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The roadmovie free8/21/2023 ![]() OL21113874W Page_number_confidence 74.24 Pages 134 Partner Innodata Pdf_module_version 0.0.19 Ppi 360 Rcs_key 24143 Republisher_date 20220824080634 Republisher_operator Republisher_time 143 Scandate 20220819122632 Scanner Scanningcenter cebu Scribe3_search_catalog isbn Scribe3_search_id 9780231850889 Tts_version 5. A live-action prequel feature film following a young The Ice Road de Vil. As the destination draws closer, the claustrophobia in the car grows alongside the love they have for each other.yusufpiskin. The FREE Kids Movie Summer shows are going on all summer and YES we will be here on the 4th of July Given the weather forcast its a great FREE (for. Dad has a broken leg and a mood to match while Mum fusses over her two children and the dog. ![]() Urn:lcp:roadmovieinsearc0000arch:lcpdf:9a889786-8d32-4c2c-9677-64d05d4a22fa Driving across wide landscapes, a family navigates a road trip full of conflicting emotions. Access-restricted-item true Addeddate 02:12:55 Autocrop_version 0.0.14_books-20220331-0.2 Bookplateleaf 0002 Boxid IA40659021 Camera USB PTP Class Camera Collection_set printdisabled External-identifier Grab takeout from a surrounding restaurant, pull out your lawn blanket and enjoy a free movie screening of Everything Everywhere.
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Whats london fog tea8/21/2023 Just order your hot or iced London Fog Tea Latte. No need to get crazy and break down the entire ingredient list for your barista. How To Order an Iced London Fog Tea Latte: Starbucks shares the nutritional facts based on the grande (473ml) sized drink. What are the Nutritional Facts for a London Fog Tea Latte? I just prefer iced drinks, since I live in the land of eternal sunshine (California). If you are a fan of vanilla based drinks, you will love the London Fog latte. According to the Starbucks website the flavor is, “Bright, citrusy spark of bergamot blends with subtle hints of lavender and mixes with vanilla syrup, milk and ice to create this delicious reinvention of a classic Earl Grey tea.” The London Fog tea latte is my drink of choice whenever I’m feeling a little under the weather, because it has a soft, soothing flavor with a creamy texture. The London Fog has a much softer taste, using soothing notes of vanilla, earl grey tea, milk or milk substitute, for a tea latte similar to a milk tea.īecause of these softer flavors, the London Fog is often infused with additional flavors like lavender or honey, which are also delightful. You can even add coffee for what is called a dirty chai (read the dirty chai taste test here). Chai has a very specific, unique flavor, thanks to the combination of spices like cinnamon, cloves, cardamom and more. The main difference between the two tea lattes is the use of the warming spices in the chai. How Does a London Fog Compare To a Chai Tea Latte? cup of green tea has 40-60mg of caffeine, so it’ll be similar to the slight buzz you’ll receive from a cup of green tea, with a more soothing flavor. One cup of plain coffee offers you 95mg of caffeine, so you’re looking at a little less than half of that in our fog. You’ll get a gentle kick from 40mg of caffeine in a grande. Yes, the London Fog tea latte is caffeinated (otherwise, we probably wouldn’t write about it!). It’s easily customized to taste, too! How Much Caffeine is in a Iced London Fog Tea Latte? Easy!Ī lot of variations also incorporate a honey syrup or even lavender. ![]() What Is a London Fog Tea Latte:Ī London Fog tea latte has a strongly-brewed earl grey tea base, mixed with either cold or steamed milk, vanilla syrup or extract, possibly some simple syrup if using extract, and ice (if iced). ![]() So, if you’ve been looking for a sign to go get yourself an iced or hot London Fog, this is it: GO GET YOU ONE. Today, I’m sharing all about the Starbucks iced London Fog tea latte – what’s in it, what it tastes like, how it compares to their chai tea latte, and much more. With just enough caffeine to perk you up, but gentler on the stomach, they are the perfect compliment for a coffee heavy morning. I love a good tea latte – whether it’s a chai tea latte or a London Fog tea latte – I feel they make a wonderful afternoon drink.
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Rockstar foxy without ecordian8/20/2023 In a situation where he's about to kill the player instead of helping them, he would warn them of their upcoming death rather than killing them instantly or feel angered.įirst appearance purchasable product ( Catalog Items). He has a penchant for giving boosts after interacting with his bird. Compared to the original Foxy, he is shown in Ultimate Custom Night to be kinder. Rockstar Foxy has many of the same personality traits as the original Foxy. There shouldnt be many broken parts on these, the textures are final and every bone has been checked, but if any bugs are found please put it in the Problems and Bugs Report page. It also has blue eyes and a black eyepatch covering the right eye. After a 2 week wait, here are the new Rockstar models by a1234agamer. Out of all the counterparts of Foxy, Rockstar Foxy appears more pirate themed.Ī parrot animatronic now rests on his left shoulder, with lime accents and a green body. He plays an accordion colored black with mauve accents and a keyboard with white color and black accents. Ill definitely be drawing more of the crew, including the rockstar versions, Lefty and FUNTIME CHICA <3<3<3<3 All FNaF art for this month will have NSFW versions on Patreon. Like the other rockstar animatronics, Rockstar Foxy has a golden star-shaped button on his chest. He lacks rosy cheeks, unlike other rockstar animatronics. Plus, Rockstar Foxy retains his metal hook for his right arm and has a brown, wooden peg leg in place of his left leg. He also has four tufts of "fur" sticking out the top of his head. Charged 2 patrons get: Sfw version (Hi-res) Nsfw version Charged 5+ patrons get Sfw version (Hi-res) Nsfw version Nsfw version with. His eyes are colored darkish-yellow. He also has darker shades of red on his kneecaps, shoulders, and eyebrows. Animatronic performer (formerly) Powers / Skills Playing accordion Soundproofing Adding Faz-Coins Cooling the room Adding power Hobby Playing accordion. I'll definitely be drawing more of the crew, including the rockstar versions, Lefty and FUNTIME CHICA <3<3<3<3 All FNaF art for this month will have NSFW versions on Patreon. Unlike other Foxy counterparts (excluding Funtime Foxy), it appears that Rockstar Foxy is fully repaired, with crimson colors and lighter accents on the muzzle, eye sockets, belly, and ear insides. Rockstar Foxy is an animatronic pirate fox resembling the designs of both the original Foxy and Withered Foxy from the second game. The Freddy Files: Updated Edition, page 194 “ His parrot will fly across the screen in your office if you click on it, Rockstar Foxy will appear and either jump-scare you or offer you one of four upgrades: adding 1 percent to your power, resetting the office temperature to sixty degrees, soundproofing the office, or granting you ten Faz-Coins.
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2019 macbook pro dual monitor setup8/20/2023 Gerald Lynch is the Editor-in-Chief of iMore, keeping careful watch over the site's editorial output and commercial campaigns, ensuring iMore delivers the in-depth, accurate and timely Apple content its readership deservedly expects. ![]() To expand your workspace or home office setup, check out our best charging stations and best webcams for Mac guides for further ways to enhance your working environment. It also has a built-in cable so you can unplug the dock and easily toss it in your bag before traveling. It has two HDMI and two USB-A ports, along with Gigabit Ethernet, all while being tiny and almost half the price of more expensive docks. If portability or price is a concern, then you may wish to consider Belkin's Thunderbolt 3 Dock Mini instead. It's expensive but it's the ultimate docking station for most people. Outside of HDMI ports, it offers multiple sockets for every conceivable physical connection to your MacBook Pro or Mac (and even your iPad), while also providing fast charging at 98W. If you want to get the most from your shiny new MacBook, such as if you've just bought the latest MacBook Air with M2, then the CalDigit TS4 Thunderbolt 4 dock is a must have. That's all while providing fast data transfer and 4K, 5K, or 8K display support. ![]() They differ from the best USB-C hubs as Thunderbolt docks usually have a power supply that can charge your laptop and mobile devices. The best MacBook Pro docking stations enable multi-display use with charging support, and that's why they typically use Thunderbolt instead of just USB-C. Which MacBook docking station should you choose? Upgrade your workspace with the best docking stations Each will make it easier to connect lots of devices and peripherals including those that need high-speed data transfer. Whether you need to add more Thunderbolt 4 ports, or you need old favorites like full-size USB-A ports, a docking station can take the hassle out of juggling connections.īelow, we've collated the best MacBook Pro docking stations you can buy right now. You only use one plug while gaining multiple inputs and outputs. A MacBook docking station removes the strain from the MacBook itself. If you need to plug in loads at once, like screens, hard drives, or keyboards, you need a docking station to get the most from your setup. Even the best MacBooks could do with more options for hooking up accessories. MacBook Pros may have more ports than they used to have, but they still don't have many. It's important to buy one of the best docking stations for MacBook Pro if you want to turn your Apple laptop into a truly great workplace powerhouse.
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Gswitch and triangle8/20/2023 Kiyomi reveals that Mikasa is a descendant of a shogun. The military then have a meeting with her. She explains that Zeke had brought them together. Zeke had told her of his true allegiances, having always been loyal to the Eldian Restorationists, despite appearances. He offers Hizuru the opportunity to exploit the resources under Paradis in exchange for their cooperation in his secret plan. Kiyomi divulges the details of this plan: to display the destructive potential of the Earth-shaking, to spend 50 years modernizing Paradis, and to have Historia succeed Zeke as the Beast Titan, bearing as many royal-blooded children as possible. Eren disagrees with the plan, although Historia reluctantly accepts. Hange admits that they had found no solution, and questions Eren for acting alone. Eren reacts violently, explaining Hange has no power over him or Zeke, before grabbing Hange's collar, asking Hange what they can do. ![]() ![]() At the graveyard, Niccolo, Jean, Connie, and Mikasa talk about Sasha before meeting with her family. The Anti-Marleyan Volunteers give Titan injections to Pixis, though he has them arrested due to the current uncertainty around them. Zeke is taken to a Forest of Giant Trees to be held captive. Gabi fakes a seizure, and knocks out the investigating guard, before escaping the prison with Falco. Reiner awakes, wondering where the two children are, and Historia sits outside in a rocking chair, visibly pregnant, when a man implores her to go indoors. Mikasa reveals her mark of the Asian clanĪs Eren cleans himself up, Hange visits him in his cell and asks what he is doing. Hange claims to have heard Eren saying "fight, fight" to himself. Not getting any response, Hange tries to change the subject and notes Eren's new hair, but Eren bluntly asks what Hange is here for. Hange reflects back two years ago when the Survey Corps met with the Anti-Marleyan Volunteers. Despite completing the harbor and increasing goodwill between both sides, Levi still refuses for them to meet with Eren. Soon, a ship arrived bringing Kiyomi Azumabito Mikasa is jarred to see how much she reminds her of her mother. ![]() Later in a meeting, Kiyomi shows a seal showing her bloodline, the same one that Mikasa has tattooed on her wrist. Despite some reservations, Mikasa reveals it and confirms her heritage. Kiyomi states that her ancestors were allied with the Eldian Empire due to friendly relations with the Fritz family and the shogun of the nation of Hizuru. Man the forge and craft your best weapons for your warriors in Jacksmith! You’re a donkey on a mission that takes you across the land, but the trails are blocked by a variety of monsters - time to call in the local warrior clans for help! You’ll design swords, bows, shields, and other weapons in a completely hands-on blacksmith shop. : Sneak Peek: Our Next Game: Jacksmith!.Collect better ores and parts to make even better weapons, and keep making progress across the land towards the evil wizard Dudley! When all of your soldiers are equipped, it’s off to battle to fight your way further down the path! While the warriors fight, you’ll need to gather loot and help out with your trusty cannon. Bombs: Fired by Scout to use them, the player can either click on a bomb's icon or press its hotkey (1 for Cannonball, 2 for Fireball, etc.).: Sword Making: Hammering, Building, and Presenting.: Jacksmith Sword Making Part 1: Casting. Two of them are beneficial for the soldiers, and the rest damage or hinder enemies. Please refer to this article for a more detailed explanation of the weapon parts. Weapons in Jacksmith are composed of individual weapon parts that are assembled together. Some parts are common to multiple weapon types (e.g., grips are used in swords, bows, axes, maces and pikes), but the quantity and types of parts used vary among the different weapon types. ![]() There is one weapon part for each type of parts with no Elemental Bonus that the player has an infinite supply of. Other weapon parts have Elemental Bonuses but must be collected during battle or bought from Gander's shop.Įach weapon has two main stats: Power and Durability. Power is the attack strength of the weapon, and Durability is how long the weapon lasts before breaking. Luck is the chance to make enemies drop more loot or better loot when attacked.
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Delete war thunder account8/20/2023 ![]() Selling/advertising the sale of accounts, codes, gold generating apps, cheating bots, etc. No posts related to breaking the rules set out by Gaijin.No posts related to breaking Gaijin's terms of service. Private messages containing responses in languages other than English, slurs of any kind, or otherwise excessive levels of salt are not allowed. Note: There is no requirement to hide usernames in submissions, as all server replays are publicly available. Don't encourage witch hunts against anyone. ![]() No abuse, harassment, racism, xenophobia, hate speech, discrimination, flame-baiting, trolling, nor general assholery.No abuse, harassment, witchhunting & assholery. If posting NSFW material, tag it NSFW.Having a witty related caption or title is not enough and it must contain a vehicle or element from the game. Memes must be clearly visually relevant to War Thunder.Note that memes visible during the non-meme days, but posted during meme days will not be removed. Memes may only be posted on meme days.Must be relevant to War Thunder in terms of time frame and purpose.And in the 'battles' menu are two campaign menues. So you can train there your vehicles without paying repair costs. You can use it to create fights against bots. Must be flaired with the SUGGESTION flair. If you pick up one of your vehicles and click on 'test flight' or 'test drive', you will see a 'mission editor' on the left side.If your suggestion is there already, don't post it again. If for a vehicle suggestion, please first refer to the updated list of previously suggested vehicles.Posts made to promote other games will be removed. Posts of history entirely unrelated to War Thunder should be posted instead to /r/history, /r/aviation, /r/WWIIplanes, /r/AirCraftPorn, /r/TankPorn, etc.This means just having a witty related caption or title is not enough. Posts with "clickbait" titles will be removed.Īll content should be clearly relevant to the game of War Thunder and its vehicles.If your submission has an unclear title you should submit a top-level comment explaining the content.r/WarThunder aims to make its content clear from a quick glance. Visual representations of lootboxes are banned.This is understood to include multiple posts by different users about the same topic Submitting low-effort posts of any kind in quick succession will lead to post removals and may lead to a ban.If submitting multiple videos/gifs/images, post them in a single text post with descriptions for each item.Posts made within an hour of each other will be removed. Users are limited to two posts for any given 24-hour period. It is not a catch-all flair for jokes and satire.ĭon't spam /r/WarThunder. individual screenshots or minor discoveries. The DATAMINE flair is for substantive datamining posts.It is intended only for official War Thunder news from Gaijin sites and sources. Unflaired posts don't get an upvote button and incorrectly flaired posts may be removed. Your account must be 3 days old to comment and at least 30 karma to post here.įlair your post appropriately after submitting. Submit a link Submit text post Please activate this subreddit's custom style for access to extra functionality such as content filtersįor Sim mode, visit r/WarthunderSim! Rules Once you're done, easily share it with friends and foes alike across social networks.Ĭan't find your game? Suggest a game or vote for it on our Ideas portal. Grab the clips you love most, give it a quick trim if you like, or move to the video editor to combine them into an epic collage. See the best (and not so best) moments, review your APM speed, and relive the game. Once the match is over, you can flip through your captured clips in the match timeline. About a day after the sale ends, he logged on and pretty much saw all of his golden eagles missing and had a bunch of vehicles that he didnt purchase. We are now offering opportunity to unlink your Xbox-bound account. My friend joined back in after not playing for years and bought some GE during one of the sales. Posted DecemThe following instruction is for War Thunder accounts created in the Xbox version of the game and linked it to email in order to login in the PC-version of the game. However, after deleting my Gaijin account, it says that Ive already registered to War Thunder with. While playing, the app automatically captures your best moments and biggest plays, as well as manually recording on demand. War Thunders support and security is absolute garbage. So I deleted my Gaijin account, and started a new one. Outplayed is the ultimate video capturing app for gamers.
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Flavored gelatin candy8/20/2023 But I used it anyway and the finished popcorn was fine. When I tested the mixture (carefully, because it's still pretty much hot molten sugar), it still felt a bit grainy to me. Reduce heat to low and simmer for 5 minutes. Stir to combine and until Jello and sugar crystals are completely dissolved. Place butter and corn syrup in small saucepan on medium heat and stir until butter is melted.Īdd sugar and Jello. While we used Cherry Jello, this recipe works with any of their flavors. It's what helps to give it that crunchy candy coating when baking that is so delicious. Like my favorite Caramel Corn recipe, this Jello popcorn uses light corn syrup. Just use something that is as plain as possible. You can also use the pre-popped bags you find at the store. I have a microwavable bowl that I use with kernels to pop my own but you can also use plain microwavable popcorn bags if you have to. Cherry Jello (but you can also use other Jello flavors!).Scroll to the printable recipe card for full measurements. Trust me, once you taste this Jello popcorn, you won't be able to put it down! Popcorn is also a pretty inexpensive thing to make and it's easy to make in large quantities making it a great idea for parties. ![]() And it's pink! Who doesn't love to eat pink, especially on Valentine's Day. You know I love my desserts, and this one is so super easy to make. I've used it to make my popular Strawberry, Jello and Angel Food Cake Dessert. Jello is a quick and easy way to make tasty treats. ![]() ![]() It's tangy and fruity and you will totally crave it! This recipe, in particular, uses cherry Jello. This Cherry Popcorn can be made without a candy thermometer (thanks to the corn syrup) and is flavored easily by using Jello. My baker friend, Kristin, showed me just how easy it is to make even flavored popcorn even if you don't have any baking skills. This candy popcorn recipe is perfect for people who don't feel like they are great in the kitchen or want to get into the science of making homemade candy. Adding a candy-coated flavoring, made from flavored Jello, makes it extra special and can take it into new, sweet territory. Popcorn is a favorite crunchy snack for young and old. You are going to crave this candied Jello popcorn. With just 5 ingredients, this easy cherry Jello Popcorn recipe is full of fruity flavor and baked to crunchy, candied perfection! It's the perfect sweet snack or fun dessert idea for families! And it's super easy to make! Let's make this Cherry Jello Popcorn recipe.
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Ripgrep gui8/20/2023 ![]() Reader feedback is essential and especially so for self-published authors. It could be anything from a simple thank you, pointing out a typo, mistakes in code snippets, which aspects of the book worked for you (or didn't!) and so on. I would highly appreciate it if you'd let me know how you felt about this ebook. Reference solutions are provided for both GNU grep and ripgrep. Visit for markdown source, example files, exercise solutions and other details related to the book.īased on the book contents as well as the exercises, I made an interactive TUI app with 50+ questions. If you are new to the world of the command line, check out my Computing from the Command Line ebook and curated resources on Linux CLI and Shell scripting before starting this book. In other words, be proactive and curious instead of just consuming the content passively. You are also expected to get comfortable with reading manuals, searching online, visiting external links provided for further reading, tinkering with illustrated examples, asking for help when you are stuck and so on. You should also be comfortable with concepts like file redirection and command pipelines. You should be familiar with command line usage in a Unix-like environment. Two different implementations are discussed in this book - GNU grep and ripgrep.Įxercises are also included to test your understanding. In addition to command options, regular expressions will also be discussed in detail. This book heavily leans on examples to present features one by one. An important feature that GUI applications may lack is regular expressions, a mini-programming language to precisely define a matching criteria. The grep command is a versatile and feature-rich version of that search functionality usable from the command line. The provided template repo can be used to create a new user configuration repository on your GitHub account or cloned directly.You are likely to be familiar with using a search dialog (usually invoked with the Ctrl+F shortcut) to locate the occurrences of a particular string. We have created a template repository for easily making a user configuration file: Astronvim/user_example To begin making custom user configurations you must create a user/ folder. Language Server Protocol with Native LSP.Statusline, Winbar, and Tabline with Heirline.Common plugin specifications with AstroCommunity.This is currently an experimental feature and may lead to instability until the next restart. Run :AstroReload to reload the AstroNvim configuration and any new user configuration changes without restarting. Run :AstroUpdatePackages ( pa) to update both Neovim plugins and Mason packages Reload AstroNvim ( EXPERIMENTAL) Run :AstroUpdate ( pA) to get the latest updates from the repository Update AstroNvim Packages Run :Lazy sync to update and clean plugins Update AstroNvim Run :Lazy clean to remove any disabled or unused plugins Run :Lazy update to apply any pending plugin updates Run :Lazy check to check for plugin updates ![]() Node - Node is needed for a lot of the LSPs, and for the node repl toggle terminal ( tn)Įnter :LspInstall followed by the name of the server you want to installĮxample: :LspInstall pyright Install language parser Įnter :TSInstall followed by the name of the language you want to installĮxample: :TSInstall python Install Debugger Įnter :DapInstall followed by the name of the debugger you want to installĮxample: :DapInstall python Manage plugins .Python - python repl toggle terminal ( tp).bottom - process viewer toggle terminal ( tt).go DiskUsage() - disk usage toggle terminal ( tu).lazygit - git ui toggle terminal ( tl or gg).ripgrep - live grep telescope search ( fw).Terminal with true color support (for the default theme, otherwise it is dependent on the theme you are using).A clipboard tool is necessary for the integration with the system clipboard (see :help clipboard-tool for supported solutions).Tree-sitter CLI ( Note: This is only necessary if you want to use auto_install feature with Treesitter).Nerd Fonts ( Optional with manual intervention: See Recipes/Customizing Icons).If you are on AstroNvim v2.0 and are upgrading to AstroNvim v3.0 please see theĪstroNvim is an aesthetic and feature-rich neovim config that is extensible and easy to use with a great set of plugins ⚡ Requirements
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I love you in italian8/20/2023 ![]() ![]() Such feedback will allow you to make any needed corrections to your Italian pronunciation. Improving and refining your Italian pronunciation requires that you receive real-time and accurate feedback. Let’s take a look at the Spanish translation of gnocchi: The Italian gn sound is pronounced very nasally and is comparable to the sound of the Spanish ñ. Have you ever ordered the Italian dish known as gnocchi? This delicious, dumpling-style dish can help us learn how to correctly pronounce the gn sound in Italian. Examples of these Italian words with a c that sounds like a k include capra, Capri, Campari, cannoli, and campione. Of note, the words will include one of these vowels a, o, or u. You’ll hear this same k sound in Italian words. The Italian letter c can sound like an English c and very similar to the k sound, as you hear in English words like car, can, cat, call, company, Carol, campus, California, and code. That said, the Italian letter c is pronounced differently in other contexts. (In Spanish this is called el ceceo and differs markedly in Iberian Spanish.) In contrast with the Spanish pronunciation of the letter c, in Italian the letter c can have a hard ch sound, like you hear in the English word “change.” You may be familiar with the Spanish pronunciation of the letter c which is often spoken as an s sound. And that general rule is to deemphasize the vowel that precedes the double consonants.Īnother notable characteristic of Italian pronunciation relates to the letter c. But even though every Italian word is enunciated a bit differently, there is a general rule-of-thumb when it comes to pronouncing words with double consonants. You will encounter this again and again in popular words, including the words anno and pizza and the name Alessandra. If you’re a novice learner of Italian, one of the first features you’ll notice is the frequent use of double consonants. ![]() Rosetta Stones will lead you step-by-step in your journey to learning to understand and speak Italian with confidence. So whether it’s a short break from watching the kids, or your morning drive to work, Rosetta Stone language lessons are designed to fit into your daily life. So you can fit Italian language lessons into your life, not fit your life around language lessons. That’s because Rosetta Stone breaks up the journey to learn a new language into brief, 10-minute lessons. Learn Italian Words and PhrasesĪre you concerned about the commitment you’ll need to make to learn Italian? You needn’t be. Basically, if you speak one of these other major languages of the EU, you’re well on your way to speaking Italian. Even the English language, while technically a Germanic language, is heavily influenced by the same Latin roots that formed modern Italian. You probably already know far more Italian words than you’d imagine, too-and not just the ones related to food. Plus, if you already speak another Latin-derived language, like Spanish or French, Italian is unlikely to present major challenges. Having a reason to begin learning Italian-like hoping to express your love in a dozen ways-can be the perfect jumpstart your study of the language. Sei tutto per me = You’re everything to me.Sei l’uomo dei miei sogni = You’re the man of my dreams.Sei la donna dei miei sogni = You’re the woman of my dreams.While the basis of it all is “ amore” (love), here are some other useful loving expressions: But that’s just the beginning of Italian terms of endearment, as the language has no shortage of loving words. If you’d like to say “my love” to someone in Italian, you would say “amore mio”. ![]() 10.8K How to Say My Love in the Italian Language
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Example of manic episode8/20/2023 ![]() Hypomanic and depressive symptoms that do not meet bipolar II disorder criteria, no major depressive episodes, occurring over two years, with no more than two months free of symptomsīipolar disorder, not otherwise specifiedĭoes not meet criteria for major depression, bipolar I disorder, bipolar II disorder, or cyclothymia (e.g., less than one week of manic symptoms, without psychosis or hospitalization)īipolar disorder, mixed features type or major depressive disorder, mixed features type Hypomanic episode with major depression no history of mania, but can have a history of hypomania Manic or mixed feature episode with or without psychosis and/or major depression Lithium, quetiapine, or a combination of quetiapine and lithium or valproic acid is effective for maintenance of bipolar disorder. Lurasidone (Latuda) combined with lithium or valproic acid is an effective treatment for acute bipolar depression. ![]() Quetiapine and cariprazine (Vraylar) are effective single agents for the treatment of acute bipolar depression. 12Įffective combination therapies for acute mania include lithium or valproic acid with quetiapine (Seroquel) or risperidone (Risperdal). Lithium, valproic acid (Depakote), and some antipsychotics are effective single agents for acute mania. Systematic review of randomized controlled clinical trials regarding treatment generalized to screening Screen all patients 12 years and older for depression, including all pregnant patients in the perinatal period screening should be implemented with adequate systems in place to support accurate diagnosis, psychotherapy, and follow-up. Patients and their support systems should be educated about the chronic nature of this illness, possible relapse, suicidality, environmental triggers (e.g., seasonal light changes, shift work, other circadian disruption), and the effectiveness of early intervention to reduce complications. Psychotherapy is a useful adjunct to pharmacotherapy. Ongoing management involves monitoring for suicidal ideation, substance use disorders, treatment adherence, and recognizing medical complications of pharmacotherapy. Monotherapy with antidepressants is contraindicated during episodes with mixed features, manic episodes, and in bipolar I disorder. Active lifestyle approaches include good nutrition, exercise, sleep hygiene, and proper weight management. Pharmacotherapy with mood stabilizers, such as lithium, anticonvulsants, and antipsychotics, is a first-line treatment that should be continued indefinitely because of the risk of patient relapse. Physicians should consider bipolar disorder in any patient presenting with depression. New diagnostic criteria and specifiers with attention on mixed features and anxious distress aid the physician in recognizing episode severity and prognosis. Affected individuals have higher rates of other mental health disorders, substance use disorders, and comorbid chronic medical illnesses. ![]() Bipolar disorders are common, recurrent mental health conditions of variable severity that are difficult to diagnose. |