Personal Letter

                                Pandaan March 16th 2020



Dear Alex,

How are you? I hope you and your family are well. How was your trip to Japan? I am sorry to not reply to your letter soon. I was away for one month. I went to my hometown in Surabaya. I visited my mom, she was hospitalized. Now, she much better and able to do her daily activities. 

I am now back in Pandaan. What about your plan to Pandaan next month? Let me know your plan. I will make myself available. I can pick you up from the airport. Can't wait to see you here.

Sincerely,

Nathan

Cause and Effect

Cause and Effect: Smoking and Pain

       Rapid-fire clinical pearls on emerging topics in pain medicine were presented to session attendees by some of the field’s seasoned veterans. As part of that discussion, W. Michael Hooten, MD, associate professor of anesthesiology in the Departments of Anesthesiology, Pain Medicine, Psychiatry, and Psychology at the Pain Rehabilitation Center, Mayo Clinic, in Rochester, Minnesota, posed very poignant questions to the audience regarding smoking and chronic pain.

“At the end of the day, it’s harder for opioid patients to quit smoking,” said Dr. Hooten. “But by answering three major questions, we’re hoping we’ll find out why.”

      First off, does smoking cause pain? Nicotine does have analgesic or nociceptive properties, and smoke from nicotine and tobacco can have an effect on analgesic medications. Examining the results of a study Dr. Hooten conducted in 2011, which explored the effects of depression and smoking on pain severity in opioid patients, he determined that, in terms of a causal link, smoking does not cause pain. Though depression mediated the relationship in the study, smoking is still considered to be a weak risk factor for chronic pain.  

     Secondly, do smokers experience greater pain than non-smokers? In his clinical experience, Dr. Hooten has seen smokers report a little bit more pain severity on a consistent basis. However, depression also plays a factor, often mediating that relationship.

     Lastly do smokers use more opioids to manage their pain than non-smokers? “In my clinical practice, smokers consume more opioids, and this observation is predominantly driven by men. There’s a predominant sex effect. Depression, though, is not a factor.”

Explanation Text

How Meteor Falls

       Meteor is strange object from outer space to atmospher and we usually call it falling star. Unfortunately, phenomena of meteor falls come from one of sky object namely Meteorida. Meteorida is small objects which encircle Sun and it is known when this object move into atmosphere and heat up cause friction. Radiant gas which produce look like a star that moving or falling in sky and this sign usually call meteor phenomenon. In fact it is icident that burning from sky cause of fricton with molecul atmosphere. When meteor come into level 100 km from Earth surface, as a result volume of atmosphere quite firm and rub againts meteorite. Increasingly approach to Earth so pressure and temperature will be higher because of friction.

       It is make hot effect for meteor rocks and can melt some from those rocks. Hot effect from those meteor bring when some rocks fall to earth. Hot effect from meteorite rock is not like ignition fire impact but Hot effect from meteorite only hot pressure that scorch not burn. 

     Actually everyday our Earth always enrolled by strange object and cause meteor accident. Nevertheless most of meteorida has broke become dust before come into earth surface. This incident happen because of our atmosphere is a great shield so it can save our Earth from the strange object falling.