#VanLED

[cheaprv]

Keystone, Colorado. Photo by Victor Villanueva.

[arnekleivsvollen]

Grunnleggende Dovremålsegenskaper

Her er noen segenskaper av dialekta som snakkes i Dovre kommune. Dovre ligger i Nord-Gudbrandsdalen, Oppland fylke, midt i hjertet av Norge. Jeg har vært veldig interessert i denne dialekta fordi familien på min fars side har røtter der. Hvis du vil høre et lydklipp av noen som snakker dialekta, er det ei lenke nederst i innlegget. :) Pronomer [bokmål – dovremål] jeg/meg – e/me' du/deg – du/de' han/ham – hainn['n]*/honom hun/henne – ho['o]* vi/oss – oss dere – døkk de/dem – døm *Hainn og ho kan uttales bare «'n» og «'o» i rask, daglig tale. Personlige pronomer er brukt før du sier noens navn og de forkortede formene brukes vanligvis i denne sammenhengen. f.eks. 'O Kari æ så avlaus tå se'. Spørsmålsord [bokmål – dovremål] hva – kæ hvor – kær/kæl/kor hvordan – kordan hvem – køm/kem hvorfor – kæffor/keffor når – ner Adjektiver Adjektiver med -ig slutninger vil slutte på -e: [bokmål – dovremål] skikkelig – skikkele vanlig – vanle osv. Verb Dialekta bruker kløyvd infinitiv. Verb pleier å bøyes uten -r slutningen. f.eks. Nogo så abraksle' ha' e' ailder sett. Hainn va' akta og æra. Du fæ' tølja tå bleggje lite grann så 'n går* lettar'inn. *Noen, men ikke alle sterke verb som å gå beholder -r slutningen. Jamvektsord eksempler (å-å) [bokmål – dovremål] å snakke – å tålå [beslektet med bokmålsordet «tale»] å lage – å lågå å komme – å kåmmå hage – hågå mage – mågå hane – hånå nese – nåså dager – dågå Andre vanlige ord [bokmål – dovremål] er – æ ikke – ikkje/'kje det – dæ den – deinn man – mainn med – mæ eller – eill/ell få (verb) – fæ til – te om – um opp – upp aldri – ailder mye – mykjy noe(n) – nogo(n)/någgå(n)/nugu(n) ut av – utu Unike ord [dovremål – bokmål] mehenkje – hunnmygg f.eks. Ho æ stygg mehenkja i kveill.

lugumt – passelig f.eks. Dæ æ lugumt ner dæ passa' slik.

løyle – morsom/morsomt f.eks. 'O Marte æ ei løyle jænte.

Kilder og flere detaljer om Dovremål Ord og uttrykk frå Dovre bok av Alf Eriksen [norsk IP-adresse er nødvendig og tilgjengelig med VPN] Store norske leksikon NTNUs Nordavinden og sola dialekt database (med lydklipp) Ord om fjell [Dikt fra Nord-Gudbrandsdalen]

[satan-offical]

(I love Mel's lore and I don't think Satan knows much so here I am)

*Mel was showing Satan YouTube and was just scrolling randomly somehow they found family channels more specifically vanl life content. You found this one channel that seemed to have a younger version of Mel but Mel quickly changed it. So once she got up to do something you checked out the channel more and it was a younger version of Mel. Later she came back*

@mel-child-of

(didn't realize how much I wrote)

Hey bestie, I checked that one van life channel you skipped (YouTube is so confusing)

[thetruemasterofgames]

What I like about the Pluto and roku options is they aren't pirating they are allowed to show it amd its tracked like a vanle network, so you can watch no guilt if you are watching somwthing by a smaller creator, creators still get viewership credit.

[comeupkid415]

wide vanl mq by ReppinDa415ripaj

[nursingwriter]

THERAPY FOR PATIENTS WITH ANXIETY DISORDERS Therapy for Patients with Anxiety Disorders Introduction From the onset, it would be prudent to note that most people at some point in their lives experience anxiety. However, anxiety could be deemed abnormal or unusual when it is not only frequent, but also rather excessive or intense. Client X (a hypothetical name), a 46-year-old white male, presents with symptoms consistent with generalized anxiety disorder (GAD). It is important to note that he has been referred by his PCP following an ER visit where he complained of breath shortness, chest tightness, and an impending doom feeling. At present, Client X indicates that he still experiences shortness of breath and chest tightness. He further indicates that he experiences the impending doom feeling on an intermittent basis. He reports frequent alcohol use to help him cope with the aforementioned symptoms. The results of a Hamilton Anxiety Scale (HAM-A) return a score of 26. In essence, this could be interpreted as moderate to severe anxiety. There are a number of patient factors that I would be taking into consideration in the making a decision about which pharmacological intervention would be most appropriate on this front. The said factors are inclusive of; patients age, occupation, and socioeconomic status. I would also be seeking to establish whether the patient is on any other medication and whether he has in the past been diagnosed with any psychiatric disorder or chronic illness. There may also be need to establish whether at this point in time, Client X has any other comorbid psychiatric disorder. The relevance of the factors highlighted above cannot be overstated when it comes to the need to minimize the probability of side effects, and further enhancement of patient convenience. In as far as the latter objective is concerned, i.e. patient convenience, it should be noted that past studies have established that this happens to be a crucial consideration in efforts to promote adherence to the treatment regimen. Decision #1: begin Paxil 10 mg po daily From the onset, it would be prudent to note that I opted to commence the treatment journey with Paxil 10 mg po daily prescription. I selected this particular decision owing to the fact that Paxil happens to be a selective serotonin reuptake inhibitor (SSRI). Strawn, Geracioti, Rajdev, Clemenza, and Levine (2018) point out that SSRIs happen to be an ideal first-line treatment for GAD. In the words the authors, SSRIs inhibit the reabsorption of serotonin by neurons, so increasing the availability of serotonin as a neurotransmitter (1059). They also have less side effects which is ideal in this case given Client Xs occupation. I selected the SSRI indicated, as opposed to the two other options, because as Strawn, Geracioti, Rajdev, Clemenza, and Levine (2018) observe, SSRIs happen to be rather safe and are known to have fewer side effects. This is in comparison to anxiolytics (i.e. buspirone) and tricyclic antidepressants (i.e. Imipramine). Paxil 10 mg was also selected with Client Xs hypertension in mind. Unlike the SNRIs and tricyclic antidepressants such as Imipramine, Paxil 10 mg is less likely to have an adverse impact on the clients blood pressure. More specifically, as Calvi et al. (2021) indicate, tricyclic antidepressants have been associated with increases in blood pressure, as well as orthostatic hypotension, particularly imipramine (113). I expect Client X to experience relieved symptoms 2-6 weeks after commencement of treatment. He will be started on a low dose to permit his body to adjust to the drug. Essentially, if an SSRI is effective, it is recommended to take the medication for another 6 to 12 months, and then gradually reduce the dose (Clevenger, Malhotra, Dang, Vanle, and IsHak, 2018, p. 51). One of the ethical considerations of relevance on this front happens to be fidelity. This relates to ensuring that patients have access to competent, safe, as well as quality care. Thus, it is my responsibility in this case to recommend an intervention that will be of benefit to Client X, i.e. in relation to the alleviation of the GAD symptoms he presents with. Decision #2: no change in drug/dose at this time I selected this decision because as the client has indicated, his symptoms have gotten better. As Client X notes, he no longer experiences shortness of breath or tightness in chest. Further, he points out that over the last 4-5 days, he has noticed marked decrease in work-related worries. HAM-A returned a score of 18 - interpreted as mild to moderate anxiety. The objectives of decision #1 were, thus, met. This is more so the case given that I had expected the client to experience relieved symptoms 2-6 weeks after commencement of treatment with Paxil 10 mg which is the period of time statistically significant results, as Strawn, Geracioti, Rajdev, Clemenza, and Levine (2018) indicate, should be expected at lower dosing. Increasing the dose to 20 or 40 mg po daily would at this point be premature given that Client Xs symptoms have improved. The dose of an SSRI may be increased if the response from the patient happens to be unsatisfactory. There is also need to minimize the probability of dropout especially given that a research conducted by Furukawa et al. (2019) on the optimal dose of SSRIs indicated that the relationship between the dose and dropouts for any reason indicated optimal acceptability for the SSRIs in the lower licensed range (603). I hope to achieve continued decrease in anxiety. More specifically, during the next visit, I expect Client X to indicate even more decreased worries about work. Lower doses of SSRIs have less side effects than higher doses (Furukawa et al., 2019). One of the ethical considerations of relevance on this front happens to be nonmaleficence. This has got to do with taking the precautions necessary to secure the wellbeing of the client and ensure that they are not harmed by any of the interventions instituted (McHenry, 2006). On this front, there would be need to take precautions to ensure that the dosage instituted does not adversely impact Client Xs wellbeing and safety. Decision #3: increase drug to 75 mg po daily I selected this decision because the client reports no further improvement in symptoms. As a consequence, there is need to make the relevant therapeutic adaptations going forward. Increasing the drug to 75 mg po daily would be an ideal course of action. This is the maximum recommended dose (Furukawa et al., 2019). Given that the client was started at a relatively low dose and registered some improvement, an increase in dosage would likely prove beneficial. Adding an augmentation agent would not be ideal at this point because Client X has been at a lower dose of the SSRI, i.e. Paxil 10 mg po daily. There would be need to first consider what therapeutic effect a higher dose of the SSRI would have. Switching to an SNRI would also be inappropriate at this point because as Clevenger, Malhotra, Dang, Vanle, and IsHak (2018) indicate, if an SSRI proves effective, there is need to continue a course of the same for a minimum of 6 months. The SSRI selected proved effective at a lower dose at 4 weeks follow up. By making this decision, I expect the clients anxiety symptoms to decrease significantly over the next few weeks. Furukawa et al. (2019) point out that where lower doses are ineffective meta-analytic reviews suggest that higher doses of SSRIs may be more effective (604). One of the ethical considerations of relevance on this front happens to be autonomy. The treatment plan could be affected by patients refusal to take the drug. Indeed, the client has in this case questioned the efficacy of the intervention because, as he indicates, the medication might not be effective for him as he has not experienced any further decrease in anxiety. Autonomy relates to the need to embrace the patient as a unique individual and thus respect the decision that the said patient makesin relation to available treatment options (McHenry, 2006). There may, however, be need to address the clients concerns by way of explaining the mechanisms of actions of the drug and the need to incorporate an augmentation agent. Conclusion Upon factoring in the specific circumstances of this particular client, a decision was made that the best medication to start treatment with would be Paxil 10 mg po daily (an SSRI). A lower dosage was selected because of the need to ensure that the side effects of the SSRI were minimized. Available evidence indicates that SSRIs are rather safe and are known to have fewer side effects (Strawn, Geracioti, Rajdev, Clemenza, and Levine, 2018). The need to blunt the said side effects cannot be overstated owing to the fat that the client works in a sector that requires maximum concentration and focus. Some of the common SSRI side effects are inclusive of, but they are not limited to; blurred vision, dizziness, feeling agitated, etc. These side effects could be amplified at higher doses. Going forward, there will be need to ensure that the client is well-informed about how to maximize the benefits of any of the proposed intervention. This is more so the case with regard to what to avoid whilst taking the medications as well as when to take the medications (i.e. before or after meals). Client X will also be advised that it could take a few weeks for him to experience noticeable changes in as far as alleviation of symptoms is concerned even after revision of dosage. He will also be advised to report any serious adverse effects. In the final analysis, it would be prudent to note that to enhance the effectiveness of the interventions proposed above, there may be need to also incorporate cognitive behavioral therapy (CBT). There are studies indicating that combining CBT with the various pharmacological interventions results in better treatment outcomes. For instance, as Strawn, Geracioti, Rajdev, Clemenza, and Levine (2018) indicate that there is evidence indicating that the effects of SSRIs could be amplified by CBT. References Calvi, A., Fischetti, I., Verzicco, I., Murri, M.B., Zanetidou, S., Volpi, R., Cought, P., Tadeschi, S., Amore, M. & Cabassi, A. (2021). Antidepressant Drugs Effects on Blood Pressure. Frontiers in Cardiovascular Medicine, 8(3), 112-116. Clevenger, S.S., Malhotra, D., Dang, J., Vanle, B. & IsHak, W.W. (2018). Clinical and economic outcomes of adjunctive therapy with pregabalin or usual care in generalized anxiety disorder patients with partial response to selective serotonin reuptake inhibitors. Ther Adv Psychopharmacol., 8(1), 49-58. Furukawa, T.A., Cipriani, A., Cowel. P.J., Leucht, S., Egger, M. & Salanti, G. (2019). Optimal dose of selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine in major depression: a systematic review and dose-response meta-analysis. Lancet Psychiatry, 6(7), 601-609. McHenry, L. (2006). Ethical issues in psychopharmacology. J Ed Ethics, 32(7), 405-410. Strawn, J.R., Geracioti, L., Rajdev, N., Clemenza, K. & Levine, A. (2018). Pharmacotherapy for Generalized Anxiety Disorder in Adults and Pediatric Patients: An Evidence-Based Treatment Review. Expert Opin Pharmacother., 19(10), 1057-1070. https://www.paperdue.com/customer/paper/anxiety-disorders-pharmacological-interventions-term-paper-2179434#:~:text=Logout-,AnxietyDisordersPharmacologicalInterventions,-Length6pages Read the full article

[poconopaula]

Check out this listing I just added to my Poshmark closet: 3 Pura Vida, bracelets.

[hawkesoutdoor]

Now at #hawkesoutdoors #mercedes #winnebago #sprintervans and more #vanl...

[palletwoodcamper]

We Got Tiger Power ! Yeah Solar Power #rv #rvlife #camping #camper #vanl...

[bentself]

RV Music Life ! Outside Set Up 👽

#bentself #rvlife #musiclife #tourlife #travels #independentmusician #diyartist #indielabel #rvliving #vanlife #traveling #nomad

[idekanymore-doglikecreature]

went with vanl extra, using the pronounce feature it sounds like normal vanilla extract

hannibal & will are HAVING ANOTHER BABY

so name poll time! (doing this early so i dont mess up the timing like last time)

if you dont already know theyve had one baby, we named her abigail :3 so abigail is not an option on this poll

i'll let the game pick babies gender, personality, & looks(but i'll edit the looks a lil bit) but i will name the baby whatever wins!!

[cheaprv]

Germantown, Wisconsin. Photo by Josh Turner.

[chikachons]

[ao3feed-larry]

"Quotation Marks"

by Vanlesbian

Louis trained for two years for this moment to finally follow in his family's footsteps to time travel for TARC. His first mission- the UK in 1944 to take footage of the war to be used for Memory Chips being developed by the lab to sell to the public for entertainment. Louis' mission is only supposed to last five days, five minutes back in 2064. However, when he accidentally meets Alex, a discharged soldier trying to run from his demons, his mission no longer seems to matter compared to the boy with dimples.

Or

Louis time travels from 2064 to 1944 London where he meets Alex at a gay underground speakeasy and all original plans get thrown to the wind until he's forced to come back to his own time.

Words: 2396, Chapters: 1/22, Language: English

Fandoms: One Direction (Band)

Rating: Mature

Warnings: Graphic Depictions Of Violence, Major Character Death

Categories: M/M

Characters: Alex (Dunkirk), Louis Tomlinson, Harry Styles, Liam Payne, Zayn Malik, Niall Horan

Relationships: Harry Styles/Louis Tomlinson, Alex (Dunkirk)/Louis Tomlinson

Additional Tags: Time Travel, Not Really Character Death, Smut, Fluff and Smut, Angst, Not Beta Read, Not Canon Compliant, Homophobic Language

via AO3 works tagged 'Harry Styles/Louis Tomlinson' https://ift.tt/39Rm2A8

[veggiemadness]

Vanilla the Rabbit X Knuckles the Echidna - Fan Child Design

Another off the large as life Suggestion List I have on one of my DA Journals. This design is on sale to adopt on my DeviantArt Account.

[vanle23]

#tbt from 2008 at the WarRoom with the homies to celebrate @peedie206 birthday from that year #throwbackthursday #random #money #club #warroom #nightlife #seattle #birthday #homies #friends #goodtimes #memories #vanle#2008 https://www.instagram.com/p/CaXvX1wvcNn/?utm_medium=tumblr