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Because of the difficulty in timing onset asthma symptoms heart buy cheap montelukast 4mg on line, the 1-month duration criterion applies only to the specific symptoms listed above and not to any prodromal nonpsychotic phase. The diagnosis of schizophrenia should not be made in the presence of extensive depressive or manic symptoms unless it is clear that schizophrenic symptoms antedated the affective disturbance. If both schizophrenic and affective symptoms develop together and are evenly balanced, the diagnosis of schizoaffective disorder (F25. Schizophrenia should not be diagnosed in the presence of overt brain disease or during states of drug intoxication or withdrawal. Similar disorders developing in the presence of epilepsy or other brain disease should be coded under F06. Pattern of course the course of schizophrenic disorders can be classified by using the following five-character codes: F20. The clinical picture is dominated by relatively stable, often paranoid, delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. Disturbances of affect, volition, and speech, and catatonic symptoms, are not prominent. Examples of the most common paranoid symptoms are: (a)delusions of persecution, reference, exalted birth, special mission, bodily change, or jealousy; (b)hallucinatory voices that threaten the patient or give commands, or auditory hallucinations without verbal form, such as whistling, humming, or laughing; (c)hallucinations of smell or taste, or of sexual or other bodily sensations; visual hallucinations may occur but are rarely predominant. Thought disorder may be obvious in acute states, but if so it does not prevent the typical delusions or hallucinations from being described clearly. Affect is usually less blunted than in other varieties of schizophrenia, but a minor degree of incongruity is common, as are mood disturbances such as irritability, sudden anger, fearfulness, and suspicion. The course of paranoid schizophrenia may be episodic, with partial or complete remissions, or chronic. In chronic cases, the florid symptoms persist over years and it is difficult to distinguish discrete episodes. In addition, hallucinations and/or delusions must be prominent, and disturbances of affect, volition and speech, and catatonic symptoms must be relatively inconspicuous. Delusions can be of almost any kind but delusions of control, influence, or passivity, and persecutory beliefs of various kinds are the most characteristic. It is important to exclude epileptic and drug-induced psychoses, and to remember that persecutory delusions might carry little diagnostic weight in people from certain countries or cultures. The mood is shallow and inappropriate and often accompanied by giggling or self-satisfied, self-absorbed smiling, or by a lofty manner, grimaces, mannerisms, pranks, hypochondriacal complaints, and reiterated phrases. There is a tendency to remain solitary, and behaviour seems empty of purpose and feeling. This form of schizophrenia usually starts between the ages of 15 and 25 years and tends to have a poor prognosis because of the rapid development of "negative" symptoms, particularly flattening of affect and loss of volition. Hebephrenia should normally be diagnosed for the first time only in adolescents or young adults. The premorbid personality is characteristically, but not necessarily, rather shy and solitary. For a confident diagnosis of hebephrenia, a period of 2 or 3 months of continuous observation is usually necessary, in order to ensure that the characteristic behaviours described above are sustained. For reasons that are poorly understood, catatonic schizophrenia is now rarely seen in industrial countries, though it remains common elsewhere. These catatonic phenomena may be combined with a dream-like (oneiroid) state with vivid scenic hallucinations. Diagnostic guidelines the general criteria for a diagnosis of schizophrenia (see introduction to F20 above) must be satisfied. Transitory and isolated catatonic symptoms may occur in the context of any other subtype of schizophrenia, but for a diagnosis of catatonic schizophrenia one or more of the following behaviours should dominate the clinical picture: (a)stupor (marked decrease in reactivity to the environment and in spontaneous movements and activity) or mutism; (b)excitement (apparently purposeless motor activity, not influenced by external stimuli); (c)posturing (voluntary assumption and maintenance of inappropriate or bizarre postures); (d)negativism (an apparently motiveless resistance to all instructions or attempts to be moved, or movement in the opposite direction); (e)rigidity (maintenance of a rigid posture against efforts to be moved); (f)waxy flexibility (maintenance of limbs and body in externally imposed positions); and (g)other symptoms such as command automatism (automatic compliance with instructions), and perseveration of words and phrases. In uncommunicative patients with behavioural manifestations of catatonic disorder, the diagnosis of schizophrenia may have to be provisional until adequate evidence of the presence of other symptoms is obtained. It is also vital to appreciate that catatonic symptoms are not diagnostic of schizophrenia. A catatonic symptom or symptoms may also be provoked by brain disease, metabolic disturbances, or alcohol and drugs, and may also occur in mood disorders. Includes: catatonic stupor schizophrenic catalepsy schizophrenic catatonia schizophrenic flexibilitas cerea -81 F20. Diagnostic guidelines this category should be reserved for disorders that: (a)meet the general criteria for schizophrenia; (b)either without sufficient symptoms to meet the criteria for only one of the subtypes F20. Some schizophrenic symptoms must still be present but no longer dominate the clinical picture. These persisting schizophrenic symptoms may be "positive" or "negative", though the latter are more common. It is uncertain, and immaterial to the diagnosis, to what extent the depressive symptoms have merely been uncovered by the resolution of earlier psychotic symptoms (rather than being a new development) or are an intrinsic part of schizophrenia rather than a psychological reaction to it. They are rarely sufficiently severe or extensive to meet criteria for a severe depressive episode (F32. Diagnostic guidelines the diagnosis should be made only if: (a)the patient has had a schizophrenic illness meeting the general criteria for schizophrenia (see introduction to F20 above) within the past 12 months; (b)some schizophrenic symptoms are still present; and (c)the depressive symptoms are prominent and distressing, fulfilling at least the criteria for a depressive episode (F32. If the patient no longer has any schizophrenic symptoms, a depressive episode should be diagnosed (F32. If schizophrenic symptoms are still florid and prominent, the diagnosis should remain that of the appropriate schizophrenic subtype (F20. Diagnostic guidelines -82 For a confident diagnosis, the following requirements should be met: (a)prominent "negative" schizophrenic symptoms, i. Includes: chronic undifferentiated schizophrenia "Restzustand" schizophrenic residual state F20. Delusions and hallucinations are not evident, and the disorder is less obviously psychotic than the hebephrenic, paranoid, and catatonic subtypes of schizophrenia. With increasing social impoverishment, vagrancy may ensue and the individual may then become self-absorbed, idle, and aimless. Diagnostic guidelines Simple schizophrenia is a difficult diagnosis to make with any confidence because it depends on establishing the slowly progressive development of the characteristic "negative" symptoms of residual schizophrenia (see F20. There is no dominant or typical disturbance, but any of the following may be present: (a)inappropriate or constricted affect (the individual appears cold and aloof); (b)behaviour or appearance that is odd, eccentric, or peculiar; (c)poor rapport with others and a tendency to social withdrawal; (d)odd beliefs or magical thinking, influencing behaviour and inconsistent with subcultural norms; (e)suspiciousness or paranoid ideas; (f)obsessive ruminations without inner resistance, often with dysmorphophobic, sexual or aggressive contents; (g)unusual perceptual experiences including somatosensory (bodily) or other illusions, depersonalization or derealization; (h)vague, circumstantial, metaphorical, overelaborate, or stereotyped thinking, manifested by odd speech or in other ways, without gross incoherence; (i)occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations, and delusion-like ideas, usually occurring without external provocation. There is no definite onset and its evolution and course are usually those of a personality disorder. It is more common in individuals related to schizophrenics and is believed to be part of the genetic "spectrum" of schizophrenia. Diagnostic guidelines this diagnostic rubric is not recommended for general use because it is not clearly demarcated either from simple schizophrenia or from schizoid or paranoid personality disorders. If the term is used, three or four of the typical features listed above should have been present, continuously or episodically, for at least 2 years. A history of schizophrenia in a first-degree relative gives additional weight to the diagnosis but is not a prerequisite. They are probably heterogeneous, and have uncertain relationships to schizophrenia. The relative importance of genetic factors, personality characteristics, and life circumstances in their genesis is uncertain and probably variable. Other psychopathology is characteristically absent, but depressive symptoms may be present intermittently, and olfactory and tactile hallucinations may develop in some cases. Clear and persistent auditory hallucinations (voices), schizophrenic symptoms such as delusions of control and marked blunting of affect, and definite evidence of brain disease are all incompatible with this diagnosis. However, occasional or transitory auditory hallucinations, particularly in elderly patients, do not rule out this diagnosis, provided that they are not typically schizophrenic and form only a small part of the overall clinical picture. Onset is commonly in middle age but sometimes, particularly in the case of beliefs about having a misshapen body, in early adult life. Apart from actions and attitudes directly related to the delusion or delusional system, affect, speech, and behaviour are normal. Diagnostic guidelines Delusions constitute the most conspicuous or the only clinical characteristic. They must be present for at least 3 months and be clearly personal rather than subcultural. There must be no evidence of brain disease, no or only occasional auditory hallucinations, and no history of schizophrenic symptoms (delusions of control, thought broadcasting, etc. Includes: paranoia paranoid psychosis paranoid state paraphrenia (late) sensitiver Beziehungswahn Excludes: paranoid personality disorder (F60. Disorders in which delusions are accompanied by persistent hallucinatory voices or by schizophrenic symptoms that are insufficient to meet criteria for schizophrenia (F20. Delusional disorders that have lasted for less than 3 months should, however, be coded, at least temporarily, under F23.
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While European Catholic countries easily accepted the reform asthma vomiting order 5mg montelukast with amex, Protestant coun tries grudgingly acquiesced. Throughout the Americas, however, the Julian-Gregorian calendar was imposed as an instrument of power and symbol of dominance over the peoples the Europeans had conquered, including the high civilizations of the Maya, Inca, and Aztecs-all of whom happened to use, among other calendars, a Thirteen Moon! As European domi nance and control spread around the planet, even nations with their own established timing systems accepted, for the sake of "international policy," the Gregorian Oulian) calendar system for measuring the solar year. And so Western dominance over every aspect of global life became absolutely assured-until the moment of the Inevitable Event. Given the irregularity of the Julian-Gregorian calendar and the pursuit of the accuracy of astronomical time, history could be nothing more than a compilation of Summary Critique. Only a species whose time sensibility had been captured by instruments of artificial measure could have become so alienated as to have pro duced the monstrous conundrum known as the "fast world," a civilization where money and technological advance prevail over human sensibility and the natural order. It is toward the correction of this destructive momentum that all efforts of calendar reform must now be directed. In light of this critique, it is worth reprinting the opening section of the "United Manifesto by Advocates of Calendar Reform" that was first published in 1914 at the beginning of the First World War-some ninety years in advance of the Great Cal endar Change of 2004. It can be seen that the issues of irregularity that prompted reform then are still issues today. However, the effects of not attending to these issues have only become compounded and even more complex, resulting in the chaos of a world at war with terror. Such is the nature of an error gone uncorrected over time-it only becomes more entrenched and turns into the dogmatic and hopelessly conflicted thinking of the everyday mind and its way of life. Therefore we have resolved to unite in urging and advising that the very simple changes under noted should now be made in the Julian and Gregorian Calendars by international agreement. To remove yourself from the fires of your own self-created apocalypse, change your calendar. This occurred through a number of key events accompanied by a number of publications detailing the mathematical, cos mological, theological, and scientific aspects and imperatives of the Law of Time. By the standards of the synchronic order, all events form points in a radial time set that describe a geography of time defined as a chronotopology. Coined by the late philosopher and mathematician Charles Muses, the term chronotopology defines an event point of meaning that creates a root meaning from which time-formed, -blossomed, or -radiated meanings emerge above a horizon of meaning.! In this chronotopology, the "root meaning" occurred in 1989 at the Museum of Time in the form of the discov ery of the 12:60 and 13:20 timing frequencies, and the subsequent working out of the implications of this discovery. The "horizon of meaning" was reached July 26, 1993, kin 144, with the decoding of the Telektonon Prophecy and the consequent development of the World Thirteen Moon Calendar Change Peace Movement. The "source meanings," however, extend back to the seventh century with the origins of the prophetic traditions underlying the discovery of the Law of Time. The seven years of prophecy established the field of radiated meanings of the Law of Time as a set of radiated event points and a body of literature and tools. Here follows, then, a brief chronotopology of the key event points of this movement: 1989 Root meaning: discovery of the 12:60 and 13:20 timing frequencies, Museum of Time, Geneva, Switzerland. During this chronotopological sequence of radially connected event points, key writings, publications, and tools describing and defining the Law of Time and the synchronic order include: Dreamspell: the Journey of Times hip Earth 2013, 1990-91 Thirteen Moons in Motion and Turtle of the Thirteen Moons, 1993, 1996 the Story of Time: the Story of Turtle and Tree, 1993 Treatise on Time Viewed from its Own Dimension (Published as the Call of Pacal Votan: the World Thirteen Moon Calendar Change PeaceMovement. What emerges from consideration of all these events and accompanying literature is an entirely new model of the universe as well as a program for the reorientation of knowledge and the social reorganization of human ity-all based on a corrected understanding of time through the implementation of the calendar change. This was all to demonstrate that there is much more to a calen dar change than the mere replacing of one calendar with another, for a calendar itself bears within it an understanding of time that tacitly and unconsciously shapes our very thinking about time. What the calendar change, then, really signifies is the end of one worldview and the birth of another. These constituent principles include: time is art; universal telepathy; holonomic consistency and reciprocity; synchronic order; fractal and ra dial mathematics of the 13:20 matrix; biosphere-noosphere transition; Banner of Peace; Pax Cultura, Pax Biospherica;the psi bank and the dynamics of the evolution of time as the evolution of consciousness; fourth-dimensional time and third dimensional space. A mere consideration of these constituent principles will make one realize to what extent the calendar change is more than just an end to history, but the establishment of a new world, a New Heaven and a New Earth. This is precisely the promise offered by the Thirteen Moon calendar change and the dis covery of the Law of Time. A subsequent event, the lifting of the magnificent sarcophagus lid-measuring some four-by-three meters and weighing several tons-to reveal the human remains amidst a splendor of jade, including the jade mask, occurred on November 27, 1952. For some forty years afterwards, scholars debated the meaning of the tomb and the person buried within it. In the 1970s, the Russian scientist Knozerov dubbed the man in the tomb an "astronaut" or "cosmonaut" because of the similarity of the position of the figure sculpted on the sarcophagus lid to the positions of Russian cosmonauts in their little space capsules. This theory inflamed the imagination of some and was debunked by others, the end result being the enhancement of the awesome mystery of the tomb and the intention of its designer, the man buried in it. Its symbolism has been interpreted to varying degrees by different archaeologists. In my book the Mayan Factor, the placement ofPacal Votan in his "time of power," 631-683, is defined and analyzed as occurring in the most harmonic and mathematically synchronic point of 21 2. And herein lies the key question: What was his purpose, and why did he construct his tomb to be so elegantly buried for 1,260 years, to be discovered and opened just sixty years before the closing of the cycle, A. Clearly, the mystery of the tomb and its discovery had everything to do with the end of the cycle. Like a hawk circling its prey, the meaning of the tomb finally came to my consciousness like a direct hit from the beyond. Such was the revelation of the Telektonon Prophecy on the morning ofJuly 26, 1993. The coded key was the tiled "speaking tube," by which the tomb was discovered in the first place. Suddenly, this tube spoke its meaning to me: Earth Spirit Speaking Tube, Telektonon by name. After four intense weeks of decoding the glyphs and symbols of the tomb while living in the pool house of an isolated estate in the wind blown northern part of the main island of Hawaii, I knew that I had to abandon the dreamlike life I led in this Pacific paradise, and with my wife and companion head directly into the unknown, the first stopping point being Mexico, the source of the prophecy. After four months or so of traveling through Mexico, completing the de coding and announcing the prophecy, including a return to the tomb, we were fi nally directed to a converted carport in a field near the village of Ocotithin, not far from the birthplace of Quetzalcoatl. It was here where, for a period of nine morn ings, I awoke dutifully two hours before sunrise to listen to the voice and write down by hand, in a specially prepared notebook, the words exactly as I heard them. Because the prophecy itself is so inextricably connected with the Law of Time and the message of Time and the Technosphere, I feel it is important to present it as background information to the text of this book. In actuality, the text of the Proph ecy is an integral part of the Telektonon, Game of Prophecy, where it is read, section by section, on a daily basis, according to the code number of the kin of the day. Proclamation on behalf of the three messengers of the awakening, of the three special voices of prophecy, the special witness of time and the last call. Telektonon the inner sun the mother of all prophecy message of the star witness, Bolon Ik received and repeated by her servant in love, Pacal Votan. In the seventh year of Harmonic Convergence the seven seals of the apocalypse become the seven years of prophecy. Telektonon Prophecy of Pacal Votan Thirteen moons the path to walk; thirteen moons the path to talk; people of the dawn, one mind, people of the book, one God; one living prophecy, one people, one Heaven, one Earth. For this I remind you of the Cube of the Law, Telektonon, and the 28-day, thirteen moon way that is the path of the righteous. Nah Chan, Palenque, Xibalbay, Tollan, Xochicalco, Tepozteco, Amatlan: in these signs dwell my special agents, the witnesses of truth, 13. For those with eyes, with open mind and sincere heart, this teaching is complete in every stone alignment and marking of the star command base now called Palenque. New Jerusalem is the Palace of Bolon Ik, whose number is 1,728 (144 x 12), Cube of the Law. Twenty-eight is the power of Telektonon, the Spirit Tower of the power of 7 times 4. And everything there in the palace is laid out foursquare from the cord of Heaven, which is the command of the Telektonon. Everyone and everything moved and lived within this Law: one mind, one spirit, one will. Within the dimensions and measurements of the cube are all knowledge of Heaven and Earth. And in order to know, expand on, and delight in the sublime Law of the Cube, God created you, 0 children of the day of truth. And though shaped of no more than mud and sounding clay, in you is the perfection of knowing the Cube of the Law, if only you remembered! Babylon came to be and in its center the Tower of Babel, the monumental curse for no longer knowing time. In the forgetting was the separation of the people of the dawn from the people of the book. The Tower of Babel was a deceit intended to show the Cube of the Law existing outside of the perfection of knowledge already formed within you, a children of the day of truth.
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Follow-up data were available for three studies only asthmatic bronchitis yreatment purchase 10 mg montelukast fast delivery, and therefore data were not able to be analysed by meta-analysis. Courses included five lessons delivered online over 8 weeks, and shared the same overall format. Participants in the clinician guided condition received weekly telephone or email contact designed to be approximately 10 minutes per contact. The intervention consisted of eight, twice weekly sessions lasting between 90 and 120 minutes over a 4-week period. Treatment gains for the intervention group were either maintained or further improved at the 6-month follow-up across all primary and secondary outcomes. The psychodynamic therapy intervention comprised 24 x 50-minute sessions twice-weekly over a period of 12 weeks. However, this difference was no longer significant at 6-month follow-up, with treatment effects remaining large and comparable for both groups. Seventeen of the original 23 participants completed the 1-year follow-up assessment. Fifteen of the 17 participants who were assessed at follow-up no longer met diagnostic criteria for panic disorder. Participants were split into nine groups, with up to eight participants in each group. Twenty-seven participants were excluded from the analysis because they failed to attend at least seven sessions. Large within-group effect sizes were demonstrated from pre to post-treatment for panic and depressive symptomatology, and there was a medium effect size for the measure of intolerance of uncertainty. Participants received on average three therapy sessions, and 46% of the studies used only one session of treatment. Compared with nonexposure treatments, exposure-based treatments led to significantly greater improvement in symptoms at both posttreatment and follow-up, with medium effect sizes observed. Furthermore, exposure treatments augmented with cognitive interventions did not outperform exposure treatments alone. Although single-session treatments were effective, a greater number of treatment sessions was associated with more favourable outcomes. The exposure interventions ranged from a single 3-hour session to six 1-hour weekly sessions. Only articles that included adult samples were included in the summary of findings. A medium effect size was found in favour of multiple sessions of in-vivo exposure at posttreatment compared with single sessions; however, this was no longer significant at 1-year follow-up. Compared with exposure alone, a large effect size in favour of applied tension was found for reducing fainting at both posttreatment and 1-year follow-up. Participants were familiarised with the programs before beginning exposure according to their unique treatment condition. All three conditions demonstrated significant and large within-group treatment effects across all outcome measures from both pretreatment to posttreatment and at 1 year follow-up, although the effects were smaller at follow-up. A medium effect size was found in favour of psychodynamic therapy compared with waitlist. Combined psychological and pharmacological treatments produced large effect sizes. However, there was no evidence to suggest that combined treatments were more effective than were either alone. Participants in the two active conditions received 12 weekly manualised 1-hour treatment sessions, matched on number of sessions devoted to exposure. Clinicians completed follow-up booster phone calls (20?35 minutes? duration) once a month for 6 months following the 12-week treatment period. Effect sizes for both groups were large compared with waitlist control participants. The interventions both consisted of 12 weekly 2-hour group sessions plus a brief check-in at 3-month follow up. There were no significant between-group effects on any measure for the intervention groups. The smartphone application corresponded to the content of the eight modules and could be used to complete homework tasks/exercises and to rate mood. Participants were encouraged to complete one module per week, but had 10 weeks to complete treatment. The clinician support consisted of twice-per week feedback for a total of 15 minutes per participant per week to support treatment progress sent via the smartphone application. The two intervention conditions received 16 weekly manualised individual therapy sessions of generally 50-minutes? duration, with a booster session 2-months posttreatment. Large effect sizes were found for both intervention groups compared with the waitlist group. Cognitive therapy was significantly more effective than was interpersonal therapy at both posttreatment and follow-up, with small to medium effect sizes found across measures at both time points. Treatment outcomes were maintained at follow-up, with no significant differences from posttest to follow-up. Both active interventions were manualised and involved up to 25 individual 50-minute sessions delivered on a weekly basis. In the current review, there was insufficient evidence to indicate that any of the other interventions were effective. Active treatment conditions as a whole produced large within-group effect sizes at both posttreatment and follow-up. Furthermore, compared with antidepressants, psychological interventions were associated with a significantly larger reduction in mean scores. It is important to note that in the majority of cases, participants were permitted to continue any antidepressant medication throughout studies in which psychological interventions were the active intervention. Studies were classified and analysed depending on amount of therapeutic contact (minimal contact, predominantly self-help, and self-administered) and therapy type (bibliotherapy, internet-based, computer-based). One study included young people aged less than 16; however, the meta-analysis produced comparable results when this study was removed from the analysis. Significant between-group differences were also noted for self-reported measures of depression and cognitive biases in favour of the intervention group. Participants in the fluvoxamine group were monitored by a psychiatrist and received 50 to 300 mg of the medication for 10 weeks. Family members of the participants were randomly allocated to a brief manualised family intervention or no treatment. Most family members were spouses/partners (72%), but there were also parents (22%) and siblings (6%). No significant between-group differences were found at Weeks 4 or 25, although the difference approached significance in favour of the intervention group at Week 25. Participants were given an audio recording of guided mindfulness exercises to practise at home. There is also Level I based on a single, poor quality meta-analysis of just five studies. In evidence for eye movement desensitisation and reprocessing for the current review, there was insufficient evidence to indicate that the treatment of posttraumatic stress disorder in adults. The same evidence from the 2007 guidelines (derived from the previous 1996?2004 search) was retained where no new evidence was identified. Interventions were mostly delivered on a weekly basis, with treatment duration ranging from 6 to 15 weeks. Clinician contact ranged from 100 minutes to 1,260 minutes over the course of treatment. Within-group depression and quality of life outcomes had similar results, with medium posttreatment and follow-up effects. Participants received an average of 17 face-to-face therapy sessions (range three to 25 sessions). Participants in the active treatment conditions received weekly 60-minute sessions of therapy over an 8-week intervention period, following manualised procedures. Of the studies that provided age data, the mean ages of participants ranged from 8. Subgroup analyses revealed that treatment duration greater than 60 minutes was superior to shorter treatment duration, significantly reducing both anxiety and depression.
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If I think about an unpleasant event it means it must have happened 0 10 20 30 40 50 60 70 80 90 100 6 asthma definition 1245 buy montelukast 5mg on-line. My thoughts alone have the power to 0 10 20 30 40 50 60 70 80 90 100 change the course of events. When I have bad thoughts it must 0 10 20 30 40 50 60 70 80 90 100 mean I want to have them. My memories / thoughts can be 0 10 20 30 40 50 60 70 80 90 100 passed into objects. Copyright -Adrian Wells, Petra Gwilliam & Sam Cartwright-Hatton From Wells, A (2009) Metacognitive Therapy for Anxiety and Depression. If you are concerned about your results in any way, please speak with a health professional. Unpleasant thoughts come into my mind against my will and I cannot get rid of them 2. I ask people to repeat things to me several times, even though I understood them the first time 4. I have to review mentally past events, conversations and actions to make sure that I didn?t do something wrong 6. I feel obliged to follow a particular order in dressing, undressing and washing myself 16. I get upset at the sight of knives, scissors or other sharp objects in case I lose control with them 21. I find it difficult to touch an object when I know it has been touched by strangers or certain people 23. After doing something carefully, I still have the impression I haven?t finished it 27. I feel that I must repeat certain words or phrases in my mind I order to wipe out bad thoughts, feelings or actions 37. After I have done things, I have persistent doubts about whether I really did them 38. This was part of a larger prevalence survey Protections regulations regarding research with prison already reported. We obtained along with legal/criminal variables of inter further expected that antisocial ofenders with comor est. In the frst, sub jects are asked about 6 specifc problematic child Subjects hood misbehaviors; if? All newly committed ofenders way and was administered to a subset of 220 ofend are admitted for essential intake and reception activi ers. Variables indicating emotional well-being were par indicator that the disorder needs to be included in the ticularly afected, including role limitations due to emo diferential diagnosis in prison settings, particularly tional health, mental health, and the summary scale for when the presenting complaints involve irresponsibil mental health; social functioning was also worse in the ity, aggression, or deceitfulness. Although the overall rate appears high, this rate falls in the midrange of what others have reported. Repeat ofenders, those on special program diagnosis were incomplete and group assignment was ming, persons violating probation, maximum security not possible. Because there were relatively few women in have substantial psychiatric comorbidity, and have the study, caution should be used in attempting to gen impaired quality of life. Second, while Not surprising was the fact that antisocial ofend recall bias could have altered reports of symptoms, the ers were more likely to report a history of prior mental potential for bias is likely reduced by the use of multiple health treatment and impaired quality of life than were validated self-report measures. Black receives research/grant support logic study and involved only newly committed ofend from AstraZeneca and Forest Laboratories and is a con ers without special security or medical designation. A critical implication is that correctional cle or with manufacturers of competing products. Prev The Mini International Neuropsychiatric Interview National Comorbidity Survey. Diagnostic and statistical manual of mental dis personality syndromes and specifc drug use disorders morbidity among prisoners: summary report. Script for personal interview ders: results from the National Epidemiologic Survey on personality disorder in violent ofenders. J Forensic status and well-being of patients with chronic condi order diagnoses in a non-patient sample: demographic Sci. Toronto, Ontario, Canada: Multi-Health in 71 men with antisocial personality disorder. Psychiatric comor term outcome of antisocial personality disorder com 2006;47:276-295. Davis Professor Professor and Chairperson Department of Psychiatry and Behavioral Sciences University of Texas Medical Branch Galveston, Texas Claudia F. Philadelphia, Pennsylvania this activity is sponsored by SciMed and supported by an educational grant from AstraZeneca. Women and girls sometimes fnd themselves pressured by marketing campaigns compelling them to achieve a certain aesthetic that was never intended by nature. We support the recommendations of this report and the way in which women have been placed frmly at the centre of care. Dr Tony Falconer President of the Royal College of Obstetricians and Gynaecologists Good cosmetic practice covers a range of activity from provision of information, communication, informed consenting, through appropriate education and training of the physician/surgeon and other members of the team to use of properly maintained equipment and premises, documentation, collection of data and regular audit these aspects are all elucidated in the document. Professor Harminder S Dua President of the Royal College of Opthalmologists Cosmetic surgery is an increasing area of healthcare in which the public is at particular risk of suffering substandard treatment and potentially unpleasant and irreversible complications. This report outlines the standards, behaviours and competencies that practitioners of these procedures should follow. This means that the standards of practice are, in comparison with other areas of healthcare, relatively unclear. The Cosmetic Surgical Practice Working Party was, as its name suggests, established to consider cosmetic surgical practice. However, this remit was broadened by the Working Party to consider cosmetic practice as a whole in order to refect the role of the wider surgical team. This document therefore draws on expertise from the medical, dental and nursing professions to produce clear, widely applicable professional standards. The purpose of this document is to bring together and build on a number of existing standards documents that cover or specifcally address cosmetic surgical practice. This document is not intended to replace or change the existing regulatory requirements of the professions but instead aims to draw out and harmonise some of the common standards across the three healthcare professions that have previously varied in content or detail. It is for the government to decide if it would like to regulate the sector more closely. However, the medical professions have a responsibility to highlight the issues and to provide the standards that we would expect both ourselves and our colleagues to meet. Non-surgical procedures such as laser treatment or injectables (eg Botox?) may be administered by those with no healthcare qualifcations whatsoever. In this document it is recommended that only licensed doctors, registered dentists and registered nurses should provide any cosmetic treatments (including laser treatments and injectable cosmetic treatments). The level of training and experience required would vary depending on whether the procedure is invasive or minimally invasive. Minimally invasive procedures would only be carried out by doctors, dentists and nurses who have undertaken appropriate training. This document is the result of a working group comprising experts from across the remit of cosmetic practice and sets out professional standards, behaviours and competencies for doctors, dentists and nurses who currently offer or intend to offer cosmetic procedures. In drawing together the standards for all cosmetic practitioners, the working group highlights the following common standards. Organisations that provide cosmetic procedures have a responsibility to support practitioners to fulfl their professional commitment to provide high standards of care. The Cosmetic Surgical Practice Working Party (the Working Party) met frst on 5 November 2010 to discuss the scope and direction of its work. It was agreed that the standards produced should encompass minimally invasive procedures including lasers and injectable treatments as well as invasive cosmetic surgery. The report was shared with key external stakeholders including representatives of the cosmetic practice industry, and their comments were considered carefully by the Working Party. The standards have been put to public consultation (in January 2012) and it is thought they will be published by the end of 2012. These terms, rather than aesthetic surgery? or aesthetic practice?, were chosen because they match common English usage and patient perception more closely. The Working Party believed that it was important to agree a defnition that it would work to, and adopted the following defnition: Operations and all other invasive medical procedures where the primary aim is the change, the restoration, normalisation or improvement of the appearance, the function and well being at the request of an individual.
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Functional Consequences of Obstructive Sleep Apnea Hypopnea More than 50% of individuals with moderate to asthma icd 10 buy montelukast with mastercard severe obstructive sleep apnea hypopnea report symptoms of daytime sleepiness. A twofold increased risk of occupational accidents has been reported in association with symptoms of snoring and sleepiness. Motor vehicle crashes also have been reported to be as much as sevenfold higher among individuals with elevated apnea hypopnea index values. Clinicians should be cognizant of state govern? ment requirements for reporting this disorder, especially in relationship to commercial drivers. Reduced scores on measures of health-related quality of life are common in individ? uals with obstructive sleep apnea hypopnea, with the largest decrements observed in the physical and vitality subscales. Individuals with obstructive sleep apnea hypopnea must be differentiated from individuals with primary snoring. Individuals with obstructive sleep apnea hypopnea may additionally report nocturnal gasping and choking. The presence of sleepiness or other daytime symptoms not explained by other etiologies suggests the diagnosis of obstructive sleep apnea hypop? nea, but this differentiation requires polysomnography. Definitive differential diagnosis between hypersomnia, central sleep apnea, sleep-related hypoventilation, and obstructive sleep apnea hypopnea also requires polysomnographic studies. Obstructive sleep apnea hypopnea must be differentiated from other causes of sleepi? ness, such as narcolepsy, hypersonmia, and circadian rhythm sleep disorders. Obstructive sleep apnea hypopnea can be differentiated from narcolepsy by the absence of cataplexy, sleep-related hallucinations, and sleep paralysis and by the presence of loud snoring, gasping during sleep, or observed apneas in sleep. Daytime sleep episodes in narcolepsy are characteristically shorter, more refreshing, and more often associated with dreaming. Obstructive sleep apnea hypopnea shows characteristic apneas and hypopneas and oxy? gen desaturation during nocturnal polysomnographic studies. Narcolepsy, like obstructive sleep apnea hypopnea, may be associated with obesity, and some individuals have concurrent narcolepsy and obstructive sleep apnea hypopnea. A diagnosis of narco? lepsy does not exclude the diagnosis of obstructive sleep apnea hypopnea, as the two con? ditions may co-occur. For individuals complaining of difficulty initiating or maintaining sleep or early-moming awakenings, insomnia disorder can be differentiated from obstruc? tive sleep apnea hypopnea by the absence of snoring and the absence of the history, signs, and symptoms characteristic of the latter disorder. However, insomnia and obstructive sleep apnea hypopnea may coexist, and if so, both disorders may need to be addressed concurrently to improve sleep. Nocturnal panic attacks may include symptoms of gasping or choking during sleep that may be difficult to distinguish clinically from obstructive sleep apnea hy? popnea. However, the lower frequency of episodes, intense autonomic arousal, and lack of excessive sleepiness differentiate nocturnal panic attacks from obstructive sleep apnea hy? popnea. Polysomnography in individuals with nocturnal panic attacks does not reveal the typical pattern of apneas or oxygen desaturation characteristic of obstructive sleep apnea hypopnea. Individuals with obstructive sleep apnea hypopnea do not provide a history of daytime panic attacks. Attention-defidt/hyperactivity disorder in chil? dren may include symptoms of inattention, academic impairment, hyperactivity, and in? ternalizing behaviors, all of which may also be symptoms of childhood obstructive sleep apnea hypopnea. The presence of other symptoms and signs of childhood obstructive sleep apnea hypopnea. Obstruc? tive sleep apnea hypopnea and attention-deficit/hyperactivity disorder may commonly co-occur, and there may be causal links between them; therefore, risk factors such as en? larged tonsils, obesity, or a family history of sleep apnea may help alert the clinician to their co-occurrence. Substance use and substance withdrawal (including medications) can produce insomnia or hypersomnia. A careful his? tory is usually sufficient to identify the relevant substance/medication, and follow-up shows improvement of the sleep disturbance after discontinuation of the substance/med? ication. An individual with symptoms and signs consistent with obstructive sleep apnea hypop nea should receive that diagnosis, even in the presence of concurrent substance use that is exacerbating the condition. Risk esti? mates vary from 30% to as much as 300% for moderate to severe obstructive sleep apnea hypopnea. Obstructive sleep apnea hypopnea also may occur with in? creased frequency in association with a number of medical or neurological conditions. As many as one-third of individuals referred for evaluation of obstructive sleep apnea hypopnea report symptoms of depression, with as many of 10% having depression scores consistent with moderate to severe depression. Severity of obstructive sleep apnea hypop? nea, as measured by the apnea hypopnea index, has been foimd to be correlated wi^ se? verity of symptoms of depression. Specify current severity: Severity of central sleep apnea is graded according to the frequency of the breathing disturbances as well as the extent of associated oxygen desaturation and sleep frag? mentation that occur as a consequence of repetitive respiratory disturbances. Subtypes Idiopathic central sleep apnea and Cheyne-Stokes breathing are characterized by increased gain of the ventilatory control system, also referred to as high loop gain, which leads to in? stability in ventilation and PaC02 levels. This instability is termed periodic breathing and can be recognized by hyperventilation alternating with hypoventilation. Individuals with these disorders typically have pC02 levels while awake that are slightly hypocapneic or normocapneic. Central sleep apnea may also manifest during initiation of treatment of ob? structive sleep apnea hypopnea or may occur in association with obstructive sleep apnea hypopnea syndrome (termed complex sleep apnea). The occurrence of central sleep apnea in association with obstructive sleep apnea is also considered to be due to high loop gain. In contrast, the pathogenesis of central sleep apnea comorbid with opioid use has been at? tributed to the effects of opioids on the respiratory rhythm generators in the medulla as well as to its differential effects on hypoxic versus hypercapneic respiratory drive. Individuals receiving chronic methadone maintenance therapy have been noted to have increased sonmolence and de? pression, although the role of breathing disorders associated with opioid medication in caus? ing these problems has not been studied. In individuals with severe Cheyne Stokes breathing, the pattern can also be observed during resting wakefulness, a finding that is thought to be a poor prognostic marker for mortality. Diagnostic Features Central sleep apnea disorders are characterized by repeated episodes of apneas and hy popneas during sleep caused by variability in respiratory effort. These are disorders of ventilatory control in which respiratory events occur in a periodic or intermittent pattern. Idiopathic central sleep apnea is characterized by sleepiness, insomnia, and awakenings due to dyspnea in association with five or more central apneas per hour of sleep. Central sleep apnea occurring in individuals with heart failure, stroke, or renal failure typically have a breathing pattern called Cheyne-Stokes breathing, which is characterized by a pattern of periodic crescendo-decrescendo variation in tidal volume that results in central apneas and hypopneas occurring at a frequency of at least five events per hour that are accompa? nied by frequent arousals. Central and obstructive sleep apneas may coexist; the ratio of central to obstructive apneas/hypopneas may be used to identify which condition is pre? dominant. Alterations in neuromuscular control of breathing can occur in association with med? ications or substances used in individuals with mental health conditions, which can cause or exacerbate impairments of respiratory rhythm and ventilation. Individuals taking these medications have a sleep-related breathing disorder that could contribute to sleep distur? bances and symptoms such as sleepiness, confusion, and depression. Specifically, chronic use of long-acting opioid medications is often associated with impairment of respiratory con? trol leading to central sleep apnea. Associated Features Supporting Diagnosis Individuals with central sleep apnea hypopneas can manifest with sleepiness or insomnia. Obstructive sleep apnea hypopnea can coexist with Cheyne-Stokes breathing, and thus snoring and abruptly terminating apneas may be ob? served during sleep. Prevaience the prevalence of idiopathic central sleep apnea is unknown but thought to be rare. The prevalence of Cheyne-Stokes breathing is high in individuals with depressed cardiac ven? tricular ejection fraction. In individuals with an ejection fraction of less than 45%, the prev? alence has been reported to be 20% or higher. The male-to-female ratio for prevalence is even more highly skewed toward males than for obstructive sleep apnea hypopnea. Cheyne-Stokes breath? ing occurs in approximately 20% of individuals with acute stroke. Central sleep apnea comorbid with opioid use occurs in approximately 30% of individuals taking chronic opi? oids for nonmalignant pain and similarly in individuals receiving methadone mainte? nance therapy. Development and Course the onset of Cheyne-Stokes breathing appears tied to the development of heart failure. The Cheyne-Stokes breathing pattern is associated with oscillations in heart rate, blood pres? sure and oxygen desaturation, and elevated sympathetic nervous system activity that can promote progression of heart failure. The clinical significance of Cheyne-Stokes breathing in the setting of stroke is not known, but Cheyne-Stokes breathing may be a transient find? ing that resolves with time after acute stroke.
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Leading researchers in sleep medicine and sleep neuroscience have frequently called for this change in education start times to asthma inhalers over the counter cheapest montelukast improve learning and reduce health risks. Few, if any, educational interventions are so strongly supported by research evidence from so many different disciplines and experts in the field. Considering Options for Change Despite the substantial body of evidence from scientific, medical and education research supporting later school starts, almost all adolescent education in the United States currently has early start times. This leaves states, school districts and other responsible bodies in the untenable position of defending a current practice that has been demonstrated to be detrimental to student learning, health and safety. It seems prudent for these parties to demonstrate a greater awareness of the issues, engage with other stakeholders and consider some of the options for reasonable and appropriate changes. Changing community habits based on conventional wisdom can be difficult and needs to be handled confidently. Current early start times have determined timing of other activities (bus transportation and student athletics, for example), and organizers of these activities may resist change. Although most students (and increasingly parents) would support change, there will remain some who are opposed to it. These are not reasons, however, for stakeholders to avoid considering options There is a major shift in public for reasonable and appropriate changes to school start times. School districts There is a major shift in public knowledge and attitudes are increasingly finding toward later start times. School districts are themselves compared to districts increasingly finding themselves compared to districts with later start times, and this has with later start times, and this has fuelled calls to take fuelled calls to take action in many action in many communities. Normal risk management of change, including planning and implementation preparation, needs to be in place in due course. Another possible strategy is to simply act decisively to improve public schools by moving to later starts. Altering education times can be legitimately presented as a strategy to both improve learning and reduce health risks. This message, especially the potential reduction of risk for children, can be powerful for families. Indeed, evidence of consultations with families has shown positive responses from families and students once a change to later start times is implemented. Finally, in an increasingly accountable education environment, a powerful means to increase test scores, reduce health risk and improve faster than other states or districts must have at least some appeal. Emerging Legal Risks7 There appears to be no argument for keeping early start times that is supported by scientific or medical studies, and this may make it difficult to defend current practice. The mere existence of more than 3 million adolescents and young adults younger than 24 with delayed sleep phase 3 50 disorders indicates the scale of potential problems arising from negligence suits (given that states already spend millions of dollars on settlements and judgements from injuries to students). Education start times are the responsibility of education bodies and institutions, and thus it could be argued they have full responsibility for any foreseeable negative impact of early start times. Education bodies and institutions have an affirmative duty to provide a reasonable standard of care to their students, in part because of the compulsory nature of education. This duty of care may include warning of known risks or dangers and providing a safe environment (this may be taken to include the temporal environment). These considerations, taken as a whole, suggest that consideration of legal risks involved in keeping early start times may be advisable. Education Policy on Starting Times While start times are typically set at the local level, leaders can help raise awareness of the overwhelming evidence that later starts are beneficial. State support could take the form of briefing papers such as this one, or through sharing examples of successful approaches to the management of change. There are other preliminary steps that can be taken, for example giving advice on improving the quality of sleep to students. Although biological drivers determine the extent of the shift to later wake/sleep times in adolescence, the impact on sleep can be made worse by use of screen technologies in the last hour before sleep (such as televisions, computers and phones). Sleep can be enhanced when bedroom temperatures are lower, and there are other ways to contribute to better quality sleep. The current context is one in which there is a growing pressure to change to later start times for adolescent students (see Political and Legislative Context in sidebar). Of particular note is the House Concurrent Resolution calling for secondary schools to begin the school day no earlier than 9 a. Many colleges already start at these times both in the United States and internationally. It is a change that is in the best interests of our students, families, communities and nation. Political and Legislative Context Public interest is growing in later school starts with organizations including the National Sleep Foundation and campaigns such as Start School Later taking a consistent line that change is necessary. Virginia and Massachusetts have considered new laws, and Maryland passed legislation related to later school start times recently. Action on a national level includes the House Concurrent Resolution 176 (2009): Expressing the sense of the Congress that secondary schools should begin the school day no earlier than 9 a. Secretary of State for Education in 2013 tweeted let teens sleep, start school later. The effect of start times What time should the school dence directly linking school start day begin? Dis achievement school students on standardized tricts often stagger the start times tests. I find that delaying school of different schools in order to start times by one hour, from reduce transportation costs by using fewer buses. The effect is largest mance, staggering start times may not be worth for students with below-average test scores, sug the cost savings. A number of school districts have by Fred Danner and Barbara Phillips in 2008, responded by delaying the start of their school day, have found that earlier start times may result in and a 2005 congressional resolution introduced fewer hours of sleep, as students may not fully by Rep. Just over half of middle it increasingly difficult for them to fall asleep early in the schools begin at 7:30, with substantial numbers of schools evening. Lack of sleep, in turn, can interfere with learn beginning at 8:00 and 8:15 as well. But as the student population For students who have entered adolescence, later start times have the potential to be a more cost-effective method of increasing achievement than other common education interventions such as reducing class size. Researchers have like schedule, generating differences in start times for the same wise reported a negative correlation between self-reported school in different years. More middle school students, the impact of start times is greater than one-quarter of students begin school at 8:30 or later, for older students (who are more likely to have entered ado while more than 20 percent begin at 7:45 or earlier. However, I also find evidence of other potential words, middle school start times are somewhat earlier in mechanisms; later start times are associated with reduced Wake County than in most districts nationwide. The typical television viewing, increased time spent on homework, and Wake County student begins school earlier than more than fewer absences. Regardless of the precise mechanism at work, 90 percent of American middle-school students. First, administrative data for every student in North Carolina between 2000 and 2006 were provided by the North Carolina Wake County Education Research Data Center. It encompasses all test scores by assigning each student a percentile score, which public schools in Wake County, a mostly urban and sub indicates performance relative to all North Carolina students urban county that includes the cities of Raleigh and Wake who took the test in the same grade and year. Start times for schools in the district are proposed by source of data is the start times for each Wake County public the transportation department (which also determines bus school, which are recorded annually and were provided by schedules) and approved by the school board. As a result, almost only be used for the roughly 28 percent of students in my all magnet schools during the study period began at the earli sample whose middle school changed its start time while est start time. Results the data allow me to use several different methods to My first method compares students with similar characteris analyze the effect of start times on student achievement. The results indicate that a one-hour delay schools that start earlier to the scores of similar students at in start time increases standardized test scores on both math later-starting schools. As noted race, limited English status, free or reduced-price lunch above, however, these results could be biased by unmeasured eligibility, years of parents? education, and whether the differences between early and late-starting schools (or the student is academically gifted or has a learning disability. However, a remain the results produced by this first approach could be ing concern is that the student composition of schools may misleading, however, if middle schools with later start times change. For example, high-achieving students in a school differ from other schools in unmeasured ways. For example, it could be the case that more-motivated principals lobby the district to receive a later start time and also employ other Better Later (Figure 1) strategies that boost student achievement. If that were the case, then I might find that schools with later start times Test scores rise for students attending schools that move have higher test scores, even if start times themselves had their start times later. To deal with this potential problem, my second approach Effect on Test Scores focuses on schools that changed their start times during 2 the study period. This enables me to compare the test scores of students who attended a particular school to the test scores of students 1.
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However asthma symptoms pubmed buy montelukast 5 mg without prescription, if negative-psi was indicated, the play-run bets were then predicted in the opposite direction of the majority vote. If scores in the test-run were close to chance, no attempt was made to predict the playrun bets. However, readers are not encouraged to rush out and try to apply this technique right away. The statistical procedures can be quite complex, particularly when one takes into account position effects and scoring declines. They found these individuals scored much higher in the precognitive tests than other executives. Given the challenge of applying remote viewing protocols to practical ends, Harold Puthoff worked with a group of parents hoping to raise money for an alternative school for their children. Puthoff They undertook a 30-trial series in which remote viewing was used to predict the daily outcomes of a commodities market variable (which was then successfully traded in the market). The sequence in detail was: (a) remote viewers generate transcripts; (b) without reference to the transcripts, two objects are selected and labeled (by use of a random number generator) market-up, market-down objects; (c) a judge determines a consensus vote as to which of the two objects is being described (and the associated market movement prediction is passed on to a trader); (d) at the close of the following market day the actual "ground-truth" market-movement object is shown the viewers for feedback, closing the loop. Seven parents interested in raising funds for the school volunteered as remote viewers. The number of remote viewing trials per person over the entire series ranged from a maximum of 36 (six pilot, 30 market trials) to a minimum of twelve. In a second series, using the same formal method, when they were trying to make money for themselves, Puthoff and his colleagues were unsuccessful. Bernard Grad, was introduced to a Hungarian refugee named Oskar Estebany who claimed that some form of healing energy emanated from his hands. Estebany had been a cavalry officer in the Hungarian army before the 1956 uprising and originally discovered his healing abilities in treating the army horses. In a series of ingenious experiments with Estebany, Grad provided the scientific foundation for the existence of psychic healing. His first experiments were with laboratory mice whose backs had been deliberately wounded by carefully removing an area of skin. Wound size after eleven days Wound size after fourteen days the treatment consisted of Mr. One control group received similar handling from medical students who did not claim to have unusual healing ability, while the mice in another control group simply remained in their cages without handling at all. The experiment was carefully controlled so that the individuals who cared for the mice and measured their wounds did not know which of the test groups they were in. A total of 300 mice were used in one experiment, which was eventually published after several pilot studies. This experiment showed significantly faster wound healing in the mice treated by Mr. It was difficult to maintain that the mice were susceptible to the power of suggestion. In his next experiment, Grad used barley seeds which were treated with a saline solution. Sterile and sealed in bottles under vacuum the solution was normally used for intravenous infusion of humans. Then they were baked in an oven 323 just long enough to injure, but not kill them. Twenty seeds were planted in each of twenty-four pots-with identical soil, temperature, and humidity conditions. During the test period no person knew which seeds had been given the treated water. However, after the conclusion of the experiment it was found that those pots with seeds which had been watered from the bottles treated by the healer had more plants growing in them and the plants were also taller. Plant growth affected by psychic healing treatment (courtesy Bernard Grad) In a third experiment, Grad attempted to determine if he could get effects from other subjects. In fact, he hypothesized that if a psychic healer could cause greater plant growth, perhaps treatment by psychiatric patients would inhibit growth. One of these was psychiatrically normal, the second was a hospitalized depressed neurotic, and the third a hospitalized depressed psychotic patient. The plants treated with the solution held by the normal subject showed greater growth than either the control or the depressed subjects. This effect was statistically significant and the "normal" subject also claimed to feel some sort of flow through his hands during the experiment. One of the depressed subjects was so amused with the experiment that her mood picked up as soon as she was asked to hold the bottle of saline solution. Her plants rew consistently, but not significantly larger than the control plants. The seeds treated from the bottle of solution which she held showed less growth than the untreated control group. Another experiment was performed testing the effect of healing on the rate at which thyroid goiters developed in mice whose diet was deficient in iodine and contained thiouracil. Studies did not adequately shield for the possibility of conventional physical influences. Also, researchers measuring the results were often not blind as to which animals were in the test condition and which were controls. This procedure created a relatively consistent wound size upon incision for all subjects. This study eliminated the influence of suggestion and the expectation of healing, as well as the placebo effect, by utilizing a double blind design. Neither the doctor nor the laboratory technician knew whether any particular subject was in the experimental or control group. In fact, none of these individuals even were informed, until after the data had been collected, that this experiment was a test of psychic healing. A special laboratory had been constructed which kept the healing practitioner separated from all other experimental personnel, including the subjects themselves, who simply placed their arms through a hole in the wall of the laboratory room. They were told that the study was designed to measure electrical conductivity of the body. The noncontact healing treatments lasted for five minutes each day, for sixteen days. The healing practitioner was located behind the wall through which the subjects placed their arms. Circumstances were exactly the same for both treatment and control groups with the exception that the healing practitioner was not present during the sessions with control subjects. Statistical differences in wound size between the healing and control group were significant when measurements were made on both the eighth and sixteenth days after the original wounds. After the statistical analysis had been completed, the experimenter interviewed the subjects, the healing practitioner, the medical doctor and the laboratory technician independently. These interviews confirmed that almost all essential experimental protocols were maintained throughout the study. Although this is one of the best healing studies on record, it may be faulted on several grounds. The experimental protocols were violated when the healing practitioner was unable to schedule afternoon sessions. Thus all of the experimental subjects were scheduled in the morning, while control subjects were scheduled in the afternoon. While it is unlikely that the time of treatment, in itself, would have produced a differential healing effect, a significant difference still exists insofar as there was no human being near the arm of the control subjects during the supposed treatment period. Thus, there was no effective experimental control for effects such as electromagnetic radiation that may have emanated from the healing practitioner. When poured on suspensions of yeast cells the solutions were found to have a slight inhibiting effect on the growth of this organism as compared with controls in which the glucose had not been subjected to treatment. The demonstrated existence of effects caused by the laying on of hands still left unanswered many questions regarding the mechanisms of this phenomenon. What is it about the hands of a healer that can affect wound healing or plant growth?
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The biological rhythm that governs our sleep-wake cycle is called the circadian rhythm asthma over the counter medication generic montelukast 10 mg amex, a hard-wired clock? in the brain that controls the production of the sleep-inducing hormone melatonin. More adult-like sleep patterns develop, there are increases in daytime sleepiness, and there is a shift in the circadian rhythm towards later bed and wake-up times (Crowley et al. There are also times of the day 1This is scaled relative to work from Chetty et al. For adolescents, alertness begins in the late morning, drops off mid-afternoon, and peaks again in the early evening (Cardinali, 2008). Standard academic schedules are quite out of sync? with teens? circadian rhythms and require students to wake up earlier than their ideal wake time and have many of their classes at a time that is asynchronous 2 with their optimal cognitive function. The second is through the cognitive load a student has experienced prior to the start of a class. While we expect student fatigue to unambiguously hinder academic performance, the time-of-day effect may vary throughout the day. Because academic achievement is an interaction of both learning and teaching, we also estimate the effect of instructor fatigue. Unlike students, teachers are frequently assigned to teach the same class multiple times per day. Tiredness and mental fatigue could mean teachers are less effective as the day goes on, but learning-by-doing could lead to improvements later in the day. Separately identifying these three components of the daily school schedule allows us to suggest a number of strategies for improving student achievement. The impact of school start times on student achievement has been studied using natural variation across schools or cohorts for identi? Relatively few studies have looked at differential achievement across morning and afternoon classes. Pope (2015) concludes that learning actually decreases throughout the school day by comparing standardized test scores of students who had classes in the morning versus afternoon. Approximately 40 percent of classroom instructors have terminal degrees, similar to large universities where graduate students teach introductory courses. There are four 53-minute class periods each morning and three each afternoon after an 85-minute lunch 3 break. Prior to the start of freshman year, students take placement exams in mathematics, chemistry, and select foreign languages. Scores on these exams are used to place students into the appropriate starting courses. Students have no ability to choose the class period or their professors in the required core courses. On M days, students have one set of classes and on T days they have a different set of classes. Thus, the same student has two different class schedules within the same semester. Students are coded as in class for both M and T day of their language course, but only the grade and preceding courses from the M day are included in analysis. Athletes are dropped from primary analysis due to their course schedules being in? For each student we have pre-treatment demographic data and measures of their academic, athletic, and leadership aptitude. Other individual-level controls include indicators for whether a student is Black, Hispanic, Asian, female, a recruited athlete, whether they attended a military preparatory school, and the number of class credits students have on that schedule-day. We also consider whether a student received an A or F in the course as an outcome to see the impacts on the extremes of the grade distribution. In this study, we focus primarily on the mandatory introductory courses in mathematics, chemistry, engineering, computer sciences, English, foreign languages and history. Nineteen percent of the students are female, approximately four, eight, and nine percent are black, Hispanic, and Asian, respectively. First, the number of observations for each class period differs, with the most for? The goal of this analysis is to determine how much of the variation in grades across the class periods is due to time of day and course schedules, abstracting from differences in student, instructor, and course characteristics. Methodology and Results Primary Analysis We begin our analysis by verifying that assignment to different class periods is random with respect to student ability. To do so, we regress student background characteristics on periods of the day dummy variables and course-semester? Peer academic composite is the one variable showing differences, with peer quality? being lower in the morning and higher in the afternoon. This is due to the inclusion of athletes whose courses are dispropor tionately in the morning. Athletes are included when calculating other students? peer variables, but excluded from the sample we analyze. Nonetheless, we are also careful to control for classroom level peer characteristics to address differences in peers across classes and control for professor characteristics by including instructor-semester and course-by-day? The estimates for all students in our sample are shown in the top panel of Figure 2. First, grades rise and fall over the course of the day?grades dip st th th nd th during 1, 4 and 7 periods and a peak during 2 and 6 periods. Finally, the general pattern is similar across ability groups, but appears to be more pronounced for the lower tercile students. Mean performance in 2 period is quite strong even though it is at a time asynchronous th with adolescents? optimal learning times. Alternatively, 4 period is at a time that is synchronous with adolescents? optimal learning times for learning; however, mean grades in those periods are quite low. Using a regres sion framework, we are able to disentangle the effect of different components of the daily class schedule on student achievement from all other attributes of the student and their schedule. F atigue is a vector of the student fatigue characteristics, which we discuss in detail below and InstructorSchedule is a vector of instructor schedule characteris tics, also described below. To control for classroom peer effects, we include P eersicjtsp, the average 5 pre-treatment characteristics of all students in the class except for individual i. The number of consecutive and cumulative classes can vary both across students and within students because nd th th of the M/T schedule-days. For example, Student A may have classes during 2, 4, and 6 st nd th th periods on one schedule-day, while Student B has classes during 1, 2, 5, and 6 periods. By th 6 period, Student A has had two cumulative classes, but zero consecutive classes (since he had th 5 period off), while Student B has had three cumulative classes and one consecutive class. Accordingly, we include the following variables in the F atigue vector: the number of consecutive and cumulative classes a student had before a class and the squares of these variables to account for non-linear fatigue 7 effects. We include analogous variables in the InstructorSchedule vector: the number of consecutive and cumulative classes an instructor has taught before a given class and the squares of these terms. It is unclear, a priori, exactly how instructor schedules should affect student achievement. Teaching may not be cognitively-taxing as learning, but certainly leads to more physical fatigue. Here, rather than comparing two students taking the same course at different times of the day, we are comparing students in the same class (classmates) who had dif ferent schedules earlier in the day. For a given section of a class, students have been randomly assigned to the section at hand and also their preceding schedules. By comparing students in the same section, we are holding teacher quality and time of day constant. Even-numbered columns also include individual 8As before, only core freshman courses are considered. The estimates show that the time of day a class is taken can have a large effect on achievement. The student fatigue estimates show consistently negative effects of consecutive classes? each consecutive class decreases performance in a course by about 0. The num ber of cumulative classes a student had before a given class also has negative effects on achieve ment, but the statistical signi? These results suggest that achievement is certainly affected by the fatigue that students experience throughout the school day. Fatigue hinders students? performance as the school day progresses, offsetting rd the bene?
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Diagnostic Features Female orgasmic disorder is characterized by difficulty experiencing orgasm and/or markedly reduced intensity of orgasmic sensations (Criterion A) asthma definition 90 buy montelukast uk. Women show wide vari? ability in the type or intensity of stimulation that elicits orgasm. Similarly, subjective descrip? tions of orgasm are extremely varied, suggesting that it is experienced in very different ways, both across women and on different occasions by the same woman. For a diagnosis of female orgasmic disorder, symptoms must be experienced on almost all or all (approx? imately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts) and have a minimum duration of approximately 6months. The use of the minimum severity and duration criteria is intended to distinguish transient orgasm difficulties from more persistent orgasmic dysfunction. The inclusion of "approx? imately" in Criterion B allows for clinician judgment in cases in which symptom duration does not meet the recommended 6-month threshold. For a woman to have a diagnosis of female orgasmic disorder, clinically significant dis? tress must accompany the symptoms (Criterion C). In many cases of orgasm problems, the causes are multifactorial or cannot be determined. If female orgasmic disorder is deemed to be better explained by another mental disorder, the effects of a substance/medication, or a medical condition, then a diagnosis of female orgasmic disorder would not be made. Finally, if interpersonal or significant contextual factors, such as severe relationship dis? tress, intimate partner violence, or other significant stressors, are present, then a diagnosis of female orgasmic disorder would not be made. Many women require clitoral stimulation to reach orgasm, and a relatively small pro? portion of women report that they always experience orgasm during penile-vaginal inter? course. It is also important to consider whether orgasmic difficulties are the result of inadequate sex? ual stimulation; in these cases, there may still be a need for care, but a diagnosis of female orgasmic disorder would not be made. Associated Features Supporting Diagnosis Associations between specific patterns of personality traits or psychopathology and orgas? mic dysfunction have generally not been supported. Compared with women without the disorder, some women with female orgasmic disorder may have greater difficulty com? municating about sexual issues. Overall sexual satisfaction, however, is not strongly cor? related with orgasmic experience. Many women report high levels of sexual satisfaction despite rarely or never experiencing orgasm. Orgasmic difficulties in women often co? occur with problems related to sexual interest and arousal. Each of these factors may contribute differently to the presenting symptoms of dif? ferent women with this disorder. Prevalence Reported prevalence rates for female orgasmic problems in women vary widely, from 10% to 42%, depending on multiple factors. Only a proportion of women experiencing orgasm difficulties also report associated distress. Many women learn to experience orgasm as they experience a wide variety of stimulation and acquire more knowledge about their bodies. There is a strong association between relationship problems, physical health, and mental health and orgasm difficulties in women. Conditions such as mul? tiple sclerosis, pelvic nerve damage from radical hysterectomy, and spinal cord injury can all influence orgasmic functioning in women. Selective serotonin reuptake iruiibitors are known to delay or inhibit orgasm in women. Women with vulvovaginal atrophy (charac? terized by symptoms such as vaginal dryness, itching, and pain) are significantly more likely to report orgasm difficulties than are women without this condition. Menopausal status is not consistently associated with the likelihood of orgasm difficulties. There may be a significant genetic contribution to variation in female orgasmic function. Culture-Related Diagnostic issues the degree to which lack of orgasm in women is regarded as a problem that requires treat? ment may vary depending on cultural context. In addition, women differ in how important orgasm is to their sexual satisfaction. Diagnostic M arkers Although measurable physiological changes occur during female orgasm, including changes in hormones, pelvic floor musculature, and brain activation, there is significant variability in these indicators of orgasm across women. Functional Consequences of Female Orgasmic Disorder the functional consequences of female orgasmic disorder are unclear. Although there is a strong association between relationship problems and orgasmic difficulties in women, it is unclear whether relationship factors are risk factors for orgasmic difficulties or are conse? quences of those difficulties. Nonsexual mental disorders, such as major depressive disorder, which is characterized by markedly diminished interest or pleasure in all, or al? most all, activities, may explain female orgasmic disorder. If the orgasmic difficulties are better explained by another mental disorder, then a diagnosis of female orgasmic disorder would not be made. If interpersonal or significant contextual factors, such as severe relationship distress, intimate partner violence, or other significant stressors, are associ? ated with the orgasmic difficulties, then a diagnosis of female orgasmic disorder would not be made. Female orgasmic disorder may occur in association with other sexual dysfunctions. The presence of another sexual dysfunction does not rule out a diagnosis of female orgasmic disorder. Occasional or? gasmic difficulties that are short-term or infrequent and are not accompanied by clinically sig? nificant distress or impairment are not diagnosed as female orgasmic disorder. A diagnosis is also not appropriate if the problems are the result of inadequate sexual stimulation. Comorbldlty Women with female orgasmic disorder may have co-occurring sexual interest/arousal difficulties. Women with diagnoses of other nonsexual mental disorders, such as major de? pressive disorder, may experience lower sexual interest/arousal, and this may indirectly increase the likelihood of orgasmic difficulties. Female Sexual Interest/Arousal Disorder Diagnostic Criteria 302. Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following: 1. Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approximately 75%-100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts). Absent/reduced sexual interest/arousal in response to any internal or external sex? ual/erotic cues. Absent/reduced genital or nongenital sensations during sexual activity in almost all or all (approximately 75%-100%) sexual encounters (in identified situational con? texts or, if generalized, in all contexts). The sexual dysfunction is not better explained by a nonsexuai mental disorder or as a consequence of severe relationship distress. Diagnostic Features In assessing female sexual interest/arousal disorder, interpersonal context must be taken into account. A "desire discrepancy," in which a woman has lower desire for sexual activ? ity than her partner, is not sufficient to diagnose female sexual interest/arousal disorder. In order for the criteria for the disorder to be met, there must be absence or reduced fre? quency or intensity of at least three of six indicators (Criterion A) for a minimum duration of approximately 6months (Criterion B). There may be different symptom profiles across women, as well as variability in how sexual interest and arousal are expressed. In another woman, an inability to be? come sexually excited, to respond to sexual stimuli with sexual desire, and a correspond ing lack of signs of physical sexual arousal may be the primary features. Because sexual desire and arousal frequently coexist and are elicited in response to adequate sexual cues, the criteria for female sexual interest/arousal disorder take into account that difficulties in desire and arousal often simultaneously characterize the complaints of women with this disorder. Diagnosis of female sexual interest/arousal disorder requires a minimum duration of symptoms of approximately 6months as a reflection that the symptoms must be a persistent problem. The estimation of persistence may be determined by clinical judgment when a duration of 6months cannot be ascertained precisely. There may be absent or reduced frequency or intensity of interest in sexual activity (Crite? rion Al), which was previously termed hypoactive sexual desire disorder. The frequency or inten? sity of sexual and erotic thoughts or fantasies may be absent or reduced (Criterion A2). The expression of fantasies varies widely across women and may include memories of past sexual experiences. The normative decline in sexual thoughts with age should be taken into account when this criterion is being assessed. There may be absent or reduced sexual excitement or pleasure during sexual activity in almost all or all (approximately 75%-100%) sexual encounters (Cri? terion A4). Lack of pleasure is a common presenting clinical complaint in women with low de? sire.
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Because the projector follows the exact movements of the eye labile asthma definition montelukast 4mg fast delivery, the same image is always projected, stimulating the same spot, on the retina. The image will begin to vanish, then reappear, only to disappear again, either in pieces  or as a whole. The ability to perceive a stimulus as constant despite changes in sensation is known asperceptual constancy. When it is closed, we see it as rectangular, but when it is open, we see only its edge and it appears as a line. But we never perceive the door as changing shape as it swings?perceptual mechanisms take care of the problem for us by allowing us to see a constant shape. When you are outdoors, both colors will be at their brightest, but you will still perceive the white t-shirt as bright and the blue jeans as darker. When you go indoors, the light shining on the clothes will be significantly dimmer, but you will still perceive the t-shirt as bright. This is because we put colors in context and see that, compared to its surroundings, the  white t-shirt reflects the most light (McCann, 1992). In the same way, a green leaf on a cloudy day may reflect the same wavelength of light as a brown tree branch does on a sunny day. Illusions occur when the perceptual processes that normally help us correctly perceive the world around us are fooled by a particular situation so that we see something that does not exist or that is incorrect. Square A in the right-hand image looks very different from square B, even though they are exactly the same. The line segment in the bottom arrow looks longer to us than the one on the top, even though they are both actually the same length. It is likely that the illusion is, in part, the result of the failure of monocular depth cues?the bottom line looks like an edge that is normally farther away from us, whereas the top one looks like an edge that is normally closer. The illusion is caused, in part, by the monocular distance cue of depth?the bottom line looks like an edge that is normally farther away from us, whereas the top one looks like an edge that is normally closer. The moon illusion refers to the fact that the moon is perceived to be about 50% larger when it is near the horizon than when it is seen overhead, despite the fact that both moons are the same size and cast the same size retinal image. The skyline of the horizon (trees, clouds, outlines of buildings) also gives a cue that the moon is far away, compared to a moon at its zenith. If we look at a horizon moon through a tube of rolled up paper, taking away the surrounding horizon cues, the moon will immediately appear smaller. The monocular depth cue of linear perspective leads us to believe that, given two similar objects, the distant one can only cast the same size retinal image as the closer object if it is larger. Illusions demonstrate that our perception of the world around us may be influenced by our prior knowledge. But the fact that some illusions exist in some cases does not mean that the perceptual system is generally inaccurate?in fact, humans normally become so closely in touch with their environment that that the physical body and the particular environment that we sense and perceive becomes embodied?that is, built into and linked with?our cognition, such that the  worlds around us become part of our brain (Calvo & Gamila, 2008). The close relationship between people and their environments means that, although illusions can be created in the lab and under some unique situations, they may be less common with active observers in the real  world (Runeson, 1988). People who are warned that they are about to taste something bad rate what they do taste more negatively than people who are told that the taste won?t be so  bad (Nitschke et al. Plassmann, O?Doherty, Shiv, and  Rangel (2008) found that wines were rated more positively and caused greater brain activity in brain areas associated with pleasure when they were said to cost more than when they were said to cost less. And even experts can be fooled: Professional referees tended to assign more penalty cards to soccer teams for videotaped fouls when they were told that the team had a history of aggressive behavior than when they had no such expectation (Jones, Paull, & Erskine,  2002). Chua,  Boland, and Nisbett (2005) showed American and Asian graduate students different images, such as an airplane, an animal, or a train, against complex backgrounds. Furthermore, Asian-American students focused more or less on the context depending on whether their Asian or their American identity had been activated. Human factors has worked on a variety of projects, ranging from nuclear reactor control centers and airplane cockpits to cell phones and websites (Proctor & Van Zandt,  2008). For instance, modern televisions and computer monitors were developed on the basis of the trichromatic color theory, using three color elements placed close enough together so that the colors are blended by the eye. Knowledge of the visual system also helped engineers create new kinds of displays, such as those used on notebook computers and music players, and better understand how using cell phones while driving may contribute to  automobile accidents (Lee & Strayer, 2004). About two thirds of accidents on commercial  airplane flights are caused by human error (Nickerson, 1998). During takeoff, travel, and landing, the pilot simultaneously communicates with ground control, maneuvers the plane, scans the horizon for other aircraft, and operates controls. On the left is the initial design in which the controls were crowded and cluttered, in no logical sequence, each control performing one task. The controls were more or less the same in color, and the gauges were not easy to read. More of the controls are color-coded and multifunctional so that there is less clutter on the dashboard. Text sizes are changeable?increasing readability?and many of the functions have become automated, freeing up the pilots concentration for more important activities. Displays that are easy to see in darker conditions quickly become unreadable when the sun shines directly on them. It takes the pilot a relatively long time to adapt to the suddenly much brighter display. The display cannot be so bright at night that the pilot is unable to see targets in the sky or on the land. Human factors psychologists used these principles to determine the appropriate stimulus intensity needed on these displays so that pilots would be able to read them accurately and quickly under a wide range of conditions. The psychologists accomplished this by developing an automatic control mechanism that senses the ambient light visible through the front cockpit windows and that detects the light falling on the display surface, and then automatically adjusts the intensity of the display for the pilot (Silverstein, Krantz, Gomer, Yeh, & Monty, 1990; Silverstein & Merrifield,  1985). Consider some cases where your expectations about what you think you might be going to experience have influenced your perceptions of what you actually experienced. The role of vection, eye movements, and postural instability in the etiology of motion sickness. The distorted room illusion, equivalent configurations, and the specificity of static optic arrays. Journal of Experimental Psychology: Human Perception and Performance, 14(2), 295?304. Altering expectancy dampens neural response to aversive taste in primary taste cortex. Talis pater, talis filius: Perceived resemblance and the belief in genetic relatedness. Marketing actions can moderate neural representations of experienced pleasantness. See the ball, hit the ball: Apparent ball size is correlated with batting average. A psychophysical approach to air safety: Simulator studies of visual illusions in night approaches. The effects of spatial sampling and luminance quantization on the image quality of color matrix displays. The development and evaluation of color systems for airborne applications: Phase I Fundamental visual, perceptual, and display systems considerations(Tech. Each sense accomplishes the basic process of transduction?the conversion of stimuli detected by receptor cells into electrical impulses that are then transported to the brain?in different, but related, ways. Psychophysics is the branch of psychology that studies the effects of physical stimuli on sensory perceptions. Most of our cerebral cortex is devoted to seeing, and we have substantial visual skills. The eye is a specialized system that includes the cornea, pupil, iris, lens, and retina. Neurons, including rods and cones, react to light landing on the retina and send it to the visual cortex via the optic nerve. The shade of a color, known as hue, is conveyed by the wavelength of the light that enters the eye. The Young-Helmholtz trichromatic color theory and the opponent-process color theory are theories of how the brain perceives color. The ear detects both the amplitude (loudness) and frequency (pitch) of sound waves. Important structures of the ear include the pinna, eardrum, ossicles, cochlea, and the oval window.