tyb!
APRIL 4, 2016
THE SCHEDULE
In the morning, the President and the Vice President will receive the Presidential Daily Briefing in the Oval Office. This meeting is closed press.
Later in the morning, the President will hold a bilateral meeting with NATO Secretary-General Stoltenberg; the Vice President will also attend. The Secretary General’s visit underscores the importance the United States places on the transatlantic bond that NATO embodies, and on a North Atlantic Alliance whose full adaptation to a changing strategic environment will ensure that the Alliance continues to uphold international order and advance the interests of the United States and all of NATO’s members and partners. There will be a pool spray at the bottom of this meeting in the Oval Office.
In the afternoon, the President will have lunch with the Vice President in the Private Dining Room. This lunch is closed press.
Later in the afternoon, the President will host a reception for Greek Independence Day in the East Room. The Vice President will also attend. This reception is closed press.
All times ET
10:00 AM
The President and Vice President receive the Presidential Daily Briefing
Oval Office
Closed Press
11:10 AM
The President holds a bilateral meeting with NATO Secretary-General Stoltenberg; The Vice President also attends
Oval Office
Pool Spray at the Bottom
(Gather Time 11:45AM – Brady Press Briefing Room)
12:30 PM
The President and the Vice President meet for lunch
Private Dining Room
Closed Press
2:55 PM
The President hosts a reception for Greek Independence Day; The Vice President also attends
East Room
Closed Press
it's the ugly one he was fucking, beau's widow
and look how his face looked going by the casket
looks guilty
On the other hand,poisoningseldom presents as a stroke mimic. Due to its limited availability, methyl iodide poisoning is rarely seen in clinical practice, and only fewer than 15 case reports have been described in the literature.
Methyl iodide is a monohalomethane, analytic and organic chemistry reagent used by the pharmaceutical industry in microscopy for refraction and also as a fumigant. The population at risk of methyl iodide poisoning via inhalation are workers at the industry, such as occupational groups like tractor drivers, shovelers, soil sealers and tarp removers involved in pre-plant field fumigation. Bystanders (general population) near the area of fumigation are also at risk. The risk through water absorption and to those in the pharmaceutical industry, however, is not significant.
The exact mechanism of neurotoxicity is still debated on, but glutathione (GSH) depletion through methyl halide metabolism is hypothesized. It is also believed that neurotoxicity develops through the high lipid solubility of methyl iodide and due to the effects of proteins and macromolecules on methylation [6].
In an acute exposure, methyl iodide is a pulmonary and dermal irritant, causing pulmonary edema and alkali burn. Characteristics of the poisoning are: delay in the onset of symptoms after an exposure to the chemical; renal failure, cerebellar and Parkinsonian symptoms, seizures and coma occurring in severe cases; and psychiatric disturbances like personality changes (sleeping problems, excitation, depression, delusions and hallucinations) and cognitive problems (memory, learning, language and cognitive reaction problems) that can last for months or even years [7].
A review of the documented cases shows that many patients had experienced chronic neurological syndromes characterized primarily by delayed psychiatric, behavioral and cognitive sequelae [8]. Some patients had purely psychiatric symptoms, while others had neurological deficits as well. Some patients had recovered fully in a course of months, while others had persistent symptoms. Our patient had a fairly rapid onset of neuropsychiatric symptoms presenting like a posterior circulation stroke. The acute onset could have been related to a large accidental exposure via inhalation of the chemical, although the quantity of such exposure is usually difficult to determine. An interesting laboratory marker, although non-specific, is a rise in lipid level as was observed in our patient [9].
Other poisons that may behave like methyl iodide in its neurotoxicity include monohalomethanes like methyl chloride and bromide, solvents like toluene (glue sniffing) and insecticides like organophosphates. The mechanism of toxicity is different for toluene and organophosphates. Cases of poisoning usually involve those who are part of the production and handling of these chemicals.
The accurate diagnosis of stroke depends on how accurate is our patient history obtained using clinical signs suggestive of an anatomical lesion in the part of the brain supplied by a blood vessel. Recent advances in imaging techniques, such as diffusion-weighted MRI, is accurate in supporting the diagnosis [10] in most of the cases reported. However, there is still no substitute for proper history taking and clinical examination.