuals who suspect a loved one might have a receptive language disorder should take prompt action to confirm a diagnosis and seek help. With the right treatment, people with this condition can learn to communicate effectively and live full lives.
Development of receptive language skills is critical in helping people build strong self-esteem through connecting with others, building relationships, and succeeding in school and work. If a professional diagnoses the disorder, various receptive language disorder strategies are available to assist those with the issue.
How to Seek a Receptive Language Disorder Diagnosis
To ensure a person who may have receptive language disorder gets help as soon as possible, individuals should trust their instincts and get feedback and assistance from others. Steps to seeking a diagnosis include:
Learning the possible signs and behaviors of the disorder
Asking others, such as teachers, whether they're noticing any telltale signs
Being proactive, acting on suspicions that the loved one has the disorder
Seeking the assistance of a professional, such as a primary healthcare provider; a speech therapist; and, in the case of serious behavioral problems, a psychologist
How Speech-Language Professionals Diagnose Receptive Language Disorder
When evaluating patients for receptive language conditions, medical professionals and speech therapists perform various tests to rule out issues such as hearing and vision problems. For people who speak multiple languages, speech therapists evaluate receptive language in all those languages but focus on the primary language for testing. In some cases, a neuropsychologist examines the individual for cognitive issues.
Following are some typical tests for diagnosing receptive language disorder:
Hearing tests: To determine whether hearing problems are hampering the individual's ability to process verbal communication
Language comprehension tests: To compare comprehension abilities to the expected language comprehension for someone that age
Observational tests: To see how the individual interacts with others in different settings
Vision tests: To establish whether issues with sight are causing the communication problems
Psychological tests: To uncover potential cognitive issues
Once a professional identifies the issue, implementing strategies to improve receptive language disorder is critical.
How to Assist Someone with Receptive Language Disorder
Key practices can make understanding spoken and written communication easier for those diagnosed with receptive language disorder. When interacting with children or with adults, the following actions can improve communication:
Making Communication Easier for Children with Receptive Language Disorder
To help children understand as they're reading or when others are speaking, incorporate practices that encourage focus and listening. Some ways to help children struggling with receptive language disorder at school and at home include:
Looking them in the eye when speaking
Being positive and compassionate
Using short and simple instructions
Confirming that they understand the need to listen
Eliminating distractions
Encouraging them to ask others to repeat themselves if necessary
Using email or texts, whenever appropriate, can be helpful for older children who find verbal communication difficult.
Making Communication Easier for Adults with Receptive Language Disorder
Communication at home and in the workplace is a concern for adults with receptive language disorder. To help adults with this issue communicate effectively, take steps such as the following:
Communicate in writing when possible, allowing time for well-thought-out responses.
Provide advance notice of speaking expectations, allowing the individual to prepare remarks and anticipate questions.
Send the individual an agenda for activities such as meetings, helping the person with receptive language disorder prepare mentally for discussion topics.
Offer the individual plenty of time to speak, allowing for thinking through comments.
Receptive Language Activities
Efforts focused on strengthening receptive language skills are valuable for all toddlers and children as well as adults. These activities range from having simple conversations to telling jokes.
Also, read more: Associate vs. Bachelor's Degree: Differences in Salary and Job Outlook
Receptive Language Activities for Toddlers and Children
Work to strengthen receptive language should begin early, using activities such as games, reading, and role-playing. Following are some receptive language activities for toddlers and children:
Reading picture books and pointing to objects
Playing games with predictable directions, such as "Simon Says"
Playing "I Spy" and naming items to find
Putting together jigsaw puzzles and describing them
Participating in role-playing activities that emphasize appropriate interaction
Making observational comments about what they're doing and asking questions
Having frequent, simple conversations
Asking them to look at someone who's speaking and not interrupt
Building on the complexity of instructions as they master them
Receptive Language Activities for Adults
For adults, receptive language problems often occur as a result of injury or stroke. Following are some activities to practice to strengthen receptive language skills in adulthood:
Pointing to objects and body parts
Following increasingly more challenging directions, building from directions with one step
Responding to progressively more complex questions, starting with yes-or-no questions
Using single words and phrases and building to paragraphs in communication
Practicing telling jokes to encourage understanding
What Types of Receptive Language Therapy Exist?
Treatment options for receptive language disorder vary according to the needs of the individual experiencing the problem. From in-home activities that a speech therapist prescribes to therapy sessions conducted in office settings, the following can help address receptive language concerns:
Speech therapy, one on one or as part of a group
Classes or support programs at school
Psychological treatment for serious behavioral problems
Family activities as prescribed by a speech-language professional
When students with receptive language disorder receive treatment at school, they might do so on an individual basis for severe cases, in group therapy for young children, or through team-based teaching during class.
Types of Receptive Language Therapy for Children
Speech-language professionals can employ various therapies to treat receptive language issues in children. These therapies generally fall into one of the following categories:
Vocabulary Development
Language intervention activities can expand the child's vocabulary to ensure the vocabulary is at an age-appropriate level. A speech therapist may speak to and play with the child to help connect words to meanings. These activities allow the child to practice words and verbal interactions, often emphasizing words that can have multiple meanings while using them in sentences.
Multisensory Exercises
Multisensory techniques for treating receptive language disorder engage hearing and all the other senses. This approach to communication promotes neurological connections to enhance understanding.
Learning Assistance
Receptive language therapy can also teach children strategies that can help them during class activities. These strategies include asking individuals to repeat what they said and practicing following increasingly complex directions.
Types of Receptive Language Therapy for Adults
Adults experiencing problems with receptive language typically receive therapy that focuses on problem-solving, memory, and organization. They also learn tactics to use in social situations to improve communication, such as looking people in the eye.
How Long Do People Need Receptive Language Therapy?
The length of receptive language therapy varies according to factors such as the severity of the condition and how committed the individuals and their families are to following prescribed steps for addressing the issue. For children with receptive language disorder, the condition may improve with age — or it may improve but require continued therapy into adulthood. Adults whose disorder is due to brain injury or stroke may see improvement in communication as they recover from the injury, lessening the need for therapy. Among the factors that can affect how long an individual requires receptive language therapy are:
Severity of the disorder
Frequency of therapy
Other medical conditions
Resources to Learn More About Receptive Language Disorder
Various resources are available to individuals seeking details about receptive language disorder. The following sources offer articles, research, and tools about receptive language and how to address problems with it:
A Day in Our Shoes — A Day in Our Shoes, a website from special education advocate Lisa Lightner, provides expert information, such as definitions related to language disorders; strategies for addressing these disorders, including receptive language disorder; and Individualized Education Program (IEP) components for children with language disorders.
Attitude — Attitude provides guidance and support for those living with attention deficit hyperactivity disorder (ADHD). Among its materials are information about language disorders, such as receptive language disorder, that commonly occur alongside ADHD.
American Speech-Language-Hearing Association — ASHA, a professional organization for the speech-language pathology community, offers research and publications that provide an in-depth look at various language disorders. ASHA's website also includes resources to help individuals who are coping with these disorders, including a Pro Find tool to seek professional help.
Centers for Disease Control and Prevention — The CDC's site includes a section about speech and language disorders in children, offering tips for working with children to encourage language development and finding help for children with speech and language disorders.
Be Proactive in Addressing Receptive Language Disorder
People who notice signs of receptive language disorder in a loved one should act promptly to address the issue. Difficulty listening, comprehending conversations and written materials, and following directions are a few indicators of potential receptive language issues.
Quickly implementing receptive language disorder strategies for treatment — including therapy from a speech-language professional — can put those struggling with the condition on the path to better social connections, greater success in school and work, and healthier self-esteem.
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ghisellerousso
Ghiselle is a UK-based professional blogger, content writer, and content marketer who writes about travel and tourism, finance, real estate, and other topics on his blog. Passionate about writing, traveling, and getting the best deal on everything he buys, Oliver also writes for customers and helps them publicize their products and services in the US and UK markets. She is a traveler who has visited over 35 countries and loves his job because it gives him the opportunity to find stories, experiences, and places which he can share with his readers.
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redpajama_set_name: RedPajamaCommonCrawl


text:
package cloud

import (
	"io"
)

type GraphAPI interface {
	Find(Query) ([]Resource, error)
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	FilterGraph(Query) (GraphAPI, error)
	FindOne(Query) (Resource, error)
	MarshalTo(w io.Writer) error
	ResourceRelations(r Resource, relation string, recursive bool) ([]Resource, error)
	VisitRelations(Resource, string, bool, func(Resource, int) error) error
	ResourceSiblings(Resource) ([]Resource, error)
	Merge(GraphAPI) error
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type Resource interface {
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type Resources []Resource

func (res Resources) Map(f func(Resource) string) (out []string) {
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redpajama_set_name: RedPajamaGithub


EPL-PM-50LED-100 explosion proof LED light can illuminate up to 4,000 sq ft of work space and features a pedestal mount base stand and 100 ft of chemical resistant SOOW cord.
Larson Electronics' EPL-PM-50LED-100 explosion proof LED light can illuminate up to 4,000 sq ft of work space and features a pedestal mount base stand and 100 ft of chemical resistant SOOW cord. It is designed for illuminating enclosed areas and hazardous locations where flammable vapors, gases and dusts may be present. The LED lamp assembly is constructed of four 12.5 W light emitting diodes producing a total of 4,333 lm of light. The cast aluminum body provides durability and vibration resistance. The lamp can be easily adjusted up or down 90 degrees and is equipped with 100 ft of 16/3 chemical and abrasion resistant cord.


A short film about who we are, where we come from, and where we are heading; it's a journey from stardust to singularity.
'Edifice' is an artistic cinematic peace from creative film director Ash Thorp, one of the wonderful minds who brought us one of our favourite ever Sci-Fi concepts 'Lost Boy', as well as a loaded background as an artistic director on some highly notable feature films. It is from no doubt that when we started seeing bits and pieces teaser from this new short, we were glued from excitement. The film perhaps didn't garnish the grandiose storyline we were anticipating, but were we ever entranced by its cinematic appeal.
Edifice is an experimental short film inspired by personal beliefs of who we are, where we come from, and where we are heading; it's a journey from stardust to singularity. This purely cinematic film is intended to stimulate your mind and senses, while provoking further thought about our passage and presence in this world.
This is certainly the type of film that makes you stop and think, but at the same time lets you get lost in your own mind while following these exhilarating visuals. As a filmmaker, it let's you take a step back and say "Ok, maybe I don't need that insane twisting storyline", and could tell a story through calming visuals. A big part of the film is the mood set by the incredible soundtrack scored by Ben Lukas Boysen, which fluently allows the visuals to mesh into one memorable experience.
Anytime someone can put up a 100 minute making-of video on a 7 minute short, you know they put in a ton of passion and thoughts behind every single shot in the film. This is a real bonus treat from Ash, we highly suggest to take the time to go through it all.


Needleworkers delight in the ability to transform and create fabulous objects using thread.
While magicians never reveal the secrets of their trade, Inspirations supplies detailed instructions for taking a handful of silk, cotton or wool threads and transforming them into beautiful pieces for your wardrobe or home. In this issue, we feature the outstanding Grand Prize winning project from our 'Stitch Your Heart Out' competition, report on Beating Around The Bush, and showcase the incredible costume embroidery for HBO's Game Of Thrones.


text:
Symbolized by the Bull, Taureans possess extreme determination and a will to succeed. As a result, their stubborn attitude may alienate them from others. Nonetheless, to their friends, they are extremely loyal and reliable. Self-indulgent, the Taurus revels in fine food, drink, and lavish surroundings. With a materialistic bent, the finer things in life take precedent in a Taurean's eye. Usually good natured and slow to anger, they make for faithful spouses and loving parents. Taurus can benefit from curbing its obstinate nature and realizing that those with the most toys don't always win.
The transient Horse lives for the open road, reveling in its sojourns with the energy of a mighty stallion. Horses crave love and intimacy. Yet, relationships present themselves as a cruel catch-22, making the Horse feel trapped and confined. Fortunately, fresh love connections are always within reach, as this sign exudes the kind of natural sex appeal that others find irresistible. Given to random fancies, Horses tend to lose sight of the big picture, resulting in a trail of unfinished business. Ironically though, this sign is skilled at motivating those around it. Possessing poise and a commanding presence, the Horse can stimulate a crowd with ease. Once it finds some inner peace, the Horse can curb that wandering soul and learn to appreciate what's on its side of the fence. The most compatible match for a Horse is the Dog or the Tiger.
Your1Anna
City: Lugansk - Learn More about Lugansk!
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Looking For: I would really like to meet man , who is serious and truly willing to build special relationships. I promise i can give so much special feelings and moments for you in return
On the southeastern tip of Ukraine you can find the wonderful city of Lugansk. The city itself has always been the hub of industry in Ukraine and as time progresses it continues to share with the world the many wonderful things it has to offer. With a population of only about 500,000, a lucky visitor can find some of the most beautiful Ukrainian women within the city's borders.
 The city of Lugansk started in 1795 when a wealthy British industrialist built a metal factory on the grounds. This relatively small push from an outsider helped create an industrial center that continues to thrive to this very day. In 1882 Lugansk finally received the official status of being a city and was heavily utilized by the Soviets for its industrial capabilities.
 Though primarily a working-class city, Lugansk has much to offer for the casual visitor. Philip's Cathedral is one such place to visit. This is the place where Philip of Luhansk is said to have seen the Virgin Mary and found inspiration in the vision to go out and heal the sick. Lugansk also has a very entertaining circus where audience interaction is key to the enjoyment of the show. Visitors are also encouraged to visit the May Day Park, where one can ride the giant Ferris Wheel and take in an amazing view of the entire city. For those who are looking for a more lively atmosphere there are also numerous cafes and restaurants to chose from while walking the city streets.
 Lugansk is a wonderful city full of vibrant, beautiful ladies. Those who take a little time to prepare for the trip will most certainly not be disappointed.

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Namuv,
BLAACKANGEL


Catering for larger party groups of 20-50 children, FOOTBALL KIDS sports parties are structured, organised and fun. Activities include a combination of warm-up, obstacle relays & football match/s or tournament. If required, Kwik Cricket can run alongside the football match/s. Medals & trophy awards and gift for birthday child, can be included in your party booking.
FOOTBALL KIDS parties are held at Harefield Academy, Northwood Way, UB9 6ET – where our Academy has been based for the past 5 years. We have access to all of the facilities and run parties on their incredible indoor 4G football pitch, then moving to a dedicated canteen area for food & drink afterwards. Tables can be organised to accommodate party numbers.
Did you know, FOOTBALL KIDS parties don't have to include football! Should you require sports party full of energy & fun, we are able to bespoke party activities.
To make your FOOTBALL KIDS sports party the best ever, we are looking at ways to develop party structure adding to the FUN. If you have attended a recent FOOTBALL KIDS party, please email us your feedback, comments, ideas etc.
FOOTBALL KIDS Parties are now run by Dominic who has been a part of the FOOTBALL KIDS coaching team since 2010 initially as a youth coach. Dom, has been actively involved in sport from the age of 6, played in the first U'7's team in 2001 – going on to play football in the Red Division of the Watford Friendly League for 9 years. Dom also played rugby & cricket for his school team, St John's Preparatory School, Northwood, where he was a pupil for 9 years. Dom has a natural talent for teaching and organising children in sports and has recently been running activity parties at David Lloyd Leisure.


Curb Side Carry-Out by Johnny Carino's Italian Restaurants!
Even the best intentions can be held up by life's many surprises: a meeting running late, no time to go to the grocery store, terrible traffic, etc. Sometimes you just need a break from the kitchen. We understand and we're happy to help.
We will bring your order to your car once you're safely parked.
Let Johnny Carino's take care of dinner.
Choose from our entire menu including lite selections, through Carino's Italian Curbside Pickup.


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De Pere es una ciudad ubicada en el condado de Brown en el estado estadounidense de Wisconsin. En el Censo de 2010 tenía una población de 23.800 habitantes y una densidad poblacional de 747,34 personas por km².

Geografía
De Pere se encuentra ubicada en las coordenadas . Según la Oficina del Censo de los Estados Unidos, De Pere tiene una superficie total de 31.85 km², de la cual 29.98 km² corresponden a tierra firme y (5.85%) 1.86 km² es agua.

Demografía
Según el censo de 2010, había 23.800 personas residiendo en De Pere. La densidad de población era de 747,34 hab./km². De los 23.800 habitantes, De Pere estaba compuesto por el 93.97% blancos, el 0.89% eran afroamericanos, el 1.18% eran amerindios, el 1.47% eran asiáticos, el 0.03% eran isleños del Pacífico, el 0.67% eran de otras razas y el 1.79% pertenecían a dos o más razas. Del total de la población el 2.15% eran hispanos o latinos de cualquier raza.

Referencias

Enlaces externos

Ciudades de Wisconsin
Localidades del condado de Brown (Wisconsin)


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Jake Clarke of Superheaven Looks Good in a 'Yellow Gown'
Courtesy of Jake Clarke
Last year, I probably listened to Superheaven more than any other band on the planet. The four members seem to innately understand how to lock into ultra-tight songwriting, the rocky choruses of "Sheltered" and "Poor Aileen" burned into my memory alongside tons of others. Sadly, the group recently disbanded, taking a break for an undisclosed amount of time.
Normally, this would be a bummer of massive proportions, but it's an opportunity that's afforded guitarist / singer Jake Clarke more time to push himself with his solo work. Next February, Clarke is releasing a split 12" with dreamy Wilkes-Barre punk band Spur. Today you can hear "Yellow Gown," one of Clarke's tunes, for the first time. Some of the familiar elements from his time in Superheaven remain — the subtly deep guitar work is still there to dive into. More than anything, it's apparent how smart of a songwriter Clarke is, able to deliver a dichotomy between heavy and dreamy. It's an exciting look into what the future holds for Clarke, his songwriting chops maturing with every new song.
Hear Clarke's new song below, and pick up the split from Disposition Collective, out February 3.
JAKE CLARKE on TOUR
Feb. 18 — Brooklyn, NY @ Wayward Social (w/ Alcoa)
Feb. 24 — Philadelphia, PA @ the Pharmacy (w/ Spur)
Feb. 25 — Wilkes-Barre, PA @ the Other Side (w/ Spur)
Filed Under: Jake Clarke, Superheaven


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Amore non soffre opposizioni is an 1810 opera buffa by Simon Mayr for the Teatro San Moisè, Venice. It is written in the new Neapolitan style without recitatives.

Recordings
 Amore non soffre opposizioni. Monika Lichtenegger (Elmira / Zefirina), Laura Faig (Gelmina), Richard Resch (Ernesto), Giulio Alvise Caselli (Argante), Josef Zwink (Martorello) & Philipp Gaiser (Policarpo) East-West European Festival Orchestra, Frank Hauk, 2CD Naxos.

References

Operas
1810 operas
Operas by Simon Mayr


The best place to start responding to some of those issues is at the Board of Examiners of Electrical Contractors and / or perhaps the Division of customers matters (simply the Authority creating legislation), not to mention, the Better Business agency.
Now let us imagine for a moment you have actually an electrical tasks needed complete.
Maybe not a crisis -- perhaps it`s just repairing a light that stopped functioning.
Could you name many technicians and obtain multiple bids? You can easily, but i`dn`t necessarily indicates it.
People genuinely believe that they should bring multiple bids for virtually any work. This isn`t the outcome, and in reality, putting to bid every little task may in reality backfire.
Great contractors tend to be few and far in between, and requesting multiple bids for a tiny job will only alienate all of them the next time in. Test considering this from her perspective. Their particular times is worth almost certainly about $100/ hr, yet, they helps make the time to come your residency and provide your with a free estimate for whatever services you might need.
Generally, an excellent builder will endeavour to offer you an \"extra-competitive\" quote, particularly the first-time around, just to allow you to a client.
But how will you determine if 1st company taking walks into the house could be the good contractor? Some quick guidelines may apply here, but remember there are also exclusions to every guideline.
To learn additional about click site and electrician clearwater fl, please visit all of our site electrical contractors (my latest blog post).
Even though you ponder throughout the fact that there is no purpose to hire a specialist when you can effortlessly follow guides to install electronic products and handle other minor tasks by yourself. Here are a few explanations why its feasible to select an expert electrician to be of assistance.
• Can comprehend the root of the difficulty at the same time - Although you employ a professional during an error in the electric relationship, they`d at as soon as understand the dilemmas and not hover around trying to find possible locations that could be the reason behind the mistake.
• competed in their job - No one can claim to be an expert electrician unless they usually have the required instruction is one. They need to undergo a few training sessions and examinations that will finally let them have the license are an expert.
• Would create her work better - While they detect the difficulties with just one look, they`ve been likely to restore the problem in the fastest time feasible. You are able to be assured that the task is done right without the need to spending some time and money by doing it your self in the wrong means and endure endlessly.
• covered appliances - as they come up to install or restore your resources, it is possible to rest assured it would stay secured without having any scratches. It is because they understand functionalities of all electronic devices and therefore would assist in defending its portion in a far better fashion.


text:
/**
 * Interface for the author piece of the attachments.
 */
export interface IMessageAttachmentAuthor {
    /** The name of the author. */
    name?: string;
    /** Providing this makes the author name clickable and points to this link. */
    link?: string;
    /** Displays a tiny icon to the left of the Author's name. */
    icon?: string;
}


Perlin, M.W. An expert system for scoring DNA database profiles in the Proceedings of Promega's Eleventh International Symposium on Human Identification. Biloxi, MS, 2000.
Abstract: Forensic DNA databases are becoming an increasingly valuable law enforcement tool for convicting repeat offenders and exonerating the innocent. However, constructing such databases is quite laborious. After generating STR profiles in the lab, people expend even greater effort visually reviewing the data before it enters the database. All artifacts must be detected, and no error can be tolerated. With millions of forensic samples to be analyzed, this bottleneck has become a formidable task.
We have developed software analysis methods that can automate this data review and potentially eliminate 90% of the work. Our fully automated TrueAllele® system inputs raw fluorescent DNA sequencer (gel or capillary) files, processes the gel image (separating colors, tracking and sizing lanes), and analyzes the STR experiments (quantitating and sizing peaks, comparing with ladder peaks, calling alleles). For each allele call, TrueAllele assigns a quality score and applies artifact detection rules. These quality checks enable a user to focus on just the 10% of suspect data, thereby eliminating most of the review effort.
TrueAllele models every step of the STR data generation process. By computing hundreds of variables for each genotype, the system can compare the observed data against expected behavior. Large deviations between expected and observed enable the software to flag potentially problematic data for human review.
TrueAllele automatically extracts the information it needs from the raw data (e.g., ABI/377 collection files). After automated image processing, the software provides a user quality assurance review for assessing data runs (lane tracking, gel quality, control lanes, etc.). Automated data processing continues with peak quantitation, allele designation, and quality scoring. In the allele-based quality assurance review, the user focuses on those designations which TrueAllele has flagged as having specific problems. After reviewing (and possibly editing) this small subset of data, TrueAllele then generates files for submission to the DNA database (e.g., CODIS).
TrueAllele operates independently of DNA sequencer manufacturer or technology, and runs on all major computer platforms (Macintosh, Windows, and UNIX). The program can analyze any panel of STR loci, allelic ladders, or internal size standards. Evaluation software is available from www.cybgen.com.
The TrueAllele expert system is designed to provide an automated computer-based second scorer for STR database profiles. The British Forensic Science Service (FSS) has selected TrueAllele automated scoring for scaling up the UK National DNA Database. We anticipate that TrueAllele will have a role in significantly reducing the human review of forensic STR data, assessing the quality of STR data and providing laboratory feedback, and fully automating the forensic STR data scoring process.


Review Snapshot: Galway city, June Bank Holiday weekend, a sky full of sun, a bottle of bucky, Mr. Scruff and a couple of friends; the winter is over, and life is good again.
Last time I saw Mr. Scruff was at the Tony Allen gig in Crawdaddy last year, but because of Mr Allen's afrobeat sensation, and the free mojitos outside, I didn't really get to see much Scruff. What I had seen, however, had been something fresh. As we sat in the bar about nine o'clock sipping our drinks, he was playing soft chill out, laid back beats perfect for the start of the night. When I came back in a couple of hours later, buzzing off the closest I will ever be to Fela Kuti, he was spinning funk, klezmer and afrobeat to a room full of the demented. Hot damn. This weekend I was looking forward to five hours of solo-scruff loving.
As a DJ, Mr. Scruff is damn impressive. The breadth of his musical palette is phenomenal, and he manages to own all genres. Not dipping in and out, with the ebb and flow of fashion, but appreciating them, owning them, and moulding them into his vision. From funk to reggae, trance to ambient, to soul and indie, nothing seems forced, nothing is quirky for quirkiness' sake. The ability to keep a crowd in the palm of his hand for five plus hours, while building a set from chill out to full on hoolie… I guess its easy when you know how.
I've never been to the Black Box, and God knows what it would be like for a band, but for a DJ it is perfect: A huge cavernous space, plenty of room to throw yourself about, and cheap cans at the bar. For the black hole that the best sets can be, it couldn't be better.
Something that got me about the night was the difference to a traditional gig. This was an all night show, much more like a club with great tunes than any live spectacle, and it was one of the best nights I've had in a long time. I don't know why, but it seems much easier to just turn off and enjoy without the visual attraction of a band to distract you. There were only two problems with the gig, some uncharacteristically dodgy visuals (Galway, Oranmore, Spanish Arch… eh a little lame?) and a virtual, and equally uncharacteristic absence of the funk.
They are minor quibbles though, and the set was so good, it is hard to nitpick. In fact the only let down came right at the end, in the overwhelming oddness of the last, encore, tune. After whipping the crowd into a mad trad-infused climaz, the encore was The Cure's Love Cats, a great tune, sure, but not for the time and place.
Eclectic, enjoyable and ridiculously infectious, Mr. Scruff puts on one hell of a good show, and five hours of solid bogey is better than any gym.
The idea about the town name dropping is supposed to be humorous or 'lame'. You'd expect 'Big Up Brooklyn/Detroit' etc not 'Big Up Camden' (Im a Londoner). Its just for fun.


text:
Record Wins
What is Williams Interactive
Williams Interactive
Williams Interactive, commonly referred to as WMS, is a notable gaming software company that claims a wealth of experience spanning many years. Founded at a time when internet-based casinos had not seen the light of the day, this gaming expert has been part of evolving trends that continue to revolutionise the gaming market. It specialises in the production of casino games; top names among them are Video Slots, Poker Variants and Lottery games. It also offers progressive jackpots, where a network of WMS casinos and players in different casinos can contribute to the same pool of the top prize.
Williams Interactive, How To Stay Relevant
Williams Interactive has grown into one of the best suppliers of gaming products to authorised casinos. To remain relevant, this gaming giant engages its workforce fully to ensure new arrivals are availed on a regular monthly basis. Some casinos get games exclusively from WMS, while others have at least a game or two from this designer. A look at the list of WMS casinos come with reputable sites such as Simba Games Casino.
A collection of other renowned casinos with William Interactive titles include; Vegas Spins casino that is also known for its friendly welcoming and regular bonuses. At Arcade Spins Casino you can interact with a number of titles from this designer. The Zinger Spins gaming house also comes with a sizeable number of WMS products. The best thing with all these casinos is that they have been optimised for mobile gaming implying that you can try a good number of WMS's games while on the go.
Williams Interactive Competitiveness
Modern web-based casinos have grown globally because of players love for slot gaming. Globally, slot gaming is a fast growing gaming category. It is no wonder large investors, such as leading designer Williams Interactive, are joining the industry. To gain a competitive edge in this very competitive market, WMS has incorporated eye-catching graphics and well-researched and prepared graphics into their slot game creations. Additionally, the designers treat players to epic and generous bonuses all uniquely designed to suit slot games by this specific designer.
If you want to try a host of WMS slots, log into your casino and look out for immersive games like The Guardian of the South and Great Zeus. There is a collection of thrilling titles that include the likes of Hot Molten Money, Game of Dragons 2, and The Jungle Warrior to mention just a few. A good range of comic-themed titles come with options like Jungle Wild 2, Mad Men, and The Simpsons.
Final Thoughts On Williams Interactive
Williams Interactive has been designing top casino games since the early days of Brick and Mortar gaming platforms. With the advent of modern technology in the gaming industry, this gaming techie has aligned itself with the current day gaming demands. It creates gaming products across categories. However, video slots are more subscribed because of their widespread popularity. All games are optimised for mobile gaming hence you can jump into a world of epic wins while at the comfort of your home.
Copyright www.gapyearblog.org.uk | All Rights Reserved


Of the gamut of reforms introduced in the early 1990s, this book focuses exclusively on those in the external sector.
Before the onset of the reforms in India, the foreign trade, investment and debt scenario was in a state of serious distress with retrogressive consequences for the pace of economic development. This initiated the process of economic reforms and liberalization in the country.
Of the gamut of reforms introduced in the early 1990s, this book focuses exclusively on those in the external sector. It examines the reform measures in this area and evaluates their adequacy and effectiveness.
- strengthening of the balance of payments position through Indian ventures abroad.
The picture that emerges does much to demystify the subject and unravel interrelated issues with clarity.
This book will be of interest not just to students and researchers in economics and international trade but also to policy-makers and general readers.
VYUPTAKESH SHARAN is Visiting professor, Delhi School of Economics. He was previously ICSSR Senior Fellow, South Asian Studies, School of International Studies, Jawaharlal Nehru University, New Delhi. He is also Professor and Dean, Magadh University and Head, Department of Commerce, P G Centre, College of Commerce, Patna.
INDRA NATH MUKHERJI is Professor, South Asian Studies, School of International Studies, Jawaharlal Nehru University, New Delhi.


text:
A Sketch of the Life and Works of John Milton (from a Course of Lectures ...
מאת Albert Hamann
Wissenschaftliche Beilage zum Programm der Luisenschule.
Ostern 1886.
A Sketch of the Life and Works of John Milton
(from a course of lectures held at the Victoria Lyceum during the winter
of 1885 – 1886).
Oberlehrer an der Luisenschule zu Berlin, Honorary Master of Arts of the University of Oxford.
R. Gaertners Verlagsbuchhandlung
Hermann Heyfelder.
Toen
a reco
Life and Works of Milton.
1. Milton's Youth and Early Manhood. 1608—1639. The family of John Milton probably derives its name from the parish of Great Milton near Thame in Oxfordshire. The grandfather of the poet was a yeoman at Stanton St. John, about five miles from Oxford, and at the same time under-ranger of the forest of Shotover. His son, John by name, joined the_Anglican church and was in consequence disinherited by the father who remained faithful to Rome. John Milton then went up to London where he set up in business as a scrivener, a position in which he performed the functions of a solicitor of our own day. He succeeded, and acquired a considerable fortune which he owed to his industry and intelligence. He lived in the heart of the City, Bread Street, Cheapside, in a house which bore the sign of the Spread Eagle. Here, John Milton the poet, was born on the gth of December 1608. His childhood was happy and rich in promise. From his father who was an excellent musician and distinguished himself even as a composer, he learned the art which was destined to distract and to soothe him in his blindness; his private tutor, Thomas Young, as well as the headmaster of St. Paul's School which he afterwards frequented as a day scholar, Alexander Gill, were men of note, the latter especially was one of the best scholars and the greatest pedagogue of his time. Young Milton studied with extraordinary zeal, reading deep into the night, whereby he sowed already when a boy the seeds of that malady which was to destroy his eyesight. At sixteen he went to college, being admitted as a pensioner of Christ's Cambridge in 1625. Here he continued his comprehensive reading for seven years, taking his degrees of B. A. and M. A. in due time. How beautiful he was at this time of his life, and how gentle were his manners is attested by the nickname which his rougher companions gave him, calling him "the Tady of the college". At Cambridge he felt the first stirrings of his genius. Besides a number of Latin poems which far surpass the ordinary college exercises, he wrote some fine sonnets and his Ode on the Nativity, -- at Christmas 1629,- a poem full of promise but at the same time somewhat laboured and in some passages chilled by conceit.
In the mean time his father had retired from business and had fixed his abode in the little village of Horton, in the southern part of Buckinghamshire, the very heart of the sweet rural scenery of Central England. Here he was, in 1632, joined by the young student from Cambridge, who, though already 24 years old, had not yet formed
any fixed plan as to his future profession. He only seemed desirous of devoting some more years to a process of quiet and steady preparation for some great purpose, having a mind "made and set wholly on the accomplishment of greatest things". Few poets have been as fortunate as young Milton who was able to add to his seven years of academical studies five years of persevering self-education in the retirement of a comfortable home, in the midst of delightful scenery. Here we find no trace of that struggle for existence, those hardships, humiliations, disappointments, and guilty passions which mark and mar the lives of many poets both in England and in Germany.
In this quiet retreat the poet deepens and enlarges his studies whilst his human sympathies expand. The sweet charm of the English landscape delights his eyes grown dull in the college shades; his power of observation is developed. He does not however study nature with the keen glance of the scientific observer; he looks at her with the eye of the poet and the artist, enjoying light and colour, the beauty and harmony of outline, the sweet sounds and smells of wood and field, the sublime grandeur of the starry heavens. The English love of the country, of life in the open air breathes also in Milton's poetry, nor did it ever forsake him; twenty years later when he sat in total darkness amidst the brick and mortar of London, those fair scenes returned in all their freshness to his mind's eye in Paradise Lost.
This sojourn at Horton is the happiest period of Milton's life; the poetical gift of purest fancy has perhaps never asserted itself with more power and abundance in Milton's works than in the poems of his early manhood: (L'Allegro, Il Penseroso, Comus, and Lycidas.
The two first of these poems are the most beautiful idyls in the English language; they breathe the sweet fragrance of fields and meadows, they reveal that keen perception and enjoyment of nature, not of the rustic who lives in the country, but of the student who leaves his narrow chamber, the close discussion, and the dusty books, on a holiday, to draw in with swelling breast and thirsty eyes the light, the wide air, the glory of the fair world. But the subject of these two poems is Man in the two contrasted moods of joyous emotion and of grave reflection, — but the joy is innocent, and the reflection is free from sour misanthropy. We need not assume two different types of character, — the light-hearted, life-enjoying youth and the stern and melancholy man , far less need we see in these poems an intentional contrast of the two great factions then forming in England, — the gay cavalier and the sombre puritan; -- the same man, perhaps Milton himself, may pass and has passed through such varying moods seeing at one time only the bright side of things, keenly enjoying all that is beautiful, treading the air, as it were with head erect, regarding at another time the reverse of the medal, conscious of the dark sides of existence, of the great unsolved problems that surround us. No doubt the former mood is more peculiar to sanguine youth, the latter to manhood saddened by experience, and there are moments in history when a whole nation passes through such a transition as England at that time, when the bright sky of the merry old country was rapidly overcast. Milton, having now arrived on the threshold of mature manhood, joining moreover in that movement of the whole English people, gives eloquent utterance to either of these moods, passing from a rapid, life-stirring, and sparkling allegro to an impassioned, soulful, and solemn adagio.
In the Allegro the poet invokes ,heart-easing Mirth" as his muse to bring with her jest and youthful jollity:
"Come, and trip it, as you go,
On the light fantastic toe." Then he describes the unreproved pleasures free to which she is to introduce him calling him out into the sweet fields to listen
"how the hounds and horn Cheerly rouse the slumbering morn, From the side of some hoar hill,
Through the high wood echoing shrill." And then he sallies forth to enjoy the sights and sounds of hill and dale, watches neat-handed Phillis dressing the rustic meal and binding the sheaves, joins in the frolics of the country dance, and listens over the spicy nut-brown ale" to the stories about Queen Mab and the drudging goblin.
,,Tower'd cities please us then,
And the busy hum of men," and he enjoys the sight of brilliant revelries and masquerades and sits spell-bound in the theatre,
"If Jonson's learned sock be on,
Or sweetest Shakspeare, Fancy's child,
Warble his native wood- notes wild."
And all the while the poet's soul floats on the waves of sweet music -
"on soft Lydian airs,
Married to immortal verse; -
With wanton heed and giddy cunning
The melting voice through mazes running."
The poet ends with this apostrophe to his Muse:
"These delights if thou canst give,
Mirth, with thee I mean to live." In the Penseroso the poet calls upon divine Melancholy, the daughter of Vesta and Saturn, to come to him in
"sable stole of cypress lawn
Over thy decent shoulders drawn
With even step, and musing gait;
And looks commercing with the skies,
Thy rapt soul sitting in thine eyes." She is to come accompanied by Peace, Leisure, and the divine cherub Contemplation; no sound may be heard
"'Less Philomel will deign a song
In her sweetest saddest plight,
Smoothing the rugged brow of Night;" whilst the moon rides in the high heaven
"oft as if her head she bowed
Stooping through a fleecy cloud," – or the pensive Goddess may approach the poet in his solitary chamber by the glowing embers of the hearth where, by the light of the lamp, Plato's immortal pages may absorb the interest of the reader or
"gorgeous Tragedy
In sceptred pall comes sweeping by,