Zero Trust Demystified: 5 Essential and Elusive Questions Answered
In the ever-shifting landscape of cybersecurity, organizations must constantly adapt and innovate and fortify their defenses to protect their valuable assets from sophisticated and evolving threats. One approach that has gained prominence in recent years is the Zero Trust Framework. It is a security approach predicated on the notion of “never trust, always verify.” As security leadership seeks to employ this framework to fortify their organizations, they are often confronted with a plethora of unanswered questions.
In this article, we will seek to unravel the mysteries surrounding the five key questions I continually hear as I meet with customers and security professionals all over. These questions range from aligning the Zero Trust Framework with existing security architecture and policies to measuring its effectiveness and determining when success has been achieved. By providing further insight around these commonly asked questions, it is my hope it will help equip security professionals with the insights necessary to implement and maintain a robust Zero Trust Framework that can stand up to the daunting challenges of today’s cyber threats.
Question 1: How to Align a Zero Trust Framework with an Organization’s Existing Security Architecture and Policies?
In recent years, the Zero Trust Framework has emerged as a powerful paradigm shift in the world of cybersecurity. It revolves around the idea of “never trust, always verify,” which means that organizations should not implicitly trust any user, device, or network, whether internal or external. Instead, they should continuously validate and authenticate every access request, regardless of its origin. World-class implementations of a Zero trust framework attempt to achieve most of this additional validation and authentication largely behind the scenes so as not to take away or degrade the user experience for the organization’s employees, partners and customers. This approach is an effective way to mitigate cyber threats and protect valuable data assets, as it minimizes the likelihood of unauthorized access or breaches.
Implementing a Zero Trust Framework in an organization requires careful examination of its existing security architecture and policies to ensure seamless integration. The following steps outline the process of aligning the Zero Trust Framework with your organization’s current security setup:
1. Assess the Current State: Begin by examining your organization’s existing security infrastructure, policies, and practices. Identify any areas that need improvement or are misaligned with the Zero Trust principles.
2. Map Existing Controls: Determine which existing security controls, such as firewalls, intrusion detection systems, and access control mechanisms, can be integrated into the Zero Trust Framework. This mapping exercise helps identify gaps and overlaps, allowing you to streamline the process and optimize resource allocation.
3. Define Clear Policies: Establish clear, consistent policies that govern user, device, and network access within the organization. These policies should follow the Zero Trust principles, ensuring that access is granted only after thorough validation and authentication. Ensure that your policies cover all aspects of your organization, including remote work and BYOD scenarios.
4. Establish Strong Identity and Access Management (IAM): Implement a robust IAM system that enables secure authentication and authorization of users, devices, and applications. Utilize multi-factor authentication (MFA), single sign-on (SSO), and role-based access control (RBAC) to enforce the principle of least privilege, granting access only to the necessary resources for each individual’s role.
5. Deploy Micro-segmentation: Divide your organization’s network into smaller, isolated segments based on the function or sensitivity of data. This approach reduces the attack surface and limits the potential damage in case of a breach, as attackers cannot easily move laterally within the network.
6. Continuously Monitor and Log: Implement continuous monitoring and logging of network activity, user behavior, and access requests. This data allows for real-time analysis and alerts, enabling rapid detection and response to potential threats.
7. Regularly Review and Adjust: Periodically review your security architecture and policies to ensure they remain effective and aligned with the Zero Trust Framework. As the threat landscape evolves and your organization grows, adjustments may be necessary to maintain optimal security.
By following these steps, security leadership can successfully align their organization’s existing security architecture and policies with the Zero Trust Framework, enhancing overall protection and minimizing the risk of cyberattacks.
Question 2: What are the Key Components and Technologies Required for Effective Zero Trust Framework Implementation?
Implementing a Zero Trust Framework effectively necessitates the use of several key components and technologies that work together to provide a robust and secure cybersecurity environment. If your organization has already invested in the any of the items below and this investment has the capability to meet your particular needs for Zero Trust, then you should by all means use it. In fact, it is potentially a great way to slim down any costs or reduce implementation time. The following are essential elements to consider when implementing the Zero Trust Framework in your organization:
1. Identity and Access Management (IAM): A strong IAM solution is critical to the Zero Trust Framework, as it enables the proper identification, authentication, and authorization of users, devices, and applications. Implementing multi-factor authentication (MFA), single sign-on (SSO), and role-based access control (RBAC) helps ensure that users are granted access only to the resources necessary for their roles and responsibilities.
2. Micro-segmentation: Micro-segmentation is the practice of dividing the network into smaller, isolated segments based on function, data sensitivity, or other relevant factors. This approach limits the potential damage in case of a breach by preventing attackers from easily moving laterally within the network.
3. Network Access Control (NAC): NAC solutions ensure that only authorized and compliant devices are allowed to access the network. They continuously monitor and enforce security policies, verifying the health and compliance of connected devices and blocking access when necessary.
4. Security Information and Event Management (SIEM): A SIEM system collects, analyzes, and correlates security event data from various sources, including logs, network traffic, and user activity. SIEM helps security teams detect and respond to potential threats in real time, enabling rapid incident resolution and minimizing damage.
5. Data Loss Prevention (DLP): DLP solutions monitor and control the movement of sensitive data, both within the organization and across its perimeter. They help prevent unauthorized access, exfiltration, and disclosure of sensitive information, which is crucial for maintaining data integrity and compliance with regulations.
6. Encryption: Encrypting data at rest, in transit, and during processing adds an additional layer of security, ensuring that even if unauthorized access occurs, the data remains unreadable and useless to attackers.
7. Endpoint Security: A comprehensive endpoint security solution, including anti-malware, host-based intrusion prevention systems (HIPS), and endpoint detection and response (EDR) technologies, helps protect devices from malware, exploits, and other threats, reinforcing the Zero Trust Framework.
8. Cloud Access Security Brokers (CASB): As organizations increasingly adopt cloud services, CASBs help enforce security policies and controls for cloud applications and data, ensuring that they adhere to the Zero Trust principles.
9. Threat Intelligence: Integrating threat intelligence feeds and platforms into your security ecosystem can help you stay informed about emerging threats and vulnerabilities, enabling proactive defense strategies and informed decision-making.
10. Continuous Monitoring and Analytics: Continuously monitoring and analyzing network activity, user behavior, and access patterns allows security teams to detect anomalies and potential threats quickly, ensuring swift response and mitigation.
By leveraging these key components and technologies, security leadership can implement a Zero Trust Framework effectively, significantly enhancing their organization’s overall cybersecurity posture.
Question 3: How to Measure the Effectiveness and Success of a Zero Trust Framework in an Organization
Evaluating the effectiveness and success of a Zero Trust Framework implementation within an organization is crucial to ensuring that the framework is functioning as intended and providing the desired level of security. While there are several objective elements listed below to measure and evaluate, you should also consider some subjective elements around the soft benefits like brand reputation protection, customer loyalty, and others. The following metrics and indicators can help security leadership measure the impact of their Zero Trust implementation:
1. Reduction in Security Incidents: One of the most telling signs of a successful Zero Trust implementation is a noticeable decrease in the number and severity of security incidents. Track the number of breaches, unauthorized access attempts, and other incidents before and after the implementation to quantify the improvement.
2. Faster Incident Detection and Response: Zero Trust Frameworks emphasize continuous monitoring and real-time analytics, which should lead to faster detection and response times for security incidents. Measure the average time it takes to detect and respond to incidents and compare these figures to pre-implementation data.
3. Compliance Metrics: Ensuring compliance with various industry standards and regulations is an essential aspect of maintaining a secure environment. Monitor compliance metrics, such as the percentage of devices meeting security policy requirements or the number of data access policy violations, to assess the effectiveness of your Zero Trust implementation.
4. User Access Metrics: Analyzing user access patterns, such as the number of unique users with access to sensitive resources, the percentage of users with the least privileged access, or the number of successful MFA challenges, can provide insight into how well the Zero Trust principles are being enforced in the organization.
5. Network Segmentation Metrics: Assess the effectiveness of your micro-segmentation implementation by monitoring metrics like the number of network segments created, the percentage of traffic traversing segment boundaries, and the number of attempted unauthorized segment access incidents.
6. Security Maturity Level: Assess the overall security maturity of your organization by using industry-standard maturity models, such as the NIST Cybersecurity Framework or the CIS Controls. Compare your organization’s maturity level before and after the Zero Trust implementation to determine its impact on your security posture.
7. Employee Awareness and Training: Zero Trust Frameworks require a comprehensive understanding of security policies and procedures by employees. Measure the effectiveness of training programs, such as the percentage of employees who have completed training or the results of simulated phishing attacks, to gauge the organization’s preparedness for a Zero Trust environment.
8. Return on Investment: Evaluate the financial impact of implementing the Zero Trust Framework, including costs associated with technology acquisition, deployment, and maintenance, as well as any financial benefits resulting from the reduction in security incidents or increased operational efficiency.
Reviewing, analyzing, and sharing these metrics with executive leadership will enable security leadership to assess the effectiveness and success of their Zero Trust implementation. By addressing any areas of concern, ensuring gaps are handled properly, and continuously refining the framework, organizations can maintain a robust cybersecurity posture that aligns with the evolving threat landscape.
Question 4: What are the Potential Challenges and Obstacles in Adopting a Zero Trust Framework and How to Address Them
Adopting a Zero Trust Framework can bring significant benefits to an organization’s cybersecurity posture. However, it is not without some challenges and obstacles. Security leadership should be aware of these potential issues and devise strategies to address them effectively and early. Some of the most common challenges and their respective solutions include:
1. Resistance to Change: A Zero Trust implementation often requires a significant shift in mindset and approach to security, which may be met with resistance from employees and stakeholders. To address this challenge, communicate the benefits and rationale behind the Zero Trust Framework clearly and consistently. Engage in training and awareness programs to help employees understand their role in maintaining a secure environment.
2. Complexity of Implementation: Implementing a Zero Trust Framework can be complex, involving multiple technologies and processes. To streamline the process, develop a phased implementation plan that prioritizes the most critical security gaps and incrementally builds upon them. Engage with experienced consultants or service providers to help navigate the intricacies of the implementation.
3. Integration with Existing Infrastructure: Integrating the Zero Trust Framework with existing security infrastructure can be a significant challenge. To ensure seamless integration, perform a thorough assessment of your current security architecture and identify the areas that need improvement or realignment with the Zero Trust principles. Leverage existing technologies and solutions where possible, and invest in new tools only when necessary.
4. Legacy Systems and Applications: Organizations often rely on legacy systems and applications that may not be compatible with Zero Trust principles. To address this issue, consider modernizing or replacing these systems with more secure alternatives that align with Zero Trust principles. If that is not feasible, develop compensating controls and monitoring mechanisms to mitigate the risks associated with these legacy systems.
5. Balancing Security and User Experience: Implementing a Zero Trust Framework may initially result in a perceived increase in friction for end-users due to more stringent access controls and authentication requirements. Strive to strike a balance between security and user experience by implementing user-friendly solutions like single sign-on (SSO) and adaptive multi-factor authentication (MFA) that adjust to the user’s context and risk level.
6. Scalability and Performance: As organizations grow and evolve, the Zero Trust Framework must be able to scale and adapt to meet changing needs. Ensure that your chosen technologies and solutions can scale with your organization without compromising performance or security.
7. Continuous Monitoring and Improvement: Maintaining an effective Zero Trust environment requires ongoing monitoring and adaptation. Invest in technologies and processes that enable continuous monitoring, analytics, and threat intelligence. Regularly review and update your security policies, controls, and technologies to stay aligned with the evolving threat landscape and the needs of your organization.
Proactively addressing the challenges and obstacles that your organization may face will help security leadership pave the way for a successful Zero Trust Framework adoption, ultimately enhancing their organization’s overall security posture.
Question 5: How to Recognize a Successful Zero Trust Framework Implementation
Achieving a successful Zero Trust Framework implementation is an ongoing process that requires continuous monitoring, assessment, and improvement. However, there are several indicators that can help security leadership recognize when they have reached a mature and effective Zero Trust environment:
1. Reduction in Security Incidents: A successful Zero Trust implementation should lead to a noticeable decrease in security incidents, breaches, and unauthorized access attempts. Track and compare the frequency and severity of incidents before and after implementing the framework to measure its effectiveness.
2. Improved Compliance Metrics: Ensuring compliance with industry standards and regulations is a key aspect of a mature Zero Trust environment. Monitor your organization’s compliance metrics, and if you observe a consistent improvement in meeting requirements and reducing violations, this is a sign of a successful implementation.
3. Streamlined Access Control: In an effective Zero Trust environment, user access should be consistently and efficiently governed by the principle of least privilege. Assess whether access controls are granular and role-based, and whether users are granted access to only the resources necessary for their roles.
4. Faster Incident Detection and Response: A mature Zero Trust implementation should enable rapid detection and response to security incidents. If your organization consistently demonstrates the ability to detect and mitigate threats quickly, this is a strong indication of a successful Zero Trust Framework.
5. Robust Micro-segmentation: Effective network segmentation, which limits lateral movement and reduces the attack surface, is a hallmark of a successful Zero Trust environment. Assess the degree to which your organization has achieved granular micro-segmentation and monitors segment boundaries for unauthorized access.
6. Employee Awareness and Training: The success of a Zero Trust Framework is highly dependent on employees understanding and adhering to security policies and procedures. A high level of employee awareness and participation in security training programs is an indication of a well-established Zero Trust culture.
7. Consistent Security Maturity Level: Assess your organization’s security maturity using industry-standard models, such as the NIST Cybersecurity Framework or the CIS Controls. A mature and successful Zero Trust implementation should result in consistently high-security maturity ratings.
8. Positive Return on Investment (ROI): If your organization can demonstrate a positive ROI on the Zero Trust implementation, including reduced security incidents, increased operational efficiency, and improved compliance, this is a strong indication of success.
9. Ongoing Improvement and Adaptation: A successful Zero Trust environment requires continuous evaluation and improvement. If your organization is consistently reviewing and updating its security policies, controls, and technologies to stay aligned with the evolving threat landscape, this demonstrates a successful and mature Zero Trust implementation.
By considering and evaluating some of these relevant indicators and continually striving to optimize your organization’s Zero Trust environment, you can achieve and maintain a successful and effective Zero Trust Framework that significantly enhances your cybersecurity posture and reduce your organization’s risk.
There is Power in a Zero Trust Approach
Ultimately, embracing a Zero Trust approach offers a powerful method to strengthen an organization’s cybersecurity posture amidst growing attack surfaces and the evolving threat environment. It has become increasingly evident over the last couple of years that the successful implementation of a Zero Trust framework is a multifaceted endeavor that takes some work, but it yields significant benefits for an organization’s ownership, employees, and customers.


The Design Hotels Book
For a quarter century, Design Hotels™ has been at the forefront of a movement in hospitality, curating a global collection of independent, design-driven hotels that function as social hubs and platforms for extraordinary experiences. In celebration of this benchmark, Design Hotels™ sent some of the world’s leading editorial and lifestyle photographers around the world to capture the unique character of 25 hotels at the vanguard of their hand-selected collection. Each hotel tells a story, rich with emotion and steeped in the history, culture, and nature of its local environment. The new, special edition of the brand’s wildly popular annual brings these stories to life through evocative photo essays and reportage. This edition of The Design Hotels™ Book is a distillation of a quarter century of pioneering design and original experiences, as well as a must-have for a worldwide community of travelers, likeminded in their pursuit of singular aesthetic environments, genuine local culture, and transformative, boundary-pushing travel experiences that defy conventional notions of luxury.


What is it?
Through the E-loan service, MU users have access to more than 10 000 scanned titles of the most frequently required study literature from Masaryk University library collections. An E-loan is the electronic equivalent of a common physical present loan. An authorized MU user can borrow a scan of a book for a limited time (currently 4 hours) via a computer network. The user can borrow electronically only one book at a time, after returning the E-loan he can borrow another one.
How to use it?
The E-loan is available at https://katalog.muni.cz:
- By clicking on the "E-loans Filter" link, you will filter out only those books at MU available for E-loan.
- After clicking on the record of the selected title, the link "E-loans" + login with UCO and secondary password will appear in the book details.
- Login and if one of the copies of the book is free, you can borrow its scan for a maximum of 4 hours.
- After the time limit expires (or the E-loan is returned earlier), you can E-loan another book.
Scanned books available for E-loan are labeled on cover with logo.


Yoga for Real Life
''The effervescent, charismatic Maya Fiennes will do for relaxation and yoga what Nigella Lawson did for food and cookery. In "Yoga for Real Life", she has written a book aimed at bringing yoga principles into all aspects of your everyday life. It is full of yoga tips, exercises and wisdom. ''
A Book That Can Change Your Life...
Maya Fiennes, who teaches the Kundalini method of yoga both face-to-face and on Sky TV, introduces her method, shares her story, and reveals the secrets of Kundalini Yoga that have helped her and her students to manage the stresses and strains of everyday life, the challenges that most of us encounter at some stage in our lives.
Chapters include: 'Be Here, Now', 'Detox and De-stress', 'Self esteem', 'Staying Youthful' and 'Love and Relationships'. Combining poses, breathing, chanting and meditation to give you a full mind-body workout, with recipes, mantras and Maya's personal story, and illustrated with full-colour photographs by David 'Jamie Oliver' Loftus, Maya shows how yoga practice and philosophy can easily be incorporated into your daily routine. "Yoga for Real Life" is a book for your handbag, your desk, and your bedside table: your indispensable guide to achieving the most from your daily life - for the rest of your life.


An Undesirable Element is a fascinating tour through the tumultuous years that helped create modern Afghanistan. Fayez survived Soviet Afghanistan and revolutionary Iran, only to find himself watching from exile as his country devoured itself. Improbably, he returns after 2001 to help resurrect Afghanistan's devastated higher education system, giving an insider account of the challenges of building education in a land dominated by warlords and fundamentalism. The result is a poignant reminder of how much Afghanistan has endured, and the flicker of hope that remains despite it all.
- Anand Gopal, author of No Good Men Among The Living: America, the Taliban, and the War through Afghan Eyes, finalist for the 2014 National Book Award
A compelling read, An Undesirable Element recounts an Afghanistan many have forgotten. It serves as a rallying cry to once again imagine all that country might be. It's a tale as extraordinary as the land from which it comes.
- Elliot Ackerman, author of Dark at the Crossing, finalist for the 2017 National Book Award
An Undesirable Element moves fast as flames and offers a luminous account of the last half century of Afghan conflicts and redevelopment. Trevithick's oral history of Sharif Fayez's story is a trove: from a kiss on the head by the late Afghan King Zaher Shah, Fayez's life intersected with the future leaders and quiet supporters of his country - both heroic and tyrannical - from Columbia University to a post-revolutionary university in Mashad, Iran. Fayez is a modest but robust storyteller whose eventual position as Afghanistan's first Minister of Higher Education after the Taliban is only one of the strange twists and turns his story offers. His deft handling in the rebuilding of Afghanistan should be read by anyone interested in how one can use patience and determination to bring hope to a country reduced to rubble.
- Adam Klein, editor, "The Gifts of The State: New Afghan Writing"
The term visionary tends to be misapplied to those who are merely headstrong. But it is a perfectly apt description for Sharif Fayez, the most important figure in education in 21st-century Afghanistan, yet one that history may have neglected without his memoir. Such an omission would have deprived future generations of Afghans from understanding how Fayez, perhaps more than any single person, created hope for the country’s young minds at the turn of the millennium and, in so doing, altered a nation's destiny.
— Martin Kuz, Freelance journalist


Brett Botelho splits his time living between California and Colorado. In the summer, he lives in Southern California and trains, goes to the beach and spends time with his Husky Avalanche, whom you may recognize. In the winter, he lives in Frisco, CO where he trains for the US Paralympic Snowboard team and enjoys the mountains. He became an amputee on 12/1/14 and hasn't looked back since. He is also the author of his self-written book: Standing My Own Ground - Getting Back Up When It Seems Impossible, which was released to the public in October 2017.


Posted January 19th, 2020 / Ends May 18th, 2020
Mokume Gane A Comprehensive Study
Mokume Artist Steve Midgett provides free access to "Mokume Gane A Comprehensive Study", the most in-depth resource for Mokume Gane information. All 160 pages of the hardcover book Mokume Gane A Comprehensive Study, acknowledged as the preeminent text on mokume gane has been published on the website www.mokume.com .
In this comprehensive book, Midgett shares the art of Mokume Gane from it’s ancient beginnings in Japan to its resurgence in the digital age along with detailed how-to information for making mokume by multiple methods, and 5 step by step mokume jewelry projects.
Accompanying each chapter of the book will be an important section called New Layers that will highlight what we’ve learned since the hardback book was first published and new developments in the practice of mokume gane. It will include information and insights from current leaders and innovators in the field and be an ongoing discussion of all things mokume.
To access your free copy visit www.mokume.com/book.


The Rabbi was travelling once again and he went out from the region of Tzor, and came through Tzidon to the Sea of the Galil, within the region of the Ten Cities. The people there brought to him one who was deaf and spoke with difficulty, and they implored him to lay his hand on him.
The Rabbi took him aside from the crowd, by himself, and put his fingers into his ears, and after spitting, he touched the man's tongue with the saliva; and looking up to heaven with a deep sigh, he said to him, "Ippattach!" that is, "Be opened!" And the man's ears were opened, the impediment of his tongue was removed, and he began speaking plainly.
The Rabbi gave them orders not to tell anyone; but the more he ordered them, the more widely they continued to proclaim it. They were utterly astonished, saying, "This Rabbi has done all things well; he makes even the deaf to hear and the mute to speak!"
-- This is the life of The Rabbi. --


A paper writer’s main aim is to create masterpieces of scholarship, analysis and research from most forms and fields. To become a successful paper writer, a writer must have good command over the English language and a comprehensive grasp of the field of academic writing. Many authors are hired by big publishing houses because of their expertise for a paper writer. There are many sub-specialties within the field of academic writing and the following are some examples:
A thesis statement is the center of this assignment and it’s by far the most important document that will determine your newspaper’s content. The thesis statement is the announcement that simplifies the entire paper also gives essay writing service it its direction. The best papers contain the most important information in the shortest period. If your thesis statement contains several paragraphs, then the newspaper will take more time to compose and it could possibly be reversed by the evaluator.
The different types of paper writing assignments include both verbal and written pieces. For written pieces, the writer is required to research and collect data and to show them in a meaningful manner. For verbal pieces, the author is required to do research and evaluation of this subject matter as well as to compose a concise essay on the grounds of the gathered data. A freelance paper writer may also specialize in a certain sort of paper writing duties. As an example, if a writer specializes in research papers, he or she might be asked to essay writing service write reports and testimonials on a specific topic.
Many authors make a specialty from habit writing assignments. They usually begin writing masterpieces for a customer before branching into custom writing assignments. Clients usually give writing tasks to a group of writers and assign them various sub-type of papers depending on the theme of the undertaking. A few of those custom writing assignments may include: thesis statements, commentaries, descriptive essay, reviews, book reviews, journal articles, case studies, and dissertations.
As is true with most professions, some newspaper authors excel in one specific area and others in another. Some of the public areas where writers excel include: creative writing, copywriting, business writing, non-fiction, creative non-fiction publications, technical non-fiction books, short story collections, poems and essay writing service sonnets, and other sorts of non-fiction and ingenious literature. Many writers who have succeeded in building a name for themselves in this subject are known for their use of metaphors, similes, and alliterations.
Paper writing help sites provide help and information regarding what exactly are considered to be the best papers, which provide maximum aid to pupils so as to complete their academic work on time. In fact, it is not unusual to find hundreds of websites offering newspaper writing help. A few of the websites have guidelines and tutorials about what are considered to be greatest newspapers. Other sites focus mainly on various types of academic writing. If you are a student looking for information on the best way best to write better papers, you can always turn to an academic writing aid site for replies.


Christine is the author of the book “Working the Double Shift A Young Woman’s Journey with Autism” , self advocate and a person with autism. She has spoken about her experiences with various groups including the US Autism and Asperger Association, Southwest SELPA , Manhattan Beach Unified School District and the FRED Conference. When she didn’t meet certain developmental milestone at age 4 she went to see a psychologist who diagnosed her as autistic. Through intensive speech, social skills, occupational and educational therapies, Christine was able to mainstream in first grade. Using behavioral therapy, Christine began to understand her feelings and find ways to manage her stress and anxiety.
Christine graduated high school with honors and attended El Camino College. She has transferred to Loyola Marymount University where she is majoring in psychology. Her aspiration is to be a behavioral therapist working with other autistic individuals. Hobbies include writing, horseback riding and drawing.


The introduction of tumor necrosis factor (TNF) inhibitors in the late 1990s revolutionized the treatment of rheumatic diseases, such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), providing patients with another therapeutic option when conventional therapies were ineffective. However, when these diseases fail to respond to anti-TNF therapy, it is still difficult to determine the next best course of action.
“One of the big challenges we have in treating psoriatic arthritis, and I would say rheumatoid arthritis was fine, is how to manage patients who have failed their first biologic therapy,” Christopher Ritchlin, MD, MPH, professor of allergy, immunology; and rheumatology at the University of Rochester, Rochester, New York, he said Medscape Medical News. “In the case of both RA and PsA, it’s quite often an anti-TNF agent.”
For approximately 30-40% of patients, TNF-blocker therapy is discontinued due to non-response or intolerance. Doctors can switch to another targeted biological or synthetic disease-modifying antirheumatic drug (DMARD) or add another conventional DMARD, such as methotrexate. Now, several case studies and promising results from Phase 2 clinical trials suggest that combining two biologics could be an alternative strategy to improve patient response to treatment. However, concerns about safety and higher costs remain.
Target multiple mechanisms of action
Rheumatic conditions affect multiple areas of the body and involve different signaling pathways, said Ritchlin, who also heads the Clinical Immunology Research Unit at the University of Rochester. PsA, for example, affects the skin, peripheral joints, axial skeleton, and entheses.
“The question is, are these various manifestations multiple? [ones] are they often seen in a patient who is likely to respond to single pathway targeted therapy?” he said.
Combination therapies have been effective in treating leukemia and lymphoma as well as HIV infection, writes Melek Yalin Mutlu, MD, and colleagues at the Friedrich Alexander University Erlangen-Nuremberg and Erlangen University Hospital, Erlangen, Germany, in a review on the combination of biological DMARDs in the treatment of RA and PsA. The review was published on April 17 in Articular bone spine.
“Cumulative evidence on the success of combination therapies in various diseases supports a similar approach in rheumatology, and concurrent or sequential blockade of multiple mechanisms that generate or propagate arthritis could theoretically improve efficacy,” the authors write. “On the other hand, targeting multiple targets in the immune system carries a risk of adverse events, with infection being a major concern.”
Clinical trials failed
Clinical trials of combination biological therapies for rheumatic disease have been attempted previously, but these combinations have not shown superior efficacy and increased the patients’ risk of infection. A study published in 2004 compared monotherapy with the TNF inhibitor etanercept (Enbrel) to the combination of etanercept and anakinra (Kineret), an interleukin-1 (IL-1) antagonist, in 244 patients with active RA despite methotrexate therapy. The researchers found no statistically significant difference in achieving 20 percent improvement in the modified American College of Rheumatology (ACR20), ACR50, or ACR70 response criteria between the groups receiving etanercept and anakinra and those receiving etanercept alone. There were nine serious infections among patients treated with etanercept and anakinra, including one death due to pneumonia. There were no serious infections in the etanercept monotherapy group.
In another rheumatoid arthritis study, 121 patients were given etanercept 25 mg twice a week and were randomly assigned to also receive either a placebo or low-dose abatacept (Orencia), a T-cell costomulation inhibitor There was no significant difference in disease improvement between the two groups, although the rate of serious adverse events was nearly six times higher in the etanercept-abatacept group (16.5% vs 2.8%).
Those studies had a “chilling effect on the whole field for a few years,” Brian Feagan, MD, senior scientific director of gastrointestinal contract research firm Alimentiv in London, Ontario, Canada, told Medscape. People were reluctant to try new biological combinations, due to fears that these safety issues would plague subsequent trials.
But a recent phase 2 study, led by Feagan, suggests that some combinations may be effective. In the Janssen-sponsored VEGA study, researchers found that a combination of guselkumab (Tremfya), an IL-23 inhibitor, and golimumab (Simponi), an anti-TNF agent, was more effective than either drug used as monotherapy for initial induction treatment for moderate to severe ulcerative colitis. Importantly, there was no difference in adverse events between any of the groups. This same combination therapy is now being tested for patients with active PsA in Janssen’s AFFINITY study, for which Ritchlin is a principal investigator.
Other studies have also yielded promising results. One study enrolled 51 adults with active RA who were all receiving stable doses of either a TNF-blocker or etanercept or adalimumab (Humira) and methotrexate. Patients were randomly assigned to receive a course of rituximab (Rituxan) or placebo. The researchers found that the safety profile of this TNF inhibitor/methotrexate/rituximab combination was “consistent” with the safety profiles of previous studies of dual methotrexate/rituximab combinations without any TNF inhibitor; there were no new safety signals. At 24 weeks, 30% of the rituximab group achieved ACR20, compared with 17% of the placebo group. A total of 12% of the rituximab group achieved ACR50, compared with 6% of the group receiving placebo.
“B-cell depletion is fundamentally different from cytokine inhibition and even co-stimulation blockade, making an additive effect more likely,” write Mutlu and colleagues in their review. Reports have also suggested possible benefits of the combination of a TNF inhibitor and an IL-17 inhibitor in the treatment of rheumatoid arthritis and PsA, as well as of the combination of a TNF inhibitor and an IL-23 antagonist for the PSA.
While these combinations require controlled clinical trials, “there are some smoke signals out there that this might be an effective strategy for some patients,” Ritchlin said.
In addition to the AFFINITY study, two clinical trials are ongoing in France. The first, CRI-RA, is evaluating the combination of baricitinib (Olumiant), a Janus kinase (JAK) inhibitor, and adalimumab. While baricitinib is not a biologic, as it is a targeted synthetic DMARD, the therapy is more potent than conventional DMARDs and the same potential safety concerns apply. However, the use of a combination of tofacitinib (Xeljanz) and several biologics has been reported for RA patients; no serious side effects were reported in the 11 months of therapy. The randomized, placebo-controlled trial began in July 2021 and will enroll 178 patients. The estimated completion date of the study is July 2025.
“Of note, baricitinib does not directly block downstream TNF signaling, although an indirect effect on TNF production is likely,” reads the CRI-RA entry on clinicaltrials.gov. “Targeting multiple inflammatory cytokines in combination may lead to more effective treatment and better clinical responses in RA patients than current second-line strategies.”
The second study, titled SEQUENS-RA, is evaluating the use of TNF blockers followed by abatacept for RA patients who test positive for anti-citrullinated protein autoantibodies (ACPAs). In the past, the combination of a TNF blocker and abatacept has not led to promising results, but in this study, the drugs will be administered sequentially.
“Although abatacept has shown a very good tolerance profile that may be superior to other bDMARDs [biologic DMARDs]rheumatologists may be reluctant to use it as a first-line bDMARD as there is a belief of slower efficacy than other bDMARDs or JAK inhibitors,” according to the clinical trial description. inflammatory phase, the use of TNF inhibitors, followed by abatacept to induce immunological remission, would optimize the response and tolerance of ACPA-positive patients with RA.”
The randomized study of 220 participants began in November 2022. The estimated date for completion of the study is November 2025.
Finding the right patients
Although these trials had some promising results, the difference in efficacy between biologic monotherapy and dual therapy was mostly moderate, write Mutlu and coauthors. Identifying disease subtypes for which there may be an increased likelihood of response to dual biologic treatment, especially multidrug-resistant types, could improve efficacy in future studies, they argue. “The good effects of bDMARD combinations in resistant patients indeed point in this direction, although they have been observed in uncontrolled studies,” note the authors.
Insurance coverage remains a “major challenge” for these dual therapies due to the higher expense, Ritchlin noted. More targeted therapies could help convince these companies to pay for these therapies.
“I would argue that if we were able to demonstrate a phenotype of a patient that would respond to biologics and not monotherapies, [then] many companies would be inclined towards this kind of approach,” he said.
Ritchlin reports financial relationships with AbbVie, Bristol-Myers Squibb, Janssen, Pfizer, Eli Lilly, Novartis and UCB. Feagan reports financial relationships with AbbVie, Amgen, Janssen, Pfizer, Takeda and many other pharmaceutical companies.
Follow Medscape on Facebook, ChirpingInstagram and YouTube.
#Biological #doubles #PsA


Just before Christmas we promoted the ‘Young Writers’ competition titled, Integer.
Students were asked to write a short story based on or around numbers and do so in exactly 100 words. It may sound easy but it takes good writing skills to construct a story in such a small word count. Stories were submitted online and, having now received word from the organisers, I am delighted to tell you that eighteen of our students’ stories have been selected for publication! Once permission has been granted by parent/carers their stories will appear in book format which is a compilation of all winning entries.
All winners are given the opportunity to buy their own copy to keep at home but a copy will also be available in the LRC for all students to view. Winners came from years 7- 10 and we are enormously proud of their achievement. Please join me in congratulating the following students: Kai Pierre (7), Igor Lasota (7), Aleyna Sener (7), Zain Cherifi (7), Aleyna Sener (7), Taylan Sefer (7), Tuana Sener (7), Natasha Jackson (7), Gabriella Didiomenco (8), Elisa Mustafa (9), Antreas Papadopoulos (9), Eliana Blackman (9), Joseph Pozzuto (9), Arda Korkmaz (9), Zam Francis (9), Stephanie Gyamfi-Manu (9), Ria Oscar (9), Natasha Jackson and Sarah Collins (10)


Every time I step into Faye's room, I always find something that makes me laugh or smile. This girl absolutely loves to read, and it just amazes me every time I look at the piles of books in her room. I clear this little nightstand off at least twice a week. And yet, it somehow always manages to be overflowing with books. She reads and reads and reads, to the point where we have to ask her to stop reading. How many hours a day should a 6 year old spend reading?
Here is a another view, in case you were wondering what exactly Faye is reading. Right now she is reading the Harry Potter books (she's on number 3 and I've told her that is all she can read until she is older - any thoughts about that for those of you who are Harry Potter fans?), Nancy Drew, Junie B. Jones, which is her favorite but she can read one of those in about 20 minutes, and some other miscellaneous books. She's told me she loves mystery books. The strangest thing to me is Faye's method of reading books. She will start one book, then another, then another, before going back and finishing something else. At any point in time she could be reading 5 or 6 books! I don't know how she keeps them all straight, but she does and can tell you the story almost word for word.
This afternoon when I walked into her room I had a really good laugh. I saw this on her dry erase board...
Apparently the boys are no longer allowed in her room!


Canada's Golden Hour Book
The Canada's Golden Hour Book is a limited edition of 500 copies. All profits will be donated to the Nature Conservancy of Canada.
The book is a beautifully bound collection featuring the top fifty photographs captured on June 4, 2016 during Canada's Golden Hour Photo Project. With a printed dust jacket, linen hard cover, premium paper and detailed printing, this book is a beauty both to view and display. It makes a great gift too!
The book is currently available for pre-order for $44.99. Books are expected to ship to customers in early August 2016.
Pre-order the book via Posterjack.ca


MFAH Book Club Tours
This is where art and literature meet! Designed for established book clubs—whether formal or informal groups—the MFAH Book Club links works of literature to works of art at the Museum of Fine Arts, Houston.
The MFAH Book Club presents three selections per year. Each book:
- Is featured for a four-month period in the fall, spring, and summer
- Is accompanied by a downloadable discussion guide to facilitate group discussions
- Culminates with a docent-led tour at the Museum, scheduled in advance (see below)
The spring 2017 selection for the MFAH Book Club is Dreaming in Cuban by Cristina García.
Tours: February 1–May 31, 2017
• Download the Discussion Guide
About the Book
Cristina García’s acclaimed book is the haunting, bittersweet story of a family experiencing a country’s revolution and the revelations that follow. The lives of Celia del Pino and her husband, daughters, and grandchildren mirror the magical realism of Cuba itself, a landscape of beauty and poverty, idealism and corruption. Dreaming in Cuban is “a work that possesses both the intimacy of a Chekov story and the hallucinatory magic of a novel by Gabriel García Márquez” —The New York Times.
About the Author
Cristina García is the author of seven novels. Her work has been nominated for a National Book Award and translated into 14 languages. She is the recipient of a Guggenheim Fellowship, a Whiting Writers’ Award, a Hodder Fellowship at Princeton University, and an NEA grant, among others. García has taught at universities nationwide. Recently, she completed her tenure as University Chair in Creative Writing at Texas State University-San Marcos and as Visiting Professor at the Michener Center for Writers at the University of Texas-Austin. She lives in the San Francisco Bay area.
The summer 2017 selection for the MFAH Book Club is The Last Painting of Sara de Vos by Dominic Smith, a New York Times best seller and New York Times Book Review Editors’ Choice.
Tours: June 1–September 30, 2017
Discussion guide coming soon!
How to Participate
For book clubs and other groups of six or more confirmed participants:
- Read the book. Most MFAH Book Club selections may be purchased at the MFA Shop, where Museum members receive a discount. Reading copies are also available in the Museum’s Kinder Foundation Education Center and at the Museum's Hirsch Library.
- Download the discussion guide to facilitate your conversation. This guide features questions about the book and select artworks on view at the MFAH.
• Discussion Guide for Dreaming in Cuban
- Request a docent-led tour by e-mailing email@example.com—a minimum of 3 weeks in advance—with the following information:
• The name of your group and number of participants
• The primary organizer's name, telephone number, and e-mail address
• Your preferred date and time for your tour (see below for tour availability)
Tours related to Dreaming in Cuban are available between February 1 through May 31, 2017.
Choose from the following days and times:
Tuesdays, 2 p.m. or 3:30 p.m.
Wednesdays, 2 p.m. or 3:30 p.m.
Thursdays, 10:30 am, 3:30 p.m., or 6:30 p.m.
Sundays, 2 p.m. or 3:30 p.m.
Note: If your group meets on a specfic day and/or time not listed above, please e-mail firstname.lastname@example.org with a request, which we will try to accommodate.
- Look for a confirmation e-mail, within 5 business days, with information about when and where to meet the docent at the Museum.
Questions? E-mail email@example.com
What to Expect on an MFAH Book Club Tour
• MFAH Book Club tours are free for MFAH members and free with general Museum admission for nonmembers.
• Tours last approximately 1½ hours.
• Camp stools are provided for seating.
• Docents facilitate tours, selecting several artworks on view at the Museum that they feel best connect with aspects of the featured book.
• Excerpts from the book are a vital component of these discussion-based tours, so we encourage you to bring your copy of the book along.
• Expect lively discussion of the book and artworks!
Since the MFAH Book Club's inception, the Museum has featured a wide range of fiction and nonfiction picks. Though tours are not offered for these past selections, discussion guides are available here.
The MFAH Book Club receives generous support from Aggie and Joe Foster.
All Learning and Interpretation programs at the Museum of Fine Arts, Houston, receive endowment income from funds provided by the Louise Jarrett Moran Bequest; Caroline Wiess Law; the William Randolph Hearst Foundation; The National Endowment for the Humanities; the Fondren Foundation; BMC Software, Inc.; the Wallace Foundation; the Neal Myers and Ken Black Children’s Art Fund; the Favrot Fund; and Gifts in honor of Beth Schneider.


Medium, a popular online publishing platform, offers distinct experiences for its users based on the type of account they choose. Understanding the differences between free and paid accounts on Medium can help users decide which is best suited for their reading and writing needs.
Access to Content
Free accounts on Medium provide users with access to a limited number of stories like these each month. These stories can be from both amateur and professional writers, covering a wide range of topics. Once the monthly limit is reached, users are required to wait until the next month to access more free articles or to upgrade to a paid account for unlimited access.
Paid accounts, known as Medium Memberships, offer unlimited access to all stories on the platform. This includes exclusive content that is only available to paying members. These stories often come from well-known authors or are high-quality pieces curated by the Medium team. The unlimited access allows for deeper exploration and engagement with the diverse content available on Medium.
Interaction with Content
Users with free accounts can read, clap (Medium’s version of a ‘like’), and respond to stories they have access to. They can also follow authors and publications to keep track of new content. However, their interaction with content is limited by the monthly story cap.
In addition to the benefits offered to free account users, paid members have the added advantage of being able to interact with an unlimited number of stories. They can engage more deeply with the community by responding to stories, participating in conversations, and providing feedback to authors. This unrestricted interaction fosters a more robust and dynamic community experience.
Writing and Publishing
Both free and paid account holders on Medium have the ability to write and publish stories. They can create their own publications, join existing ones, and even monetize their content through Medium’s Partner Program, regardless of their account type.
While the writing and publishing features are similar for both account types, paid members often have access to enhanced analytics and insights about their stories. These insights include detailed information about readership, engagement, and the performance of their articles. This data can be invaluable for writers looking to grow their audience and improve their writing.
Supporting Writers and Publications
Free users support writers indirectly through their engagement with stories. Claps and responses can increase a story’s visibility, but free users do not contribute financially to the authors.
A portion of the membership fee paid by Medium members goes directly to the writers and publications they engage with the most. This financial support incentivizes quality content creation and helps sustain the platform’s diverse range of voices and topics.
The choice between a free or paid account on Medium depends largely on a user’s reading habits, desire for unlimited access to content, and interest in supporting the writing community. While free accounts offer a taste of what Medium has to offer, paid accounts provide an all-access pass to the platform’s full range of stories, enhanced community interaction, and additional benefits for writers. Ultimately, both types of accounts contribute to the vibrant and diverse ecosystem that is Medium.


Bedford Select makes it easy to create your own composition reader or literature anthology. Choose from more than 800 essays, stories, poems, plays, images, and instructional materials to build an affordable course text for your students.
- With Bedford Select, students pay only for material that will be assigned in their course—nothing more.
- It is easy for instructors to create their ideal text for a composition or literature course - one that can be ordered again (or readily modified from term to term).
- Because quality matters, Bedford Select books are built to the same standards as the highly praised and widely used composition readers and literature anthologies published by Bedford/St. Martin's, an imprint of Macmillan Learning.


From autonomous vehicles to video surveillance, the potential uses for AI in our everyday lives are vast. Hackers, however, are rapidly coming up with attacks on these new applications for AI. Most attacks take advantage of the vulnerability of deep learning systems to disrupt the signal (image, sound) and “trick” or, in some cases influence the AI’s decisions. List, a member of the Carnot Network, develops trustworthy AI. The institute recently came up with some effective ways to fend off attacks.
Specifically, they intentionally introduced random modifications of the neural activations from the earliest stages of the neural network design process. The goal is to scramble the network during the learning phase as well as during operation. The researchers’ approach enables the machine to remember only the relevant parts of incoming information and to not be fooled by an attack. An alternative for existing machines that need additional protection is to introduce the noise directly into the incoming signal. These modifications are made using an “overlayer” that mitigates or neutralizes the effects of an attack.
The loss of performance that occurs when the defect is introduced is offset by the fact that the system is more robust and can better withstand attacks. A demonstrator presented at CES 2020 was well received. An article* was also published very recently in Neural Information Processing Systems, a major scientific journal in the field of AI.
*Pinot, R., Meunier, L., Araujo, A., Kashima, H., Yger, F., Gouy-Pailler, C., and Atif, J. (2019). Theoretical evidence for adversarial robustness through randomization. In Advances in Neural Information Processing Systems 32, pp. 11838–11848.
Read article at http://www.cea-tech.fr/


Jurnalist Saleem Safi Presents Latest Book “Aur Tabdeeli Galay Par Gayi” to Prime Minister Shehbaz Sharif
In a momentous occasion, senior journalist Saleem Safi had the esteemed privilege of presenting his latest book, titled “Aur Tabdeeli Galay Par Gayi” (And Change Embraced Us), to Prime Minister Muhammad Shehbaz Sharif. This engaging literary work delves deep into the intricate social and political changes that have shaped the landscape of Pakistan. Saleem Safi, widely recognized for his insightful analysis and thought-provoking commentary, has cemented his position as a highly respected journalist and author.
The presentation of “Aur Tabdeeli Galay Par Gayi” to Prime Minister Shehbaz Sharif underscores the significance and relevance of the book within the current political landscape. It sheds light on crucial aspects of Pakistan’s societal fabric and offers a critical analysis of the ever-evolving dynamics within the nation. The event serves as a powerful testament to the role of intellectuals and journalists in shaping public discourse and engaging with policymakers.
The interaction between Saleem Safi and Prime Minister Shehbaz Sharif symbolizes the exchange of ideas and the invaluable contribution of intellectuals to the national dialogue. “Aur Tabdeeli Galay Par Gayi” is poised to reach a broader audience, stimulating meaningful conversations and deepening the collective understanding of the societal and political changes unfolding in Pakistan. As readers delve into the pages of this enlightening book, they are invited to reflect upon the challenges and opportunities that lie ahead for the nation.
The presentation ceremony further highlights the importance of fostering intellectual engagement and encouraging dialogue between thought leaders and policymakers. Saleem Safi’s work acts as a catalyst for introspection, providing a platform for contemplation and analysis of Pakistan’s socio-political landscape. It is expected that “Aur Tabdeeli Galay Par Gayi” will spark renewed discussions and ignite a desire for positive change among individuals from all walks of life.
Prime Minister Shehbaz Sharif’s acceptance of the book demonstrates his commitment to engaging with intellectual voices and promoting informed discourse on matters of national importance. The event serves as a testament to the enduring influence of literature and the power of ideas to shape the course of a nation’s destiny.
As “Aur Tabdeeli Galay Par Gayi” takes its rightful place on bookshelves across the country, it promises to make a lasting impact on readers, challenging their perceptions and enriching their understanding of the societal transformations underway in Pakistan. The book stands as a testament to the invaluable role of journalists and intellectuals in documenting the winds of change and guiding the nation towards a brighter future.


NANCY is a provocative psychodrama about love, intimacy, and trust – and the slippery nature of truth. A serial imposter, Nancy has gotten more and more comfortable assuming fake personas, and lines have started to blur between fact and fiction, and performance versus reality.
Blindsided by the death of her mother, and facing rejection by a love interest, Nancy’s life begins to unravel. When she meets a couple whose daughter went missing thirty years ago, she becomes increasingly convinced these strangers are her real parents. As their bond deepens, reasonable doubts give way to willful belief – and the power of emotion threatens to overcome all rationality.


Olibrix is a one-of-a-kind destination where books bring people together to educate us, engage our curiosity and to continue to look at the world through a different lens.
Our Mission is to provide access to children's books written and translated into different languages to every household, school, and community.
At Olibrix we believe that literature and languages are the gateways to a brighter future for our children. Every purchase supports a child's development and piques their curiosity about books and different cultures. We promise to always stay true to our core values of quality, transparency, and equality.


You Save: $14.99 (60%)
Little Edith loves to do handstands. But is she any good at them? Can she actually stay upright? In her 7 days of perseverance she learns the power of practice. Thwarted by spiders, worms and her dad’s newspaper, Edith tells her own tale of mastering the art of being upside down. All the while, readers will be counting down the seconds with her and learning the days of week in her story that ends with the prize of an ice lolly.
Beautifully illustrated by leading designer Lisa Stickley, this is a lovely book to cherish and learn from. A light hearted tale that at its heart will teach one of life’s great secrets: practice makes perfect.
30 in stock


(ebook, epub and kpf file)
We all have them, most of us see them, but only a few people pay attention to them: the scattered, transparent and mobile dots and strands in our field of vision. In ophthalmology, they are called “eye floaters” and explained as vitreous opacities.
But is this explanation correct? In this book, the author Floco Tausin follows the seers’ experience that eye floaters are not a cloudiness of the vitreous humour, but a shining structure and an expression of our state of consciousness.
In this collection of previously published and revised texts, the author explores the shining structure of consciousness in ancient civilizations. Topics include works of art, myths and worldviews of Ancient Egypt, Mesopotamia, Ancient China and Pre-Columbian Central America.


To commemorate the 40th anniversary of the Ash Wednesday fire, the Gisborne Gazette has produced a book that features the stories of 63 individuals and families who survived the traumatic events of February 16, 1983. There is also a wealth of information gathered from reports published at the time.
This handsome book is illustrated with many photographs, some of which were taken during the fire.
All copies of the book have been sold.
For anyone who missed out, copies can be seen at the Gisborne Library, the Gisborne Genealogical Group and the Gisborne Historical Society.


Ridley Pearson: In Harm's Way
Ridley Pearson's newest Walt Fleming novel will be out on August 3rd. I can't wait to find out what's going on with Walt and Fiona, and what adventure Walt will take me on this time. Below is the blurb from Ridley's July 2010 newsletter.
"Sun Valley sheriff Walt Fleming's budding relationship with photographer Fiona Kenshaw hits a rough patch after Fiona is involved in a heroic river rescue and she attempts to duck the press. Despite her job and her laudable actions, she begs Walt to keep her photo out of the paper, avoiding him when he can't. Then Walt gets a phone call that changes everything: Lou Boldt, a police sergeant out of Seattle, calls to report that a recent murder may have a Sun Valley connection. After a badly-beaten body is discovered just off a local highway, Walt knows there is a linkbut can he pull the pieces together in time?"
You can email him for autographed copies of the book at firstname.lastname@example.org


In the sunset of life it isn’t fun to suddenly realize, that you never had the life you wanted. That things never went the way you thought they should, and even if you generally think that your life has been mostly fine — the day will come when you realize, the “somedays” you dreamed about aren’t coming.
It can happen when you are watching an old show on TV, that show you watched in your formative years, the one that made you laugh, the one you all talked about the next day, the one that seemed to describe your forward path — but it never did. And that is because life is not a sitcom. There is no team of writers plotting all the twists and turns. No one to type up the happy ending.
They say that you are responsible for writing your own story. But no one tells you that you may carry one story in your head, while you live out another. And even if that life is full of love and laughter, the day will come where a snippet of music, a mention of a movie or the title of a book will open up a dark hole under your feet. And if you aren’t careful, you will fall into this hole, tumbling over and over like Alice, watching all the souvenirs of your life cascading around you, and as hard as you try to catch them, you can’t.
Tokens of you childhood streak by like shooting stars, the puffs of smoke that were your dreams, from the days when all seemed possible. And as you plummet you are joined by fleeting ghostly shadows of lovers and friends who swirled in and out of your life. They whisper as they pass by, but you cannot catch what they say, you’ve forgotten the sound of their voices. From deep inside you, memories flicker, what were those plans we had? The promises made to each other, the song you promised to sing at her funeral, but by then you had lost touch.
Soon you are wrapped in swirling clouds of motherhood — diapers and first teeth and the leftover equipment of their childhood activities, photos and toys and high school rings: the music of a thousand performances. Then comes the rising of a deepening ache as one by one they leave home, and the feeling of loss, of “never again” threatens to drown you. There are points of light that fill you full of warmth, and again your head fills up with dreams, this time you will get things right. The circle will re-form itself with everyone reachable, touchable, lovable and the next generation running in and out, calling for you.
However, the hole continues to widen and as hard as your try to hold their hands, to encircle them with your arms, they drift away, smiling as they go, their own dreams covering them like fog.
And you wake up one day to realize, you are living in a house that no one will visit, in a place where no one will return, and the vision of your sunset years reveals itself to be just more smoke.
You wonder what was the turning point, where was that bend in the road that took you in the wrong direction. No amount of turning around will get you back to that place, you have no choice but to continue falling, holding on to the new life where there is still love and laughter, no longer trying to catch the things that are falling away, trying as best as you can to quiet the heartache, accepting that you have reached to part of the journey where losses mount.
With an understanding nod (after so many years denying it) to Judith Viorst’s “Necessary Losses.”
Originally published at http://www.smilesideoflife.com.


Healthcare is a humanistic field where language mediates key interactions between doctors, researchers and patients. But recent developments in language models present a unique chance to revolutionize artificial intelligence systems.
Large language models (LLMs) are advanced artificial intelligence (AI) systems designed to process, understand, and generate human-like text. They are based on deep learning techniques and trained on massive datasets typically containing billions of words from various sources such as websites, books and articles. This extensive training allows LLMs to understand the nuances of language, grammar, context, and even some aspects of general knowledge.
LLMs are extensive pre-trained AI systems that can be easily adapted for various domains and tasks with minimal adjustments. These dynamic and engaging models hold significant potential in extracting universally valuable insights from medical knowledge sources.
The Role of Language Models in Healthcare
Today, there are several potential use cases of such models in healthcare, including search in large datasets, clinical decision support, analysis and structuring of key findings, as well as rapid resolution of problems associated with the timely first aid provision, and much more.
Some areas in which Language Models can help healthcare:
- Transform and extract key ideas from large volumes of scientific articles, medical materials and notes without lengthy proofreading of the entire text.
- Compare information from cluttered and unstructured text with organized lists in the electronic health record to ensure clinical data accuracy.
- Converting data back from machine-readable forms into natural language for better understanding.
- Search simultaneously across different data sources.
- Transform images, such as PDF reports or scans of surveys into text lists.
- Speech identification processing, allowing users to manage clinical notes or other data that we can convert to text.
Improving Clinical Decision Support
Language models play a crucial role in clinical decision support systems (CDSS) by providing healthcare professionals with valuable insights and recommendations based on the analysis of medical data and texts. Here, we’ll discuss how language models aid in CDSS. And provide case studies to illustrate their effectiveness in successful diagnosis and treatment recommendations.
How Language Models Aid in Clinical Decision Support Systems:
Data Processing and Extraction:
Language models are excellent at processing large volumes of unstructured medical data. This includes electronic health records (EHRs), a variety of medical literature, and clinical notes. They also have the ability to extract important details such as patient demographics, medical history, symptoms and diagnostic reports, making this information easily accessible for in-depth analysis.
Based on a patient’s historical data, language models can also be used to predict potential complications and responses to treatment. This way, they will help doctors identify risks more quickly and tailor treatment plans that meet individual needs and circumstances.
Natural Language Understanding:
Language models have the ability to interpret medical narratives expressed in natural language. They can discern medical conditions, medications, treatments, and the relationships between various elements in the text. This capability enables a more comprehensive understanding of the patient’s health status and medical history.
Clinical Guidelines Integration:
CDSS powered by language models can integrate clinical guidelines and best practices, ensuring that healthcare professionals receive up-to-date and evidence-based recommendations for diagnosis and treatment.
Medical Knowledge Base:
Language models are trained on extensive medical literature, enabling them to understand and access a wide range of medical knowledge. This knowledge can be used to provide context-aware recommendations for diagnosis and treatment.
Case Studies Illustrating the Effectiveness of Language Models in CDSS:
IBM Watson for Oncology:
One prominent example of a clinical decision support system (CDSS) is IBM Watson for Oncology. This system is designed to analyze a patient’s medical records. It is able to match them with an extensive database of medical literature, clinical trial data and expert knowledge in the field of oncology. A study conducted in India demonstrated the effectiveness of the system. Watson for Oncology provided treatment recommendations consistent with those of human oncologists in 96% of breast cancer cases and 93% of colon cancer cases. This highlights its significant potential for improving cancer treatment and highlights the important role of language models in medical decision making.
Mayo Clinic’s Clinical Text and Knowledge Extraction System (cTAKES):
cTAKES is an open source clinical decision support system (CDSS). It uses natural language processing (NLP) and language models to extract structured information from clinical descriptions. Its innovative approach has found widespread use, improving the analysis of clinical data and making it more accessible for research and decision support purposes.
Cleveland Clinic’s Cardiology AI System:
The Cleveland Clinic developed an AI system powered by language models to predict patient outcomes in cardiovascular disease cases. By analyzing EHRs and clinical notes, the system provided physicians with predictive insights, enabling more informed decision-making and personalized treatment plans.
Google’s DeepMind and Moorfields Eye Hospital:
Google’s DeepMind collaborated with Moorfields Eye Hospital to develop an AI system that utilizes language models to analyze retinal scans and identify eye diseases. The system demonstrated accuracy levels comparable to human experts in diagnosing conditions like diabetic retinopathy.
Based on all of the above, we can see that such implementation of language models provide compelling examples of how they can improve and enhance clinical decision support systems (CDSS), providing accurate and timely recommendations for diagnosis and treatment. They highlight the enormous potential of language models to revolutionize healthcare by improving the quality of care, minimizing diagnostic errors and ultimately helping to save lives.
One of the main potentials of using language models is their ability to improve patient-doctor interactions by acting as virtual healthcare assistants. These virtual assistants can answer patient queries, provide accurate medical information. And facilitate more effective communication between patients and healthcare providers. In this context, we will dive deeper into how language models can improve this interaction. And delve deeper into the concept of virtual health assistants.
Improving Patient-Doctor Interactions with Language Models:
Because language models can transform data, they can be used to make complex medical information more accessible to everyday users. Patients can ask questions about their health conditions, medications, treatment options and more in simple language. So the language model can provide clear explanations.
Patients frequently feel anxious while awaiting test results or when confronted with a new diagnosis. Language models can offer information and comfort, assisting patients in comprehending their conditions and treatment plans more thoroughly. This support can significantly alleviate stress and anxiety levels.
Language models can act as educational tools, offering patients information on preventive measures, lifestyle changes, and disease management. This empowers patients to take an active role in their healthcare.
Virtual health assistants driven by advanced language models operate 24/7, enabling patients to access information and assistance whenever they need. This proves particularly invaluable for individuals facing urgent issues or residing in diverse time zones.
Language models play a crucial role in overcoming language barriers and enabling communication with patients who do not speak English. These models can translate queries and deliver responses in various languages, guaranteeing that healthcare information is readily available to a wide-ranging patient demographic.
Virtual Health Assistants for Answering Patient Queries and Providing Medical Information:
Virtual medical assistants can help patients book an appointment with the right doctor quickly and efficiently, ensuring that patients receive timely care.
When patients are unsure of the need for a visit and consultation with a doctor or do not have the opportunity to visit a clinic in the near future, the ability of virtual assistants to classify and offer recommendations for primary care becomes especially useful.
Virtual medical assistants can provide accurate and up-to-date information about prescription and over-the-counter medications. And in this way, patients can learn about the uses, side effects and interactions of drugs.
After a medical appointment, virtual health assistants can follow up with patients to check on their progress, remind them of prescribed treatments, and answer any questions that may have arisen since the visit.
Virtual health assistants can provide personalized health education materials, videos, and resources tailored to an individual patient’s specific condition or health objectives.
Privacy and Security:
Safeguarding the privacy and security of patient data is paramount. Virtual health assistants must comply with rigorous privacy regulations such as HIPAA (in the United States). And implement strong security measures to safeguard patient information.
In critical situations, virtual health assistants can guide patients through basic first aid procedures. And provide instructions on seeking emergency care.
In summary, virtual health assistants driven by language models hold the promise of enhancing patient-doctor interactions by offering prompt, precise, and easily accessible information to patients. They have the capacity to boost patient engagement, alleviate the workload of healthcare professionals, and ultimately improve healthcare results. Nevertheless, it’s crucial to strike a balance between automation and human interaction to preserve the personal and empathetic aspects of healthcare delivery.
Certainly, here are real-world examples showcasing specific use cases of language models in healthcare:
Radiology Report Analysis:
Use Case: Language models help analyze radiology reports to extract critical information, identify abnormalities, and assist radiologists in their interpretations.
Example: Enlitic, a healthcare AI company, employs NLP techniques to analyze radiology reports and images. Their system can quickly identify and prioritize cases that may require immediate attention. Potentially reducing the time it takes for patients to receive necessary care.
Medical Image Captioning:
Use Case: Language models are utilized to generate descriptive captions for medical images, aiding in documentation and interpretation.
Example: IBM’s Medical Sieve project combines image analysis with natural language processing to create detailed captions for medical images. This technology can assist healthcare professionals in understanding and communicating complex visual information, especially in radiology and pathology.
Use Case: Language models are employed to analyze scientific literature and databases to identify potential drug candidates and predict their effectiveness.
Example: Insilico Medicine, a biotechnology company, uses AI and language models to accelerate drug discovery. They analyze vast amounts of biological data and research papers to identify new drug targets and design novel compounds with the potential to treat diseases, including cancer and Alzheimer’s.
Clinical Trial Matching:
Use Case: Language models assist in matching patients with appropriate clinical trials based on their medical records and eligibility criteria.
Example: Trialjectory is an AI-driven platform that uses NLP to analyze patient records and match eligible individuals with suitable clinical trials. This technology helps patients access cutting-edge treatments and facilitates the recruitment of participants for medical research.
Patient Data Extraction:
Use Case: Language models extract structured information from unstructured patient data, such as electronic health records (EHRs) and clinical notes.
Example: Google’s Healthcare API leverages language models and NLP to convert free-text clinical notes and medical records into structured data that can be easily integrated into EHRs. This simplifies data retrieval and analysis, benefiting both healthcare providers and researchers.
Disease Surveillance and Outbreak Prediction:
Use Case: Language models analyze online sources, including news articles and social media, to monitor disease trends and predict potential outbreaks.
Example: HealthMap, an initiative by Boston Children’s Hospital, uses NLP to scan online news reports, social media, and other sources to detect and track disease outbreaks in real-time. This information aids public health authorities in responding swiftly to emerging health threats.
These real-world examples highlight the versatility of language models in healthcare, demonstrating their ability to assist healthcare professionals in various tasks, improve patient care, and advance medical research. As language models continue to evolve, their impact on the healthcare industry is expected to grow, driving innovation and improving healthcare outcomes.
In conclusion, we can confidently state that language models have had a significant and transformative impact on analyzing medical texts and diagnosing illnesses in healthcare. They have become reliable tools for healthcare professionals, helping them process data efficiently, make better clinical decisions, and provide patients with medical information. These models have played a major role in reducing mistakes in diagnosis and improving medical research.
Looking forward, the use of language models in healthcare is expected to grow further, thanks to advancements in language technology, their integration into medical processes, and ethical considerations. The global influence of these models in healthcare, along with their ability to overcome language barriers and enhance healthcare outcomes, promises a future where healthcare is more precise, efficient, and focused on patients. This underscores their crucial role in shaping the healthcare industry.


Francoise, all your friends have gathered in your time of need, sending all their love.
For the last year or so, you have been the best friend and strength to those on Acmepet's message boards. You fix graphics, write webpages, and just plain be a friend. In your time of need, we would like to try to return that favor, and at least show you we care.
This guestbook is in honor of Nick, a wonderful friend, companion, and husband.
This guestbook is an honor book for you and he!
Read Guestbook Memorial
Sign Guestbook Memorial
Now for a few gifts from your friends:
A Gift from Zac's Mom
A poem from Robin
A Gift from Robin, aka Furfeather
This Eternal Flame Burns for Nick.
Visit the Page of Eternal Flames
Now, from JD, this Beautiful work of art of poetry.
The Head Trainer Recruits an Angel.
A dedication to Leilah's Mom.
Leilah was restless.
The more she tried to get comfortable and rest, the more troubled she became.
Something was wrong.
Earlier, Mom had come home in a rush and with tears in her eyes.
The phone wouldn't quit ringing and the house suddenly seemed cold.
At one point, Mom grabbed her up and hugged her so tight she
thought she wasn't go to be able to breathe. And when she finally got
back down on the floor again, her fur was wet. She gave a little wag
of her tail, which usually made Mom smile, but this time it only made
Mom start crying again.
So Leilah jumped up and ran to the window. After all, if
Mom was home, that meant Dad would be home soon, didn't it?
But when she looked out the window, the world outside looked
different, somehow. . . Like it was missing something. She ran
back over to Mom and looked at her, asking the question with her eyes.
The phone rang again, and Mom was strong when she answered it, but began crying again.
That's when Leilah thought she heard Mom say something about Dad.
The room started looking misty and gray, and she couldn't seem
to focus real well on anything. Suddenly, Leilah became very tired.
She laid down on her little bed, closed her eyes and prayed that
Mom was mistaken, that what she had said on the phone wasn't true.
And as Leilah continued praying, she slowly dozed off into a deep, but fitful slumber. . .
Leilah awoke with a start.
The world seemed very bright, very warm and comforting and
as she stood up and slowly stretched, she saw another dog standing
in front of her. Baring her teeth at the stranger, Leilah prepared to
drive the stranger away. But upon looking around, she discovered she was not at home!
"Don't be afraid," the other dog said, taking a step forward.
"Who are you?" asked Leilah.
"My name is Charlie," answered the other dog, a female
"We think you have some questions, so we brought you here to help answer them."
"Where am I," asked a very confused Leilah.
"You're in a place that has many names," explained Charlie.
it the Rainbow Bridge, others call it the Big Kennel,
but your Mom and Dad would call it Heaven."
"But I'm not dead, what am I doing here?"
"No, you're not," agreed Charlie. "But the Head Trainer
you up here so the two of you could talk. There's something
you have to do before going back home to your Mom."
"Say good-bye to somebody you know."
Leilah got an uneasy feeling in her stomach. As Charlie began leading
Leilah inside through the Gates Made of Milk Bones, the Head Trainer appeared.
"Hello, Leilah," said the Head Trainer. "Charlie will
take you to the
place you need to go, then you'll come back and we'll talk for a
bit before it's time for you to go back to your Mom."
"This way," motioned Charlie, as she started up the path over
where the Looking Glass stood. The Looking Glass was a special
window to Earth in which you could look down and see everyone.
All you had to do was think, and that message would go to whoever
you were thinking about. It was how all the dogs in the Big Kennel
would talk to their owners whenever their owners became sad.
As they approached the Looking Glass, Leilah saw a man sitting down
in the grass and petting another dog. Somehow, the man looked
really familiar. Then when he turned to see who was approaching. . .
"DAD!!!" shouted Leilah, as she bolted for the man.
"DAD! I'm so glad I found you. Mom and I were looking
everywhere and Mom is so worried and scared, she's crying and
everything. I can't believe I found you! Oh, DAD!!!"
Nick at first looked sad, then he gave a small, lopsided
grin as he gave Leilah a quick hug. "How are ya', girl?"
Leilah just wagged her tail and licked Nick's face like nothing
else mattered. Then it finally dawned on Leilah what was going on.
"Oh no, Dad. . ." stammered Leilah. "No--"
"It's all right," Nick assured Leilah. "It's OK. I know this scares you, but trust me, it's all right."
"But what about Mom?" cried Leilah. "What are we going to do without you? Mom will be so lonely."
"No," answered Nick, "because she has you."
"And she also has me," said the Head Trainer, who had just
walked up and sat down on the grass with Nick, Charlie and Leilah.
"WHY DID YOU HAVE TO DO THIS???" wailed a sobbing
Leilah to the Head Trainer. "It's not fair. Dad was so good to all
of us and Mom loved him so much. Why did you have to TAKE HIM NOW?!?"
"Leilah," began the Head Trainer, "there are things
there on Earth that are good, and there are things happening that
are not good. Do you understand why I bring dogs home here?"
"Yes," Leilah quietly answered. "You make them angels to
look out for other dogs who are not as lucky as me.&"
"You're very wise," nodded the Head Trainer. "And I do
with people. It's a very difficult time down on Earth for a lot of people
right now. While I could stop it all in the blink of an eye, I choose
to let humans have free will and reign over their lives. But some of the
people have problems to great for them to bear alone, and they ask me
for help. There are elderly people who are all alone in nursing homes
with nobody to talk to, nobody to listen to them. There are children
living in impoverished inner-city neighborhoods surrounded by drugs
and criminals. There are children and women who are being abused
and molested. And there are good people who sometimes make
mistakes that could get them in a lot of trouble if
somebody wasn't there to stop them."
"Those people, Leilah," continued the Head Trainer, "they need angels."
"But why my Dad?" asked Leilah.
"Leilah," Nick began, "the Head Trainer and I were
talking. Seems I
would've gone anytime, and nobody knew it. If your Mom
and I had really known about it, we wouldn't have lived our lives to
the fullest. We would've held back, we would've always worried about
when "it was time." And that would have distracted us from truly
living every day to its fullest, to love each other unconditionally--like
our wedding vows: For richer or poorer, in sickness and in health, until death do us part."
"Instead," said the Head Trainer, "your Mom and Dad lived
with through the joy of their love for each other one day at a time.
They are great people, people with goodness in their hearts and souls.
People who will not let death affect their love for each other."
Charlie got up and went over to Nick and whispered something in his ear.
Nick smiled, nodded and gave Charlie a pat on the head.
"Leilah," said Nick. "It seems there is a job for me to
do up here.
I'll be in training for a while, but when I'm finished I'll be going back
and forth to Earth. There are children who need an angel, and
there are others who need help and guidance that they can't get anywhere
else. Those people all alone in a strange hospital who know they'll never leave?
I'll be there with them, talking to them and giving them comfort.
The children who are being abused? I'll be there with them, taking
their pain to spare them any more. And just as Charlie here shows
dogs how to get around up here, so will I when it's time for people to come Home."
"So, does that mean I'll see you when you're
down on Earth?" asked a hopeful Leilah.
"I'm afraid not," answered the Head Trainer. "But, you
when your Dad is down there for you will suddenly feel young again,
and his memory will suddenly wash through you, making you happy, not sad."
This was all just too much for Leilah, and she began sobbing again.
"But, but. . . I'll miss you so much--and what about Mom?"
As Charlie moved over to comfort Leilah, Nick gently stroked
Leilah's neck. "Tell Mom that I love her dearly--and in ways now
that I can no longer express. But we can no longer talk person to
person, no, we will now have to express our love soul to soul,
spirit to spirit. I will always love Mom, always, and will be there to
comfort her thoughts in her times of need. And until we meet a
gain, Leilah, I need you to be there for Mom."
The Head Trainer nodded at Charlie. "OK, Leilah," said
"it's time to go back down. Your mom will be waking up
soon, and you need to be there when she does."
As everyone got up, the Head Trainer petted Leilah one last time,
as did Nick. And as they all walked by the Looking Glass,
a chorus of angels appeared all around them and began singing a
symphonic chorus filled with Joy, Glory, Praise and Hope.
And down on Earth, that chorus reverberated throughout,
manifesting itself in a variety of nature's most awesome displays:
Spectacular rays of sunshine. Life-giving rain storms.
Crashing ocean waves. Pure white driven snow flakes.
Infinite winds whipping across the plains.
Giving her dad one last look, Leilah turned to
Charlie and said, "I'm ready. Let's go back."
Charlie paused, and then pointed. Nick was at the
Looking Glass with the Head Trainer.
"Francoise," he began, "I loved you when we first met and
you every single day we were blessed to have together.
Be strong, my love, for our time apart will not be an eternity,
but our time together when we meet again will be for Eternity."
"I love you."
Leilah turned and looked at Charlie.
"The Head Trainer only takes the best for His angels, doesn't he."
"Nothing but the best," was Charlie's reply.
(dedicated to loving memory of Nick and to his bride and
Francoise. God truly Blessed the both of you.)
God Bless you with Strength and Love. And Francoise, with every tear that falls, ours are falling with you!
Some Links for you to read'
I Do Not Sleep
On Joy & Sorrow
Life will not go on the same without him.
If it were the same,
we could only conclude his life meant nothing,
made no contribution.
The fact that he left behind a place that cannot be filled,
is a high tribute to the uniqueness of his soul.
From Til we Meet Again
To add graphics or other gifts, email firstname.lastname@example.org
Backgrounds by Over the Rainbow


Would you know evil if it walked up and shook your hand?
The following is paraphrased from William Lashner's "Fatal Flaw"
The submission of will is the start of goodness.
I tell you a person can be evil without cleft feet and a tail. What is it to be evil in this world? It is to have an unsubmitted will, to swear allegiance to nothing but the inner demons of one’s self, and to use every possible means to bend others to those same demons.
The evil all cleverly hide it behind a veneer of good intentions. Nothing exists to temper their desires. Whatever they want is right, whoever opposes them is wrong, everything they do is justified and proper, everything in this universe exists for the purpose of serving them. You can see it in the way they deal with people and the way they deal with problems.
What they do, on the surface, seems righteous but there is always in evil people a desperate attempt to portray themselves as the soul of righteousness. And just as inevitably, whenever a portion of the evil slips from that false cover of propriety, they are quick to angrily blame someone else for the evil deed.


In the book, Gale Hawthorne is Katniss Everdeen’s best friend in District 12, the coal mining district on the outskirts of the country. The two hunt together and divide up the game that they catch. Although there’s no overt romance in the relationship, Katniss continually evaluates her feelings for him. But when she is sent to compete in the games, where she faces off against 23 intense competitors, Gale is left behind. While Katniss thinks about him during the games, the story never shows him after the games begin. In the film, however, the first-person narrative is changed to a third-person narrative so viewers will see what Gale is doing as his friend competes in the games. We watch as he desperately longs for Katniss and notices that she’s developing an onscreen relationship with fellow tribute, Peeta Mellark.
In an early scene in the book, Katniss makes camp near a young woman who starts a campfire. After the young woman is discovered, she is attacked and nearly killed by some of her fellow tributes. But when they discover that she’s alive after the attack, Peeta is sent to finish the job. In the conclusion of the book, Cato; facing off against a group of mutant mutts, survives for several hours before Katniss puts him out of his misery. In the movie, however, these deaths are done quickly. The film finds the bonfire girl dying quickly after she’s attacked and Cato only suffering a few moments before Katniss ends his life.
The biggest change between the book and the movie is the reaction to Rue’s death. In the book, Katniss only knows that she receives District 11’s appreciation for her kindness in the form of a gift dropped into the arena. In the movie, the complete reaction of District 11 is brought into greater focus. The people of District 11 begin to revolt against the capital officers who watch over them. They fight against the government that has taken one of their own and sent her into a battlefield to die for their viewing pleasure.


Pearls are frequently mentioned in the New Testament, and were considered by the ancients among the most precious of gems, and were highly esteemed as ornaments. The kingdom of heaven is compared to a "pearl of great price."
In the book of Matthew pearls are used metaphorically for anything of value, or perhaps more especially for "wise sayings."
No mention shall be made of coral or of crystal; the price of wisdom is above pearls.
Job 28:18 ESV
The heart of PEARLS is to connect older women with younger women in a mentoring relationship to encourage and challenge one another in their walk with Christ. Women invest in the lives of each other through encouragement, guidance, listening, laughing and loving. The goal is to form strong and lasting relationships that are a source of support, growth and strength. A mentoring relationship between an older and younger woman will be filled with treasured pearls of wisdom. Wisdom gained through life experiences and walking with God.


Board covered paperback
See-through pages and magic surprises! It’s true!
Hold the special pictures up to the light to discover what’s inside a rocket, a castle, and even inside your body! There are also plenty of exciting facts.
Draw in your own surprises, too!
What present will you draw inside the box?
Which snacks will you draw in the fridge?
Who will you draw behind the door?
“This book is a must for inquisitive children who want to know how things work – by lifting the pages up to the light, you can see the inside of many things from the human body to a medieval castle.” – J.A. Smith
Thames and Hudson.