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It is not surprising, then, that 40% answered that the collective health of Americans would be better now if light cigarettes had never been introduced to the market. However, in both samples it was found that a tobacco exposure reduction approach was perceived as an obstacle to some smokers who otherwise might have tried to quit altogether. In addition to these negative attitudes toward tobacco harm reduction, Warner and Martin (2003) reported that their sample was also supportive of regulatory policy. However, respondents were significantly less supportive of a tax based on the level of risk to the consumer (65% agreement). Accordingly, Kim, Borgida, and Stark (2007) conducted a mail survey in the Fall of 2003 with the Minnesota Center for Survey Research. Surveys were mailed to a random sample of households in the five-state Upper Midwest region of the United States (Minnesota, Iowa, North Dakota, South Dakota, and Wisconsin); 438 adult participants (38%) returned the survey, and 21. Similarly, slightly less than half of average consumers (49%) supported differential taxation. Several studies have been conducted examining public attitudes toward varying types of tobacco products, including reduced exposure products. These give us insight both into what the public believes about tobacco products, and also what may be influencing or informing their attitudes toward these products and issues related to exposure reduction. More importantly, these beliefs each independently contributed to the belief that these cigarettes were safer than regular cigarettes. Over half of participants rated the claims made in advertisements for light and ultra-light cigarettes as delivering less tar and being milder as credible, and 15. These data show that many smokers harbor misconceptions about light and ultra-light cigarettes, based on their experience with these cigarettes and exposure to advertising claims about these cigarettes. Their beliefs that light and ultra-light cigarettes are milder, and deliver less tar and nicotine, lead to beliefs that these cigarettes are safer to smoke. These beliefs combine with sensory impressions of light and ultra-light cigarettes as milder to reinforce the perception of safety and reduced risk (see Kozlowski et al. Hamilton, Ouellette, Rhodes, Kling, and Connolly (2004) replicated the above effect by showing participants advertisements for regular, light, and reduced-harm cigarettes, and obtaining ratings of safety and other perceptions of these ads. These participants also believed that light and reducedharm cigarettes posed fewer health risks than regular cigarettes, despite the absence of independently verifiable scientific evidence that these products are lower in risk. Smokers (N = 1,000) and ex-smokers (N = 499) completed a telephone survey regarding their smoking history and their perceptions of the reduced exposure product Eclipse, a modified cigarette. Almost a quarter of all smokers perceived Eclipse as completely safe-as carrying the same risk as not smoking at all. It seems clear that participants in this study overestimated claims of "reduced risk" by the manufacturers of Eclipse, with many taking this to mean "no risk. The key public health issue is that the attitudes of consumers toward these reduced harm products may well be shaped by advertising of these products (see chapter 37, this volume). However, it is our contention that the psychological basis of the attitude also may influence the way consumers respond to these messages. Many psychological studies of attitudes have examined the relationship between attitudes and their structural components, focusing primarily on cognitive and affective bases of attitudes (Eagly & Chaiken, 1993; Crites, Fabrigar, & Petty, 1994; Haddock & Zanna, 1998). The ratings of thoughts and feelings about harm reduction, as well as predictors such as knowledge about tobacco products, and experience with smoking, were regressed onto overall attitudes toward harm reduction products in order to understand the primary predictors of overall attitudes. It was found that, for smokers, their feelings about harm reduction were the primary predictor of their overall attitudes toward harm reduction, but for non-smokers, neither their thoughts nor their feelings about tobacco exposure reduction predicted their overall attitudes. This suggests that one way of understanding consumer attitudes towards these products lies in understanding the structural basis of their attitudes; whether their attitudes are primarily derived from their feelings or primarily from their thoughts about the products. The feelings associated with smoking-taste, reduction of cravings, relaxation-may create positive attitudes that are difficult to counter through merely providing relatively abstract data on the health risks of these products (also see Kozlowski et al. In addition to differentiating the cognitive and affective base, a second approach involves examining whether the attitude reflects different functional qualities-the satisfaction of value expressiveness (symbolic beliefs) or instrumental needs (self-interest). Kim, Borgida, and Stark (2007) examined three potential predictors of support for federal regulation of harm reduction products: product knowledge, self-interest, and symbolic beliefs about the role of government in society.

Julie Broderick Assistant Professor, Physiotherapy, Trinity College Dublin Catherine L. Granger Associate Professor of Physiotherapy, University of Melbourne citied that Coronavirus: how physiotherapists are helping patients recover May 5, 2020 11. Kim Jackson, Rachael Lowe, Jarapla Srinivas Nayak, Tony Lowe and Oyemi Sillo citied that techniques of autogenic drainage [Available from. Maria Panagioti,1 Charlotte Scott,1 Amy Blakemore,1,2 and Peter A Coventry3 citied that Overview of the prevalence, impact, and management of depression and anxiety in chronic obstructive pulmonary disease [Available from. The video link made and shared by Reliva Physiotherapy and Rehab with the patients [Available from: docs. S Agrawal Institute of Physiotherapy and Medical Care Education, Navsari, India, Intern of Bachelor of Physiotherapy, S. S Agrawal Institute of Physiotherapy and Medical Care Education, Navsari, India Abstract Background: Trapezitis is a commonly seen condition due to overuse and faulty posture. It causes range of motion restriction of cervical spine, tenderness and neck pain. Aim: To evaluate the long term effect on pain and restricted range of motion following three days of treatment involving deep transverse friction massage, ischemic compression and sham conventional group in upper trapezitis. Methodology: A Randomized controlled trial with 66 subjects (F = 61, M = 5) complaining of upper trapezius pain since 15 days were randomly allocated for the study into three different groups with 22 subjects in each group (Group A= Deep Transverse Friction Massage, group B = Ischemic Compression and group C = Conventional Therapy). Pre and post treatment visual analogue scale and lateral flexion of the cervical spine to the opposite side were taken. Result and Conclusion: the results showed statistically significant improvement (p=0. Hence all the three groups were equally effective in reducing tenderness of upper trapezius. Key words: - Deep transverse friction massage, Trapezitis, Ischemic compression, Trigger point Introduction the upper trapezius muscle is designated as a postural muscle of neck and it is highly susceptible to overuse. Neck pain prevalence varies widely in different studies, with a mean point prevalence of 13 % (range 5. When basic injury is not treated, spasm causes formation of muscle knots, called trigger points. The myofascial trigger point in the trapezius is most commonly found at the midpoint of the upper border of the muscle. Simons described criteria for identification of taut band - a tender spot on the taut band, referred pain or altered sensation at least 2 cm beyond the spot, elicited by 48 Indian Journal of Physiotherapy and Occupational Therapy. Amongst that there is only one pilot study comparing the immediate effect of deep transverse friction massage and ischemic compression. More over the pilot study was done only on two groups where group A was given deep transverse friction massage and group B was given ischemic compression. Hence the third group undergoing sham control intervention should be included which can demonstrate that both treatment were better than sham intervention and either of the treatment was more effective. Aims and Objectives: To find out the effect of deep transverse friction massage, ischemic compression and sham conventional group and compare the effect of all groups following three days of treatment. Agrawal Institute of Physiotherapy and Medical Care Education presenting complaints of trapezitis and were screened by therapist 1 and who fulfilled inclusion and exclusion criteria were selected for the study. The patients were asked to mark Visual analogue scale with the average pain intensity for their pain over 24 hours. Then opposite side lateral flexion range was measured using Universal Goniometer according to the protocol by Norkin. Deep Transverse Friction Massage was applied with forefinger which was reinforced by the middle finger. This technique was executed with the muscle in relaxed position, as recommended by Cyriax and Cyriax (1992) and was applied for 3 minutes. Pressure was released when there was decreased tension in the TrP or when TrP was no longer tender or one min had elapsed, whichever occurred first. Figure 2: Top left: Measurement of lateral flexion, Top right: Ischemic compression Bottom left: Deep transverse friction massage. Bottom right: Conventional exercise 50 Indian Journal of Physiotherapy and Occupational Therapy.

On a quantitative level, indices extracted from the plot correspond to time-domain indices. The former reflects short-term vagal activity whereas the latter represents sympathetic modulation. Nevertheless, there is no consensus on the optimal time lag yet, which itself could be subject to inter-individual differences. Entropy Entropy-based methods find their roots in information theory in which they are conceptualized as measures of complexity (or "unpredictability") of a signal. While they originated from fields of thermodynamics [75], their applications have expanded towards the quantification of complexity in physiological systems and have been used widely as a diagnostic tool in biomedicine. The underlying concept of entropy is that it quantifies repetitions of patterns in a signal, with greater entropy indicating higher randomness and unpredictability (and thus, complexity) and lower entropy values implying that the cardiac system is predictable. However, another important difference is that ApEn computes regularity based on short time sequences whereas SampEn considers the entire time series [75]. In order to estimate complexity from irregularity statistics more accurately, Costa et al. While a comparison of clinical validity across these entropy measures has been demonstrated in a few studies. Fractal Measures Fractal methods are more recently developed methods to assess noisy and nonstationary time series. Its computation disregards nonstationarities in the cardiac time series and hence any spurious correlations due to artifacts of nonstationarity behavior. The short-term correlations correspond to the baroreceptor reflex whereas the long-term correlations measure regulatory mechanisms in the cardiac system [20]. It is therefore unsurprising that they are associated with distinct psychological constructs, such as cognitive abilities, neural processes, personality traits and psychopathological disorders. Therefore, researchers have highlighted its potential role as a protective factor against stress [123,129,130]. A similar pattern would be expected with borderline personality disorder, given the shared physiopsychological mechanisms with bipolar disorder [152]. This has led researchers to propose that a restrained vagal activity could be a transdiagnostic biomarker across psychiatric disorders [17,155,161,162]. This hypothesis is further supported by the observation of worsening parasympathetic tone during the chronic course of psychiatric conditions [155,163], and parallel improvements in parasympathetic parameters as symptom severity reduces over the course of treatment [14,145,164,165]. This model emphasizes the importance of having reciprocal interactions and coherence between the regulatory systems to maximize the adaptability to environmental demands [167,168]. According to the model, cardiac coherence can be induced by breathing at a steady pace approximating 0. According to [172], regular breathing exercising techniques help to continuously stimulate and exercise autonomic reflexes, especially the baroreflex. Instructions on how to get Python and NeuroKit2 up and running can be found at neurokit2. Data Preprocessing Cardiac activity data stored on the disk can be loaded using functions appropriate to the format. For the purposes of this tutorial, we will download and use an example dataset available in NeuroKit2, which consists of recordings of four participants during 8 min of resting state. For this tutorial, we will use the bio process function which allows for less customization of the pipeline and relies on sensible default parameters for performing signal-specific operations. Alternatively, users can customize their own processing pipeline following the tutorial available on the documentation of NeuroKit2. Table 2 shows an example of the indices output and Figure 1 shows an example of the diagnostic plot.

It is advisable that students be required to take a leave of absence if they are severely ill (457, 458). Students should be directed to inpatient hospital care if their weight is considerably below an expected healthy weight and they meet the other indications for hospitalization listed in Table 8. When the psychiatrist and other health care professionals serve as "dual agents" for the school and whenever information must be shared among health care professionals, appropriate consents must be obtained and the requirements of the Health Insurance Portability and Accountability Act followed. For the student to be permitted to continue in school, these clinicians may require a minimum weight and other physical, behavioral, or laboratory target measures to ensure basic medical safety. Identification of risk and protective factors Many efforts have been made to understand how eating disorders develop. Overall, our understanding of risk and vulnerability still outweighs our knowledge of protective factors and resilience. Temperamental factors, eating dysregulation, attachment issues, deficient self-regulation, childhood abuse in the case of bulimia nervosa, and sociocultural ideals of health and beauty may all contribute to risk and pathogenesis (367, 459, 460). A history of childhood obsessive-compulsive traits-notably perfectionism, rigidity, and rule-bound behavior-may also be associated with an increased risk for the development of an eating disorder (461). Richly documented clinical histories of patients with anorexia nervosa followed over 30 years from infancy to early midlife suggest several potential risk factors related to early perceived body image distortions, body regulatory problems, and academic and interpersonal problems (146). Because it is well known that the risk of eating disorders is transmitted in families, it is important to offer particular help to patients with eating disorders who are themselves mothers. In some patients, increasingly compulsive exercise may precipitate anorexia and bulimia nervosa (447, 464). Female athletes in certain physical activities such as ballet and gymnastics are especially vulnerable (465). Unlike habitual runners, ballet dancers exhibit eating pathology similar to that of individuals with eating disorders (466). Male bodybuilders are also at risk, Treatment of Patients With Eating Disorders 65 Copyright 2010, American Psychiatric Association. Programs have been designed to influence these risk factors and thus prevent eating disorders. A recent meta-analysis (471) of prevention programs suggests that programs vary significantly in their impact, ranging from an absence of any effect to a reduction in current and future eating pathology. Some effects persist as long as 2 years and are superior to minimalintervention control conditions. Larger effects occur for selected (versus universal), interactive (versus didactic), and multisession (versus single-session) programs; programs offered solely to female patients and to participants over age 15 years; programs without psychoeducational content; and trials that use validated measures. Several of these programs have resulted in enhanced knowledge about eating disorders and healthy eating. A few have resulted in improved attitudes toward size, shape, eating, and weight, and some have addressed self-esteem and "weightism" and stressed normal/healthy attitudes and behaviors. Because some studies even suggest that certain preventive efforts actually increase the likelihood that maladaptive eating behaviors would be attempted, particularly among adolescents (455), caution is recommended in selecting target populations for such intervention and proper follow-up is necessary. Weight preoccupation and excessive self-evaluation of weight and shape are primary symptoms in both disorders, and many patients demonstrate a mixture of both anorexic and bulimic behaviors. Patients with atypical features who deny a fear of weight gain, accurately appraise their bodies as malnourished, and deny distorted perceptions of their body constituted about 20% of the patients admitted to a specialty eating disorder program (478). Denial of a fear of weight gain was found in 28% of anorexia nervosa patients assessed via a structured interview (479). Anorexia nervosa appears in two subtypes: restricting and binge eating/purging; this classification into subtypes is based on the presence or absence of binge eating or purging symptoms.

Her emergency angiogram showed acute occlusion of the left anterior descending artery (to the anterior wall). She had chronic, asymptomatic occlusion of the right coronary artery (to the inferior wall), and the distal vessel was supplied by collaterals from the left anterior descending. Comment: Retrograde P waves distort the T waves, so this is probably a nodal rhythm. Comment: this is a relatively common occurrence (we staged it for this purpose with one of the technicians). Another common lead misplacement involves the V leads and bizarre R wave progression across the precordium. Index Page numbers in italics refer to figures and those in bold to tables, but note that figures and tables are only indicated when they are separated from their text references. Children with class-switch defects due to these deficiencies, also known as hyper-IgM syndromes, have decreased levels of IgG and IgA, and elevated or normal levels of lowaffinity IgM antibodies. Although B cells are present, there is an inability to class-switch or generate memory B cells. Regular replacement therapy with immunoglobulin is crucial in individuals with this disorder, whether the disorder is of the Xlinked or autosomal recessive variety, as reported in the 2 largest-scale series of patients. A normal antibody response to polysaccharide antigens is defined differently according to age: In children ages 2-5 years, >50% of concentrations tested were considered protective, with an increase of at least 2fold observed, and in patients ages 6-65 years, >70% of concentrations tested were considered protective. Any of these phenotypes may warrant antibiotic prophylaxis, immunoglobulin replacement, or both, depending on the clinical situation. Further evidence of infection, including abnormal findings on sinus and lung imaging, complete blood count, C-reactive protein, and erythrocyte sedimentation rate can additionally support the need for immunoglobulin supplementation in these patients. When the severity of infections, frequency of infections, level of impairment, or inefficacy of antibiotic prophylaxis warrants the use of immunoglobulin in this form of antibody deficiency, patients and/or their caregivers should be informed that the treatment may be stopped after a period of time (preferably in the spring in temperate regions) and that the immune response will be reevaluated at least 3-5 months after the discontinuation of immunoglobulin. Repeated multiple cessations of therapy to affect this determination are not useful and can potentially harm the patient. Normal levels of immunoglobulins with impaired specific-antibody production (selective antibody deficiency) Patients with normal total IgG levels but impaired production of specific antibodies, including those with isolated deficient responses to numerous polysaccharide antigens following vaccination, can present a diagnostic challenge. Immunoglobulin replacement therapy should be provided when there is welldocumented severe polysaccharide nonresponsiveness and evidence of recurrent infections with a proven requirement for antibiotic therapy. Antibody function, however, is initially partially impaired but ultimately typically intact. Although the study did not include a control group, the investigators reported a decreased frequency of overall infections (from 0. One of the most common secondary causes of hypogammaglobulinemia is medication, especially corticosteroids, some seizure medications, and certain biologics such as rituximab. Severe hypogammaglobulinemia should be considered a risk for infection and should be managed accord ingly. In general, an IgG level <150 mg/dL is widely accepted as severe hypogammaglobulinemia, for which additional testing apart from verification of the low level is not required prior to starting replacement therapy. Levels between 150 and 250 mg/dL are also considered severely low but warrant consideration of additional testing for specific antibody against vaccines to assess function, depending on the clinical history. However, at least 3 recently published studies-an open-label study in 10 patients,45 a retrospective study in 17 adult patients with subclass 3 deficiency,46 and a retrospective study in 132 patients with subclass deficiency47-demonstrated decreased infections, a need for antibiotics, and improved quality of life. Of the 13 patients, 2 did not respond, 6 had ``dramatic' relief from recurrent infections, and 5 had ``moderate' relief. Immunoglobulin replacement therapy is not indicated for selective IgA deficiency; however, poor specific IgG antibody production, with or without IgG2 subclass deficiency, may coexist with selective IgA deficiency. In this case, however, it would be prudent to view this phenotype as one of selective antibody deficiency (see preceding text) owing to the known substantive role of missing antibody quality. Thus, while they are coincident and potentially compounding, focus should not be taken off of the selective IgG antibody deficiency as being the most relevant and more substantive than IgG2 or IgA deficiency. That study was unable to conclude any increased risk for adverse reactions associated with IgA deficiency, and recommended larger-scale, prospective trials to address this issue. These defects include poor anamnestic antibody responses to booster immunization with fX174, diphtheria and tetanus toxoids, pneumococcal and H influenzae vaccines, as well as poor antibody and cell-mediated responses to neoantigens such as keyhole limpet hemocyanin. As more immunodeficiencies are described and their molecular mechanisms elucidated, it will be important to develop more refined laboratory tests for a comprehensive assessment of B-cell function.