#Psychomotor Testing Approach

[jcsmicasereports]

Tracking the Recovery of a Mild Traumatic Brain Injury Patient utilizing a 60-s Combined Functional Near-Infrared Spectroscopy and Psychomotor Testing Approach: A Case Study by Dr. Cory M. Smith in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Identifying and tracking the recovery of patients with mild traumatic brain injuries (mTBI) has remained elusive due to the lack of non-invasive, objective neuroimaging techniques. The purpose of this case study was to provide a proof of concept for performing a combined functional near-infrared spectroscopy (fNIRS) and 60-s psychomotor vigilance testing (60-s PVT) that can identify and track the recovery of a patient with a mTBI. The patient was a 19-year-old female acrobatics and tumbling athlete who was kicked in the left temple by a teammate. Video footage of the injury was utilized to determine the region of impact and weekly fNIRS and 60-s PVT assessments were performed throughout the 10 weeks of recovery. The patient was cleared for activity based upon symptoms at week 7; however, the patient reported increased symptomology during weeks 7 and 8 following exercise. Our fNIRS neuroimaging technique was able to detect the systemic physiological responses associated with mitochondrial dysregulation and oxygen extraction fraction at weeks 1 to 8. Based on our findings, the patient remained injured at week 8, and that the physical activity performed at weeks 7 and 8 may have regressed recovery and induced additional dysfunction resulting in increased recovery time. In conclusion, we were able to identify and track the recovery of our patient with a mTBI using our non-invasive combined fNIRS and 60-s PVT approach. Results provided real time physiological responses associated with the injury throughout the recovery process.

Introduction: Identifying and tracking the recovery of patients with mild traumatic brain injuries (mTBI) has remained elusive due to the lack of non-invasive, objective neuroimaging techniques and that each injury may be unique in its severity, signs and symptoms.1 This present case provides an overview of a novel utilization of functional near-infrared spectroscopy (fNIRS) combined with a 60-s psychomotor vigilance test (60-s PVT) for the monitoring of a patient with a severe mTBI. fNIRS examines the hemodynamic responses in brain tissue by using specific wavelength light absorbance rates to quantify the oxygenated (O2Hb), deoxygenated (HHb), and total hemoglobin (tHb) within a targeted region of the brain.2–4 mTBI’s with associated cerebral damage (e.g., cerebral hemorrhage), require increased nutrient exchange to heal causing greater blood flow to the damaged region when under load.5–8 Furthermore, following a mTBI, moderate to severe cognitive tasks are often contraindicated as they induce a worsening of symptoms.9–11 As a result, complex screening tools may induce greater severity scores immediately following a mTBI or place the patient at increased risk of adverse events such as headaches, nausea, or malaise.12,13 The 60-s PVT utilized in this case study mildly stimulates the major regions of the brain through visual, motor, and cognitive stimuli to induce a hemodynamic shift over the damaged region which would otherwise be undetectable.14,15 To our knowledge this is the longest published tracking of the recovery of a patient with an mTBI using fNIRS following injury onset.16–18 In addition, the present case is novel in that neuroimaging began within 72-hr from the onset of injury, weekly tracking was performed, and the exact time and location of injury was established through video footage of the injury’s occurrence which allowed for precise neuroimaging and tracking of the patient during their recovery. 

Our fNIRS technique is ideal for real-world monitoring as it is not as impacted by movement or environmental conditions as the traditionally used electroencephalograms (EEG). In addition, fNIRS is more portable than functional magnetic resonance imagining (fMRI) techniques which are costly and cannot be performed on the field during sporting events.5,19 The fNIRS technology has been shown to have greater spatial resolution than EEG, similar to that of fMRI.2,4,20,21 In addition, fNIRS has slightly lower temporal resolution than EEG, but much greater than that of fMRI. Thus, the portability and unique blend of spatial and temporal neuroimaging resolution makes the use of fNIRS ideal for identifying and tracking mTBI in real-world environments.2,4,20,21 However, previous studies using fNIRS have shown mixed results in its ability to identify mTBI’s.17,18,22–24 We hypothesized that these conflicting results were the result of methodological approaches that included unoptimized post-processing neuroimaging data fusion and mTBI-specific analysis algorithms for regional injury determinations.17,25,26 Furthermore, other fNIRS studies have utilized O2Hb hemoglobin measures in their statistical analyses. However, many studies have reported HHb and tHb as more robust in detecting alterations in cognitive load and neuroplastic changes.3,18,27,28 Therefore, the purpose of this case study was to provide a proof of concept for performing weekly fNIRS (O2Hb, HHb, and tHb) and 60-s PVT monitoring of a unique mTBI patient suffering from severe symptoms. 

Methods

Patient: The patient was a 19-year-old female acrobatics and tumbling athlete. Prior to enrollment in college, the patient had a history of concussions with prolonged recovery periods. During a synchronized tumbling pass the patient was kicked in the left temple by a teammate, followed by hitting her forehead on the mat during landing. Immediately following the impact, the patient presented with signs and symptoms (e.g., headache, altered mental status) warranting a referral to an emergency department (ED) for further evaluation. At the ED a head computerized tomography (CT) scan revealed that the patient was suffering from a severe mTBI. However, results of the CT scan did not identify a skull fracture or hemorrhaging. An assessment completed by the school’s medical staff after being released from the hospital found the patient was suffering from headaches, visual disturbances, and disorientation. Further, neurocognitive testing revealed substantial deficits in processing speed, reaction time, and executive functioning. The patient was then re-evaluated the day after the initial injury where she reported headaches, disorientation, and fatigue.

In total, the patient was symptomatic for 10 weeks following injury. Video footage of the injury was utilized to determine the region of impact and weekly neuroimaging assessments were performed throughout the 10 weeks. Recovery from the mTBI during this time was marked by a slow and steady decrease in symptoms (e.g., headaches, difficulty sleeping, sensitivity to light/noise, vision issues, dysphasia, emotional disturbances). The patient did not return to any physical activity until seven weeks after the initial injury. However, her activity was early threshold aerobic exercise primarily consisting of cycling while being monitored for increases in reported mTBI signs and symptoms. Due to the prolonged recovery and previous concussion history, the medical team and patient decided that further participation in the sport was not feasible. Thus, the patient medically disqualified from further participation. This project was approved by the institutions IRB (Approval ID#: 2012044), is aligned with the Declaration of Helsinki, and the patient’s consent was provided to publish the data within this case study. This study.29

Functional Near-Infrared Spectroscopy Signal Analysis:

The overall fNIRS-derived hemodynamic responses were monitored each week for 10 weeks of the patient’s recovery beginning after the onset of the injury. The location of placement for the fNIRS sensors were determined based on video footage of the injury and athletic trainers present at the time of injury. fNIRS hemodynamic monitoring were collected over left (Injured) and right (Control) superior temporal region of the patients’ head using a 4x1 optode to receiver layout which was secured to the head with a full head neoprene cap, chin strap, and pressure relief system to maintain sensor placement (OxyMon MKII, Artinis Medical Systems, Einstinweg, Netherlands). The centerpoint of the 4x1 sensor grid was the location of impact and the identical location on the opposing side of the head. Each of the 4 optodes on each region of the head were sampled at 10 Hz for each of the 762 and 848 nm wavelengths utilized to monitor the hemodynamic responses. Each wavelength penetrates through the skull and into the cerebral cortex at a distance of ~2.5 cm. The thickness of the skull was estimated based on the patients age and utilized to calculate a correction factor for the differential pathlength factor (DPF) caused by the refraction of the skull fNIRS signals were performed by filtering for Mayer waves, respiration, and heart pulsation by examining the power density spectrum prior to the continuous wavelet (CWT) analysis. A Morlet Wavelet was utilized for the CWT transform using time-step coefficients without any overlap was then performed. The Wavelet coefficients were determined from the culmination of all the CWT data over each weeks 60-s PVT test and was used to further analyze the CWT Multiscale Peak Detection to quantify the amplitude of each CWT. This analysis allowed for the calculation of fNIRSamp values for O2Hbamp, HHbamp, and tHbamp. Together, these metrics provide the regional cerebral blood flow (tHbamp), metabolic stress (HHbamp), and available oxygen (O2Hbamp) in the Control and Injured regions of the brain. Each hemisphere’s 4 optode grid channels were then summated to provide an individual activation level for each locations site of interest during each week’s 60-s PVT.

Three exploratory t-tests were performed on the mean Control and Injured tHbamp, HHbamp, and O2Hbamp measures, collapsed across the 10 weeks for sufficient data points, to determine the gross differences in hemodynamics throughout the 60-s PVT. 

Psychomotor Vigilance Test: 

A 60-s PVT was performed each week while wearing the fNIRS neuroimaging sensor on the injured and control regions of the patient’s brain. The 60-s PVT test was performed on a touch screen tablet (iPad 10.2in 9th generation, Apple, Cupertino, CA) using the Research Buddies software (Research Buddies Version 1.53). During to quantify injury severity as it has been suggested that a PVT has difficultly determining differences in patient injury severity scores.14 In a previous study31 that examined healthy, military non-TBI patients suffering from extreme hypoxemia and physical fatigue reported an average 60-s PVT time ranging from 380-450-ms. Taken together, the findings of these previous studies suggest that a 60-s PVT can help to identify deficits and potentially severity, but the 60-s PVT alone is unable determine if an mTBI occurred and its injury severity. However, the addition of our fNIRS neuroimaging technique coupled with the 60-s PVT results may allow for a methodology of tracking the occurrence and severity of mTBI patients. 

Functional Near-Infrared Spectroscopy: Neuroimaging:

Neuroimaging the contralateral side of the brain as a Control was effective for identifying the hemodynamic and metabolic differences from the Injured region of the brain in our patient as a pre-injury image was unavailable. The relatively consistent tHbamp, HHbamp, and O2Hbamp metrics across the 10 weeks for the Control compared to the Injured side reflects a low neurophysiological load placed on the Control region of the brain typical of a non-mTBI patient during the 60-s PVT (Figure 4).2,26 Furthermore, Figure 5 illustrates the similarities in the neurophysiological load placed on the Control and Injured regions of the brain at the initial 0 to 10-s of the 60-s PVT, however, after 30-s of load a greater hemodynamic and metabolic responses occurred in the Injured but not the Control region of the brain. Thus, the 60-s PVT load placed on the brain was minimal enough to not impact the Control region of the brain while sufficient at stimulating a response from the Injured region of the brain. Therefore, the utilization of a Control region was effective and allowed us to develop a target recovery threshold for the Injured region of the brain to match the tHbamp, HHbamp, and O2Hbamp of the Control region. The combined tHbamp, HHbamp, and O2Hbamp pattern of responses throughout the 10 weeks of recovery indicated maintenance of the patients Oxygen Extraction Fraction (OEF) in the Injured region of the brain. 32 The HHbamp and O2Hbamp ratio remained relatively constant in the Injured region of the brain with a concomitant increase in tHbamp which suggested that greater oxygenation utilization was required in the Injured region of the brain compared to the Control (Figure 4). The overall increased blood flow to the Injured region and increased metabolic demand, as indicated by the greater HHbamp, likely aimed to offset the mTBI associated Ca2+ overload within the patient. Increasing of the patients overall regional blood flow (tHbamp) to the Injured region may reflect a protective mechanism to avoid the catabolic effects of a Ca2+-induced intracellular dysregulation that has been shown to result in the overproduction of free radicals, activation of cell death signaling pathways and stimulation of inflammatory responses.33–35 That is, the fNIRS responses captured throughout the recovery of this patient tracked with the expected systemic physiological responses associated with the maintenance of OEF. Furthermore, it has been well established that mTBI’s result in mitochondrial dysregulation which result in a greater hemodynamic shift to the injured region of the brain to provide sufficient oxygen, dilution, and clearance rates for the metabolic byproducts.33,34 It is hypothesized that the combined mitochondrial dysregulation induced hemodynamic shift was likely the driving factor for the increased metabolic stress (HHbamp) while OEF further stimulated a greater hemodynamic flow to the Injured region of the brain to avoid further injury associated with a buildup of metabolic byproducts. The combined regional cerebral blood flow regulation pattern (tHbamp) and increased metabolic demand captured in this patient indicated that the damage to the patient’s brain was detectable using our fNIRS approach. Furthermore, the combined utilization of our CWT tHbamp, HHbamp, and O2Hbamp methodology allowed for identification of the hemodynamic shifts associated with the injury and increased load induced by the 60-s PVT. 

In our patient, all fNIRS metrics that were elevated from weeks 1 to 8 improved to within Control values at week 9 and remained at the Control levels at week 10 (Figure 4). The tracked improvements in all fNIRS measures suggest that this patient’s recovery became physiologically improved at week 9, however, the patient reported minimal symptomology at rest at week 7 which cleared the patient to begin light physical activity. During weeks 7 and 8 the patient reported increased symptomology when exercising which was her rate limiter to perform physical activity. Considering the onset of the symptomology due to exercise and the fNIRS detected hemodynamic shifts associated with mitochondrial dysregulation coupled with OEF, the patient may have been less symptomatic if exercise was resumed at week 9.32,34 Specifically, the improved fNIRS and 60-s PVT metrics at week 9 were closely aligned with the Control and expected reaction time values, respectively, suggesting that our fNIRS approach could track the physiological recovery in this patient (Figure 4). Early physical activity in patients with mTBI’s has been linked to increase metabolic byproduct accumulation, greater hemodynamic shifts, potential reduced recovery rates, and increased symptomology.32,34,36,37 Thus, the elevated tHbamp, HHbamp, and OxyHbamp values at week 8 suggest that the physical activity performed at weeks 7 and 8 may have regressed recovery and induced additional dysfunction, lengthening recovery time. Therefore, further development of this non-invasive neuroimaging approach will provide clinicians with a useful assessment tool to make more informed decisions on the rate of recovery and activity a patient may be prescribed.

Limitations: This was an exploratory case study performed on a single patient to examine the clinical feasibility of the fNIRS and 60-s PVT analysis approach which will need greater refinement and development prior to clinical adoption. We acknowledge that greater data from a larger population should be studied to make this technology useable when real-time accounts or video footage of the injury site is unavailable. Thus, data from this study should not be applied to a broader patient pool until further studies focusing on the refinement and application of this approach is completed. The data from this case study does provide the foundational information needed to replicate the study methodology and highlights the relevance to the clinical community aiming to develop non-invasive mTBI monitoring devices.   

Conclusion: In conclusion, the 60-s PVT was capable of detecting deficits in our patient, however, the 60-s PVT alone was unable to determine injury severity. The addition of our fNIRS neuroimaging technique was able to detect the systemic physiological responses over the injured region of the brain that align with mitochondrial dysregulation induced hemodynamic shifts and increased metabolic stress (HHbamp). In addition, tHbamp and HHbamp identified OEF which further stimulated a greater hemodynamic flow to the Injured region of the brain to avoid a buildup of metabolic byproducts. The neuroimaging from the contralateral side of the brain was effective as a Control in our patient as a preinjury image was unavailable. Using the Injured and Control region neuroimaging, we determined the elevated tHbamp, HHbamp, and OxyHbamp values at week 8 suggest that the physical activity performed at weeks 7 and 8 may have regressed recovery and induced additional dysfunction, lengthening recovery time. Therefore, this case study showed that a combined 60-s fNIRS neuroimaging and PVT technique was capable of detecting the patients mTBI and tracked her recovery better than subjective assessments. Furthermore, the physiological data obtained through our non-invasive neuroimaging approach was able to identify the patient’s physiological response including potential mitochondrial dysregulation and OEF. Therefore, the physiological responses and recovery state capture in our patient indicates that the weekly assessments of a combined 60-s fNIRS and PVT approach could provide clinically relevant data on the recovery status and injury severity. Future research should focus on the development of fNIRS threshold values that can be utilized to better identify the severity of a mTBI and its associated physiological responses in a large sample of mTBI patients. 

Acknowledgements: We would like to thank the patient for their time and willingness to volunteer for this study. In addition, we would like to thank Baylor Athletics Executive Senior Associate Athletic Director Kenny Boyd, Associate Athletic Director Carrie Rubertino Shearer, and all the athletic trainers who assisted in this project. 

[nursingwriter]

¶ … hospital community group with high incidence of diabetes and low literacy presents to the teaching efforts of a hospital nurse. Description of the selected adult learner, learning topic and related hospital circumstances I am a registered clinical nurse in St. Vincent's hospital. We are a medium-sized hospital located in a highly diverse part of the town. We have a sizeable domestic and Spanish inpatient population with diabetes, including people with long-standing diabetes related complications and co-morbidities requiring inpatient expertise. Today, that population seems to be increasing. Almost 80% of all our adult patients lack literacy referring to the ability to read and write as well as knowledge about the topic of diabetes literacy. It is not only the printed word that challenges these patients with inadequate literacy; writing, speaking, listening numeracy, and conceptual knowledge is often impaired as well. About 2/3 of these illiterate patients are Latinos and the majority of these does not speak English. Our patient average age is between 50 years and 60 years. Because diabetes is almost always a secondary diagnosis in secondary and tertiary care settings, there is not a constituent base of staff nurses dedicated to diabetes care, as once was the case. Previously, at our institution, patients were admitted to an endocrine unit for prolonged stays for diabetes control and education. This unit no longer exists, and diabetes patients are now found everywhere in our hospital. However, at times, one can find a cluster of patients with diabetes on the general medical units (primary diagnosis, in some cases) or on the cardiology unit for example. There is no diabetes teaching protocol in our hospital. We only have a written diabetes education plan (see below). The hospital management has obliged staff nurses to make themselves familiar with the education plan in order to be able to teach our diabetes patients about the risks of the disease and how a proper nutritional and exercise protocol can drastically improve their health in addition to the medication prescribed to them. Only very little communication exchange takes place in the teaching process. The plan relies heavily on a one-sided approach because of the difficulty to reach patients with inadequate literacy at all. The plan does not encourage questioning the patients about lifestyle habits, nutritional preferences etc. And not surprisingly in turn patients very rarely address any questions to us nurses. The hospital does not have a registered dietitian to bring into the mix to educate patients about how a healthy diet can have a positive impact on their diabetes and how a not so healthy one can have a negative impact. We also do not have a trained translator to facilitate communication with the only Spanish speaking patient community. Description of the current diabetes education plan We have a written diabetes education plan. The plan stipulates one-to-one instruction to our patients. Our patients are expected to be able to provide "return demonstrations" of concepts and psychomotor skills before discharge. Pre- and post instruction knowledge tests are the norm. The curriculum is long and detailed, and information is provided through booklets written in English that we hand out to our patients. Linguistic accessibility addresses the presence of bilingual staff or professional interpreters, as well as bilingual education materials (Reimer & Kelley (2001), P. 5). It presents a problem in the hospital because we do not have enough English/Spanish bilingual staff and no professional interpreter. The curriculum is long and detailed, and information is provided through booklets written for patients. As mentioned above, our educational efforts are one-on-one nurses who do not speak Spanish try their best to make themselves understandable in English. If English-speaking family members of the illiterate patient are available, we ask them to translate what we told the patient into Spanish. The current plan foresees that the nurses communicate as much detail as possible regarding the latest scientific findings on diabetes. Little focus is on the daily management of diabetes. We tell Instead, our intercultural diabetes education program is broadly implemented. Essentially, the nurses tell the patient what to eat and what not and that he/she better include a little exercise in their day. We want to reach as many patients as possible with an educational approach that is unrelated to patient beliefs and practices because we think that it is best if patients start practicing new nutritional ways "right from scratch" and not focus any longer on old bad habits that sometimes linger almost all their life long. The program is designed to get them "off" bad nutritional and lifestyle habits in the shortest time because most of them are already in a somehow worrying health situation and will leave the hospital soon. Therefore, the current program in general does not build on a patient's health belief, preferred learning style, lifestyle preferences and practices, and community context. If our patient's relatives or friends want to talk to us about diabetes and what can be done against it we of course talk to them, but our program does not entail to glean information from family members or friends before initiating our education program. Because our patients have difficulties in understanding the whole educational program and to articulate themselves, the education program dispenses from articulating clear dietary goals. It instead focuses on an integrated approach of "healing the whole person" irrespective of his cultural or economic situation. It thereby takes account of the latest scientific developments in diabetes research and the hospital personnel tries its best to communicate these findings to our illiterate patients by circumscribing them in "easy words" so that they are somehow understandable even for the lay person. There is little to no indication that the illiterate diabetes patients will engage in positive self-management practices after being discharged. Very often we hear from these patients who do not practice healthy behaviors already at the first encounter that they "don't care about their health" and are "not interested in diabetes education." When asked what things they can do to take care of diabetes right before their release almost 90% say "take medications." Critique of the current plan In general, I would criticize that the current plan -- with all its flaws -- is only an "education" plan and not (also) a "learning" plan. Successful teaching requires successful learning and this is missing here at all. I would furthermore find fault with the following: Cultural variation in learning styles is an important consideration in patient education (Reimer & Kelley (2001), p. 13). The current education program disregards this finding. The education plan provides far too much (unnecessary and patient-confusing) detail on medical science related to diabetes at the expense of essential information on daily management of diabetes. The illiterate Latino patients are certainly overwhelmed by this approach and -- if there had been any initial interest in learning about the disease -- it will dissipate in the shortest when being confronted with medical jargon on the disease even if the nurses aim to "translate" it to the patients' needs. Following the recommendations of Reimer and Kelley (2003) I would give much more focus on patient information on a healthy lifestyle nutritional and exercise regime instead of its scientific bases. The education program should be tailored to the needs of each patient because each patient has different needs. Subjecting a patient under a generalized diabetic education and learning plan does not address his particular needs and therefore not prove helpful. Instead it is a waste of precious hospital time of all persons involved and will cause unnecessary healthcare costs. Against this background, I would criticize that the learning plan does not stipulate to interview the patients' support surrounding about his/her health beliefs, preferred learning styles, lifestyle, nutritional and exercise practices, and community context before initiating the education program. Certainly I would ask these people for cultural information that can be well incorporated here as it relates to the area of health education. For example, if my intervention is nutrition counseling, I find inclusion of common foods, methods of preparation and typical units of food measurement necessary. Using written diabetes education materials in English language certainly goes nowhere with illiterate or low literate patients. With regard to patients of different ethnicity and culture, research has shown that written diabetes educational materials need to be culturally congruent in language, beliefs; perceptions in order to reach these patients (see Reimer & Kelley (2001), p. 14). The English written booklets on diabetes that are given out to the only Spanish speaking Latino patient community at the hospital do not even try to adjust educational messages according to the patient's ability to absorb and apply to personal lifestyles. Ways to improve the plan The goals of diabetes management are to reduce the personal tragedy and public health cost of diabetes and its complications and to enhance the quality of life for people with diabetes. People with diabetes need sufficient self-care knowledge to manage their diabetes effectively (Davis (2000), p. 4). Patients' self-management practices have substantial consequences on morbidity and mortality in diabetes (Heisler et al. (2002), p. 243). Patients may lack the essential knowledge unless they receive education. Medical education should follow the principles of adult learning (Schwenk, p. 2). Note: If possible, please fill in here some principles of adult learning that you might have been introduced to in class. In my opinion, successful diabetes care requires two-way communication between health care provider and patient, involvement of patients in treatment decisions, and active participation of patients in self-care and goal setting. Yet patients with inadequate literacy may lack the skills to accomplish such tasks and find it difficult or impossible to access and understand health care information and instructions or to implement recommended behaviors (Nath (2007), 43). Scholars differentiate between general literacy as mentioned above and so called "health literacy" (see Nath (2007), p. 43). Adequate health literacy implies problem-solving and decision-making skills that enable a person to apply new information in order to navigate the health care system and function successfully as a health care consumer. A person with adequate health literacy can read, understand, and act appropriately on health information. Researchers have shown that health literacy is a stronger predictor of health status than is socioeconomic status, age or ethnic background. The consequences of inadequate health literacy include poorer health status, lack of medical care knowledge, impaired comprehension of medical information, lack of knowledge about medical conditions, lack of understanding and use of preventive services, poorer self-reported health, poorer compliance rates with treatment modalities, increased hospitalizations, and increased health care costs (Pawlak (2005), p. 1). People with inadequate health literacy have difficulty understanding written or oral health care information. Moreover, they have less knowledge about diabetes than do people with adequate literacy, even after diabetes education classes (Nath (2007), 44). A 2005 National Assessment of Adult Literacy (NAAL) survey incorporated health-related tasks for the first time. The researchers found that approximately 14% of adults who were given directions on a printed sheet could not perform simple tasks, such as determining the appropriate dose based on the label information or identify which drinks were permitted before a medical test (Nath (2007) ibid). Numerous studies have confirmed an association between inadequate health literacy and adverse outcomes in patients with diabetes (Nath (2007), p. 45). Effective health education is a prerequisite for effective self-management of diabetes. A better understanding of diabetes may improve outcomes in certain populations that have large knowledge deficits, because under these circumstances even a small increase of knowledge may contribute to increased self-care (Nath (2007) ibid). Cultural appropriateness and clearness of the education program seems to be particularly important when attempting to tailor a diabetes learning/education plan to the needs of the illiterate patient. The barriers for patients with inadequate general illiteracy and health illiteracy will remain unless nurses and other hospital personnel make conscious efforts to simply educational efforts and reduce the complexity of diabetes care. This being said I think that the current learning plan could be improved and reasonably resolved in the following ways: Already from the starting point of the hospital's current diabetes education program I find it critical for its success that the following parameters are taken into consideration: The dietary goals should be clearly articulated because otherwise illiterate patients will not be able to understand them. The diet regimen should be related to patients' cultural and economic situation because patients otherwise are very likely not to stick to it. The dietary recommendations should be represented in ways that are easy for illiterate patients to understand and implement because otherwise they are not even able to start a better nutritional program. Furthermore, the following issues would need to be taken into consideration in order to improve the plan and resolve it: Self-efficacy: Research has shown an association between self-efficacy and self-management that persisted across ethnic groups and health literacy levels (see Nath (2007), p. 46). This finding suggests that healthcare providers improve self-management by increasing patients' understanding of their conditions and treatments as well as self-confidence in their own self-care abilities (self-efficacy) both of which have been shown positively related to treatment adherence (see Heisler et al. (2002), p. 244). Several strategies contribute to self-efficacy and improve education outcomes for adults with diabetes. Nurses can work to involve patients in their own care and guide them in actively learning about their disease. Patients with diabetes should also be encouraged to explore their feelings about having this disease. By teaching patients the skills necessary to adjust their behaviors, nurses can help patients control their own health outcomes, Practical, interactive exercises should focus on developing specific skills. For example, the nurse should ask the patient to select the most appropriate of several between meal-snacks and discuss the pros and cons of the various choices. Assessment of the patient's learning needs and capacities All appropriate sources of information, e.g., patient's records, should be reviewed and the history of medical problems as well as diagnoses be read in order to assess the patient's learning needs. His emotional and intellectual readiness to learn should be assured. ). Be able to evaluate and select appropriate patient education materials, taking into account the patient's background, including educational level, literacy, cultural background, etc. (Patient Education, p. 2). Making sure that the patient is a partner in the teaching-learning process gives adult learners the sense of control that they are accustomed to in their daily living (Steps in the teaching-learning process (2008), p. 1). Communication: There are many techniques that can improve the communication between hospital personnel, such as nurses and patients with inadequate literacy. Nath (2007 ibid) in this regard points out that making more use of oral and visual instructions; limiting instructions to essential information only; making instructions interactive, with patients demonstrating their understanding of the topic; and encouraging the assistance of surrogate readers present during the one-to-one education sessions to assist the illiterate patient are helpful tools .Another suggestion would be to make use of a "teach-back" approach in an interactive educational strategy in which patients are called to paraphrase their understanding of information (see Schwenk, p. 3). A study has shown that this strategy improves recall and comprehension in patients with low literacy (see Nath (2007), p. 46). Determine patient's preferred learning style: visual auditory, experiential; and use of appropriate teaching modality (talking circles, one-on-one, didactic) might also prove useful (see Reimer & Schwenk (2001), p. 4 For future work in the hospital I would suggest the following: Attempts should be undertaken to increase health care professionals' sensitivity to the problem of inadequate general literacy and health literacy. Research about literacy should be conducted and a literacy-assessment protocol be developed. Diabetes education materials for target populations should be created and evaluated. Attributes of the hospital health care system and hospital-patient relationships that reduce literacy-related disparities need to be identified. These attributes should then be included in the curricula of all health disciplines. Curricula should also include health literacy, means of assessing it, strategies to reach high-risk patients and groups, and interventions that limit the negative effects of inadequate literacy (see Nath (2007), p. 47). A registered dietitian should be hired to educate patients about how a healthy diet can have a positive impact on their diabetes. Use of a professional interpreter Equal access to services requires effective communication, which may not be available when healthcare providers are not proficient in a patient's preferred language. For people who use languages other than English, having a basic understanding is not sufficient to understand health care information, especially in stressful situations (Reimer & Kelley (2001), p. 10). Understanding what has been said by the hospital personnel is of primary importance when diabetes education is involved. I would therefore suggest that a professional interpreter be available for all encounters with the diabetes patients. I also think that nurses should be knowledgeable of techniques to facilitate an interpreted patient encounter, such as speaking directly to the patient, using short sentences and non-technical language, allowing sufficient time, and not asking the interpreter to make judgments or provide information about which they have no expertise Our hospital's written information, e.g. booklets on diabetes, should be provided in English and in our patients' primary Spanish language, so that the information is available to people in our illiterate patients' support system (see Reimer & Kelly (2001) ibid. List of References Davis, E. (2000). A quality improvement project in diabetes patient education during hospitalization. 1-6. Diabetes Spectrum Volume 13 Number 4, 2000,-Page 234. Accessed 3 October 2011. You +1'd this publicly. Undo Heisler, M. & Bouknight, R.R. & Hayward, R.A. & Smith, D.M. & Kerr, E.R. (2002). The relative importance of physician communication, participatory decision making and patient understanding in diabetes self-management. 242-252. J Gen Intern Med. 2002 April; 17(4): 243 -- 252. www.ncbi.nlm.nih.gov > ... > J. Gen Intern Med > v.17(4); Apr 2002. Nath, C. (2007). Literacy and diabetes self-management. 43-49. AJN June 2007, Vol. 107, No. 6, p. 49. Accessed 3 October 2011. Patient Education. 1-8. Read the full article

[symbioticsltd]

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The ADAPT platform is not just about testing; it’s about ensuring the right fit between the candidate and the role. By incorporating psychological consultancy and customized tests, Symbiotics helps aviation organizations create a robust selection process that identifies candidates with the highest potential. This approach streamlines the recruitment process, reduces costs, and ensures that only the best candidates are selected.

For aviation organizations looking to optimize their recruitment process, the ADAPT platform by Symbiotics offers an unparalleled solution. With features like instant reporting, global reach, and comprehensive support, it is designed to meet the unique demands of the aviation industry. To explore how the ADAPT system can benefit your organization, take advantage of the free demo access and experience firsthand the capabilities of this innovative assessment software.

[cannandco-blog]

The CBD Products

If you are worried with how CBD may affect you or interact with any medications you might be taking, it is very important to talk to your doctor. CBD has the ability to relax the human body and mind along with slow down the heartbeat. CBD and THC have lots of beneficial properties which make them well suited for skin care .https://cannandco.net

CBD is thought to have a vast scope of future medical applications because of clinical reports showing the deficiency of side effects, particularly a scarcity of psychoactivity (which is typically related to THC), and non-interference with different psychomotor learning and mental functions. CBD cannot get you high, there's still a good deal of stigma due to the fact that many individuals have a tendency to mistake CBD for THC. CBD consists of the high cannabidiol potency that's been laboratory tested. Anyone who knows about CBD and the way that it interacts with the skin won't be surprised by the advantages and potential of CBD skin care solutions. Complete CBD provides simple and straightforward accessibility to high quality CBD oil products at a portion of the cost of different retailers. American Shaman CBD is pleased to provide you with an exclusive CBD product which is wholly safe for consumption.  CANN & Co. 

Capsules typically provide 10-25mg of CBD. They are great as it's the easiest to take in your daily regimen. Because CBD capsules are full of a precise quantity of CBD, they offer a really accurate means to dose CBD.

CBD, on the flip side, can deliver lots of the exact same advantages of THC without inducing its psychoactive results. Especially in regards to all the various ways to consume CBD. In general, smoking CBD is excellent in that it is easy to adjust the dosage you take in by how you are feeling.

The other medications he's used previously also have left damaging effects, whether they were instant or durable. Treatments are available but it's a pure condition and heal slowly. If you've exhausted the normal treatments then CBD or cannabis-based skin care may be the answer for you. Naturally, when you purchase CBD Skin Care you must look at the ingredients.

Acne is chiefly happened to teenagers but can effect to anybody. The skin includes the endocannabinoid system that has many cannabinoid receptors. Men and women who suffer from dry skin will have the ability to utilize CBD creams to boost the creation of oils. As a consequence, it will choose the body more time to process the bigger quantity of that substance.

If it is a pure solution, there's not likely to be any harm in using it, Ammerman states. In truth, it can safely substitute for a number of products and ingredients utilized by us. Such products provide therapeutic advantages and are also known to give relief in instances of nausea and vomiting. You just need to make certain that you get the proper products from respectable brands in the marketplace. Please note it is not legal to ingest hemp goods in Australia and New Zealand.

A whole lot of goods are available on the internet and long-term users can go to the websites of registered manufacturers and sellers to purchase the best affordable CBD product as required. Not all CBD products are made equally. They come in all forms and naturally there will always be questions about them. The new CBD products represent a wide range of skilled delivery methods for patient requirements. The very best cbd products are useful in fixing several troubles, but you need to use them very carefully. In general, though there are several on-line CBD skincare products readily available, it's important to locate ones that undergo testing to make certain that they're safe, pure, and high-quality.

The business is presently listed on OTCQB. Other edible businesses label their goods with the total amount of cannabis that's infused in grams. Typically, the most productive approaches to discover the ideal Cannabidiol companies available on the market is to get hold of the business and inquire about the steps they take to make certain that their products are consistent and accurate to what's displayed on their label. It is getting saturated with many different CBD brands. Consumers using Cannabidiol products for relief out of their immediate wellness condition should decide on a Cannabidiol goods and delivery system which best serves their requirements.

CBD products are available in many distinct forms and in a number of diverse concentrations. For many people, they are becoming a healthy addition to their daily lives. If you're searching for CBD goods in Myrtle Beach, you might find it being sold in many forms as CBD dietary supplements, as pain relievers in the kind of oil or tinctures along with CBD edibles that are usually in high demand.

There are mainly some kinds of CBD products created by Cloud 9 Hemp. CBD pet products can be administered in quite a few ways. Even after you decide on a brand which you like, it's simple to become confused by what sort of CBD to purchase. There's a great deal of new brands popping up everyday to provide the most recent version of CBD oil.

[azeez-unv]

Evaluation of Learning

• azeezaugp@gmail.com

Educational successfulness which its primary goal is to increase human resource is influenced by many factors. 

In the world of education, one of the competencies that must be mastered by the teacher is the evaluation of learning.  

One of  the  factors is teacher ability  in performing  and  utilizing the assessment, evaluation process, and learning outcome. The ability is very important to know that the aims of the learning process determined in the curriculum reached. 

Besides, the ability can also be used to revise or to increase the learning process performed by teachers. 

The assessment principle and standard emphasizes two main ideas which are assessment must improve the learning process of the student and assessment is a valuable tool for teaching decision making.

Assessment Questions is not only data collection of the students but also data processing to obtain an overview of the learning process and learning outcome of the students.

Most of us feel free about assessment. Assessment is only asking questions to students and stopped. No, in true sense it is not called an assessment.

I will say a big No to this kind of assessment. 

True Assessment is not only about questioning the students then finished but also about following up for the learning significance. 

We should know the importance of following ups. 

To perform an assessment, the teacher needs assessment instruments in the form of good questions for testing the cognitive, affective, and psychomotor abilities of the students. 

For that reason, the questions need to be analyzed and then the questions are developed based on HOTS with Bloom's Taxonomy based which refers to Tessmer's development model.

This model has two phases: 1. A preliminary evaluation and  2. Formative evaluation. 

A learning outcome is a statement of learning accomplishment which may be the acquisition of knowledge, understanding, or an Intellectual/practical skill.

Well articulated statements of intended learning outcomes help both teachers and students, as they provide a clear explanation of what is required to successfully complete a module provided there are strong links between the learning outcomes and the assessment methods.

Evaluation of learning:

Evaluation of learning refers to the process of measuring and assessing a learner's progress and achievement in a particular subject or skill. 

There are different types of evaluations that can be used to evaluate learning, including formative assessment, summative assessment, and diagnostic assessment.

• Formative assessment involves providing ongoing feedback to learners as they are learning. This type of assessment helps learners identify areas where they need to improve and make adjustments in their learning approach. Formative assessment can take many forms, such as self-assessment, peer assessment, or teacher feedback.

• Summative assessment, on the other hand, evaluates a learner's progress and achievement at the end of a learning unit or course. Examples of summative assessment include tests, exams, and essays.

• Diagnostic assessment is used to identify a learner's strengths and weaknesses in a particular subject or skill. This type of assessment can help teachers identify areas where they need to provide additional support to learners.

Evaluation of learning is essential in ensuring that learners are making progress and achieving their learning goals. It also helps teachers make adjustments to their teaching approach and provide targeted support to learners who are struggling.

In addition to the traditional forms of evaluation mentioned above, technology has provided new ways of evaluating learning. Online quizzes, interactive simulations, and machine learning-based assessment are some of the new tools being used to evaluate learning. These new tools allow for more personalized and adaptive learning experiences and provide real-time feedback to learners.

Students are significant for learning. We, as teachers, should ensure that learning is significant for them. Unless and until they know the fact that they are coming to school for learning significance.

If they know not the purpose of coming to school, they cannot be a better student. It is not the school environment that makes learning significant. It is not the curriculum of the school that makes learning significant. Above all, it is the mind set of students and this mind set up should be built up by the school. The school environment, curriculum....all are just a tool to set up this mind sets in students.

Learning is important in all ways. Every living being are learners. But what makes it more significant is the question here?

¶ Does school make learning significant?

No, school makes learning naturally less significant. Because school is place now a days for training and drilling. It is heading towards opposite side of learning significance.

How?

Competitions, completing syllabus, making and cooking something for examination points of view, shortcuts.... So many things. 

True significant learning is different. 

If we know the answer to the question why should we learn?

Learning is significant in many different ways, both for individuals and for society as a whole. 

¶ Here are some reasons why learning is important:

• Personal growth and development: Learning provides an opportunity for personal growth and development. It allows individuals to acquire new knowledge and skills, challenge themselves, and expand their horizons. This can lead to increased self-confidence, a sense of accomplishment, and a greater sense of purpose and direction in life.

• Career advancement: Learning is often essential for career advancement. Many professions require individuals to continually update their skills and knowledge to stay competitive and relevant in their field.

• Social and cultural engagement: Learning allows individuals to engage more fully with their communities and society as a whole. It can help people understand and appreciate different cultures, perspectives, and worldviews, and contribute to building more inclusive and empathetic communities.

• Innovation and progress: Learning is essential for innovation and progress. Advances in science, technology, and medicine are all the result of people continually learning and building upon the knowledge and discoveries of those who came before them.

• Problem-solving and critical thinking: Learning can help individuals develop critical thinking skills and the ability to solve complex problems. This is essential for success in many areas of life, from personal relationships to professional and civic responsibilities.

Overall, learning is a key driver of personal and societal growth, innovation, and progress. It is essential for building a better future for individuals and for society as a whole.

Learning becomes more significant if it helps us to either acquire or require something new.

Acquiring something new and 

Requiring for existing. 

Logic is very simple. Every learning ends in acquiring and requiring.

¶ Also here are some additional points on the significance of learning:

• Improved mental and physical health: Learning has been shown to have a positive impact on mental and physical health. For example, learning new skills and engaging in new activities can help stave off cognitive decline, reduce stress, and improve overall well-being.

• Adaptability and resilience: Learning is essential for adaptability and resilience in a rapidly changing world. It can help individuals navigate new challenges and opportunities, and respond to changing circumstances with flexibility and agility.

• Citizenship and social responsibility: Learning can also help individuals become better citizens and contribute to their communities in meaningful ways. It can help people understand the issues and challenges facing their communities and the world, and empower them to take action and make a positive difference.

• Lifelong learning: Learning is not just important for children and young adults, but also for individuals of all ages. Lifelong learning can help people stay engaged, active, and fulfilled throughout their lives, and continue to grow and develop in new and meaningful ways.

• Economic growth and prosperity: Finally, learning is essential for economic growth and prosperity. Education and skills development are key drivers of innovation, productivity, and competitiveness, and can help individuals and societies thrive in the global economy.

In a nut shell, learning is significant for personal growth and development, career advancement, social and cultural engagement, innovation and progress, problem-solving and critical thinking, improved mental and physical health, adaptability and resilience, citizenship and social responsibility, lifelong learning, and economic growth and prosperity.

We teachers teach and test whether our teaching is reached or not. This is also called learning outcomes.

What are the steps for teachers to ensure whether learning outcomes are achieved?

¶ If our teachings are not reached to the students, then what a teacher should do?

There are several ways to ensure or guarantee that teaching is effective and learning outcomes are met:

• Clearly define learning outcomes: Before teaching a particular subject or skill, it is important to clearly define the intended learning outcomes. This will help guide the teaching process and ensure that students have a clear understanding of what they are expected to learn.

• Use formative assessments: Formative assessments, such as quizzes, homework assignments, and class discussions, can provide ongoing feedback on student learning and help identify areas where students may be struggling. This can help teachers adjust their teaching approach and provide targeted support to students who need it.

• Use summative assessments: Summative assessments, such as exams and final projects, can provide a final measure of student learning and help determine whether learning outcomes have been met.

• Use a variety of teaching methods: Using a variety of teaching methods, such as lectures, group discussions, and hands-on activities, can help reach students with different learning styles and engage them in the learning process.

• Provide timely feedback: Providing timely feedback to students on their performance can help reinforce learning and provide opportunities for students to make adjustments and improve their understanding of the subject or skill.

• Create a supportive learning environment: Creating a supportive learning environment, where students feel comfortable asking questions and participating in class discussions, can help promote learning and ensure that all students have the opportunity to achieve the intended learning outcomes.

• Continuous improvement: Teachers should also continually reflect on their teaching practice and look for ways to improve. This could involve seeking feedback from students, attending professional development sessions, or collaborating with other teachers.

By following these steps, teachers can help ensure that their teaching is effective and that learning outcomes are met, thereby providing students with the knowledge and skills they need to succeed.

We see, how to use these assessments in a classroom one by one in the coming days.

Because for preparing for these assignments Blooms taxonomy helps us. 

Our topic is lower order thinking and Higher order thinking

¶ What should a teacher do if learning outcomes are not met? 

If learning outcomes are not met, a teacher should take several steps to address the issue. Here are some possible actions a teacher can take:

• Analyze the situation: The first step is to analyze the situation and determine why the learning outcomes were not met. Was it due to a lack of student engagement, ineffective instructional strategies, or other factors?

(Some students are not expertised their skills in reading and writing. Most of our problems would be solved if you care about their reading and writing skills)

* Re-teach: If the learning outcomes were not met because the students did not understand the material, the teacher should re-teach the content in a different way to ensure that students understand it.

• Provide extra support: If some students are struggling to meet the learning outcomes, the teacher should provide extra support, such as one-on-one tutoring or additional practice materials, to help them catch up.

• Adjust instructional strategies: If the learning outcomes were not met due to ineffective instructional strategies, the teacher should adjust their teaching methods to better engage students and help them learn.

• Collaborate with colleagues: The teacher can also collaborate with colleagues to get new ideas and strategies to help students meet the learning outcomes.

(Just analyse their performance in other subjects. Are they same in other subjects or only in your subject? If they are not performing only in your subject, then they need your help. If their performance levels are same in all other subjects, then they need the whole team support. Any how they are in need of your support. That's all)

• Communicate with parents and students: The teacher should communicate with parents and students about the situation and work with them to develop a plan to help the students catch up.

(Here you are seeking the support of parents. Parents are called for not complaining about the child.)

• Assess and reassess: Finally, the teacher should continually assess and reassess the students' progress to ensure that they are making progress towards the learning outcomes. If they are not, the teacher may need to revisit the previous steps and make additional adjustments.

(A small size of progress makes a big difference in children's life)

¶ How to communicate with parents about their child's progress in studies? 

Communicating with parents about their child's progress in studies is an important part of a teacher's role. 

Here are some steps you can take to communicate effectively:

• Schedule a meeting: First, schedule a meeting with the parents to discuss their child's progress. This could be in person, over the phone, or via video call. Make sure to pick a time that is convenient for the parents.

• Be prepared: Before the meeting, review the child's academic performance and prepare notes about their strengths and weaknesses. Be prepared to share specific examples of the child's work, such as assignments, projects, and tests.

• Be positive: When discussing a child's progress, it's important to focus on the positive aspects of their performance. Start by highlighting the child's strengths and achievements, and then move on to areas where they could improve.

• Be specific: Use concrete examples to illustrate the child's progress. For example, you might say, "I noticed that your child has been making good progress in math. They were able to solve these complex equations with ease."

*(Restrict your talk on specific area. Don't use words such as, your child is poor in studies, he or she cannot pass if he or she studies in this way, Basics are poor in your child.......)*

• Listen to the parents: Allow the parents to share their thoughts and concerns about their child's progress. Listen actively and respond with empathy. Take note of any suggestions or requests they may have.

• Offer suggestions for improvement: Discuss ways in which the child can improve their performance. This could include strategies for studying, additional resources, or specific areas of focus for future assignments.

• Follow up: After the meeting, follow up with the parents to provide updates on their child's progress. This could include progress reports, emails, or additional meetings.

Remember that effective communication with parents is an ongoing process. By working collaboratively with parents, you can help support a child's academic success.

¶ Ways to reteach

Reteaching is an important strategy that educators use to help students who are struggling with a particular concept or skill. Here are some ways to reteach:

• Assess Understanding: Before reteaching, it's important to assess the student's understanding of the concept or skill. This can be done through formative assessments, such as quick quizzes, exit tickets, or observations. This will help you determine what the student knows and what they need help with.

• Use Visuals: Visual aids can be an effective tool for reteaching. Try using diagrams, charts, or graphic organizers to help the student better understand the concept. 

For example, if the student is struggling with fractions, you could use a visual aid to show how to add and subtract fractions.

• Break it Down: If the concept is complex, try breaking it down into smaller, more manageable parts. This can help the student better understand the concept and prevent them from becoming overwhelmed. 

For example, if the student is struggling with long division, you could break it down step by step.

• Use Real-Life Examples: Using real-life examples can help students connect the concept to their own experiences. This can make the concept more meaningful and easier to remember. 

For example, if the student is struggling with decimals, you could use examples from everyday life, such as money or measurements.

• Provide Additional Practice: Extra practice can be helpful for students who need more time to master a concept. 

This could include additional worksheets, online resources, or hands-on activities. Make sure to provide feedback on the student's work to help them improve.

• Re-teach in a Different Way: Sometimes, a student may struggle with a concept because it was not presented in a way that they can understand. 

Try presenting the concept in a different way, such as through a video or a hands-on activity. This can help the student better understand the concept.

Remember that reteaching is not a one-time event, it is an ongoing process. By using a variety of strategies, you can help students who are struggling to achieve success.

¶ Collaborate with colleagues? 

Collaborating with colleagues is an important part of being a successful educator. Here are some tips for effective collaboration:

• Establish a Common Goal: Before beginning any collaboration, it's important to establish a common goal. This could be a shared objective, a particular project or initiative, or a student outcome that you are working towards.

• Communicate Clearly: Clear communication is key to effective collaboration. Make sure to communicate your ideas clearly and listen actively to your colleagues' ideas. Be open to feedback and willing to compromise.

• Utilize Strengths: Every member of the team has unique strengths and skills that can contribute to the collaboration. Identify each other's strengths and utilize them to maximize the effectiveness of the team.

• Share Responsibility: Collaborating means sharing responsibility for the success of the project or initiative. Make sure that everyone on the team has a clear understanding of their role and responsibility in achieving the common goal.

• Set Deadlines: Set clear deadlines for each stage of the project or initiative. This will help keep the collaboration on track and ensure that everyone is working towards the same goal.

• Establish Clear Roles: Establish clear roles for each team member, including leadership roles, task assignments, and communication responsibilities. This will help ensure that everyone is clear on their responsibilities and can work together effectively.

• Evaluate and Reflect: Regularly evaluate and reflect on the progress of the collaboration. Use this feedback to make adjustments and improvements to the process and to celebrate successes along the way.

By following these tips, you can work effectively with your colleagues to achieve common goals and support student success.

¶ How to Provide extra support for students'academic success? 

Providing extra support for students who are struggling can make a big difference in their academic success. 

Here are some ways to provide extra support:

• Identify Struggling Students: The first step is to identify students who are struggling. This could be through observations, formative assessments, or feedback from parents or other teachers.

• Develop a Plan: Once you have identified the struggling students, develop a plan to provide them with extra support. This plan could include additional practice opportunities, small group instruction, or one-on-one support.

• Use a Multi-Sensory Approach: When providing extra support, it's important to use a variety of instructional strategies that engage different senses. This could include visual aids, such as diagrams or graphic organizers, auditory explanations, and hands-on activities.

• Provide Additional Practice: Extra practice is key to mastering a concept. Provide the student with additional practice opportunities, such as extra worksheets, online resources, or hands-on activities. Be sure to provide feedback on their work to help them improve.

• Use Technology: Technology can be a powerful tool for providing extra support. There are a variety of online resources, such as instructional videos, interactive games, and educational apps, that can help students better understand a concept.

• Collaborate with Colleagues: Collaborate with other educators, such as special education teachers, counselors, or other support staff, to develop a plan for providing extra support to struggling students.

• Monitor Progress: It's important to monitor the student's progress to ensure they are making progress towards mastery of the concept. This could include additional formative assessments, observations, or check-ins with the student.

[altasciences]

Why You Need a Driving Simulator for Your CNS Clinical Trials

Clinical trials involving the central nervous system (CNS) require a high level of clinical expertise due to their complex nature. CNS drug trials require specific processes in areas such as participant eligibility and operational conduct. One of the critical areas that must be analyzed in CNS clinical trials is cognitive testing using a driving simulator. With cars and other vehicles being such a ubiquitous aspect of the modern world, it is vital to test the effects of CNS drugs on a participant’s ability to drive. When conducting clinical trials, it’s important to partner with a contract research organization (CRO) with access to the tools to do just that. Here’s why.

What Are CNS Trials, and What Does Driving Have to Do with Them? In recent years, driving simulation studies have been required for any drug that could affect cognition. Many CNS drugs fall into this category. CNS clinical trials can be applicable for a variety of different special populations. From sleep categories like insomnia, sleep apnea, and delayed sleep phase syndrome to pain groups like migraine, sports injury, and fibromyalgia. When your company conducts first-in-human clinical trials, all new drugs should be tested to see how they affect the central nervous system. Due to their intricacies, these CNS clinical trials require teams with both therapeutic and technical expertise. As one of the required aspects of these trials, a team that can provide your trials with access to a driving simulator is essential. How a Clinical Driving Simulator Works for Your Study A driving simulator used in CNS clinical trials must be high-quality and meet the regulations set for these types of trials. The simulator should be able to accurately test both therapeutic and adverse drug effects while the user is driving. It should also feel like on the road driving with realistic 3D graphics that represent the driving environment. From a vehicle dashboard to the roadway and scenery, the simulator should accurately test the participant’s driving abilities. The simulator should also provide auditory feedback and steering sensitivity for an authentic driving simulation. Plus, the simulator should automatically measure psychomotor functioning, divided attention, and situational awareness as the user drives. All these aspects are important to help your team evaluate the cognitive effects of the drug you are testing. Partnering with a CRO for Clinical Trials and Driving Simulation When you are looking for a partner for early clinical development and CNS clinical trials, it is important to work with a CRO that understands the complexities of these trials. Your CRO partner should have experience with the complexities of CNS trials, including driving simulation. They should also have dedicated research physicians who can help guide participants through the trials. Access to state-of-the-art driving simulators can help make following regulations for your CNS clinical trials more efficient and const-effective. Your chosen CRO should also have driving studies designed and conducted that meet regulatory requirements, complete with full-certified driving simulation study specialists to assist with the simulation. About Altasciences Altasciences is a mid-sized contract research organization and drug development solution your company needs for your next drug development project. This integrated CRO with pharmaceutical CDMO services offers partners over 25 years of research experience for preclinical studies and clinical trials. Altasciences has developed an innovative approach that companies in the pharmaceutical and biotechnology industries have come to rely on. Plus, partners gain access to the Altasciences team’s expertise in a wide variety of study types and therapeutic indications. This includes experience in early clinical development and CNS clinical trials. Partners are able to utilize Altasciences’ resources, including over 580 beds, access to an experienced, Phase 1 clinical trial units, highly trained staff, and a recruiting database of more than 400,000 potential participants. Partner with this trusted CRO/CDMO for all your early clinical development needs. See how Altasciences can help you conduct driving simulations at https://www.altasciences.com/ Original Source: https://bit.ly/3uKy0F6

[playpowerblogs]

Cognitive tests are used by mental health academics and practitioners to better understand people's mental capacities. Different cognitive domains, such as Attention, Executive Function, Psychomotor Speed, Memory, and Emotional & Social Cognition, are assessed using cognitive tests. Using mobile applications to collect data from cognitive tests is an effective approach to create such reports.

For More Info Visit:- https://www.playpowerlabs.com/

[your-dietician]

Can Diabetes Lead to Cognitive Impairment?

New Post has been published on https://depression-md.com/can-diabetes-lead-to-cognitive-impairment/

Can Diabetes Lead to Cognitive Impairment?

Learn about cognitive impairment risk in people with diabetes and how to adapt treatments for patients with cognitive problems.

José A. Luchsinger, MD, is a professor of medicine and epidemiology at Columbia University Irving Medical Center, New York. As an expert in aging and cognition, he shares his insights on the relationship between diabetes and cognitive impairment, and how health care professionals can adapt treatment for patients with cognitive problems.

Q: What is cognitive impairment, and why does it matter for people with diabetes?

A: Cognitive impairment is a decline from usual cognitive abilities. There are different types. The one most people are concerned about is forgetfulness, which is the inability to remember events or learn material. Other types of cognitive impairment are not related to memory or can co-occur with memory problems. These include problems with attention and executive function—the ability to start, conduct, and finish a complex task.

When these problems are mild and do not impact a person’s ability to function by themselves, they’re called mild cognitive impairment. When cognitive impairment is so severe that it affects people’s ability to live independently—meaning they need help to remember things, keep track of things, or conduct activities of daily living—then we call that dementia.

People with diabetes are at risk of developing cognitive impairment, which presents challenges for following treatment.

Q: Are people with diabetes more likely to develop cognitive impairment than people without diabetes?

A: Yes. Studies have demonstrated that people who have diabetes, compared with people without diabetes, are more likely to develop cognitive problems. Older adults with diabetes have higher incidences of dementia, Alzheimer’s disease, and vascular dementia than those with normal glucose tolerance.

All cognitive domains may be affected. But the nonmemory domains, like attention, executive function, and psychomotor speed (how fast a task is done), are affected more strongly or are affected first, studies show. People with diabetes need to follow a relatively complex treatment regimen. Anything that affects their ability to remember or organize themselves to begin and carry out an action related to their treatment is important.

Why people with diabetes are more likely to develop cognitive impairment is not well understood. One explanation is that people with diabetes age just like people without diabetes. Cognitive problems increase with age, so people with diabetes are bound to have the same problems as the general population. We also know that certain comorbid conditions, such as high blood pressure, can contribute to cognitive decline.

We know that diabetes causes cerebrovascular disease—that is, vascular disease in the brain—just as it causes vascular disease in the heart or in the legs in peripheral arterial disease, for example. This damage in the brain can lead to different cognitive problems. There are studies showing that diabetes can affect memory, but whether this is caused by vascular problems or other mechanisms is unclear. Investigators are interested in figuring this out.

Q: Which groups are most at risk of cognitive impairment?

A: Some studies suggest that the more severe the diabetes or the longer the duration of diabetes, the higher the risk of developing cognitive impairment. But not all studies show this. In general, older adults are at higher risk of developing diabetes or cognitive impairment, or both, than younger adults.

Risk does vary among racial and ethnic groups. Non-Hispanic Black and Hispanic people have a greater risk of cognitive impairment than non-Hispanic white people. That’s true for diabetes, too. My colleagues and I looked at whether these disparities in diabetes could account for disparities in cognitive impairment. Our study of 941 adults age 65 and older in northern Manhattan, New York, suggested that at least part of the disparity in cognitive impairment between racial and ethnic groups could be accounted for by the disparities in diabetes prevalence.

Q: What signs of cognitive impairment should health care professionals look for in patients with diabetes? Should they screen for cognitive impairment? 

A: Anyone on the diabetes care team, family members, and patients themselves who notice problems keeping up with treatment—for example, forgetting appointments, forgetting to take medication, or trouble following a complex treatment regimen—should recognize there’s a possible cognitive issue underlying those behaviors. Another sign is that diabetes control worsens despite good treatment. We have to be careful not to judge the patient, to think they’re being irresponsible.

It’s important to go the extra mile to make sure that prescriptions are being filled. If they’re being filled, is medication actually being taken? For that, it’s necessary to do pill counts, to communicate with nurses, and to have patients bring in their medications.

As for screening, the U.S. Preventive Services Task Force does not recommend screening older adults for cognitive impairment because there is no evidence it improves patient or caregiver outcomes. However, the American Diabetes Association (ADA) 2021 practice guidelines do call for screening adults age 65 and older with diabetes for cognitive impairment. That is covered by Medicare and can be done at the initial visit and annually as appropriate.

Now, if somebody has signs of concern, then we’re talking about detection, not screening. There are various tools, such as the Mini-Mental State Examination (PDF, 29 KB), the Montreal Cognitive Assessment, the Mini-Cog, or the Memory Impairment Screen (PDF, 104 KB). The use of one or the other depends on availability and time. When you have a patient with complex issues, taking 5 or 10 minutes to do this is easier said than done. Depending on the results, the patient might need further testing and referral to a neurocognitive specialist.

Q: How can health care professionals work successfully with patients who have both diabetes and cognitive impairment?

A: Successful management of diabetes requires a high degree of patient involvement. Patients with cognitive impairment may have trouble adhering to treatment, including monitoring blood glucose, taking medications as directed, timing meals, and recognizing and managing hypoglycemia. Patients who live alone are at particular risk, as are those with complex treatment regimens.

Health care professionals can simplify treatment regimens, if possible; make sure patients have the support they need to comply with treatment; and avoid complications such as hypoglycemia. This could involve setting appropriate but not overly ambitious glycemic targets. The current ADA recommendation in elderly people with diabetes and cognitive impairment is a hemoglobin A1C level between 7% and 8%.

Depending on the stage of cognitive decline, patients may be able to perform some tasks independently and need help with others. Caregivers should be educated to help with blood glucose monitoring and to recognize signs of hyper- and hypoglycemia. Health care professionals can help arrange professional services for the patient—a visiting nurse service or other type of support system to make sure the patient can comply with treatment.

More research is needed to determine the best approaches to assess cognition and address cognitive decline in the health care setting. At what stage do you assess cognition? Do you do it when people are asymptomatic or already symptomatic? What do you do if cognitive impairment is detected? What are the best strategies to support patients? It seems that a team approach, such as a medical home, would be the ideal solution, with more support given to people who have cognitive impairment.

Q: Can improved glucose control or diabetes treatments help prevent cognitive impairment?

A: There are studies suggesting that better glucose control—through medications or other interventions—can prevent cognitive impairment, but it has not been established with certainty. For example, metformin has been tested to treat or prevent Alzheimer’s dementia, often in mildly impaired subjects. Negative and conflicting results point to the need for larger clinical trials.

ACCORD is a landmark study of tight glycemic control versus regular control in people with type 2 diabetes. A sub-study called MIND compared cognitive outcomes; no differences were found between the two groups. That is, tight glycemic control did not help prevent cognitive impairment or improve cognition.

In addition, the Diabetes Control and Complications Trial (DCCT) compared the effects of intensive insulin therapy and standard therapy in people with type 1 diabetes. It showed no relationship between hypoglycemic status and cognitive-test performance. The follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study found similar results.

Do you screen your patients for cognitive impairment? Share below in the comments.

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Recognizing Delirium in Home Hospice

Delirium Signs and Symptoms

Delirium is an intense confusional state which can cause an unexpected change in the mind, mental disarray, and passionate breakdown. It happens possibly due to beneath:

Fundamental condition substance/prescription harmfulness

Withdrawal of a substance/drug poisonous

It makes it extreme to focus, perceive, cause lack of sleep, and can't focus. Patients face intensely with abrupt beginning of mental component changes, tangible movement aggravations, and social declarations and unsettling.

Intellectual changes need cognizance, bewilderment, mental vulnerability, disarray, scattered reasoning example can't focus, labile effect, and psychosis

Unremitting unsettling influences including disillusionment, fancies, insanity, and pipe dreams

Conduct unsettling influences including nervousness, bother, disturbance, disinhibition, irritation, restless and fractiousness

Variance, disposition swings, or waxing/winding down in side effects during the entire day

Ridiculousness has different sub types, which are to be classified as:

Hyperactive – Continuous emotional episodes, perceptual changes in cognizance, Psycho motor unsettling, inconvenience, aggravations, and that might be joined by mind-set lability don't help out clinical consideration and decline to gain any clinical consideration contemplation

Hypo active – Fatigue, body solidness, absence of energy, Psycho motor hindrance, discouraged temperament, withdrawal, and hesitant of performing proactive tasks joined by dormancy and laziness that approaches absence of basic mental capacity daze

Blended – Both highlights of hyperactive and hypo active people show changes in conduct that varies day by day

Causes In The Palliative Care Setting

Practically any vacillation or change in regular exercises or aggravation of ordinary physiology can bring about ridiculousness. Patients with serious ailments are explicitly more helpless against advancement since they have extreme, confounded, changing clinical issues. Various drugs for the treatment of sickness are more dependent upon mediation.

Normal, ordinarily can be eliminated/settled:

Prescriptions (for example narcotics, steroids, benzodiazepines, anticholinergic medications)

Withdrawal (for example from benzodiazepines, narcotics, liquor)

Obstruction – Infrequent or difficult to pass stool

Urinary Retention – Inability to purge the bladder

Parchedness – Low degree of fluid in the body

More uncommon, ordinarily are frequently taken out/settled whenever lined up with objectives of care:

Metabolic unsettling influence (for example hypernatremia)

Frailty lack of red platelets

Hypoxemia-low degree of oxygen content

More uncommon, generally can't be taken out/settled:

Way to inversion isn't appropriate and contradictory with objectives of care (for example blood draws for labs, strategies)

Organ Failure – Dysfunction, liberated insusceptible reaction of body organ (for example renal, hepatic, respiratory)

CNS Pathology – Infection brought about by a wide assortment of organic entities like infection, microorganisms, parasites (for example tumor/metastasis, non-convulsive status epilepticus)

Indicative Failure – The issue in intellectual and framework mistake is that a symptomatic workup didn't track down a reversible etiology

Remedial Failure – Failure to achieve the treatment objectives bringing about deficient treatment a period restricted helpful preliminary is a disappointment at switching the wooziness

Counteraction

Forestalling wooziness begins with patients who are at high danger for fever. Characteristics include:

Age ≥ 65 years

Pattern psychological decay, hidden hindrance frameworks, for example, carelessness known as dementia

Vision issue as low vision, obscured, terrible visual perception or hearing

Low practical status, brokenness of the organ

Serious or basic ailment

Liquor abuse an example of drinking is abuse that prompts mischief to one's well being

Wretchedness mind-set problem, steady sensation of misery, bitterness

Current hip break

Post-medical procedure care after a surgery

Audit Medications

Attempt to diminish the quantity of portions and endeavor to cinch down the quantity of complete drugs utilized

Suspend, quit utilizing drugs that can bring about rare and hard to pass stools (blockage) or drying out

Stay away from and quit utilizing ideal recommended prescription, the executives, and the organization that stop and interfere with patients' ordinary rest cycle and wake-up daily schedule

Breaking point and control the utilization of prescriptions if conceivable that are related with incoherence (for example anticholinergics (e.g, diphenhydramine, scopolamine), benzodiazepines (for example lorazepam), narcotics (for example morphine), and corticosteroids (for example dexamethasone).

At the point when obliviousness and evasion are improper, not plausible for the patient's generally magnificent and ideal consideration, mitigate dose(s) to the gentle, littlest, and best

Utilize non-drug measures:

Furnish and Equip patient with advanced, apparent tickers and schedules

Make open glasses and portable amplifiers

Energize occurrences of moving, activity ambulation helps stop the advancement of stroke

Support and empower make ordinary rest wake cycle

Screen for signs and side effects and think about screening devices to trigger further appraisal:

Less clearness, mindfulness, or data of the climate

Failure to center, stay stable, maintain, or shift consideration

A modification in comprehension like neglect, mental disarray, bewilderment, language issue, aggravation, or a perceptual disarray like frustration pipedreams, disarray, or fancies

Upset rest design

Unusual psychomotor action

Passionate breakdown, aggravations like dread, outrage, discouragement, indifference, nervousness, or rapture

Screening

Screening devices recognize the presence of intellectual debilitation however may not analyze incoherence minus any additional appraisal. Mental status assessment and audit of indicative standards are needed to affirm the analysis of wooziness.

The Confusion Assessment Method (CAM)

Is perhaps the most generally utilized evaluating devices for wooziness. The presence of highlights 1, 2 either 3 or 4 beneath, may prompt an incoherence finding.

Highlight 1: Acute Onset or Fluctuating course

Highlight 2: Inattention, Inability to zero in on

Highlight 3: Unorganized, Muddled Thinking

Highlight 4: Altered and Disturb Level of Consciousness

The Memorial Delirium Assessment Scale (MDAS)

Intended to gauge the force, 10-thing, four-point spectator appraised size of incoherence with sequential perceptions. It incorporates investigation of aggravations, disarray, and absence of cognizance (mindfulness), direction, momentary memory, digit range, consideration inadequacy, coordinated reasoning, discernment, daydreams, psycho motor action, and excitement in a way that mirrors every one of the principle demonstrative measures as per the Diagnostic and Statistical Manual for Mental disorder. This instrument has the Mini-Mental Status Examination (MMSE) to survey and screen daze in numerous establishments.

The Bedside Confusion Scale

This is another apparatus to screen, screen and longitudinally follow incoherence in palliative consideration. The scale evaluates the capacity to present the a year in invert request and of cognizance state. Sequential sevens and spelling words, for example, "ranch" or "world" in reverse are other standard consideration tests.

The board

In the circle of an emergency clinic setting, and inside the shortfall of cutting edge disorder, incoherence show a few chances to invert the basic reasons; yet inside the palliative consideration setting, staggeringly near the finish of life, reversible causes don't appear to be sufficient, the exertion even the astute clinicians have a negligible decision anyway to oversee apparently. Palliative consideration clinicians are known to rapidly end the patient indications and supply backing to families and parental figures.

Workup or create something ought to depend on the individual patient's ailment status and guess

Audit and examine the drug list, coordinate and associate changes in prescription to the beginning of the manifestations, address poly pharmacy, suspend meds adding to hindrance, and tighten meds that could hasten extra issues

Utilize reversible causes, for example, drug withdrawal and contamination when lined up with objectives of care

It could be more helpful for not many patients, and results will be more beneficial to treat the incoherence instead of quest for the hidden reason

At the point when the rectification of essential issues and reasons for ridiculousness is undetected and not possible, the ordinary consideration movements to side effect the board

Non-Pharmacological Management

It incorporates predictable patient reorientation and consolation, dependable presence of relatives and dear companions, formation of a quiet and natural climate, and appropriate evaluation and the executives of tactile shortages, for example hearing misfortune (usefulness of portable amplifiers) and vision (require eyeglasses).

Guarantee well-being keep the condition of being same from conceivable peril and damage

Supply with satisfactory nourishment and hydration

Stay away from and avoid actual ruins and limitations

Reduce exorbitant incitement

Routinely screen and update patients and guarantee the patient of his or their security

Support family or some other part near being at bedside

Pharmacological mediation include:

Anti psychotics, normally haloperidol (be that as it may, second-age anti psychotics have been referred to as of late)

Benzodiazepines in select circumstances, and narcotics. Utilize the less successful portion of a medicine for the most limited span conceivable

Anti psychotics are viewed as the main line for possibly reversible insanity and might be utilized in blend with benzodiazepines and different narcotics for irreversible wooziness. Haloperidol (Haldol) is the need prescription.

Benzodiazepines are considered for irreversible daze and should stay away for conceivably reversible hyperactive incoherence except if anti psychotics don't control disturbance. Benzodiazepines are regularly answerable for daze precipitation and may compound daze emerging from different causes. Benzodiazepines are not viable as monotherapy and are suggested as an enhancement as it were. Models incorporate lorazepam (Ativan) and midazolam (Versed).

Different tranquilizers might be gainful for irreversible wooziness and are saved for tumult control, in opposition to any remaining means. Medicine models incorporate phenobarbital and propofol (Diprivan).

The Anti psychotic Debate

A few clinicians experience antipsychotics as helpful cures in low dosages to give brief, palliative alleviation data transfer capacity, while non-pharmacological measures do present.

Others accepted that insanity pharmacological administration with antipsychotics has been a quick wellspring of compound restriction and is for the most part not down to earth.

Truly, the anti psychotic class isn't new to public worry over excluded antagonistic impacts. In 2005, the FDA gave an unpredictable framework cautioning for all anti psychotic marking dependent on expanded death rates in older patients with dementia. The danger of death in drug-treated patients was 1.6 to 1.7 occasions the danger in the fake treatment bunch. The best condition was cardiovascular (for example cardiovascular breakdown, unexpected demise) or contamination (for example pneumonia). Security with the deficient proof to help the normal utilization of anti psychotics to forestall or treat incoherence, there is sufficient motivation to stop prior to choosing an anti psychotic for insanity the executives.

In 2017, discoveries of an arbitrary control preliminary achieved another conversation regarding the matter. The examination bunch included for patients with gentle to direct ridiculousness in a medical clinic setting, agents thought that it was less helpful from a low portion of risperidone or haloperidol than fake treatment. The discoveries were intriguing. Nonetheless, the patient populace, setting, and results estimated made it trying to comprehend it comprehensively. In any case, the preliminary's distribution prompted various meta-examinations organized and orderly audits in the previous three years on ridiculousness pharmacological administration.

In the Annals of Internal Medicine, a new organized audit distributed where specialists tried to research anti psychotic treatment advantages and damage in hospitalized grown-up patients with incoherence.

Taking all things together, 16 randomized controlled preliminaries and ten observational investigations with distributions going from 2004 to 2017 were inspected.

Discoveries

Agents investigate no distinction in sedation status, insanity term, medical clinic length of stay, or mortality among haloperidol and second-age anti psychotics versus fake treatment

There is no distinction in haloperidol's daze seriousness and intellectual working versus second-age anti psychotics, with deficient or no proof for anti psychotics versus fake treatment

In spite of the fact that there was some proof that shows that neurological damages related with momentary utilization of anti psychotics for treating wooziness in grown-up inpatients

Moreover, conceivably unsafe heart impacts happen all the more regularly in those controlled anti psychotics

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Impact of Consciousness Healing Treatment on Physical, Thermal and Spectroscopic Properties of Copper Chloride

Abstract

Copper plays an important role in development, normal functioning, iron absorption and transport, and immune function in human body. It is given in the supplements in the form of copper chloride to avoid the cupper deficiency associated symptoms. This study was designed to analyse the impact of the Trivedi Effect®-Energy of Consciousness Healing Treatment on copper chloride regarding its physical, thermal, and spectral properties. For this, the copper chloride sample was distributed in two halves, in which one part was termed as control sample and kept untreated. The other part was named as Biofield Energy Treated sample and it received the Trivedi Effect®-Biofield Energy Healing Treatment remotely by the renowned Biofield Energy Healer, Mr. Mahendra Kumar Trivedi. Consequently, the control and treated samples were analyzed for any change with the help of PXRD, DSC, TGA/DTG, FT-IR, and UV-Vis analytical techniques. The PXRD analysis of the treated sample showed the significant changes in the crystallite sizes from -8.35% to 30.78% along with 5.27% increase in the average crystallite size compared with the control sample. Similarly, the relative peak intensities of the Biofield Energy Treated sample showed alterations in the range from -38.00% to 527.54%, compared to the control sample. The DSC analysis revealed the increase in melting point of the treated sample (193.10°C) by 1.76% compared to the control sample (189.76°C) with 13.94% increase in the latent heat of fusion (ΔH). Also, the treated sample showed increase in the decomposition temperature by 3.96% with a significant 35.22% reduction in the enthalpy of decomposition, compared with the control sample. Besides, The TGA/DTG analysis showed the alterations in the weight loss of Biofield Energy Treated sample by -1.03, -24.44, and 2.35% in the 1st, 2nd, and 3rd step, respectively. The Tmax values of the 1st, 2nd, and 3rd peaks of the Biofield Energy Treated sample were increased by 4.68, 1.88, and 4.06% compared to the control sample. The thermal analysis revealed the increase in thermal stability of the treated sample after the Biofield Energy Treatment. Additionally, the spectral analysis including FT-IR and UV-Vis analysis did not reveal any significant difference between both the samples. The overall study concluded that the Trivedi Effect®- Energy of Consciousness Healing Treatment may help in developing a different polymorphic form of copper chloride, which might have improved thermal stability and safety profile along with better bioavailability compared to the control sample.

Keywords:  Copper chloride; The Trivedi Effect®, Energy of Consciousness Healing Treatment; PXRD; DSC; TGA/DTG; FTIR

    Introduction

The role of minerals elements in the human body plays an important role in various body functions. However, data suggest that about 98% of the human body mass is made up of nine non-metallic elements. The essential trace elements are boron, cobalt, copper, iodine, iron, manganese, molybdenum, and zinc. Copper is defined as one of the major and essential trace element that plays an important role in the body such as iron absorption and its transport. Copper is important component of the ceruloplasmin that has a ferroxidase-like activity [1,2]. Copper deficiency results in anaemic state because bone marrow develops iron deficient in spite of having enough iron stores in the body. In addition, copper is important for normal development of the skeleton [3], functioning of the central nervous system [4,5], taste sensation [6], and for skin pigmentation [4]. In addition to various human body function, copper is the third most abundant dietary trace metal after iron and zinc. Copper is also helpful in production of red and white blood cells and it is the component of various enzymatic processes. Iron can be significantly utilized in the body using copper, which is very much important for the growth of infants, development of the brain, immune system and strong bones [7]. Copper is present in many foods such as nuts, legumes, shellfish, and liver [8]. However, the malnourished infants may have been reported with copper deficiency along with those children that were dependent on cow’s milk, which has the low content of copper [9].

Different health agencies around the world have set standards for daily copper intake in the diet, which is defined according to different stages of life such as pregnant women, infant, adult, age, sex, and children [10]. Neutropenia and hypochromic anemia have been reported due to copper deficiency. Besides, different skeletal abnormalities were also reported that include osteoporosis, thickening of cartilage in costo-chondral junctions, cupping of the metaphysis, spontaneous factures, and hair pigmentation [11,12]. Copper deficiency may lead to neurological derangements such ashypotonia, psychomotor retardation, and periods of apnea [13]. Therefore, WHO (World Health Organization) reported in 1973 that the daily copper oral intake should be as 30μg/kg/ day (about 2mg/kg) in normal adults and 80μg/kg/day in infants [14]. Besides, the copper absorption in the body depends upon various factors such as gut absorption and its interaction with other nutrients. However, it was reported that only 40% of the oral dietary intake of copper is absorbed in stomach and duodenum [2]. Hence, copper chloride is considered as a copper supplement, which helps in maintaining the level within the body and preventing the depletion of endogenous stores as well as the deficiency symptoms. In recent days, the Biofield Energy Treatment has been a very useful approach in terms of the alteration in the absorption and bioavailability as well as the stability profile of any compound.

US National Institutes of Health (NIH) defined the term Biofield and its associated treatment approaches, which falls under Complementary and Alternative Medicine (CAM). It is defined as an organizing principle for the dynamic information flow, which regulates various biological function and homeostasis [15]. Over the past few decades, many energy healing practices has been reported significant outcomes in various clinical and non-clinical fields. National Center for Complementary and Integrative Health (NCCAM) defined different Energy Healing therapies under the sub-division of CAM with many advantages in addition to other therapies, medicines and practices [16] such as natural products, deep breathing, yoga, Tai Chi, Qi Gong, chiropractic/osteopathic manipulation, meditation, massage, special diets, homeopathy, progressive relaxation, guided imagery, acupressure, acupuncture, relaxation techniques, hypnotherapy, healing touch, movement therapy, pilates, rolfing structural integration, mindfulness, Ayurvedic medicine, traditional Chinese herbs and medicines, naturopathy, essential oils, aromatherapy, Reiki, cranial sacral therapy and applied prayer (as is common in all religions, like Christianity, Hinduism, Buddhism, and Judaism) [17,18]. Biofield Healing Treatment as a CAM reported with significant results in biological studies [19].

In addition, Biofield Energy Healing Treatment (the Trivedi Effect®) by renowned Biofield Energy Healer has been reported and compared with significant outcomes. Hence, Biofield Energy Healing is increasingly promoted and accepted worldwide in order to promote human wellness and improve quality of life [20]. The Trivedi Effect®-Consciousness Energy Healing Treatment has been reported with significant results in the field of chemistry [21,22], pre-clinical pharmacology [23], and pharmaceutical compounds [24], skin health [25,26] and many more. Thus, the objective of this study was to determine the effect of Biofield Energy Treatment (the Trivedi Effect®) on the physicochemical, thermal, and spectroscopic properties of copper chloride with the help of various analytical techniques such as, powder X-ray diffraction (PXRD), differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), FT-IR, and UV-visible spectroscopy.

    Materials and Methods

Chemicals and Reagents

Copper (II) chloride (cupric chloride) was purchased from VETEC, Sigma-Aldrich, India. All other chemicals used during the experiments were of analytical grade available in India.

Consciousness Energy Healing Treatment Strategies

The test compound i.e., copper chloride was taken and divided into two parts. In this, one part did not receive the Biofield Energy Treatment and named as control copper chloride. Besides, the other part of the test compound received the Energy of Consciousness Healing Treatment by the renowned Biofield Energy Healer, Mr. Mahendra Kumar Trivedi (USA), and it was considered as the Biofield Energy Treated copper chloride. In this process, the sample was placed under the standard laboratory conditions and the Healer provided the Trivedi Effect® - Energy of Consciousness Healing Treatment to the sample, remotely, for ~3 minutes through the Unique Energy Transmission process. Consequently, the control sample was subjected to “sham” healer under the similar laboratory conditions, who did not have any knowledge about the Biofield Energy Treatment. Later on, the control and Biofield Energy Treated samples were kept in similar sealed conditions and characterized with the help of PXRD, DSC, TGA/DTG, FTIR, and UV-Vis analytical techniques.

Characterization

Powder X-ray Diffraction (PXRD) Analysis

The PXRD analysis of control and Biofield Energy Treated samples of copper chloride was done using PANalytical X’Pert3 powder X-ray diffractometer, UK. The copper line was used as the source of radiation for diffraction of the analyte at 0.154 nm X-ray wavelength that is running at 40 mA current and 45 kV voltage. The instrument uses a scanning rate of 18.87°/second over a 2θ range of 3-90° and the ratio of Kα-2 and Kα-1 was 0.5 (k, equipment constant). The data was collected using X’Pert data collector and X’Pert high score plus processing software in the form of a chart of the Bragg angle (2θ) vs. intensity (counts per second), and a detailed table containing information on peak intensity counts, d value (Å), full width half maximum (FWHM) (°2θ), relative intensity (%), and area (cts*°2θ). The crystallite size (G) was calculated by using the Scherrer equation (1) as follows:

Where, k is the equipment constant (0.5), λ is the X-ray wavelength (0.154nm); b in radians is the full width at half of the peaks and θ is the corresponding Bragg angle.

Percent change in crystallite size (G) of copper chloride was calculated using following equation 2:

Where, GControl and GTreated are the crystallite size of the control and Biofield Energy Treated copper chloride samples, respectively.

Differential Scanning Calorimetry (DSC)

The DSC analysis of the samples was performed using DSC Q2000 differential scanning calorimeter, USA under the dynamic nitrogen atmosphere with flow rate of 50mL/min. For analysis, 2-4 mg sample was weighed and sealed in Aluminum pans. Further, it was equilibrated at 30°C and heated up to 450ºC at the heating rate of 10ºC/min under Nitrogen gas as purge atmosphere [27]. The value for onset, end set, peak temperature, peak height (mJ or mW), peak area, and change in heat (J/g) for each peak was recorded. Later on, the percent change in melting temperature (T) of the control and Biofield Energy Treated samples was calculated using following equation 3:

Where, TControl and TTreated are the melting temperature of the control and Biofield Energy Treated copper chloride samples, respectively.

Also, the percent change in the latent heat of fusion (ΔH) was calculated using following equation 4:

Where, ΔHControl and ΔHTreated are the latent heat of fusion of the control and treated copper chloride, respectively.

Thermal Gravimetric Analysis (TGA) / Differential Thermogravimetric Analysis (DTG)

TGA/DTG thermograms of control and Biofield Energy Treated copper chloride samples were obtained using TGA Q500 themoanalyzer apparatus, USA under dynamic nitrogen atmosphere (50mL/min). It involves the heating rate of 10ºC/ min from 25°C to 800°C and uses platinum crucible [27]. In TGA analysis, the weight loss in gram as well as percent loss for each step was recorded with respect to the initial weight of the sample. Later on, in DTG analysis, the onset, endset, peak temperature and integral area for each peak was recorded. The percent change in weight loss (W) was calculated using following equation 5:

Where, WControl and WTreated are the weight loss of the control and Biofield Energy Treated samples, respectively.

Also, the percent change in maximum thermal degradation temperature (Tmax) (M) was calculated using following equation 6:  

Where, MControl and MTreated are the Tmax values of the control and Biofield Energy Treated samples, respectively.

Fourier Transform Infrared (FT-IR) Spectroscopy

FT-IR spectroscopy of copper chloride was performed on Spectrum ES Fourier transform infrared spectrometer (Perkin Elmer, USA) by using pressed KBr disk technique with the frequency array of 400-4000 cm-1. The technique uses ~2mg of control sample and about 300 mg of KBr as the diluent to form the pressed disk followed by running the sample in the spectrometer. The same procedure was used for the Biofield Energy Treated sample.

Ultraviolet-visible Spectroscopy (UV-Vis) Analysis

The UV-Vis spectral analysis of the control and Biofield Energy Treated copper chloride samples was carried out using Shimadzu UV-2400PC SERIES with UV Probe (Shimadzu, JAPAN). The spectrum was recorded in the wavelength range of 190-800 nm using 1cm quartz cell having a slit width of 0.5nm. The absorbance spectra (in the range of 0.2 to 0.9) and wavelength of maximum absorbance (λmax) were recorded.

    Results and Discussion

Powder X-ray Diffraction (PXRD) Analysis

Figure 1 includes the PXRD diffractograms of control and Biofield Energy Treated copper chloride samples. The diffractograms of both the control and Biofield Energy Treated samples showed very intense and sharp peaks that represents the crystalline nature of the samples. Additionally, the diffractograms were analysed and the PXRD data such as Bragg angle (2θ) relative peak intensity (%), and FWHM were collected (Table 1) for calculating the crystallite size (G) of both the control and Biofield Energy Treated copper chloride. The Scherer equation [28] was used for the calculation of crystallite sizes across various planes in both the control and Biofield Energy Treated samples.

adenotes the percentage change in the relative intensity of Biofield Energy Treated sample with respect to the control sample; bdenotes the percentage change in the crystallite size of Biofield Energy Treated sample with respect to the control sample.

The PXRD diffractograms of the Control and Biofield Energy Treated samples showed highest peak intensity (100%) at Bragg’s angle (2θ) equal to 16.3° (Table 1, entry 1). The relative intensity of the PXRD peak at 2θ equal to 43.1° (Table 1, entry 11) in the Biofield Energy Treated sample was significantly decreased by 38%, compared to the control sample. However, the relative intensities of the other PXRD peaks (Table 1, entry 2-10 and 12-14) in the Biofield Energy Treated sample were significantly increased in the range from 8.01% to 527.54% compared to the control sample, which showed that the Biofield Energy Treatment might increase the crystallinity of the Biofield Energy Treated copper chloride sample. Besides, it was also analysed from the data that the crystallite sizes of the Biofield Energy Treated samples of copper chloride at 2θ equal to nearly 24.0°, 32.8°, 34.0°, 43.1°, and 49.1° (Table 1, entry 3, 6, 7, 11, and 13) were significantly increased from 7.68% to 30.78% with respect to the control sample. However, the crystallite sizes of the Biofield Energy Treated sample at 2θ equal to 38.1° (Table 1, entry 9) showed significant reduction by 8.35% as compared to the control sample. Also, the average crystallite size of the Biofield Energy Treated sample (31.95μm) was increased by 5.27% in comparison to the control sample (30.35μm). It is assumed that the Biofield Energy might be responsible for inducing the movement of crystallite boundaries, which causes crystal growth and thereby increased crystallite size. The significant alterations in the crystallite size and relative intensities of the Biofield Energy Treated sample indicated the modification in the crystal morphology as compared to the control sample. Some studies reported that such alteration in the crystal morphology due to changes in the relative intensities and crystallite size might indicate the presence of different polymorphs of the compounds and could be considered as the proof of polymorphic transition. Hence, the Biofield Energy Treatment probably introduced a new polymorphic form of the copper chloride with the help of energy transfer process [29]. Besides, any alteration in the crystal morphology might impact the dissolution and bioavailability profile of pharmaceutical/nutraceutical compound [30,31]. Thus, the Biofield Energy Treatment might improve the bioavailability profile of copper chloride.

Differential Scanning Calorimetry (DSC) Analysis

The DSC thermograms of the control and Biofield Energy Treated samples of copper chloride are shown in Figure 2 and the results are presented in Table 2.

ΔH: Latent heat of fusion/ Enthalpy of decomposition, *denotes the percentage change of Biofield Energy Treated sample with respect to the control sample.

The DSC thermograms of the control and Biofield Energy Treated samples of copper chloride (Figure 2) showed the presence of an endothermic as well as an exothermic peak. The DSC curve of the control sample exhibited an endothermic peak at 189.76°C which represents the melting point of copper (II) chloride dihydrate [32]. However, the Biofield Energy treated sample showed this peak at a temperature of 193.10°C, which was reported to be increased by 1.76% compared as the control sample (Table 3). Besides, the latent heat of fusion (ΔH) of the Biofield Energy Treated copper chloride was also observed to be significantly increased by 13.94% compared to the control sample. Previously, it was reported that the copper (II) chloride dihydrate got decomposed above 300°C along with releasing the chlorine gas [33]. In this study, the thermogram of the control sample showed a sharp exothermic peak at 416.89°C, which was observed at higher temperature i.e., at 433.40°C in the Biofield Energy Treated sample; and assigned as the decomposition temperature of the copper (II) chloride dihydrate. Thus, the decomposition temperature of the Biofield Energy Treated copper chloride was found to be significantly increased by 3.96% along with a significant reduction (35.22%) of the enthalpy of decomposition, compared with the control sample. The DSC analysis revealed that the Biofield Energy Treated copper chloride sample require different amount of energy in the form of ΔH as compared to the control sample during the process of melting. Thus, it could be assumed that there might be some alterations induced by the Biofield Energy Treatment in the intermolecular forces of the compound that causes the altered ΔH in the Biofield Energy Treated sample, compared to the control sample. Moreover, it is also presumed that the Biofield Energy Treatment may be responsible for emission of less kinetic energy during the phase transition process of copper chloride from solid state to liquid state that may be responsible for increasing the ΔH in the Biofield Energy Treated sample as compared to the control sample. Hence, it could be concluded that the Biofield Energy Treatment might act by altering the potential as well as the kinetic energy of the molecules of copper chloride, which possibly resulted in altered ΔH and melting/decomposition temperature in the Biofield Energy Treated sample in comparison to the control sample.

Thermal Gravimetric Analysis (TGA) / Differential Thermogravimetric Analysis (DTG)

The TGA/DTG analysis helps in determining the thermal stability of the compounds with the help of the thermograms, which in this case are the control and Biofield Energy Treated samples (Figures 3 & 4). The analytical data related to the TGA and DTG analysis for the contro

Tmax: Maximum thermal degradation temperature, *denotes the percentage change in the weight loss of Biofield Energy Treated sample with respect to the control sample.

 The thermal degradation of copper chloride dihydrate salt was reported to be occurred in various steps, as firstly the compound loses its water molecules under a dynamic nitrogen atmosphere in the temperature range of 66 to 132°C at 10°C/min heating rate [32]. In this study, the TGA thermograms of the control and Biofield Energy Treated copper chloride showed three steps of thermal degradation (Figure 3). The analysis showed that in the 1st and 2nd step of degradation, the Biofield Energy Treated copper chloride has reduced weight loss by 1.03% and 24.44%, respectively; while it was increased by 2.35% in the 3rd step of degradation, as compared to the control sample (Table 3). However, the overall weight loss after thermal degradation was same for both the control and the Biofield Energy Treated sample. It revealed that the Biofield Energy Treated sample possessed significant higher stability till the 2nd step of degradation, as compared to the control sample.

Besides, the DTG thermograms of the control and Biofield Energy Treated samples (Figure 4) exhibited three peaks. The Tmax values of the 1st, 2nd, and 3rd peaks of the Biofield Energy Treated sample were increased by 4.68, 1.88, and 4.06% compared to the control sample (Table 2). Overall, TGA/DTG revealed that the thermal stability of the Biofield Energy Treated copper chloride was significantly improved, compared to the control sample, which was also supported by the DSC analysis.  

Fourier Transform Infrared (FT-IR) Spectroscopy

The FT-IR spectra of control and Biofield Energy Treated samples of copper chloride are presented in Figure 5.

There were clear stretching and bending peaks in the functional group and fingerprint region in the FT-IR spectra of both the control and Biofield Energy Treated copper chloride (Figure 5). There were peaks at 2924 cm-1 and 2854 cm-1 in the spectra of both the control and Biofield Energy Treated sample, which were assigned to the aliphatic C-H stretching. Besides, there were stretching frequencies in the fingerprint region of the control sample’s spectrum at and in the Biofield Energy Treated samples at 1377 cm-1 and 1460 cm-1. According to the literature, the metal halide stretching absorption band was found in the frequency region 750-1000 cm-1 in case of the inorganic materials. Thus, the peak at 722 cm-1 represents the metal halide stretching. It revealed that the fingerprint region of the control and Biofield Energy Treated sample was remained same. The FT-IR spectra did not display any changes in the vibrational frequencies thus, it may be concluded that there was no alteration in the structural properties of the Biofield Energy Treated copper chloride sample as compared to the control sample.

Ultraviolet-visible Spectroscopy (UV-Vis) Analysis

The UV-visible spectra of both, the control and Biofield Energy Treated copper chloride samples are presented in Figure 6.  

The maximum absorbance (λmax) in the UV spectra of both the control and Biofield Energy Treated samples was observed at 868nm. Thus, it revealed no significant alteration in the absorbance maxima between the control and Biofield Energy Treated sample. Hence, it might be concluded that there was no significant alteration in the electronic transitions between highest occupied molecular orbital and lowest unoccupied molecular orbital [34] of the Biofield Energy Treated copper chloride sample, induced by the Biofield Energy Treatment.

    Conclusion

The overall study revealed that the Trivedi Effect®-Energy of Consciousness Healing Treatment has the significant impact on the physical and thermal properties of copper chloride. The PXRD analysis revealed the alterations in the relative peak intensities of the Biofield Energy Treated sample in the range from -38.00% to 527.54%, as compared to the control sample. The similar alterations were observed in the crystallite sizes across various planes of the Biofield Field Energy Treated sample in the range from -8.35% to 30.78% along with 5.27% increase in the average crystallite size, as compared to the control sample. Such alterations in the relative peak intensities and crystallite sizes along the characteristic peaks of the Biofield Energy Treated sample suggested that the Biofield Energy Treatment might create some disturbances in the crystallinity as well as the pattern of the atoms across those planes. Besides, the DSC analysis of both the samples showed the thermograms including both the endothermic and exothermic peaks. The analysis revealed that the melting point of the Biofield Energy Treated sample (193.10°C) was increased by 1.76% as compared to the control sample (189.76°C) along with 13.94% increase in the latent heat of fusion. Also, the data showed that the decomposition temperature of the Biofield Energy Treated sample (433.40°C) was increased by 3.96% as compared to the control sample (416.89°C) along with 35.22% reduction in the enthalpy of decomposition. The overall DSC data showed that the thermal stability of the Biofield Energy Treated sample was improved, as compared to the control sample. Moreover, the TGA analysis of the copper chloride samples revealed three steps of thermal degradation in which, the Biofield Energy Treated sample showed significant reduction in the percentage weight loss in the 1st and 2nd steps of degradation by 1.03 and 24.44%, respectively; while it was increased by 2.35% in the 3rd step of degradation, as compared to the control sample. The Tmax values of the 1st, 2nd, and 3rd peaks of the Biofield Energy Treated sample were increased by 4.68, 1.88, and 4.06% compared to the control sample. The overall thermal analysis showed that the thermal stability of the Biofield Energy Treated copper chloride was increased along with significant alterations in the internal energy of the molecules after the Biofield Energy Treatment. However, the FT-IR spectrum and UV-Vis analysis showed similar spectral pattern between the control and Biofield Energy Treated sample. Overall, the current analysis represented the significant impact of the Trivedi Effect®- Energy of Consciousness Healing Treatment on the physical and thermal properties of copper chloride. The Biofield Energy Treatment affected the crystallite size and crystallinity of the compound that might create a new polymorphic form of copper chloride. Additionally, the Trivedi Effect® showed its potential impact in increasing the thermal stability and internal kinetic energy of drugs which may help in designing the formulations having enhanced bioavailability, safety and stability profile. Therefore, the Biofield Energy Treated copper chloride may show better response against the copper deficiency and related diseases such as anemia, osteoporosis, pigmentation of skin, apnea, psychomotor retardation, hypotonia, etc.

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[pommunism]

so your pet has had a seizure - now what?

watching your pet have a seizure - whether it’s “fly biting” or a total grand mal - can be a deeply traumatic experience. maybe they were sleeping when it happened. maybe they were romping around with their favorite toy and suddenly fell over. regardless, now they’re flailing, their neck is rigid, they’ve lost control of their bowels and bladder, and if you’re like me when my dog first had a grand mal, you’re probably crying. so, what do you do?

first of all, what do seizures look like? in animals, they can manifest in many different ways. a generalized/grand mal, or the most extreme seizure, is when they lose total consciousness, fall over, become rigid, and spasm or paddle their legs like they’re swimming. many tend to urinate or defecate during this time. some stop breathing and turn blue. some drool excessively. some seizures are more minor and the animal may briefly lose consciousness, go limp, stare off into space unresponsively, or have facial twitches. some seizures are psychomotor, meaning they manifest as weird repetitive behaviors such as frantic tail chasing, lip smacking, snapping at the air (”fly biting”), excessive vocalizing, or aggression that are unusual for that specific animal. one animal can have different types of seizures. my dog usually has full-body generalized seizures, but when she was first started on phenobarbital, those eased up into facial twitches.

make sure your pet is away from harmful objects. this includes cords, sharp objects, furniture legs, etc - anything that can cause injury. they are completely unconscious at worst and disoriented at best and don’t understand where they are in relation to their surroundings. do not put your hands anywhere near their mouths. their jaws are also affected by muscle contractions and can reflexively snap down. it has absolutely no reflection on your relationship because they don’t know they’re doing this. the best thing you can do is gently move them to an open area and wait it out. i try to slip a puppy pad or towel under mine because she’s inclined to urinate.

time the seizure. this is SO critical, not just for you but for your vet. before i started using the stopwatch on my phone, i was trying to estimate it just by observation and i was surprised to realize i was overestimating it by a full minute and in reality, her seizures were roughly 10-20 seconds in duration. a seizure that approaches five minutes is an immediate medical emergency.

monitor their recovery. the recovery phase, also called the post-ictal phase, varies wildly between dogs. they may be unconscious for awhile. if possible, it’s a good idea to check the color of their gums and tongues by using something like a nail filer or wooden tongue depressor so you’re not sticking your fingers in their mouth. pink is good, purple means they are very low on oxygen, but if they’re breathing normally they should pink up. wrap ice packs and place them on their bellies and footpads or squirt alcohol on their footpads. overheating is the biggest complication of seizures, especially for overweight animals. they may have lost control of their bowels and bladder, so you can clean them up as best you can. it doesn’t hurt to pet them and speak softly to them. some may pop up and act almost normal. others may wake up but be temporarily blind, disoriented, clumsy, clingy, aloof, aggressive, hungry, thirsty, or have other behavioral changes for an hour or so afterwards.

write down everything that happened. this includes the date, the time the seizure started, the duration of the seizure, description of the seizure, any changes you might have noticed shortly before onset, and what their recovery was like. i keep a seizure journal in the form of index cards. this not only helps you keep track of seizures  - especially if there are more than one - but helps you and your vet look at patterns and frequency. some don’t seem to have any triggers, but others do. stress is a common one. our groomer has had to bring a dog to treatment more than once because it started seizing as soon as he put it in the tub.

are seizures an emergency? when in doubt, my answer is always yes, please take it to the vet as soon as possible. however, i understand that sometimes these things happen after hours and emergency services can be expensive. in this case, i’ll tell you to look at context. one seizure by itself isn’t necessarily an emergency, as long as it’s not secondary to another event - trauma, liver complications (is your animal yellow?), poison, etc are all events that demand immediate attention by a vet, seizures or no. if your animal has more than one seizure in a 24 hours period, that’s called clustering, and is a medical emergency. having one seizure lowers the threshold, making them more susceptible to having them. the more they have, the less time they have to recover from the previous one, meaning their brains aren’t completely able to stop misfiring and can potentially lead to the worst case scenario: status epilepticus. this happens when the brain can’t stop misfiring, period, and the pet can’t stop seizing. status epilepticus refers to a seizure that lasts five minutes or longer. this is an absolute emergency. your pet’s brain will essentially fry itself and lead to permanent brain damage and death. personally, i would have my emergency vet on the phone once my dog hit the 3 minute mark.

what happens at the vet? your vet will want background, not just about the seizure itself but the context of it and history of the pet. they may want to do blood work and x-rays. ct scans and mris are great, but out of most people’s means. animals from pet stores or backyard breeders are more prone to epilepsy because of poor breeding practices, such as inbreeding. certain dog breeds are more prone to epilepsy, such as herding dogs, boxers, and cocker spaniels. the age of the pet matters - very young animals may have a liver defect called a portosystemic shunt, while much older animals are more likely to have a brain tumor. it can be an emotionally draining appointment.

epilepsy can be managed. if your pet is diagnosed with epilepsy, the good news is that most pets respond to medication and can have normal lifespans. the first drug of choice is phenobarbital. it’s inexpensive and very effective. chronic use may eventually impact the liver, so your pet will have to have routine testing to ensure it’s in the proper range and its liver is still functioning well. some pets can stay on nothing but phenobarb their whole lives. sometimes you may be given diazepam - aka valium - that you can administer rectally to stop seizures. potassium bromide and zonisamide are most commonly used as a secondary anticonvulsant when phenobarb alone isn’t enough. keppra is also good, but less common and more expensive. instead of rectal diazepam, my dog is on intranasal midazolam, which is better to manage her problem with clustering. there are side effects, but they generally improve after a few weeks on the meds. it’s not unusual for pets to have breakthrough seizures even when they’re otherwise well-managed. some may have one seizure every 6 months. my dog clustered for no discernible reason not that long ago, but my vet and i agreed it didn’t warrant a change in meds.

the important thing to remember is that epilepsy is not a death sentence, and it doesn’t have to affect your pet’s quality of life. dogs and cats don’t have our level of awareness; believe it or not, they don’t suffer half as much having the seizure as you do watching it. my dog is as happy and stupid as ever - happier, in fact, because she actually had anxiety until she went on phenobarb. i genuinely believe she’s never been happier, not even compared to the seven years she lived without a single seizure. it’s not a burden to give her medicine twice a day (ALL my dogs’ favorite time of day, because “pill time!” means peanut butter) or always have one ear listening for the sound of her paddling on the floor, it truly isn’t. it’s just another routine, and one that keeps her healthy, happy, and by my side.

so your pet has had a seizure - now what? well, now you know you’re not alone, and whether it’s epilepsy or not, i hope this helped you in some small way. 

[journalofsportsmedicine]

Classification of Mobile Games as a Precondition of the Efficiency of their Use- Juniper Publishers

Juniper Publishers- Journal of Physical Fitness, Medicine & Treatment in Sports

Introduction

The game is a complex and multifaceted phenomenon that is comprehended by man through experience and recognized at the sensual level. It combines and structures various processes and phenomena, reveals the peculiarities and preferences of a person, simulates and tests any aspects of their life. With this phenomenon, a person knows their inner world and interacts with the surrounding reality. Through the game, a person reveals the origins that allow them to rise above themselves. Organically combining the past and the future, real and imaginative, understandable and incomprehensible, the game manifests the uniqueness and singularity of the individual, provides the necessary conditions for its self-realization.

Today, the scientific search for specialists is aimed at finding out the philosophical and psychological and pedagogical essence of the game, the study of cultural foundations, the properties and qualities of the game phenomenon, the definition of the place of the game in the educational process, the use of its opportunities in various spheres of life of different groups of the population. At the same time, the conditions for improving the gaming activity of the modern generation that provide the integrated realization of the game’s potential are not yet sufficiently studied, and as a result, the ways of using its pedagogical possibilities in the formation of the personality have not been determined. An open question remains about the influence of mobile games on the factors that determine the comprehensive and harmonious development of the individual.

One of the ways of solving this problem is related to the definition and justification of new approaches to the development of the classification of mobile games. This will help to improve the system of interdependent mobile games of one or another intended purpose and allow to better orient in the diversity of gaming objects and help to consciously and effectively use them in the pedagogical process. The purpose of the research is to develop and substantiate the conceptual model of the classification of mobile games in the context of implementing their pedagogical potential.

    Research Methods

To achieve this goal, a set of interrelated methods has been used, namely: analysis, synthesis and synthesis of scientific information on the problem of research, educational and methodological literature and Internet sources, pedagogical observations.

    Research Results

The game, as a manifestation of one of the main types of human activity, can be studied from different positions: from the pedagogical-as a means and method of influencing the personality, from psychological -as a means of mental development, the way of mastering social relationships and collective forms of activity, from sociological - as a condition of the emergence and development of communication, people’s relationships, etc. [1]. In our study, mobile games are meaningful activities that aim at achieving specific motor tasks in a rapidly changing environment. Unlike games in general, mobile games used in the pedagogical process have a clearly set goal and, in accordance with it, the expected result, which can be justified, can be determined by the necessary components of this process and characterized by educational and developmental orientation. In this case, mobile games are studied not in isolation from other forms and types of gaming activity, but as an integrative factor which contains general and universal features of gaming activity and represents the functionality of the game.

By simulating any game situation or episode, mobile games require from each participant a comprehensive manifestation of psychomotor abilities and intelligence. At the same time, participation in the game leads to an active and proactive stance, which largely determines the success in achieving the desired results. After all, the activity of the player acts as one of the psychological and pedagogical mechanisms of mental, social, moral, physical, emotional growth of personality, their inclusion in culture. It is accompanied by an interest, a feeling of pleasure and enjoyment and is based on them. According to P Lesgaft [2], functional satisfaction is the most significant feature of the game, which significantly distinguishes it from physical exercise. This is confirmed by the fact that in no other way, a person does not seek to show their own ability to fail, revealing the available psychophysical and intellectual resources, as in the game.

The classification of mobile games is considered as a connecting link in the process of knowledge, which promotes the proper relationship of pedagogical theory and practice. It acts as a form of reflection of reality and includes a certain list of logical operations. At the same time, the development of the classification allows to clarify the concept and organize the knowledge, establish connections between individual mobile games and their groups, carry out quantitative and qualitative analysis of the game material in the determined directions, outline the prospect of further research.

The analysis of literary and Internet sources and the synthesis of the best practices show that today there is no single universal feature of classification, on the basis of which it is possible to systematize the entire spectrum of mobile games. The unifying factor of modern approaches to the classification of mobile games is their order according to the level of complexity and content, organization, number and age of the players, the intensity of tension, the predominant manifestation of physical qualities and the type of motor activity [3-2].

We proceed from the fact that psychological and pedagogical substantiation of the essence of mobile games, their systematic ordering should be determined by the problems of physical education and training and is correlated with them. In physical education, this manifestation of gaming activity is seen as a process that is the basis of the formation and development of personality. As for physical education, mobile games here serve as a means and way to achieve the goal beyond its borders [7]. The need to distinguish between the two aspects of pedagogical culture - the culture of education and the culture of training, due to the need for science in the conceptual delimitation of these relatively synchronously existing phenomena, which allows deeper and more detailed study of the current state of the problem under study.

The educational process, in comparison with the pedagogical process, relies on already existing knowledge and certain achievements of the individual and, accordingly, begins ontogeny later. Education is primarily viewed as a dynamic, long-term process that has no end, and training is often limited in time. The priority of education is the harmonious, comprehensive, holistic development of personality potential, first of all, creativity and constructive and creative abilities in the process of mastering the achievements of physical education. In its turn, physical education is aimed, in the majority, at the formation of human perceptions about the system of norms and values, the strengthening of the person’s attitudes and the improvement of their qualities, which is associated with the problems of the purpose-setting of the pedagogical process. In contrast to education the free interaction between a person and the outside world, training is carried out between the subjects of the process, who are at different levels of competence. Initially, the process of training is characterized by the overwhelming influence of someone else’s viewpoint on the pupil, and further, it involves overcoming the difficult path to the formation in the individual of the ability to determine their own qualities and opportunities and act properly.

Developing the classification of mobile games requires the identification of relevant system-generating features that reflect the nature and focus of physical education and physical training. The main issues that always arise when considering the problem of classification and systematization of mobile games can be formulated as follows:

a) What signs (or separate ones) determine one or another type and kind of mobile games that are implemented in the pedagogical process?

b) Is any feature taken separately reasonable for the classification of types and kinds of mobile games?

c) If so, why is this feature put forward as the only selfsufficient factor?

d) If not, what should be the interconnection between them so that the diversity of types and kinds of mobile games is a single entity?

In any human activity (study, work, etc.), there are two interrelated processes-reproduction and creativity. They characterize the game activity and permeate all its types and kinds. These processes are dialectically interconnected, interdependent and act as two separate components. The main element is creativity, and activity at the level of reproduction is a preparatory stage for it. At the same time, both components form a single whole, in which the elements of reproduction and creativity are closely intertwined and are mutually complementary. At the same time, their ratio varies. In some cases, such as relay races, where confrontation with an opponent is mediated and the modes of motor action can be determined by already known patterns or models, the processes of reproduction will prevail. In the others, the creative search will dominate. In particular, the effective solution of tasks in team games requires the manifestation of creativity, based on previously acquired knowledge and experience, and achievement of the expected result is impossible provided that only the old template is used.

However, an indispensable element of the implementation of any mobile game is the individual knowledge. In this process, which is always based on the high activity of the participants in the game, it is possible to distinguish the following determinative activities:

a) The activity of assimilating and applying the finished information or motor skills in familiar situations

b) Activity, the content of which is the definition of possible modifications of the already acquired principles, the diversification and combination of motor activities in changing conditions

c) Activity aimed at independent discovery of principles, improvement and integration of motor activities.

In a closed circuit which is always present in the game activity, reproduction and creativity interpenetrate each other, acting in a constant unity and interconnection. Reproductive activity, unlike creative, is characterized by the fact that it always ends with the creation of a product according to already known patterns or models. In the course of such activity, a person who is in conditions of the same type operates the methods of the previously formed system in public and in their own experience. The process of finding the necessary solution to the problem involves reproduction of existing knowledge and experience, their updating and enrichment, as well as the ability to operate them and construct new ways to act. Reproductive actions are creative, on the one hand, as their foundation, and on the other - as a derivative of the creative. Creativity stems from reproduction, is the development of the latter and contains reproductive processes as one of its derivatives [8]. This pattern is the procedural side of the grouping of mobile games, which can determine their general typology, namely the following types:

a) Reproductive

b) Reconstructive-variant

c) Partial search

d) Creative

Consequently, the ratio of processes of reproduction and creativity, the level of manifestation of the latter, as one of the priorities of physical education, can serve as a necessary feature that underlies the classification of mobile games. In the school, family, social, and gender pedagogy a wide arsenal of mobile games is used which reflects the universal, national, ethnographic, geographical, historical, regional values, features and peculiarities. To study, research a large number of variants, modifications, strategies of games that meet certain sexage categories and level of player’s training is quite difficult. The possibilities of designing and adapting mobile games in accordance with the conditions of their implementation should also be taken into consideration: forms of occupation, place of conducting, number of participants, material and technical support, weather, etc. At the same time, games differ from one another not only by a formal model, a set of rules, quantitative indicators, but above all goals. Even those mobile games which contain the same rules, the information base has significant differences, provided that they are used for different purposes. Actually, the poly functional nature of mobile games contributes to the multifaceted influence on the development of the individual, on their creative, motivational, intellectual, physical, emotional and volitional spheres.

Since physical education is a purposeful process, and the principle of identifying the types of mobile games, the definition of their kinds within the framework of this typology must always be combined with the logical-content side and externally manifested, including through certain pedagogical purposes, another necessary feature of the classification of mobile games to serve their intended purpose. At the first level of grouping mobile games, the predominant orientation of pedagogical influence is determined by cognitive and developmental, educational and training, control and assessment, and recreational and recreative purposes. At subsequent levels, further distribution is carried out by refining the goals of using games and their specifics in certain tasks. Cognitive and developmental goals are first separated by separate constituents, and then detailed in accordance with the information field and subject of development: intelligence, memory, reaction, attention, etc.

Clarifying the group of educational and training purposes involves the delineation of the relevant areas with the following specification through the educational aspect of the task of mastering certain knowledge, the formation of motor skills and educational component through physical education objectives and personal qualities. In this case, mobile games often serve as commonly developing, training, special exercises and, simultaneously, a method of physical training. Control and estimating group includes objectives of systematic physical or athletic training, evaluation of motor talent, physical fitness, forecasting abilities. Further details of the goals of this group are due to the choice of the subject of study: certain physical and personal qualities, motor activities, sides of athletes training, their functional status, and elements of sport selection. In turn, the recreational and recreative components, which determine the group of recreational and recreative purposes, are specified in accordance with the objectives of disease prevention, treatment, rehabilitation of the human body, as well as the tasks of recreation in the broadest sense. Here, mobile games are mostly health-improving and specially improving exercises, attractions, amusements, sights and other emotional instruments of pedagogical influence (Figure 1).

This approach to the classification of mobile games makes it possible to further develop this open system, since, on the one hand, human creativity is unlimited and can appear in different manifestations, and on the other hand, pedagogical activity will always put forward various tasks that can be solved with the help of mobile games. This arrangement is intended to become a reference point in the whole variety of mobile games, a source of information about their pedagogical potential.

Questions of the classification of mobile games require further scientific and theoretical justification, since optimal ordering of games as an important and universal tool of pedagogical influence allows to optimize the process of physical education, to correctly orientate in the system of means and methods of physical training. At the same time, the effectiveness of the practical use of mobile games should be ensured not only through their appropriate selection in accordance with the pedagogical conditions and proper organizational and methodological solution, but also through adapting their content and structure to a particular contingent and a particular pedagogical situation.

    Conclusion

The proposed conceptual model for the classification of mobile games involves the creation of a certain system of games, consisting on the basis of the consideration of fundamental and common features, the principle of unity of processes of reproduction and creativity and the purpose of mobile games, as well as regular relationships between them. In this case, certain features reflect the pivotal aspects of pedagogical culture - physical education and physical training, and the links between the elements of the formed system are established in two directions: vertically (by the level of creativity) and horizontally (by the predominant orientation of pedagogical influence). The first direction reflects the procedural side of the grouping of mobile games and determines their type. The second one provides within the general typology the logical ordering of types of mobile games according to their intended purpose. Supplementing each other, these directions determine the integrity of the system, and the corresponding types and kinds of mobile games are considered as interacting, interconnected components.

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[laberintos-espinas]

Hey Guess What, Motherhood Is Tough: Life Coaching Vs Psychotherapy for Struggling Moms

Each mother realizes that turning into a mother, particularly in the first place is incredibly testing. Be that as it may, our general public glorifies parenthood as downright complete euphoria and ease. There are incalculable misguided judgments, suspicions and frames of mind that are very harming to our moms. "Great moms" are the individuals who can deal with everything about a sorted out, immaculate way. They keep a flawlessly spotless and clean home and bolster their kid's every intrigue and need, placing herself last on the rundown of needs. Her character, interests, public activity, and so forth don't make a difference any longer since now she is a mother. Also, for that, she is totally upbeat! Her marriage is multiple times more grounded since the child has come. Those warm, fluffy minutes do happen yet not in each moment of consistently. This romanticized picture of parenthood is destructive as endless moms contrast themselves with this unthinkable and unreasonable perfect and incessantly feel like they aren't sufficient. Many come to know the sentiments of deficiency and blame well indeed What is Functional Life Coaching Ladies over the world battle with the change of parenthood and as a result of the previously mentioned message we get, they are disregarded to feel embarrassed and. With proficient experience working with new moms as both an actual existence and progress mentor and an authorized psychotherapist, I've seen incalculable ladies who have imparted their emotions to family, companions, specialists, and are told by them (generally with well meaning goals) that they may have Post Partum Depression (PPD). This rushed naming, as well, can be destructive the same number of ladies feel unfathomably embarrassed, judged and lacking. This article is intended to explain the distinctions in battling with the progress of new parenthood and in real PPD and gives some foundation on the various methodologies and perspectives that a psychotherapist may have versus those of a holistic mentor.

Post birth anxiety (the genuine analysis is Major Depressive Episode with Post Partum Onset) is a genuine condition that ought to be treated by a prepared emotional well-being proficient. The predominance of PPD is begging to be proven wrong as the insights extend significantly. Post pregnancy anxiety isn't perceived as being symptomatically unmistakable from Major Depressive Episode (despondency) as indicated by the American Psychiatric Association (2000), in any case, a prepared proficient would determine that a Major Depressive Episode is, "With Post Partum Onset" just if the beginning of side effects happens inside about a month of conveyance. Hence, the criteria for PPD and "gloom" are the equivalent. PPD is a time of at any rate two weeks where there is either a discouraged state of mind or the loss of intrigue or delight in almost all exercises ("not minding any longer"). Additionally, at any rate four different manifestations must be available that remember changes for hunger as well as weight, rest changes (a sleeping disorder or dozing excessively, not the progressions that normally will happen with your infant's timetable), diminished vitality, sentiments of uselessness or blame, trouble with focus and thinking or deciding, psychomotor action transforms (others may see that you move more slow or quicker than expected) or repetitive contemplations of death or suicide. These side effects must persevere for the greater part of the day, consistently, for at any rate two back to back weeks. Additionally, they should make critical misery or impedances in your capacity work. The level of weakness ranges from mellow to extreme and a cautious meeting is important to make this determination. In extreme cases, an individual may lose the capacity to perform insignificant self-care or individual cleanliness undertakings or they could even experience fancies or mind flights. Explicit to ladies who include had an infant inside about a month of beginning of indications, changes in state of mind and distractions with the prosperity of your newborn child (power could run from being over-worried about the infant to encountering real daydreams) are normal as are alarm assaults. Regular maternal frames of mind towards newborn children likewise change enormously and can incorporate lack of engagement, dreadfulness of being distant from everyone else with the infant or getting meddlesome with the youngster that may even intrude on the infant's rest. A past filled with gloom expands one's hazard for the advancement of PPD as does a family ancestry of any confusion of the temperament (Depression, Bi-Polar Disorder, and so forth.). Ladies additionally should know about any ailments that may be answerable for a portion of the above manifestations, for example, hypothyroidism, for example that could be the basic reason, (American Psychiatric Association, 2000).

Ladies who meet criteria for Major Depressive Episode or PPD ought to be seen by a prepared psychological wellness proficient rather than a holistic mentor as authorized advisors and therapists are explicitly prepared to work here. There are endless methodologies psychotherapists take in treating PPD. Ladies may decide to be seen for singular treatment or gathering treatment and may likewise think about the assistance of a stimulant or hostile to uneasiness medicine (or different types of psychotropics) related to psychotherapy. It is ideal to look for the help of a prepared specialist for psychotropic meds as therapists have explicit preparing around there yet you likewise have the decision to address your obstetrician or essential consideration doctor about prescription for gloom. Psychotherapeutic intercessions frequently incorporate Cognitive-Behavioral Therapy or Interpersonal Therapy, notwithstanding, numerous hypothetical methodologies utilized in psychotherapy extraordinarily advantage ladies who experience PPD.

As far as I can tell as a psychotherapist, numerous ladies came to me with maybe a couple of the previously mentioned side effects (misery, blame, uneasiness, absence of intrigue, and so forth.). Much of the time, these ladies could/ought to have been getting the help of a holistic mentor versus a psychotherapist as they didn't meet criteria for PDD however were ladies who were battling with the change. An interminable number of them had been endorsed with a stimulant from their general specialists or OB-GYNs. Similarly as a holistic mentor ought not be training a customer who needs psychotherapy, a psychotherapist ought not be treating a customer who doesn't have critical psychological well-being concerns. It is additionally significant that ladies look for the assistance of an emotional wellness proficient with proper confirmation and those looking for an expert mentor needs to discover a supplier who is likewise ensured as there is no guideline to prevent non-guaranteed people from rehearsing as a mentor. The contrasts among instructing and treatment are many. Numerous specialists approach their work with a "what's up" point of view that is normal in western medication and in our general public's therapeutic model of care. This model searches for the issue (manifestation) and means to fix it (end of side effect) similarly as a western restorative specialist would treat an infirmity. Training is a field that works with individuals who are as of now working and it hopes to assist individuals with understanding that nothing is "off-base" with them by any means. Misguided judgments about training are many. Worth explaining is that mentors don't offer guidance. We don't assume the job of master on your life or on some random theme or territory (other than the training procedure obviously). The customer is the master of their own life. There are no decisions of "fortunate or unfortunate", "set in stone" from a mentor as we don't accept that we know "better" than any of our customers. Truth be told, we as mentors accept that, naturally, customers realize what's best for them and we effectively bolster customers in revealing this. Instructing is about association and meeting up to accomplish the existence the customer sees with their own eyes.

In my expert work as a mentor, I have worked with numerous ladies with an immense assortment of concerns. A significant number of my customers have put some distance between the dynamic, able, energetic, incredible, free (will I go on) lady who she is at the center. She feels as if she has lost herself, her personality, incidentally and she misses it enormously. Numerous ladies can reveal to you that once she had a youngster, MOST things throughout her life appeared to change. One colossal misinterpretation, in any case, is that the new mother totally changes WHO SHE IS at the center; she is never again a similar individual. Turning into a parent is not normal for any involvement with the world. Another parent's life is perpetually enhanced in a really significant manner? Guardians start to comprehend love in a manner they could have at no other time envisioned. Be that as it may, numerous ladies experience lost their character and their "previous self". She doesn't have the foggiest idea who she is any longer and feels that she can never return. Samantha, 30, with a baby and a little child encountered this. She clarified, "I knew [motherhood] would have been hard. Being a full time mother is perhaps the hardest activity on the planet. Notwithstanding, I feel that some have a belief system and portray what parenthood resembles. Being a mother is a passing to self. I give all of what I have inside me to my family". Kara, 27 and a mother of a multi month old additionally could relate clarifying, "I believed I had basically vanished. There are times I have a feeling that I'm stopping to exist as a person". Numerous ladies put off their fantasies until their children are raised. Taking care of your interests, your actual character and your fantasies for "one more day" doesn't need to be reality for ladies. There is a way and a mentor causes you discover it.

Moms experience incalculable different difficulties in new parenthood. Outright fatigue, time the executives issues, changes in self-perception, "enthusiastic rollercoasters", gigantic blame, changes in public activity, sentiments of depression and segregation because of absence of grown-up organization, alterations in tolerance, no days off or days off, loss of public activity, loss of pre-infant association with accomplice, less time for loved ones, the mind blowing requests and obligations of new mommyhood, social separation, work-life balance issues and the interminable PLANNING that currently should jump out at do pretty much anything are just a couple of the numerous battles ladies have. Parenthood is the hardest activity on the planet. N

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Revealing Rapid Keys In Chocolate Slim

With 8-level tension control for raised intensity, the Speed Physical fitness Magnetic Recumbent Exercise Bike permits you to push on your own throughout your exercise. The approach of reactive versus preventative is slowly coming to fulfillment, as well as I think extra medical professionals will certainly accept the concept of preventative medication including exercise as a modality in the years to come. With your abdominal muscles tight, slowly stroll your hands out to ensure that your body rolls along the round. Make up for your smaller carbohydrate intake before exercise by consuming carbohydrate throughout the occasion or training session. Ever since, I have actually upgraded it as needed based upon changes in our food environment as well as the weight of the clinical evidence. You have to attend to upper abdominals, lower abdominals, and also obliques, as well as each requires a different kind of workout. Contact a properly credentialed workout professional to deal with you and your medical professional. It's additionally essential to understand that eating a square meal, specifically carbohydrates, will certainly inhibit the SNS and reduce the fat burning effect of your workout. Past study has actually shown workout assists glycemic control in individuals who struggle with type 2 diabetes mellitus, one of the most usual kind. While the fitness market divides workout into categories such as anaerobic-, cardio- as well as cardiovascular training, health and fitness specialists like Dr. McGuff and Phil Campbell point out that in order to really access your cardio system, you have to perform mechanical work with your muscle mass-- and can do that on an elliptical exerciser machine, on weight training tools, or using free-weights. The FitDesk Pedal Desk 2.0 Stationary bicycle calls for a moderate mount of assembly. Those who were energetic as teens and kept up their exercise behavior as adults had a 20 percent reduced risk of death from all reasons. Inning accordance with McCallum Location, an eating condition facility, professional athletes in combat sports may be specifically prone to disordered eating as a result of the nonstop weight yo-yo of their professions. Alcohol intake negatively impacts on a variety of psychomotor abilities essential for effective exercise efficiency, consisting of reaction time, equilibrium as well as hand-eye control. Research published in 2014 3 located that if you're inactive, you have a 20 percent greater danger for having a stroke or mini-stroke (short-term ischemic assault) compared to individuals who work out sufficient to perspire at the very least four times a week. Celtic have actually punched above their weight at times in the Champions Organization, but on the occasions they have done so they have actually trusted an uniformity of spirit and personality. The water aids soothe the pressure of your body's weight on the influenced joints (hips and knees particularly), while providing resistance for your muscle mass to get more powerful. Shop abdominal muscle workout devices from preferred brands, including BOSU Balls ®, Body-Solid ®, STOTT PILATES ®, GoFit ® as well as Health and fitness Equipment ®. Boost your wellness, enhance your life-upgrade your fitness regular today with the workout equipment collection at PRICK'S Sporting Item. Likewise review any other clinical problems you have (bronchial asthma or osteoporosis, as an example) and also how they might influence your capability to workout. Hello donnabell, The Marcy ME-709 Recumbent Magnetic Bike seat adjusts forwards as well as in reverse for various elevations. It's well worth noting that your selection of morning meal food may play a substantial role in lowering or heightening experiences of appetite later, which will impact your general calorie intake for the day - as well as how foods can change your metabolic performance, and either for the benefit or detriment to your fat burning. Additionally stockpile on low-fat milk and also chocolate slim forum for treats, as research studies have revealed that calcium from these sources could assist weight-loss.

Immediate Secrets For Chocolate Slim Revealed

If a competitor like Lauzon stayed in the sauna for as long as he 'd need to lose the twelve pounds or more of water weight he had to, without interruption, it would likely be a large amount a lot more dangerous than what he was already doing. Typical exercises, such as a common crunch with rotation or a standing rotation with a light hand weight. Their success, as well as the account of somebody like Kim Little - short-listed for Globe Player of the Year - provides an opportunity to attract women into sport and also workout. The reverse banding entails affixing thick resistance bands to the top of your power shelf. Workout is Medication Canada @ Guelph launched in 2013 as well as expects expanding extra this year! Be sure to keep your core involved to stabilize your lower back," claims Lagomarsine, that adds that this exercise constructs both stability and motor control. Choose these if you already have various other equipment or other workout outlets yet are searching for means to stabilize your routine between muscle mass groups. It's likewise crucial to realize that eating a full meal, particularly carbohydrates, will certainly prevent the thoughtful nerves (SNS) as well as reduce the fat burning impact of your workout. Scientists have exposed that regular exercise improves your brain's sources that promote repressive control, aiding to make up for the assault of lures that urge unhealthy consuming (unhealthy food promotions, snack bar on every block, and so forth). The leading 10 rivals then progress to the final, where they once again carry out rope, ribbon, hoop and also ball regimens. Continue reading for 6 ideas to losing the infant weight, and a really doable workout program you will certainly have the ability to discover time for. Research studies reveal that both women and also males who exercise during their early years have a reduced risk of cancer later in life. When it comes to weight loss, component of the issue is that cardio is among the least effective forms of exercise. BMI is a measure of body make-up, came to by splitting your weight in kilograms by the square of your elevation in meters.

Choosing Efficient Solutions In Chocolate Slim

Certain, I such as food, but I also intended to get going on the enjoyable part of cutting weight - $ "placing it back on. Boxers wish to reduce weight only because they can place it back on after that and also stroll right into the cage much larger than they evaluated in at, the day before. Previous research studies have determined and determined a wide range of biochemical modifications that take place throughout workout. For one point, exercising moms-to-be needs to not exercise in the hopes of keeping their weight down during pregnancy. A randomized, regulated test at Punkaharju Rehabilitation Facility in Finland researched the effectiveness of stamina training in the neck, compared with extending or no exercise. When journeys to the health club typically aren't possible, having fitness equipment at home makes staying in form a breeze. Alleviating up on or staying clear of such activities and icing your wrists may bring some alleviation, as could decreasing your salt consumption to maintain your water weight down. After exercise, professional athletes need carbohydrate as well as liquid to replace glycogen and water losses during the exercise. Layout, building and construction and repair service of the scientific instruments made use of for exercise physiology testing and study. In numerous researches, as an example, scientists at Laval College in Quebec adhered to people with rheumatoid arthritis who joined dance-based workout. Burke, L. M. Nutrition for post-exercise healing Australian Journal of Scientific research and also Medicine in Sporting activity 29: 3-10, 1997.

Root Components For Delicious chocolate Slim Around The USA

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4 Things to Know About Driving Simulation Clinical Trials

If you are performing CNS clinical trials, there is a good chance that you will need to determine the impact of the medication on a person’s driving ability. It’s common to test for this, and several methods have been developed over the years. If this is your first CNS trial, you may need to know about driving simulation trials and whether you should partner with a contract research organization (CRO) to perform the simulation. Here are some things you should know.

Why Should You Add Driving Ability Tests? Preventing traffic accidents resulting from drug impairment is an important public health priority. This is where clinical trials come into the picture. Depending on where you hope to get drug authorization, you may need to perform driving simulation clinical trials. Countries like the United States might have restrictions on CNS drugs that could potentially impair driving. At the same time, Japan prohibits driving while on any medications known to affect the CNS, regardless of whether or not the drug has been shown to impact driving ability. If drugs that could affect our CNS are tested and shown not to impair driving, it is possible that broad restrictions can be eliminated in favor of less severe restrictions. Real World Assessments for Accurate Data There are a few ways to measure how a drug impairs driving ability during early clinical development. These include real-world on-the-road assessments, driving simulations, and neurophysical testing, including reaction times and psychomotor speed. Real-world assessment may not be feasible in evaluating drivers under all relevant conditions but is accurate for the evaluated set of conditions. It’s also expensive and time-consuming, and conditions such as weather, high traffic, and obstacles may make it difficult. Neuropsychological Testing for Impairing Effects Neuropsychological testing concerns variables such as visual perception, memory, and daytime sleepiness. It is helpful for early evaluations of potentially impairing or enhancing effects. The data can be used to rule out drugs that lack these impairing effects. Driving Simulations for a Variety of Conditions Driving simulations allow for testing in various conditions that may be hard to obtain in real-world assessments. It’s also less costly, safer, and faster. Driving simulations eliminate the risk for property damage or injury while still offering a high degree of validity. Conditions can be controlled and repeated. Simulations can also be combined with neuropsychological testing, resulting in the perfect mix of complementary information from both methods. About Altasciences Altasciences, a mid-sized drug development solution company, has more than 25 years of research experience. Altasciences has used an innovative approach to build a foundation that pharmaceutical and biotechnology companies have come to rely on. Clients are guided through the drug development process with tailor-made program roadmaps, from lead candidate selection to preclinical to clinical proof of concept, and beyond. Altasciences offers their partners expertise in various study types and therapeutic indications. Altasciences has key experience in CNS clinical trials, first-in-human clinical trials, and Ethnobridging. The CRO provides access to dedicated Phase 1 clinical trial units across North America in both the USA and Canada. Those resources include access to over 580 beds, a database with more than 400,000 potential participants, and a highly trained and experienced staff. Altasciences is the perfect choice for drug development for sponsors that need dedicated and integrated CRO/CDMO services. Partner with Altasciences to perform driving assessments at https://www.altasciences.com/ Original Source: https://bit.ly/3ePQQ63

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Computational PSG Improves Detection of Factors Affecting Daytime Alertness in Patients With OSA

The following blog post Computational PSG Improves Detection of Factors Affecting Daytime Alertness in Patients With OSA is courtesy of Elly Mackay

Compared with conventional methods, novel polysomnography (PSG) parameters better describe how the severity of oxygen desaturation during sleep affects daytime alertness in patients with obstructive sleep apnea (OSA), according to study findings published in the European Respiratory Journal.

As researchers note, current diagnostic parameters that estimate OSA severity do not optimally relate to psychomotor vigilance in patients with the condition. Analyzing potential impairments in daytime alertness could prove vital for patients with OSA, as a prior study indicated that these populations are 2 times more likely to be involved in occupational accidents compared with normal subjects.

When examining patients with neurocognitive disorders, a myriad of domains, including learning and memory, language, executive functioning, and complex attention, are considered in determining severity. Psychomotor vigilance task (PVT), a test that assesses neurocognitive performance, assists in evaluating a patient’s ability to sustain attention by measuring repeated responses to visual stimuli.

In analyzing the efficacy of conventional diagnostic parameters (eg, Apnea–Hypopnoea Index [AHI], oxygen desaturation index [ODI]), and novel parameters (eg, desaturation severity, obstruction severity) in determining psychomotor vigilance of patients, researchers examined both approaches’ ability to predict PVT performance in a study cohort of patients with OSA (n = 743).

All apneas, hypopneas, and desaturations were scored manually per established guidelines, with all PSG recordings also scored manually by sleep technicians. Participants completed the PVT test in the evening prior to the PSG and were grouped into quartiles based on PVT outcome variables. Study authors additionally examined the odds of belonging to the worst-performing quartile.

All PVT outcome variables were analyzed via binomial logistic regression.

In the study findings, desaturations played a significant role in determining psychomotor vigilance, as a relative 10% increase in median depth of desaturations elevated the odds of prolonged mean and median reaction times and increased lapse count (odds ratio [OR]range, 1.20-1.37; P <.05). Additionally, an increase in desaturation severity was associated with prolonged median reaction time (ORrange, 1.26-1.52; P <.05). Conversely, conventional AHI and ODI were not associated with deteriorated PVT performance.

Based on analyses examining the odds of performing poorly on the PVT, female sex (ORrange, 2.21-6.02; P <.01), Epworth Sleepiness Scale score (ORrange, 1.05-1.07; P <.01) and older age (ORrange, 1.01-1.05; P <.05) were significant risk factors.

“Our results highlight the importance of developing methods for a more detailed assessment of OSA severity and comprehensive analysis of PSGs. This would enhance the assessment of OSA severity and improve the estimation of risk and severity of related daytime symptoms,” says lead study author Samu Kainulainen, MS, junior researcher at University of Eastern Finland, in a release.

from Sleep Review https://www.sleepreviewmag.com/sleep-diagnostics/in-lab-tests/polysomnography/computational-psg-improves-detection-of-factors-affecting-daytime-alertness-in-patients-with-osa/

from Elly Mackay - Feed https://www.ellymackay.com/2020/04/30/computational-psg-improves-detection-of-factors-affecting-daytime-alertness-in-patients-with-osa/