The first step to surviving the bad in life is to accept the reality that it exists at all. There’s a saying among boxers that the punch that knocks you out is the one you didn’t see coming, and it’s like that with both violent crime and any of the other troubles that fate might throw your way. If you have even a hint that it’s inbound, then maybe you can sidestep it, maybe you can brace for it, maybe you can even shove back against it. When it comes to violent crime, anybody with any exposure to the news knows that it’s out there. The trick, I think, isn’t just about knowing that it exists, but that it exists in your neighborhood, on your block, even in your home. When you realize that bad things can happen to you and the people you know and love, it changes how you view the world. Paranoia isn’t a necessary outcome, but getting past obliviousness and faith that bad things only happen to other people in other places is a necessary precondition to being able to prepare for it.

It can be the hardest step, and made harder by having to face exactly what violent crime looks like. Our cultural fascination with true crime gives us an idea of what bad guys can accomplish but it’s so easy to swipe away, to hit stop and move on. It’s hard to immerse ourselves into evil, to truly internalize how cruel one person can be to another. I’d argue that it’s not healthy to dip too deeply into it, and risk losing hope about humanity. At the same time, you need to have at least the barest clue that bad guys might be motivated to hurt you for nothing more than their own ego or because you’re in the way of their payday, that they might be more dedicated and skilled than you, that they might be determined to win at all costs. It’s not even that the bad guys might hate you; worse, they may feel nothing at all or simply feel happiness and joy at taking you out of their way or making you into their example, the product of their art. It’s awful, but like a potholes in a road, we can’t do anything about it unless we know they exist and learn how to see them coming.

There is a solution though. It’s not an easy one, but even starting down the road towards finding it can be enough to keep evil merely at your doorstep and not inside and in your face. Here’s all it is:

Do the work.

By that, I’m talking about learning and implementing all of the various safety strategies that we talk about so much here at OHO. You need, as John calls it, general deselection – preventing bad guys from choosing you as their victim today – and specific and forced deselection – getting bad guys to change their minds about attacking you, with violence if necessary. The changes you might need to make to how you move through the world and interact with people could be minor, a refinement of who you are and what you do, or could themselves be a seismic shift in everything about you. You need to surround yourself with the right environments and the right people so that you can better avoid stupid people in stupid places at stupid times. It sounds simple, but it’s not easy if it requires you to find new jobs, leave your old friends, or move to new places. All that and you need so-called hard skills, using tools like pepper spray and guns and knives perhaps, not to mention being able to move your own body against the demands another might impose when they try to force you to their will.

The work is not a time-bound effort. It’s not something you can do once and have it be enough for the rest of your life. You’ll have to revisit it over and over, to learn new aspects and review old ones. As John taught us, many repetitions performed often is the only way we can ensure that we have what we need, when we need it. All of us have had the experience of being shown a new skill, trying it a few times, and struggling to perform it again a few months or years later. Picking it up again might not be as difficult as the first time around, but it will take some time, some attention. If, however, we practice it a whole lot at the beginning and keep practicing it every week, every day, at that same six-month mark after from day one, we are so much more fluent with performing it. It’s the same for self-defense skills as everything else, including keeping fresh the mindsets and thought processes that go into staying safe.

It sounds like so much, and it can be. We have to accept the terrible things that can happen to us, from other people and otherwise. We have to adjust and shift how we approach the world, and dedicate time and other resources to be able to avoid or fight back against not just bad guys, but really bad guys. It might fundamentally change who we are. And that’s no bad thing, as acknowledging that the scary stuff exists allows us to face those fears, and make positive actions to managing them instead of relying on luck and fate to survive. Beyond that, it makes us more confident, more capable of being on our own, so that we can choose when we don’t want to b<|endoftext|>Why Does My Dog Hump Blankets? (9 Reasons and When To Worry)

How many times have you walked into a room, only to witness your furry friend engaging in what seems like a comically bizarre dance with their blanket? If you’ve ever pondered, “Why does my dog hump their favorite blanket?”, you’re certainly not alone. This seemingly peculiar behavior is more common than you might think, stirring both laughter and puzzlement amongst many dog owners.

For some dogs, humping is a display of dominance or a form of play; for others, it may be a response to stress/anxiety or just an attention-seeking behavior. It could also be a result of sexual stimulation, especially in dogs that haven’t been neutered or spayed. Sometimes, it can even be a symptom of a medical issue. It’s a fascinating puzzle that requires a discerning eye to decode, and understanding it is key to ensuring the well-being and happiness of your canine friend.

There are numerous reasons behind your dog’s humping behavior and this article takes a deep dive into understanding these reasons, shedding light on this peculiar yet utterly normal part of their canine world.

Why Does My Dog Hump Blankets?

Dogs may hump blankets for various reasons, and it’s important to understand that this behavior can have multiple underlying causes. Here are some of the reasons why your dog may hump blankets

1. Dominance or Social Status

As descendants of wolves, dogs have inherent social hierarchies, often referred to as a pack mentality. Within the social construct of a pack, certain actions are taken to assert dominance or to find one’s place in the social order. Humping is one such behavior that dogs use to demonstrate their dominance. If your dog humps a blanket in front of others, it could be its way of signaling that it perceives itself to be the leader or at least above others in the social hierarchy. This action isn’t about the object being humped; it’s more about the message it sends to the other observers.

2. Sexual Arousal

Dogs, like any other living beings, have basic instinctual drives, one of which is sexual. While it may seem awkward to humans, humping due to sexual arousal is quite normal among dogs, particularly males who haven’t been neutered. Even spayed females have been known to hump objects occasionally, though this is less common. This sexual behavior can be directed towards other dogs, objects like a blanket, or even a human’s leg.

3. Excitement

Humping is also a form of expression that some dogs might use when they are extremely excited. The triggers for this excitement can vary widely from dog to dog. It could be a favorite toy, the anticipation of a walk, a visit from a beloved human, or even the arrival of a new piece of furniture. Dogs are high-energy creatures, and humping can sometimes be their unique way of burning off some of that extra energy.

4. Stress or Anxiety

Dogs may resort to humping as a way to alleviate stress or anxiety. This is akin to certain humans biting their nails or fidgeting when they are nervous. Dogs who are uncomfortable, nervous, or stressed might find the rhythmic act of humping comforting. The routine and predictability of the action can help calm them down and make them feel more secure in their environment.

5. Playful Behavior

When it comes to puppies and young dogs, humping can often be part of their play routines. It’s a natural part of their development as they figure out how to navigate social scenarios and interactions with their siblings, other dogs, or even objects. As they get older and their social skills mature, most dogs will move on from this behavior, though some may continue to engage in it occasionally. If your older dog still humps your blankets, you may want to teach him other ways to play.

6. Inappropriate Attention Seeking

Dogs are intelligent animals that are capable of learning and understanding behavioral consequences. If your pooch learns that humping an object like a blanket draws attention from you, even if it’s negative, he may continue to perform the behavior to get the reaction they desire. This inappropriate attention-seeking is a learned behavior and can be remedied with proper training and behavioral adjustment techniques.

7. Learned Habit

If humping isn’t addressed appropriately when a dog is young, it may develop into a habitual behavior. This is especially true for dogs who don’t have sufficient outlets for their energy or instincts. If your dog doesn’t have enough toys or activities to keep him engaged, he might resort to humping a blanket or other objects as a way to entertain himself.

8. Compulsive Behavior

Sometimes, excessive humping can be a


 expression or mutation burden.

Bladder Cancer Clinical Trials and Research
Through research and clinical trials for bladder cancer, we’ve made major advances in treating this disease. Learn about how you may be able take part in a clinical trial during your treatment.
Learn more

“I’m not ready to exclude anyone at this time,” Dr. Rosenberg said during the question and answer session of the panel.

One reason why a person with a PD-L1-negative tumor might still respond to PD-1 therapy is that both cancer and the immune system are dynamic. Tumors that are PD-L1–negative at the beginning of treatment might become PD-L1–positive over time as the immune system revs up and starts fighting the cancer.

On Saturday, MSK medical oncology fellow Samuel Funt looked at yet another possible predictor of response to atezo in bladder cancer: the number and diversity of immune cells circulating in the blood before treatment. He found a strong correlation between diverse numbers of circulating immune cells and ultimate response to atezo.

Researchers hope to one day find a biomarker that will reliably predict who will respond to these therapies, to be able to offer the right drug, at the right time, to the right patient.<|endoftext|>They live in a silent world. For people who are profoundly deaf or those suffering from a severe hearing loss, communicating with others and fitting into a hearing world becomes extremely difficult and limiting. Deafness and hearing loss are often caused by genetics, injury or illness, and most people think of them as lifelong conditions. But these individuals may be able to experience hearing through a cochlear implant, a surgically implanted device used to stimulate auditory nerves. Approximately 28 million Americans have some degree of hearing impairment, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). The group also estimates that about three out of every 1,000 children are born deaf or hard of hearing, and of those, 90 percent are born to parents with no significant hearing loss. Adult hearing loss increases significantly as we age, and for some, it reaches a point where traditional hearing aids are not beneficial.

Cochlear implants are a viable option for those who qualify for the surgery. Unlike a hearing aid that amplifies sound for a person who already can hear, a cochlear implant helps to create the stimulation needed to recognize sound in a person who cannot hear. Its objective is to stimulate the auditory nerves so that a signal is sent directly to the brain. The brain recognizes the signal as sound and allows a person to understand and differentiate the various levels and types of sound in their environment.

"The cochlear implant can take someone who is at the edge of functionality, or someone who is not functioning at all, and bring them back to the point where they can understand speech and have the ability to communicate," says Dr. Herbert Marks, an otolaryngologist at East Jefferson General Hospital who in 1984 performed the first cochlear implant surgery in Louisiana. "It can be a much better option for people who are struggling through life with hearing aids."

The cochlear implant works with three main components: a small device that is surgically implanted in the ear, a microphone and a processor. The implanted device is a transmitter placed under the skin behind the ear and is hooked to thin electrodes wrapped in the cochlea of the ear. The cochlea contains hair-like fibers that when stimulated send the sound signal to the brain. The microphone, an external piece used to collect sound, is placed in the location of the transmitter and held to the head through a magnet between it and the transmitter. Finally, the processor is a small box or, in some cases, a small unit outfitted to be worn similarly to a hear aid.

The three combine to form a pathway of sound to the brain. The microphone picks up sound and sends the information to the processor. The processor, through the use of an internal computer, decodes the sound levels and frequency and sends the signal to the transmitter. The electrodes stimulate the auditory nerve, and the brain then receives the signal.

Although the implant enables the brain to understand sound, the sound is not the same as that for an individual with no hearing problems. It is usually described as more mechanical or even as an AM radio out of frequency.

After receiving a cochlear implant, a patient will consult with their physician to ensure the device is properly functioning, as well as with an audiologist and speech therapist. Since individuals hear or process sounds differently, the audiologist is responsible for coding or "mapping" each patient's processor to individualize the internal computer for optimal sound recognition. The functional ability of the implant is turned on about four weeks after the surgery; it may take months to establish the best level for the patient as they either learn sound for the first time or relearn sound. Regular checkups are also needed to monitor the mapping levels.

"I have had patients literally break down in tears when we turn on the implant for the first time because they may have lived in silence for years or may have never heard sound before," says Dr. Marks. "That is part of the excitement. They can now be engaged in family conversations or (discussions) at work or school. There is no question that it can significantly change their quality of life."

As technology advances, the use of the cochlear implant is increasing. The NIDCD estimates that about 25,000 people in the United States have cochlear implants, but another 250,000 are good candidates for the surgery.

Add a comment<|endoftext|>Liver Enzymes Monitor Safe Use of Arthritis Drugs

Routine Liver Function Tests Check for Toxicity of Medications

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Liver toxicity is a potential side effect of some arthritis medications. Liver toxicity from arthritis medications is not considered common, but when it occurs it can be potentially serious. Doctors usually order routine blood tests so problems can be detected before they become clinically significant.

Liver enzymes are normally found within the cells of the liver. If the liver is injured or damaged, the liver enzymes spill into the blood, causing elevated liver enzyme levels.

Laboratory tests performed on blood samples can detect elevated liver enzymes.

Other blood tests can also signal liver function problems by detecting abnormalities involving plasma proteins and blood clotting factors. Normal or reference values for liver blood tests can vary based on the age or gender of the patient, as well as the laboratory method used for testing.

Liver Enzymes:

AST or SGOT (aspartate aminotransferase or serum glutamic oxaloacetic transaminase)

AST (SGOT) is not only found in the liver. It is also normally found in heart, muscle, brain, and kidney tissue. Injury to any of these tissues can cause an elevated blood level.
AST (SGOT) normal range is 10-34 IU/L.

ALT or SGPT (alanine aminotransferase or serum glutamic pyruvic transaminase)

ALT (SGPT) is primarily found in the liver, making it a more specific test for detecting liver abnormalities.
ALT (SGPT) normal range is 5-35 IU/L.

Alkaline Phosphatase (ALP)

Alkaline phosphatase (ALP) is an enzyme in the cells which line the biliary ducts of the liver. ALP is also found in other organs including bone, placenta, and intestine. When ALP is elevated, another test known as GGT (gamma-glutamyl transferase) can be ordered by the doctor to confirm that the elevated ALP is being derived from the liver or biliary tract.

ALP normal range is 20-140 IU/L (international units per liter).

Gamma-glutamyl transpeptidase (GGTP) or transferase (GGT)

Gamma-glutamyl transferase (GGT) is an enzyme which is useful clinically when compared to ALP. By comparing the two, it can be determined if the patient has bone or liver disease.
GGT or GGTP normal range is 0-51 IU/L.

Normal GGT + Elevated ALP is suggestive of bone disease
Elevated GGT + Elevated ALP is suggestive of liver or bile-duct disease

Other Liver Function Tests:

Bilirubin is produced from the breakdown of hemoglobin (the oxygen- carrying protein pigment) in red blood cells. The liver clears bilirubin from the body by excreting it through bile into the intestine. Elevated bilirubin levels can be indicative of liver disorders or blockage of bile ducts. In laboratory tests, bilirubin is measured as total bilirubin and direct bilirubin. Total bilirubin, as it's name suggests, is a measurement of all of the bilirubin in the blood. Direct bilirubin is a measurement of a form of bilirubin made in the liver.
Normal range for Direct Bilirubin is 0-0.3 mg/dl and the normal range for Total Bilirubin is 0.3-1.9 mg/dl

Albumin is the main protein in human blood plasma (the primary component of total protein).

Albumin is made by the liver. Laboratory testing indicates how well the liver is making albumin. Liver disease results in decreased albumin production.
Albumin normal range is 3.4-5.4 g/dL.

Total Protein

The majority of plasma proteins (albumin and globulins) in the body are produced by the liver. Laboratory testing for total protein is a way to differentiate between normal and abnormal liver function.
Total Protein normal range is 6.0-8.3 gm/dl (grams per deciliter).

Prothrombin Time

The prothrombin time (PT) or protime is a laboratory test used


’d be delighted to hear from you.

8 year old boy with a fear of dogs

Total session: 6 sessions over 10 weeks

An 8 year old boy came to see me with a fear of dogs that he had had since the age of 3. His Mum felt she was responsible for the fear, it had started whilst she was walking along holding his hand when a large friendly dog came bounding up and knocked her little boy over and started licking his face. The Mum screamed and shouted at the dog. She realises now she totally over reacted at the time, that there had been no danger to her or her boy; she had simply been taken by surprise.

Since then whenever her son saw a dog, he ran and hid behinds his parents, screaming and crying, needing to be picked up. He is always anxious when playing, fearing a dog could be nearby. The boy and the family stop themselves going to some public places in case a dog is around.

Because of the age of the boy and the severity of the fear it was paramount that the treatment plan went at his speed and not that of mine or the parents.

I established what the exact fear of dogs was. The fear was of all dogs of all sizes, breeds and of all ages even tiny puppies. The boy wanted to like dogs, he wanted to feed and stroke the dog next door to where he lived. Over the next few weeks with the use of the CD at night time we began to reduce the anxiety linked to dogs. Together we recognised his boundaries and then came up with ideas of how far he could push himself each week to help get closer to his goal of overcoming his fear. He also learnt what the normal expected amount of apprehension or anxiety regarding unknown dogs or dogs off the lead or large barking dogs should be.

During the next 6 sessions over a 10 week period he found that he could to go outside to play in parks and go to football matches and not even think about dogs or even notice that there was one near him. He gave treats to the old dog next door whilst he was tied up in the car. He went to a family BBQ and took a picture to show me of a dog running around his feet whilst he happily ate. Whilst in a pub garden with his parents a policeman and two police dogs came to search the pub, he didn’t go running back to his parents, he sat quietly and watched the dogs work, previously this would have been an extremely anxious and frightening experience for him. Yet now he was fascinated by how the dogs worked for the police.

This period of time was governed by his own ability to change his belief about dogs, at the speed and time he needed. He still wasn’t a major dog lover by the time he left me, but he wasn’t scared anymore. Dogs didn’t restrict him or his family in anyway. He was beginning to think that some dogs looked rather lovely and cute and was wondering what it would be like to cuddle them.

If you would like support resolving your own, your family’s or your employees issues please Contact us today. We’d be delighted to hear from you.

Accountant signed off work with anxiety and panic attacks

Total session: 6 over 13 weeks

Age and occupation: 41 year Accountant

This client was referred to me after being signed off work for stress and anxiety. This lady had been suffering from; panic attacks, OCD, negative thinking, stress and anxiety for a number of years. She had learnt to manage these systems by creating various coping strategies that meant she was able to hide from others how she was really feeling and how difficult she found some situations to cope with. However things had deteriorated considerably and she was now left unable to cope with the pressure and work load within the work place. She was unhappy at work, she was successful and a competent accountant yet doubted her own ability which was worsening particularly due to a bullying boss. She had been unsuccessfully applying for new positions in other companies, but knew her lack of confidence was showing through and she wasn’t demonstrating her full potential. In addition the client had an irrational feeling of guilt connected to the death of a family member when she was a teenager.

During the first session we removed the feelings of guilt relating to the family loss from many years ago. Previously my client would think about the death numerous times during the day and would still find it very upsetting. Within one session she was completely free of this issue that she had been carrying and had been haunting her since she was a little girl.

She would regularly listen to the CD at night time and over the following weeks the stress and anxiety began to reduce in many areas of her life without even needing to mention some of these issues whilst she was in the clinic room. She began to take back control and think more rationally and logically about situations. My client stopped the habit she had created of negatively thinking that something bad would happen to her or her family, particularly if she drove too far away from them or she was apart from them for too long. She began to drive further away from home and even booked a weekend away, which she had never done before. She started to take control in other areas of her life and found the confidence to visit the dentist which she had found too stressful before.

Gradually her confidence grew over the weeks. She started going out more and taking up fitness classes whilst trying to lose weight. The OCD reduced greatly, she found that she was able to stop the physical habits that she had created that would help reduce the anxiety she was feeling. Previously she would only chose certain cups to use for coffee at work or go through a certain door, convincing herself that a family member would die if she didn’t do things in a certain way or in a certain time. This client found an unknown freedom that she hadn’t experienced for at least 10 years.

After leaving the treatment program for the next 6 months she continued with her interviews and successfully acquired a new position in a company. She carried out one of her dreams and travelled to America. She also attended workshops on new interests, lost weight and carried out charity work.

The client continued to play the support CD all through her treatment programme and for the months afterwards.

If you would like support resolving your own, your family’s or your employees issues please Contact us today. We’d be delighted to hear from you.

12 year old boy who held his bowel movement for 8 hours at a time

Total session: 4 Sessions over 9 weeks

A 12 year old boy was referred to me to help him overcome the anxiety he was suffering with going to the toilet. The young boy had never been able to go to the toilet and empty his bowels when he felt he needed to go, this was a long term issue that had never been resolved since he came out of nappies as a toddler. This problem was becoming ever increasingly embarrassing as a 12 year old boy as it resulted in dirty underwear throughout the day, which his peers were beginning to notice. He had been to see various doctors, dieticians, nutritionists. Many reward or punishment approaches had been tried by his parents over the years but with no success. As he was approaching puberty at times he was showing increased anger and frustration towards his twin brother.

During the first session I ascertained exactly what would happen when he needed to go to the toilet. There was no problem when he actually put himself on the toilet, he then just got in with it and went normally. He was confident with wiping himself and then once finished he didn’t even think about it until the next time he need to go. When he next got the urge to go to the toilet he would hold it. His stomach would hurt for a while and then the urge to go to the toilet would go away for a while and return 10 minutes later. He would then worry about needing to go to the toilet and would keep stopping himself for up to 8 hours a day. He would only finally go to the toilet when he started to feel himself empty his bowels in his pants. He would then go on the toilet and open his bowels without any further issues.

After he had spent time explaining the situation to myself, he began to understand and recognise for himself that he actually spent 8 hours worrying about something that only took 5-10 minutes to complete when he got on with it, he walked out of the clinic saying ” I can’t see why it was a problem in the first place “

One week later he had managed to go to the toilet every day and without having any dirty pants, he was still holding his bowel movements for about 10 minutes each time though.

My client felt that when he went to go to the toilet he would be missing out on something; one of his brothers may cheat on a game or turn the TV channel over or carry on playing a game without him. Handing back the control I asked my client what his family could do to help him. He suggested to help him overcome this last part of holding his bowels for 10 minutes could his family support him by pausing the film, stop playing the game for a few minutes or for his brother not to run off outside without him. The family happily agreed.

The issue had been resolved by the first session, however, I needed to confirm that the changes that had been made were imbedded in and the problem had been completely resolved. Over the next few weeks my client found new ways of dealing with his brother when he had annoyed him, he managed to stop some of the habits he had created himself; fiddling with something whilst sitting or watching TV and swearing in particular, at the same time in the back ground making sure the toilet issue had been fully resolved.

After 4 sessions over a period of 9 weeks, the initial problem of holding his bowel movement had gone for 8 weeks. If he had the need to go to the toilet at any time or in any place he was able to go immediately as soon as he felt the urge


Weak recommendation, best action may differ depending on circumstances, expertise of clinician, the patient in question, or other social issues

Weak recommendation, moderate-quality evidence

Benefits closely balanced with risks and burdens

RCTs with important limitations (inconsistent results, methodological flaws, indirect or imprecise) or exceptionally strong evidence from observational studies

Weak recommendation, best action may differ depending on circumstances, expertise of clinician, the patient in question, or other social issues

Weak recommendation, Low-quality or very low-quality evidence

Uncertainty in the estimates of benefits, risks, and burdens; benefits, risks, and burdens may be closely balanced

Observational studies or case series

Very weak recommendation; other alternatives may be equally reasonable

Principles of surgical management

Intra-abdominal infections (IAIs) encompass a variety of pathological conditions, ranging from uncomplicated appendicitis to fecal peritonitis [4].

As a general principle, every verified source of infection should be controlled as soon as possible. The level of urgency of treatment is determined by the affected organ(s), the relative speed at which clinical symptoms progress and worsen, and the underlying physiological stability of the patient.

The procedure used to treat the infection depends on the anatomical site of infection, the degree of peritoneal inflammation, the generalized septic response, the patient’s underlying condition, and the available resources of the treatment center. IAIs are subcategorized in 2 groups: uncomplicated and complicated IAIs [5].

In the event of an uncomplicated case of IAI, the infection involves a single organ and does not spread to the peritoneum. Patients with such infections can be treated with either surgical intervention or antibiotics. When the infection is effectively resolved by means of surgery, a 24-hour regimen of perioperative antibiotics is typically sufficient. Patients with uncomplicated intra-abdominal infections, such as acute diverticulitis, acute cholecystitis, and acute appendicitis, may be treated non-operatively by means of antimicrobial therapy.

In the event of complicated IAI, the infectious process proceeds beyond a single organ, causing either localized or diffuse peritonitis. The treatment of patients with complicated intra-abdominal infections involves both surgical and antibiotic therapy [5].

The safety and efficacy of ultrasound- and CT-guided percutaneous drainage of abdominal abscesses has been documented in patients with appendiceal and diverticular abscesses. Percutaneous image-guided drainage may also be used to address cases of advanced acute cholecystitis.

Sepsis management

Patients with severe sepsis or septic shock of abdominal origin require early hemodynamic support, source control, and antimicrobial therapy (Recommendation 1A).

Abdominal sepsis occurs as result of intra-abdominal or retroperitoneal infection. Early detection of the site of infection and timely therapeutic intervention are crucial steps for improving the treatment outcome of sepsis patients.

Sepsis is a complex, multifactorial, evolutive syndrome that can progress to conditions of varying severity. If improperly treated, it may cause the functional impairment of one or more vital organs or systems, which could lead to multiple organ failure [6]. Previous studies have demonstrated that there is an increased risk of death as patients transition from sepsis to severe sepsis and septic shock [7]. In the context of intra-abdominal infections, severe sepsis represents the diagnostic threshold separating stable and critical clinical conditions.

Thus, early detection of severe sepsis and prompt, aggressive treatment of the underlying organ dysfunction is an essential component of improving patient outcome. If untreated, sepsis dysfunction can lead to global tissue hypoxia, direct tissue damage, and ultimately to multiple organ failure [810].

Sepsis in the surgical patient continues to be a common and potentially lethal problem. Early identification of patients and timely implementation of evidence-based therapies continue to represent significant clinical challenges for care providers. The implementation of a sepsis screening program in conjunction with protocol for the delivery of evidence-based care and rapid source control can improve patient outcomes [11].

Early, correctly administered resuscitation can improve the outcome of patients with severe sepsis and septic shock (Recommendation 1A).

Rivers et al. demonstrated that a strategy of early goal-directed therapy (EGDT) decreases the in-hospital mortality of patients admitted to the emergency department in septic shock [9].

In surgical patients early intervention and implementation of evidence-based guidelines for the management of severe sepsis and septic shock improve outcomes in patients with sepsis [12].

Patients with severe sepsis and septic shock may present with inadequate perfusion. Poor tissue perfusion can lead to global tissue hypoxia and, in turn, to elevated levels of serum lactate. Fluid resuscitation should be initiated as early as possible in patients with severe sepsis.

The Surviving Sepsis Campaign guidelines [10] recommend that fluid challenge in patients with suspected hypovolemia begin with >1000 mL of crystalloids or 300–500 mL of colloids administered over a period of 30 minutes. Quicker administration and greater volumes of fluid may be required for patients with sepsis-induced tissue hypoperfusion. Given that the volume of distribution is smaller for colloids than it is for crystalloids, colloid-mediated resuscitation requires less fluid to achieve the same results. A colloid equivalent is an acceptable alternative to crystalloid, though it should be noted that crystalloids are typically less expensive.

When fluid challenge fails to restore adequate arterial pressure and organ perfusion, clinicians should resort to vasopressor agents. Vasopressor drugs maintain adequate blood pressure and preserve perfusion pressure, thereby optimizing blood flow in various organs.

Both norepinephrine and dopamine are the first-line vasopressor agents to correct hypotension in septic shock. Both norepinephrine and dopamine can increase blood pressure in shock states, although norepinephrine seems to be more powerful. Dopamine may be useful in patients with compromised cardiac function and cardiac reserve [13], but norepinephrine is more effective than dopamine in reversing hypotension in patients with septic shock. Dopamine has also potentially detrimental effects on the release of pituitary hormones and especially prolactin, although the clinical relevance of these effects is still unclear and can have unintended effects such as tachyarrhythmias. Dopamine has different effects based on the doses [14].

A dose of less than 5 μg/kg/min results in vasodilation of renal, mesenteric, and coronary districts. At a dose of 5–10 μg/kg/min, beta-1-adrenergic effects increase cardiac contractility and heart rate. At doses about 10 μg/kg/min, alpha-adrenergic effects lead to arterial vasoconstriction and increase blood pressure. Its major side effects are tachycardia and arrhythmogenesis.

The use of renal-dose dopamine in sepsis is a controversial issue. In the past, low-dose dopamine was routinely used because of the possible renal protective effects. Dopamine at a dose of 2–3 μg/kg/min was known to stimulate diuresis by increasing renal blood flow.

A meta-analysis of literature from 1966 to 2000 for studies addressing the use of dopamine in the prevention and/or treatment of renal dysfunction [15] concluded that the use of low-dose dopamine for the treatment or prevention of acute renal failure was not justified on the basis of available evidence.

Norepinephrine is a potent alpha-adrenergic agonist with minimal beta-adrenergic agonist effects. Norepinephrine can successfully increase blood pressure in patients who are septic and remain hypotensive following fluid resuscitation. Norepinephrine is effective to treat hypotension in septic shock patients. In many studies norepinephrine administration at doses 0.01 to 0.3 μg/kg/min has been shown may be effective [16, 17].

Martin and coll. [18] published a randomized trial comparing norepinephrine vs dopamine. 32 volume-resuscitated septic patients were given either dopamine or norepinephrine to achieve and maintain normal hemodynamic and oxygen transport parameters for at least 6 h. Dopamine administration was successful in only 31% of patients, whereas norepinephrine administration was successful in 93%. Of the 11 patients who did not respond to dopamine, 10 responded when norepinephrine was added to therapy. Serum lactate levels were decreased as well, suggesting that norepinephrine therapy improved tissue oxygenation.

Recently a prospective trial by Patel and coll. compared dopamine to norepinephrine as the initial vasopressor in fluid resuscitated 252 adult patients with septic shock [19]. If the maximum dose of the initial vasopressor was unable to maintain the hemodynamic goal, then fixed dose vasopressin was added to each regimen. If additional vasopressor support was needed to achieve the hemodynamic goal, then phenylephrine was added. In this study dopamine and norepinephrine were equally effective as initial agents as judged by 28-day mortality rates. However, there were significantly more cardiac arrhythmias with dopamine treatment.

The Surviving Sepsis Campaign guidelines [10] state that there is no sufficient evidence to suggest which agent is better as initial vasopressor in the management of patients with septic shock.

Phenylephrine is a selective alpha-1 adrenergic receptor agonist primarily used in anesthesia to increase blood pressure. Although studies are limited [20], its rapid onset, short duration, and primary


ello, J.; Marshall, J.; Silva, E.; Anzueto, A.; Martin, C.D.; Moreno, R.; Lipman, J.; Gomersall, C.; Sakr, Y.; et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009, 302, 2323–2329. [Google Scholar] [CrossRef] [PubMed][Green Version]
  7. Torgersen, C.; Moser, P.; Luckner, G.; Mayr, V.; Jochberger, S.; Hasibeder, W.R.; Dünser, M.W. Macroscopic postmortem findings in 235 surgical intensive care patients with sepsis. Anesth. Analg. 2009, 108, 1841–1847. [Google Scholar] [CrossRef] [PubMed]
  8. Webster, N.R.; Galley, H.F. Immunomodulation in the critically ill. Br. J. Anaesth. 2009, 103, 70–81. [Google Scholar] [CrossRef] [PubMed]
  9. Bernard, G.R.; Vincent, J.L.; Laterre, P.F.; LaRosa, S.P.; Dhainaut, J.F.; Lopez-Rodriguez, A.; Steingrub, J.S.; Garber, G.E.; Helterbrand, J.D.; Ely, E.W.; et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N. Engl. J. Med. 2001, 344, 699–709. [Google Scholar] [CrossRef] [PubMed]
  10. Ranieri, V.M.; Thompson, B.T.; Barie, P.S.; Dhainaut, J.F.; Douglas, I.S.; Finfer, S.; Gårdlund, B.; Marshall, J.C.; Rhodes, A.; Artigas, A.; et al. Drotrecogin alfa (activated) in adults with septic shock. N. Engl. J. Med. 2012, 366, 2055–2064. [Google Scholar] [CrossRef] [PubMed]
  11. Opal, S.M.; Fisher, C.J., Jr.; Dhainaut, J.F.; Vincent, J.L.; Brase, R.; Lowry, S.F.; Sadoff, J.C.; Slotman, G.J.; Levy, H.; Balk, R.A.; et al. Confirmatory interleukin-1 receptor antagonist trial in severe sepsis: A phase III, randomized, double-blind, placebo-controlled, multicenter trial. The Interleukin-1 Receptor Antagonist Sepsis Investigator Group. Crit. Care Med. 1997, 25, 1115–1124. [Google Scholar] [CrossRef] [PubMed]
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  15. Faix, J.D. Biomarkers of sepsis. Crit. Rev. Clin. Lab. Sci. 2013, 50, 23–36. [Google Scholar] [CrossRef] [PubMed]
  16. Garnacho-Montero, J.; Huici-Moreno, M.J.; Gutiérrez-Pizarraya, A.; López, I.; Márquez-Vácaro, J.; Macher, H.; Puppo-Moreno, A. Prognostic and diagnostic value of eosinopenia, C-reactive protein, procalcitonin, and circulating cell-free DNA in critically ill patients admitted with suspicion of sepsis. Crit. Care 2014, 18, R116. [Google Scholar] [CrossRef] [PubMed]
  17. Kushner, I.; Samols, D. Oswald Avery and the Pneumococcus. Pharos Alpha Omega Alpha Honor Med. Soc. 2011, 74, 14. Available online: https://www.ncbi.nlm.nih.gov/pubmed/21615066 (accessed on 29 October 2017). [PubMed]
  18. Tillett, W.S.; Francis, T. Serological reactions in pneumonia with a non-protein somatic fraction of the pneumococcus. J. Exp. Med. 1930, 52, 561–571. [Google Scholar] [CrossRef] [PubMed]
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  21. Muller, B.; White, J.C.; Nylen, E.S.; Snider, R.H.; Becker, K.L.; Habener, J.F. Ubiquitous expression of the calcitonin-I gene in multiple tissues in response to sepsis. J. Clin. Endocrinol. Metab. 2001, 86, 396–404. [Google Scholar] [CrossRef] [PubMed]
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  24. Barati, M.; Alinejad, F.; Bahar, M.A.; Tabrisi, M.S.; Shamshiri, A.R.; Bodouhi, N.O.; Karimi, H. Comparison of WBC, ESR, CRP and PCT serum levels in septic and non-septic burn cases. Burns 2008, 34, 770–774. [Google Scholar] [CrossRef] [PubMed]
  25. Brunkhorst, F.M.; Al-Nawas, B.; Krummenauer, F.; Forycki, Z.F.; Shah, P.M. Procalcitonin, C-reactive protein and APACHE II score for risk evaluation in patients with severe pneumonia. Clin. Microbiol. Infect. 2002, 8, 93–100. [Google Scholar] [CrossRef] [PubMed]
  26. Bele, N.; Darmon, M.; Coquet, I.; Feugeas, J.P.; Legriel, S.; Adaoui, N.; Schlemmer, B.; Azoulay, E. Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients. BMC Infect. Dis. 2011, 11, 224. [Google Scholar] [CrossRef] [PubMed]
  27. Simon, L.; Gauvin, F.; Amre, D.K.; Saint-Louis, P.; Lacroix, J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: A systematic review and meta-analysis. Clin. Infect. Dis. 2004, 39, 206–217. [Google Scholar] [CrossRef] [PubMed]
  28. Póvoa, P.; Coelho, L.; Almeida, E.; Fernandes, A.; Mealha, R.; Moreira, P.; Sabino, H. C-reactive protein as a marker of infection in critically ill patients. Clin. Microbiol. Infect. 2005, 11, 101–108. [Google


 and Reminders

WhatsApp can streamline the appointment scheduling process. Patients can easily message their healthcare providers to book, reschedule, or cancel appointments. Additionally, automated reminders can be sent through the app, reducing no-show rates and improving clinic efficiency.

9. Feedback and Support

WhatsApp provides a convenient platform for patients to give feedback about their healthcare experience. This direct line of communication allows healthcare providers to address concerns, answer questions, and improve service quality based on patient input.

10. Crisis Management

In times of crisis, such as during a pandemic, WhatsApp can be an effective tool for disseminating critical information quickly. Healthcare organizations can share updates, safety guidelines, and emergency protocols directly with patients and staff, ensuring everyone is informed and prepared.

The benefits of using WhatsApp for healthcare communication are numerous and significant. By embracing this platform, healthcare providers can enhance patient engagement, streamline communication, and improve overall operational efficiency. As technology continues to evolve, leveraging tools like WhatsApp will be essential in delivering high-quality, patient-centered care. Embracing this digital transformation can lead to better health outcomes and a more connected healthcare ecosystem.

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Get to Know Us

Treatment Scholarships of Nebraska is a Lincoln-based non-profit organization dedicated to addressing the shortage of treatment options for substance use disorder and mental health in our state. Our goal is to improve the lives of those affected by the overdose and mental health crisis, as well as their families and communities. We strive to provide accessible and supportive treatment to all Nebraskans.

Making a Difference

Project Pay It Forward

The Future Looks Bright

A program has been developed to assist individuals who are undergoing residential treatment to pay for their mortgage/rent and utilities. The program is designed to help individuals focus on their recovery without having to worry about their financial responsibilities. The program provides financial assistance to eligible participants based on their income and needs.

To qualify for the program, individuals must be undergoing residential treatment for a mental health or substance abuse disorder. They must also be the primary payer of their mortgage/rent and utility bills. Eligible participants will be provided with financial assistance to help cover these expenses for the duration of their treatment.

This program is designed to alleviate financial stress and allow individuals to focus on their recovery. It is hoped that this program will encourage more individuals to seek residential treatment for mental health and substance abuse disorders.

To apply for the program, individuals must complete an application and provide documentation of their income and bills. Once their application has been reviewed and approved, they will receive financial assistance to help cover their mortgage and utility bills while they are in treatment.

Hand Up Project

Making Change Possible

The "Hand Up" program is a community-based initiative that provides support and assistance to individuals who are facing economic or social barriers that prevent them from achieving their goals. The program aims to empower individuals by providing them with the resources and tools they need to change their trajectory in life.

One of the key services offered by the "Hand Up" program is assistance with obtaining essential documents such as a driver's license, personal identification, birth certificates, and social security cards. These documents are often required for employment, housing, and accessing other services, but can be difficult and expensive to obtain for people who are facing financial hardship or other challenges.

In addition to assistance with obtaining essential documents, the "Hand Up" program also recognizes the importance of reliable transportation, such as a bus pass or even a bicycle, in helping individuals achieve their goals. For many people, lack of access to transportation can be a significant barrier to employment, education, and accessing essential services.

Through the "Hand Up" program, eligible individuals can receive financial assistance to cover the costs associated with obtaining these documents, such as application fees and transportation costs. In addition, the program provides guidance and support to help individuals navigate the often complex process of obtaining these documents.

Project Hired

Ready for Success

Project Hired is a program designed to support individuals who face barriers to employment due to limited financial means, as well as those dealing with substance use and mental health disorders. The program provides professional attire, accessories, and necessary tools to help participants secure or retain employment with self-assurance.

The program's primary goal is to help individuals achieve competitive employment and build paths to self-sufficiency and recovery. Participants are provided with a range of resources, including interview attire, grooming supplies, and tools necessary for their specific profession. In addition, the program provides career coaching and job search assistance to help participants identify job opportunities that match their skills and interests.

Project Hired recognizes that many individuals who are struggling with substance use or mental health disorders face additional challenges when it comes to securing and maintaining employment. To address these challenges, the program provides a supportive and non-judgmental environment where participants can receive the resources and support they need to succeed.

By providing professional attire and necessary tools for employment, Project Hired helps individuals present themselves with confidence and professionalism, which can significantly improve their chances of securing employment. Furthermore, by helping individuals build skills and achieve self-sufficiency, the program supports long-term recovery and provides a pathway to a brighter future.

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Orthodontist Salary - Dissidences<|endoftext|>Association of Anatomical Pathology Technology

Morning Report from AEE 2023

A report of the morning session of the AAPT AEE 2023 from Milina Caley MAAPT

On September 30th 2023, I was finally able to attend my first AAPT Annual Educational Event (AEE).

Having been in the mortuary for nearly 4 years, staffing issues and pandemic related problems finally subsided; meaning I could finally attend. The AEE is the perfect opportunity for APTs all across the UK to meet, catch up, learn, and share.

The morning started in the conference hall with registration, then everyone getting some time to view the commercial exhibitions and what up-and-coming technology/equipment is available. Shortly after, AAPT Chair John Pitchers greeted us with a brief welcome talk where he highlighted some of the positives and progress made in the world of APT over the last year. The chair of the morning session was Gemma Norburn RSciTech MAAPT.

The first talk of the day came from Dr Andrew Bamber, Consultant Paediatric and Perinatal Pathologist, and was titled ‘Paediatric Post Mortem Examinations’. As an APT working in a Trust that does not perform paediatric or perinatal post mortems, I found his presentation to be utterly fascinating. Andrew began by explaining developmental abnormalities that can be identified at post mortem, providing examples of how we can recognise them in our own work.

He then provided a photograph showing a living child’s injuries and asked us if we immediately assumed that neglect/abuse was involved; after which he revealed that it was his own child who had simply fallen onto the floor, the perfect story to emphasise how important context is in our line of work.

Also included in his presentation was information and relevant photo examples regarding evisceration and reconstruction techniques, something that I found exceptionally interesting, again due to my lack of experience with these types of post mortems. The presentation was wrapped up with some information on how Covid-19 and the subsequent pandemic affected the deaths of children.

He presented something interesting that I had not considered regarding Covid-19 related deaths, which was how there


 is bypassed.

The Procedure
  1. Results in greater weight loss than RYGB, LSG, or AGB, i.e. 60 – 70% percent excess weight loss or greater, at 5 year follow up

  2. Allows patients to eventually eat near “normal” meals

  3. Reduces the absorption of fat by 70 percent or more

  4. Causes favorable changes in gut hormones to reduce appetite and improve satiety

  5. Is the most effective against diabetes compared to RYGB, LSG, and AGB

  1. Has higher complication rates and risk for mortality than the AGB, LSG, and RYGB

  2. Requires a longer hospital stay than the AGB or LSG

  3. Has a greater potential to cause protein deficiencies and long-term deficiencies in a number of vitamin and minerals, i.e. iron, calcium, zinc, fat-soluble vitamins such as vitamin D

  4. Compliance with follow-up visits and care and strict adherence to dietary and vitamin supplementation guidelines are critical to avoiding serious complications from protein and certain vitamin deficiencies

bottom of page<|endoftext|>Dental Cleanings

Dental Cleanings

Keeping the mouth clean and healthy is just as important as maintaining a beautiful smile. Microbes tend to get accumulated on the surface of the teeth and tooth roots, thereby leaving a brownish or yellowish layer on the teeth. It is called plaque. When plaque isn't removed at regular intervals and left to stay on the teeth for a long time, it turns into a dark, sticky substance called tartar or calculus.

How harmful is tartar?

Tartar is full of harmful bacteria that have the potential to upset one's oral health to a massive extent. They usually feed on the food residues left in the mouth after a meal and release toxic acids in the process. These toxins can erode the enamel and cause cavities, which can advance to the deeper layers of the teeth if left untreated for a long time. The acids can infect the tissues of the gums and cause gum diseases such as gingivitis and periodontitis.

What is the solution?

It's a simple one - getting rid of the tartar deposits. We do this by procedures called scaling and root planing, which remove the tartar deposits from the teeth and roots, respectively. For this, we use a hand-held ultrasonic scaling device. It has a scaling tip that vibrates at ultrasonic frequencies and dislodges the tartar deposits. A jet of water will be used to wash away the tartar from the teeth surfaces. It leaves the teeth looking whiter and the mouth healthier.

What is root planing?

Root planing involves cleaning the tooth roots and clearing out the deep gum pockets using a hook-like scaling tip. Patients who have loosened gum tissues due to inflammation tend to have deeper gum pockets and a receded gum line. In such cases, the food residues and microbes tend to get deposited in the gum pockets, leading to the formation of tartar deposits on the tooth roots. During root planing, we remove these microbial deposits by gently scraping them off. Also, we smoothen the surface of the tooth roots to get rid of the imperfections, which reduce microbial deposition on them.

Please get in touch with us through online consultation or by calling us at (407) 495-1886, and we'll guide you further.

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Low vitamin D may lead to elevated CRC risk in black women

Tue, 10/26/2021 - 11:04
Posted in:

A study from the Slone Epidemiology Center and the Boston University School of Medicine suggests that Black women with a low vitamin D status have an increased risk of developing colorectal cancer (CRC), in line with the findings of previous epidemiologic studies conducted in White populations. These findings, ‘Predicted Vitamin D Status and Colorectal Cancer Incidence in the Black Women's Health Study, appear in the journal Cancer Epidemiology, Biomarkers & Prevention.

"Our findings, taken together with established evidence that vitamin D levels are generally lower in the Black population than other groups, suggest that low vitamin D may contribute to disproportionately high colorectal cancer incidence among Blacks," said corresponding author, Dr Julie Palmer, director of BU's Slone Epidemiology Center and the Karin Grunebaum Professor in Cancer Research at Boston University School of Medicine.

Vitamin D plays a role in many cellular processes in the human body and has been shown to have anti-cancer properties. It is possible that having sufficient levels of vitamin D circulating through the body may reduce the risk of developing colorectal cancer, which is a disease that affects over 150,000 individuals each year. The Black population tends to have lower levels of vitamin D because the major source of vitamin D, aside from taking vitamin D supplements, is from sunlight. They also are disproportionately burdened by colorectal cancer, with the highest rates of both incidence and mortality.

To determine vitamin D levels prior to the cancer diagnosis, the researchers developed a set of the best predictors for correctly classifying a study participant as to her rank on a scale of possible vitamin D levels from very low to very high. The prediction model derived by this process weighted variables by how strongly they were associated with actual blood levels. The researchers then applied that model to all participants in the Black Women's Health Study (49,534 participants) to get a predicted vitamin D score that would likely correspond well to their relative level.

Over follow-up, 488 incident colorectal cancers occurred - compared with women in the highest quartile of predicted vitamin D score, those in the lowest had an estimated 41% (HR = 1.41; 95% CI, 1.05–1.90) higher colorectal cancer risk. Comparable HRs were 1.44 (95% CI, 1.02–2.01) for colon and 1.34 (95% CI, 0.70–2.56) for rectal cancer.

The researchers believe it is important to determine if there is a relationship between vitamin D status and CRC risk in a Black population, so that individuals who are at an increased risk of CRC can implement strategies to increase the levels of vitamin D in their bodies.<|endoftext|>I can't pass water in public

You could use behaviour techniques on your own to try to 'decondition' yourself. Don't be in any hurry – this...

My problem is that I have terrible trouble using public toilets.

I have heard the term 'stage fright' in relation to this, but I am unsure how to handle it.

Basically I cannot urinate (standing up) at a urinal if there are other people close to me.

Although this may sound trivial I assure you I am quite worried about it because I find myself trying to avoid drinking in bars or going shopping for a whole day as I will be forced to use public toilets.

My main worry is that I cannot force urine out 'on command', which leads me to worry about possible prostate problems.

I find it extremely embarrassing to talk about it and any literature I read up about urinary control is with reference to stopping it leaking out.

I would be very grateful for any enlightment about this extremely distressing condition.

David writes:

It's bad luck that you have this problem – but in fact it's surprisingly common for men to be unable to pee when other folk are around.

It is not due to any physical cause, but it is – as you suggest – a sort of 'stage fright'.

Fortunately, there's no reason for you to fear that this difficulty will harm you physically. I know of no scientific evidence that your prostate could be harmed.

What can you do about it?

Many men do nothing, and just put up with the fact that they'll go through life having to urinate in private. However, a few men seek psychological treatment.

If you decide to do this, my advice would be to see a behavioural or cognitive psychotherapist who would gradually accustom you to the idea of passing water near other people.

Alternatively, if you're really determined, then you could use behaviour techniques on your own to try to 'decondition' yourself. Don't be in any hurry – this could take many months.

Begin by spending a week in which – several times a day – you have a pee in a compartment of a public loo with the door shut. The next week, you move on to having a pee with the door half open.

A week later, you progress to peeing with the door fully open. A week on from that, you should select a very big public loo (for example, at a motorway service station) and practise peeing at a distance of (say) 25 yards from other guys.

Over the next year, you can gradually reduce the distance until you can cope with peeing quite near other folk.

Christine adds:

I agree with everything David has said. I've sometimes heard this condition referred to as 'bashful bladder' syndrome.

And it frequently affects guys who had quite an unhelpfully strict upbringing when it came to sex and bodily functions.

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Yoga For Greater Self Control

Yoga DVD for Beginners

A thoughtful, insightful, honest, and well-written beginner’s yoga DVD review will help you make up your mind about your practice of yoga before it guides your choice of the best yoga DVD for beginners for you.

Are You Absolutely Sure You Want a Yoga DVD For Beginners?

Are you absolutely sure you want to begin the practice of yoga? Yoga does wonderful things for your body, mind, and spirit, but it will not shred and striate your muscles in the next month. Yoga will stretch, strengthen, and tone all your major muscles, but the practice of yoga may never burn enough calories for you to shed a single pound. Yoga will develop your self-control, body awareness, and grace, teaching you to move languidly and fluidly. Yoga will never increase your vertical leap, help you throw a ball faster, or fire-up your bat speed. Because yoga leads to union with the divine and eternal life in all things, it will contribute to your sense of calm contentment. Frankly, if you want to become a tougher, more intense competitor, yoga probably lives at the antipodes of what you want. So, are you sure you really want a beginner’s DVD?

Yoga is among the world’s very few zero-impact exercises. When practicing yoga, you always move, touch, flex, stretch, expand and contract gently, all while breathing into your motions and feeling each movement practically down to the fire of each tiny synapse. Practice of yoga packs no punch. It does, however, hold tremendous power. So, are you sure you really and truly want a yoga DVD for beginners?

What to Do with a Beginner’s Yoga DVD Review

If zero-impact, slow and deliberate stretching, and strengthening sounds good to you, let a proper beginner’s yoga video review guide you to the video that will fire your enthusiasm for yoga, making you eager to continue your practice day by day and pose by pose. A good beginner yoga video review, naturally, will summarize the video’s contents-how many workouts for how long with what kind of emphasis, and all the usual stuff you absolutely need to know. A helpful review, however, will focus on both the video’s continuity and its evolution; because, as you get stronger and evolve from practice to practice, you want to feel as though you resume where you left-off. You also want to feel as though you end each practice a little more powerful and proficient than where you began. Your reviewer will assess that stuff.

A good yoga DVD for beginners review also will evaluate the video’s mood and tone. Some beginner yoga DVDs have exactly the right content developed in exactly the right sequence, yet they seem so shrill and annoying no one can survive even the first twenty minutes of the two-hour disc. Some beginner yoga DVDs have all the best visuals and none of the right audio. Hip-hop music and proper yoga practice really do not mix. A good DVD review will look for harmony among all the workouts elements.

When you finish a good beginners yoga review, you should feel confident you want to pursue your practice of yoga, and you should feel equally confident that you know which beginner’s yoga DVD will guide you.

Three Yoga Poses To Crush Your Anxiety

Do you worry about anxiety? Me too. After the fabulous clothes (like cute yoga


 support system and delegate tasks when possible.

Fatigue From Screen Time

The second type of fatigue attributed to Zoom fatigue is being tired simply due to working with a screen. This is not a new phenomenon, and researchers were studying the effects long before extended Zoom sessions swept the nation. It is common to experience fatigue on a computer. The following are a few strategies to reduce screen fatigue. A computer search will reveal many more, but don’t spend too much time on the computer looking for ways to reduce computer fatigue.

  • The 20-20-20 rule: Every 20 minutes, look at something 20 feet away for 20 seconds. It helps reduce eye strain and mental fatigue.

  • Every hour stand up, get away from the computer, and take a five-minute break.

  • Individuals often become dehydrated through a long day in front of the computer. Be sure to drink enough water throughout the day.

  • Try reversing your computer documents so the background is black and the words are white. This reduces eye strain.

Fatigue From Social Demands

The third category of fatigue results from the social demands of participating in a videoconference. This, I would consider legitimate Zoom fatigue. This is different from general computer work, as social interactions with multiple people are involved. Video meetings, conferences, classes, or any other human exchange on the computer differs from being in person. When we are physically together, many cues help us interact efficiently. When someone in a group would like to speak next, they start to talk and stop quickly, shift in their seat, or hum in agreement. These signals are missing in videoconferencing, so it is more challenging to identify who will talk when. In addition, video conference calls with many participants cause faces to be small on-screen, and additional cues are lost. Because we are lacking cues, we overcompensate to find the ones we still have, which means we stare directly ahead at the screen and give our complete focus more than we would in an in-person meeting. Some individuals also find it exhausting to see their own image on their screen. Monitoring and participating in the chat is added energy, like having conversations with two people at once. Finally, it is much easier to mistakenly stack meetings one after the next so that we leave one meeting and join the next meeting seconds later with a click. Aside from removing breaks, that shift causes mental fatigue as we adapt to each changing event.

Below are a few suggestions to reduce actual Zoom fatigue:

  • Schedule breaks between videoconference meetings

  • Reduce multitasking, such as answering email while on a conference call

  • Turn off your self-view (if the situation allows) if seeing your own image is stressful

  • Identify cues for speaking, such as raising virtual hands.

Restorative Steps

Many people talk about Zoom fatigue, but often the fatigue they feel is actually from life or other computer work. There is such a thing as Zoom fatigue, but not all fatigue experienced while on Zoom is Zoom fatigue. Zoom is a convenient scapegoat for the fatigue we are all feeling. Still, we need to identify the underlying culprits creating the fatigue we experience in order to reduce the stress and strain that leaves us exhausted. To break the cycle of fatigue, we must accurately identify the source(s) and implement healthy measures to restore balance. This may be as easy as modifying our behavior to include scheduled breaks and practicing self-care. It may also mean seeking professional help to restore and support our physical and mental wellbeing.

Discussion Questions

1. Which factors during COVID-19 cause increased fatigue for you? If you could be granted access to resources that would reduce fatigue, what resources would you request?

2. The three types of fatigue noted in this article are certainly not an exhaustive list. Select one of these three, or one of your own, that has been particularly challenging for you. You do not have to share anything that you do not wish to share but think about how you have responded to that challenge. If you were to face a similar challenge in the future, what might you do differently to address the area of fatigue noted?

3. When the pandemic is over, and it will be one day, what can you do in the future to reduce fatigue due to being on Zoom calls or videoconference meetings?

Covert, B. (2021, July 20). 8 hours a day, 5 days a week is not working for us. New York Times. https://www.nytimes.com/2021/07/20/opinion/covid-return-to-office.html

Koutsimani P., Montgomery A., & Georganta, K. (2019). The relationship between burnout, depression, and anxiety: A systematic review and meta-analysis. Frontiers in Psychology 10, 284. https://doi.org/10.3389/fpsyg.2019.00284

Ramachandran, V. (2021, February 23). Stanford researchers identify four causes for ‘Zoom fatigue’ and their simple fixes. Stanford News. https://news.stanford.edu/2021/02/23/four-causes-zoom-fatigue-solutions/

Additional Resources

Sheppard, A. L., & Wolffsohn, J. S. (2018). Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmology, 3(1), e000146. https://doi.org/10.1136/bmjophth-2018-000146

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bottom of page<|endoftext|>Elderly Osteoporotic Women 3 Times More Likely to Fracture Hip

Even when comorbidities or poor prognosis are considered, osteoporosis specifically, severely raises the risk of hip fracture for women aged 80 or older.

Lisa Langsetmo, PhD

When diagnosed with osteoporosis, women aged 80 years or older face a three-fold probability of a hip fracture within 5 years, according to a new analysis for the Study of Osteoporotic Fractures (SOF) Research Group.

The severity is sharpened even further for women diagnosed with comorbidities or poor prognosis.

The investigators, led by Lisa Langsetmo, PhD, of the University of Minnesota Twin Cities, conducted a prospective cohort study from March 2018 - January 2019 across 4 US sites, including 1528 women (mean age 84.1 years) identified as potentially able to benefit from osteoporosis treatment.

The 1528 women are from a larger original sample pool of 9704 women aged 65 years or older from 1986 - 1988. At that time, the observed women were able to walk unassisted. From 2002-2004, all active, surviving women were encouraged to participate in a 16-year follow-up visit, leading 4261 women (88% of surviving participants) to return questionnaire data, and 2692 of these to complete an in-clinical examination, including measurement of hip bone mineral density (BMD).

The final analytical cohort contained 1528 women who had never been previously treated for osteoporosis.

Not all of these women in the cohort were diagnosed with osteoporosis—they were divided into 2 groups based on the National Bone Health Alliance’s disease definition criteria for having clinical osteoporosis (n= 761) or being without osteoporosis but at high fracture risk (n= 767).

Use of drug treatment to prevent fractures decreases as age increases. Concerns about comorbidities and prognosis, however, also increase with age.

Randomized clinical trials among women and men aged 50 years and older have shown that those with clinically recognized osteoporosis benefit significantly from drug treatment that prevents fractures. Unfortunately, the majority of those trials exclude or underrepresent women aged 80 or older and/or women with multiple comorbidities or poorer prognosis.

As a result, further research is necessary to determine the proper course of action for older women with osteoporosis, who face not only the risk of a related fracture, but age-related mortality risks.

The 1528 women in the final stage of the new study were contacted every 4 months regarding their overall health and any hip fractures. The five-year hip fracture probability also accounted for competing mortality risk and comorbid conditions assessed by self-report, as well as prognosis estimated using a mortality prediction index. Components considered when determining mortality risk included age, sex, specific comorbid conditions, body mass index, and difficulty performing basic and instrumental activities of daily living, all of which affected mortality rate on an index range of 0 - 21.

During the following 5 years, 125 (8%) of the women experienced a hip fracture. Just 287 (18.8%) died without ever experiencing a hip fracture.

The 5-year mortality probability was 24.9% (95% CI: 21.8 - 28.1) among women with osteoporosis as compared to 19.4% (95% CI: 16.6 - 22.3) among women who were only at high fracture risk. Both groups saw an increase in mortality alongside comorbidities and poorer prognosis.

Fracture probability across 5 years, on the other hand, was 13% (95% CI: 10.7 - 15.5) among women with osteoporosis and 4% (95% CI: 2


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Why you shouldn’t get a Miniature Schnauzer?

It was very hard to say no to that cute wrinkly face. I just couldn’t. So I took it home. How much did I pay for the little ******? $300. After the initial excitement, I realized that I was in for a long road. Here are some of the reasons why you shouldn’t get a Miniature Schnauzer:.

What are signs of your dog dying?

Signs of dog dying may not be obvious to dog owners. So here are the common signs of dog dying: 1.Change in eating habits 2. Change in water drinking habits 3. Change in sleeping habits 4. Change in activity level 5. Unusual discharge or bleeding from nose or ears 6. Decrease in energy level 7. Excessive panting and/or rapid breathing 8. Sleeping more than usual 9. Collapse and unconsciousness.

Why do Schnauzers shake?

Schnauzers do not shake to keep cool, but to keep warm. The term “wind-chill factor” is used to express how cold something feels. The lower the temperature, the more quickly body heat is lost and the body begins to feel cold. Even though Schnauzers’ coats are thick and dense, they do not help them cope with the wind chill factor as well as other dogs. That is why they shake. Labrador retrievers, malamutes and other dogs with thick, dense coats do not feel as cold as Schnauzers..

What can Schnauzers not eat?

Interesting that you have asked this question.Because these are some of the most healthiest dogs on the planet. So what they can eat is almost everything. They can eat cooked meat, fruits, vegetables, even rice. They can eat cooked scrambled eggs on toast. However, Schnauzers are lactose intolerant, so you shouldn’t give them dairy products, including cheese. They are also prone to have food allergies, so you shouldn’t give them nuts or chicken. But apart from these two things, their digestive system is very healthy so they can eat almost anything..

How smart is a miniature schnauzer?

Miniature Schnauzers are very intelligent dogs . They are quick learners, usually a little more eager to please than some other dog breeds. They are smart enough to understand simple commands from their owners from a very early age, and they will also learn how to problem solve on their own. Miniature Schnauzers are great for families with children, as they are very tolerant of rough play..

What is schnauzer lifespan?

Schnauzers live between 12 and 15 years, which is a long time for a small dog. Schnauzers can live longer than other small dogs, such as Chihuahuas and Pugs..

At what age is a schnauzer considered a senior?

Sometime in the middle of their life the schnauzer will reach maturity. This is generally between the ages of three and five. At this point the schnauzer gains all the physical characteristics of the breed. The head becomes distinguished, the body thickens and the coarse, wiry coat begins to develop. This is the mature schnauzer, and the years between four and six are known as the “prime” years. During this time the schnauzer is likely to be the best he will ever be..

How can you tell how old a schnauzer is?

The most accurate way to tell how old a schnauzer is to see the color of its eyes. If it is black, then it is usually around six years old or less. If it is brown, then it is usually around seven years old or less. If it is blue, then it is usually around eight years old or less. If it is one of the colors described above but has a white sclera, then it is usually around nine years old or less..

How old is a 13 year old miniature schnauzer in human years?

This very much depends on how big the dog actually is. A miniature schnauzer is a breed of dog and its growth is dependent on the size of its parents. A miniature schnauzer which is an inch to 1.2 inches tall and weighs 10 pounds to 11 pounds is considered a small schnauzer and is said to be between 3 and 5 years old in human years. On the other hand, a miniature schnauzer which is 1.2 inch to 1.8 inches tall and weighs 11 pounds to 16 pounds is considered a medium schnauzer and is said to be between 4 and 7 years old in human years. Finally, a miniature schnauzer which is 1.8 inches to 2.5 inches tall and weighs 16 pounds to 22 pounds is considered a large schnauzer and is said to be between 6 and 9 years old in human years..

Do Schnauzers like to cuddle?

___% of Schnauzers like to cuddle . They are very friendly dogs, but they are also terriers, which means they are quite independent. The Schnauzer tends to like its own space and doesn’t like to be the center of attention. They like to be close to you and get your attention, but they will often prefer sitting next to you, rather than on your lap. They are great dogs for people who like to be active. They like to run around and play and then they like to be tired and lay down and rest . They like to play and then go and rest and digest and then play again..

Are miniature schnauzers loyal?

The best way I can put it is that miniature schnauzer love is intense, pack-like, and is very firmly focused on their owners. A dog bred to herd doesn’t naturally stop doing what it’s bred to do. It’s very possible that your min-pin is nipping, jumping, biting, and pulling on leash because he’s doing exactly what your breeder told him to do?herding you!.

Do miniature schnauzers sleep a lot?

Yes, miniature schnauzers are one of the most active dogs, and they often sleep for short periods three to four times during the day, resting for 10-20 minutes. In the evening before going to bed they may sleep for a couple of hours. Miniature schnauzers sleep very little, but require lots of movement and exercise, so they will be happy if you walk them for 1-3 hours daily, play games with them and take them to the playground..

Leave a Comment<|endoftext|>Page last updated at 09:05 GMT, Friday, 4 April 2008 10:05 UK

Homes teeter on seaside land slip

Knipe Point land slip. Picture courtesy Radio York
One family has been told to move out of their home by insurers

Thousands of tonnes of earth have slipped away in front of homes on the Yorkshire coast leaving properties precariously balanced on a cliff edge.

Gardens and patios at Knipe Point are now in a heap 100ft (30.4m) below the homes on National Trust land at Cayton Bay, between Scarborough and Filey.

Insurers have told one family to move out, while other locals wait for news.

A trust spokesman said the slip had been caused by water and it was impossible to predict the next one.

Michael Turner of the Residents' Association said there was growing concern in the area.

"People are very worried because at the moment they don't know what's going to happen, whether there will be any more slippage.

"One family has been told to move out by their insurance company.

"We're just waiting for the results of investigations into what caused the land slip, but at the moment we're in limbo."

'Fits and starts'

National Trust property manager Bob Dicker said: "We know that this land is slipping, we know it's very active at the present time, but to put a scale on it at this stage would be unwise. We don't have enough information.

"What we're finding out, in some respects it's very obvious, we're finding out it is a land slip and we should be very careful to remember that - it isn't coastal erosion.

"The land slip itself is caused by water for the most part, there may be other causative agents, but mainly water. "

Knipe Point land slip
Homes are now perilously close to the edge of the cliffs

Mr Dicker said engineers were trying to find the source of the water that caused the slip.

"What we don't know is where is the water coming from and what sources there are in the immediate area. "

He said the land slippage had been happening in "fits and starts" and there had been quite a bit of activity for the last two or three months.

"Prior to that it had been very stable, if I can use that word, for quite some time.

"But it would be very foolish of me or anybody else to predict at the present time just what will happen either today or in ten years time.

"We do hope to have more information fairly soon<|endoftext|>top of page

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* Lower Church Lane, 25 Sep: '12-hour ordeal'

(21062) A daytime party off Lower Church Lane, BS2, near the bottom of St Michael's Hill, allegedly turned into a 12-hour ordeal for people nearby on Saturday, 25 September 2021. It's claimed the music was so loud that homes were shaking and customers were driven away from a local shop.

Christmas Steps Arts Quarter Residents and Traders Association has complained to UWE about the party and events leading up to it.

The group says a resident was notified a week in advance by a student that he planned to hold his birthday party