Condet

Cheen Lum, PharmD

• Clinical Specialist in Behavioral Care, Community Hospital North
• Ambulatory Care Pharmacist�Behavioral Care, Community Health Network, Indianapolis, Indiana

Finally asthma definition 6 star generic 5mg montelukast with amex, I would like to acknowledge friends asthmatic bronchitis 2 weeks buy 5 mg montelukast mastercard, co-workers asthma or allergies cheap montelukast 5 mg with amex, and family that have helped me along this journey with their support and encouragement asthma symptoms 4dp5dt buy 10mg montelukast overnight delivery. Accomplishments such as this are never achieved in isolation and to have an amazing group of individuals to support me has been instrumental in my success. Typical symptoms, however, include (but are not limited to) fatigue, pruritus, loss of appetite, night sweats, splenomegaly, abdominal pain, bone pain, weight loss, microvascular complications, and anemia. Typical treatment options for this population may include, but are not limited to , pharmacotherapy. Yoga, which consists of physical postures (asanas) and mindfulness-based techniques. Systematic reviews and metaanalyses have found that yoga significantly improves functional well-being, distress, anxiety, depression, fatigue, emotional function, social function, sleep quality and QoL. Much of the aforementioned work, however, has been done in breast cancer patients. Online yoga was reported to be feasible as average yoga participation was ~50 min/week (60 min/week was prescribed) and 37% averaged 60 min/week of yoga. This study was conducted to determine the feasibility of online yoga as its primary outcome25 and did not include a control group and, therefore, the significant findings are preliminary in nature. Inclusion/Exclusion Criteria Inclusion Criteria - Published study between 19952016 - Examined any type of yoga as an either an independent variable or a dependent variable - Included leukemia, lymphoma, and/or myeloma patients or survivors as study participants - Intervention or epidemiological study design - - Exclusion Criteria Study participants included patient population receiving stem-cell transplantation Examines yoga in relation to hematological cancer risk Systematic review or metaanalysis study design examined yoga as an independent variable or a dependent variable were included as were intervention. However, systematic reviews and meta-analyses as well as studies that examined yoga in relation to hematological cancer risk were excluded as this review intended to focus on primary research examining yoga and its effects on hematological cancer patient symptom burden and QoL. The search strategies were peer-reviewed by another experienced medical librarian. Although significant improvements in subjective sleep quality, faster sleep latency, longer sleep duration, and less reported use of sleep medications were found, there were no significant differences between groups for state anxiety, depression or fatigue. However, this may be due, in part, to both the adherence rate and the dose of the intervention. Only 58% of patients in the intervention group completed at least 5 yoga session (out of 7 total sessions). Additionally, seven total sessions may not have been a potent enough stimulus to improve psychosocial outcomes. Secondarily, the feasibility of collecting blood and salivary biomarkers that may be associated with fatigue will be investigated. Potential participants were excluded if they: 1) currently performed Tai Chi, Qi Gong, or Yoga at least 60 minutes or more weekly, 2) currently participated in 150 minutes/week of physical activity, 3) currently utilized Udaya. Prospective organizations were contacted via email and/or phone and asked to advertise the study by posting the provided recruitment material. Interested participants were then directed to an eligibility survey administered via Qualtrics (Provo, Utah). Participants randomized to the yoga group were asked to complete 12 weeks of at least 60 min/week of online-streamed, home-based yoga through Udaya. Those randomized to the wait-list control group were asked to resume their normal levels of physical activity for 16 weeks before being given access to the online yoga intervention materials (see Figure 2). The following sections describe the study-related procedures for the yoga group and the wait-list control group, respectively. Yoga Group the 12-week yoga prescription was a modified version of the yoga prescription from the previous feasibility study conducted by Huberty et al. Overall, the yoga prescription was 12-weeks and included 20-30 minute videos on 2-3x/week to achieve 60 minutes of yoga 13 participation each week. Weeks 1-2 were designed to be introductory in nature, with short class video lengths. Class length and difficulty gradually progressed thereafter in weeks 3-12 to include longer and slightly more challenging videos. Modifications to the yoga prescription used in the feasibility study included the addition of more meditation-based classes. These modifications were made based on qualitative feedback from the feasibility study, in which many participants mentioned that they wished there would have been more options for meditation classes. All study participants were provided with a yoga safety and modifications handout that they were asked to review prior to participating in yoga.

You might have had this experience when you were dieting or trying to study rather than party; the chocolate bar in the kitchen cabinet and the fun time you were missing at the party kept popping into mind asthma 999 buy montelukast 10mg on-line, disrupting your work asthma treatment for kid montelukast 10 mg line. James Pennebaker and his colleagues (Pennebaker asthma fev1 80 buy montelukast 10mg otc, Colder asthma treatment while pregnant discount 5mg montelukast with visa, & Sharp, 1990; Watson & Pennebaker, 1989) [23] have conducted many correlational and experimental studies that demonstrate the advantages to our mental and physical health of opening up versus suppressing our feelings. This research team has found that simply talking about or writing about our emotions or our reactions to negative events provides substantial health benefits. For instance, Pennebaker and Beall (1986) [24] randomly assigned students to write about either the most traumatic and stressful event of their lives or trivial topics. Although the students who wrote about the traumas had higher blood pressure and more negative moods immediately after they wrote their essays, they were also less likely to visit the student health center for illnesses during the following six months. Other research studied individuals whose spouses had died in the previous year, finding that the more they talked about the death with others, the less likely they were to become ill during the subsequent year. For one, expressing our problems to others allows us to gain information, and possibly support, from them (remember the tend-and-befriend response that is so effectively used to reduce stress by women). People who viewed stress as a challenge had fewer physiological stress responses than those who viewed it as a threat-they were able to frame and react to stress in more positive ways. However, we also need to learn how to control our emotions, to prevent them from letting our behavior get out of control. In their studies, they had 4- and 5-year-old children sit at a table in front of a yummy snack, such as a chocolate chip cookie or a marshmallow. However, if they ate the one that was in front of them before the time was up, they would not get a second. Mischel found that some children were able to override the impulse to seek immediate gratification to obtain a greater reward at a later time. Furthermore, the inability to delay gratification seemed to occur in a spontaneous and emotional manner, without much thought. The children who could not resist simply grabbed the cookie because it looked so yummy, without being able to stop themselves (Metcalfe & Mischel, 1999; Strack & Deutsch, 2007). Thus effective self-regulation can be recognized as an important key to success in life (Ayduk et al. It is no secret that we are more likely fail at our diets when we are under a lot of stress, or at night when we are tired. Muraven, Tice, and Baumeister (1998) [33] conducted a study to demonstrate that emotion regulation-that is, either increasing or decreasing our emotional responses-takes work. They speculated that self-control was like a muscle; it just gets tired when it is used too much. In their experiment they asked their participants to watch a short movie about environmental disasters involving radioactive waste and their negative effects on wildlife. According to random assignment to condition, one group (the increase emotional response condition) was told to really get into the movie and to express their emotions, one group was to hold back and decrease their emotional responses (the decrease emotional responsecondition), and the third (control) group received no emotional regulation instructions. Both before and after the movie, the experimenter asked the participants to engage in a measure of physical strength by squeezing as hard as they could on a handgrip exerciser, a device used for strengthening hand muscles. The experimenter put a piece of paper in the grip and timed how long the participants could hold the grip together before the paper fell out. It seems that emotion regulation does indeed take effort, because the participants who had been asked to control their emotions showed significantly less ability to squeeze the handgrip after the movie than they had showed before it, whereas the control group showed virtually no decrease. The emotion regulation during the movie seems to have consumed resources, leaving the participants with less capacity to perform the handgrip task. In other studies, people who had to resist the temptation to eat chocolates and cookies, who made important decisions, or who were forced to conform to others all performed more poorly on subsequent tasks that took energy, including giving up on tasks earlier and failing to resist temptation (Vohs & Heatherton, 2000). It turns out that training in self-regulation-just like physical training-can help. Students who practiced doing difficult tasks, such as exercising, avoiding swearing, or maintaining good posture, were later found to perform better in laboratory tests of emotion regulation such as maintaining a diet or completing a puzzle (Baumeister, Gailliot, DeWall, & Oaten, 2006; Baumeister, Schmeichel, & Vohs, 2007; Oaten & Cheng, 2006). But the experience of prolonged stress has a direct negative influence on our physical health. Men tend to respond to stress with the fight-or-flight response, whereas women are more likely to take a tend-andbefriend response. Posttraumatic stress in women after the September 11 terrorist attacks in New York City. Health psychology: Psychological factors and physical disease from the perspective of human psychoneuroimmunology. Stress and Health: Journal of the International Society for the Investigation of Stress, 25(2), 179­187; Miller, G.

Generic montelukast 4 mg line. How does asthma work? - Christopher E. Gaw.

The frontal lobes are asthma lungs order montelukast 5mg visa, as previously discussed asthma definition thesaurus proven montelukast 5 mg, richly interconnected with other cortical and subcortical regions of the brain asthma x ray 5mg montelukast. Thus asthma symptoms gerd montelukast 10 mg amex, the student should not consider the functions attributed to the frontal circuits to be solely localized or mediated by a specified region or circuit. The finding that damage to different regions of a circuit can produce executive dysfunction comparable with that evident when the frontal lobes are directly involved speaks to this caution. It is probably more accurate to describe the different frontal circuits as contributors, often major, to the mediation of certain types or forms of behavior. However, there are notable exceptions to the putative specificity of right versus left prefrontal systems. For example, verbal semantic retrieval and episodic encoding activates the left prefrontal region, whereas episodic retrieval instigates right prefrontal computations (Cabeza & Nyberg, 2000). Moreover, it is not unusual to find bilateral activation of the frontal cortex for a given task, suggesting complementary processing. Thus, care needs to be exercised when assuming a one-to-one correspondence between task content, input-output modality, or mental process recruited and the implicated anterior laterality (left versus right). Third, despite significant research and study, we do not fully understand the functions of the frontal systems, nor do researchers and clinicians agree on the functions that are associated with the different frontal circuits or regions. Dorsolateral Circuit the cognitive aspects of empathy, and the latter mediating the emotional elements (Eslinger, 1998). Often, this circuit is labeled the "executive" circuit; however, with our realization that executive functioning is implicated in the mediation of emotional, motivational, and social behavior, we consider the functions of each of the three circuits to be executive in nature. A sample of functions attributed to the dorsolateral circuit includes working memory, cognitive flexibility, maintenance of behavioral sets, selective and sustained attention, generation of strategic and divergent responses, verbal and nonverbal fluency, planning and organization, inhibitory control, abstract reasoning, memory search and retrieval, temporal-spatial "tagging" (binding time and spatial context to episodes), self-monitoring, insight, and judgment. Furthermore, the dorsolateral circuit participates in emotional-motivational behavior, such that damage to the region may precipitate depressive symptoms, although these symptoms are more frequently associated with damage to the ventromedial prefrontal region. The depressive symptoms associated with the dorsolateral prefrontal cortex are characterized by decreased initiative, apathy, indifference, psychomotor retardation, and social uneasiness (Anderson & Tranel, 2002). This depressive presentation differs from clinical depression by the absence of vegetative functions, negative cognition, and dysphoria. Some patients with dorsolateral damage demonstrate a decreased capacity to empathize with others, although this impairment is more frequently associated with disruption of the orbitofrontal circuit (Anderson & Tranel, 2002). The dorsolateral and orbital circuits may play complementary roles in empathic processing, with the former mediating In the above example, Patient U knows the arithmetic operations necessary to solve problems but cannot discern the important aspects of the problem without external structure. He rigidly adheres to this strategy and is too cognitively inflexible to think of other possibilities. Unless organized by higher order executive functions, problem-solving behavior becomes chaotic-sometimes failing to initiate, sometimes having no logical sequence, or sometimes perseverating on the first problem-solving strategy that comes to mind. Joaquin Fuster (2002, 1997) has developed a theory of prefrontal functioning that focuses significantly on the role of the dorsolateral cortex. He poses that the overarching function of the prefrontal architecture is the temporal organization of behavior, that is, the development and implementation of action sequences across time. Temporal organization of behavior extends to all voluntary behavior including skeletal, ocular, speech, and internal cognitive processes such as logical reasoning (Fuster, Van Hoesen, Morecraft, & Semendeferi, 2000). Four cognitive processes support the temporal organization of behavior: attention, working memory, preparatory set, and monitoring. These four cognitive processes are based on the functional cooperation of the prefrontal cortex and the subcortical and other cortical structures and circuits. Attentional control relates to the cooperative activation of the dorsolateral (selective, sustain, and orienting of attention), anterior cingulate (motivation and drive aspects of attention), and orbital (inhibitory control and filtering) cortices. Working memory encompasses the processes dedicated to the maintenance and manipulation of information held in short-term storage to guide behavior. Its retrospective function relates to the temporary retention of mental representations of environmental (sensory) information pertinent to goal-directed behavior. For example, you need to hold "on line" the instructions for a test if you are to perform it correctly. The temporal organization of behavior requires both retrospective memory and the preparation for action. Preparatory motor set involves the preparation, timing, and instigation of relevant goal-directed motor behaviors.

Venezuela was hyperinflationary for all years presented asthma symptoms in teens order 10 mg montelukast fast delivery, and Argentina became hyperinflationary effective July 1 asthma treatment ppt purchase montelukast 5 mg with amex, 2018 asthma symptoms due to allergies montelukast 4mg online, requiring retroactive implementation of hyperinflation accounting as of January 1 asthma levels order montelukast 5mg overnight delivery, 2018. The Group manages its global currency exposure by engaging in hedging transactions where management deems appropriate. Novartis may enter into various contracts that reflect the changes in the value of foreign currency exchange rates to preserve the value of assets, commitments and anticipated transactions. Novartis also uses forward contracts and foreign currency option contracts to hedge. The Group has designated a certain portion of its longterm euro-denominated straight bonds as hedges of the translation risk arising on certain of these net investments in foreign operations with euro functional currency. The hedge remained effective since inception, and no amount was recognized in the consolidated income statement in 2019, 2018 and 2017. As a policy, it limits its holdings in an unrelated company to less than 5% of its liquid funds. Call options are written on equities that the Group owns, and put options are written on equities that the Group wants to buy and for which cash is available. Credit risk Commodity price risk Credit risks arise from the possibility that customers may not be able to settle their obligations as agreed. To manage this risk, the Group periodically assesses country and customer credit risk, assigns individual credit limits, and takes actions to mitigate credit risk where appropriate. The provisions for expected credit losses for customers are based on a forward-looking expected credit loss, which includes possible default events on the trade receivables over the entire holding period of the trade receivables. In measuring the expected credit losses, trade receivables are grouped based on shared credit risk characteristics (such as private versus public receivables) and days past due. In determining the expected credit loss rates, the Group considers current and forward-looking macroeconomic factors that may affect the ability of the customers to settle the receivables, and historical loss rates for each category of customers. Accordingly, the Group does not enter into significant commodity futures, forward or option contracts to manage fluctuations in prices of anticipated purchases. Counterparty risk Interest rate risk the Group addresses its net exposure to interest rate risk mainly through the ratio of its fixed-rate financial debt to variable-rate financial debt contained in its total financial debt portfolio. To manage this mix, Novartis may enter into interest rate swap agreements, in which it exchanges periodic payments based on a notional amount and agreed-upon fixed and variable interest rates. Counterparty risk encompasses issuer risk on marketable securities and money market instruments; credit risk on cash, time deposits and derivatives; as well as settlement risk for different instruments. Counterparty credit risk and settlement risk are reduced by a policy of entering into transactions with counterparties (banks or financial institutions) that feature a strong credit rating. Exposure to these risks is closely monitored and kept within predetermined parameters. The limits are regularly assessed and determined based upon credit analysis, including financial statement and capital adequacy ratio reviews. In addition, reverse repurchasing agreements are contracted, and Novartis has entered into credit support agreements with various banks for derivative transactions. The Group does not expect any losses from non-performance by these counterparties and does not have any significant grouping of exposures to financial sector or country risk. Liquidity risk Liquidity risk is defined as the risk that the Group could not be able to settle or meet its obligations associated with financial liabilities that are settled by delivering cash or another financial asset. In addition, liquidity and funding risks, and related processes and policies, are overseen by management. Novartis manages its liquidity risk on a consolidated basis according to business needs and tax, capital or regulatory considerations, if applicable, through numerous sources of financing in order to maintain flexibility. The positive and negative fair values on derivative financial instruments represent the net contractual amounts to be exchanged at maturity. A 10-day period is used because of an assumption that not all positions could be undone in one day given the size of the positions. The Group uses a "Delta Normal" model to determine the observed interrelationships between movements in interest rates, stock markets and various currencies. The computation does not purport to represent actual losses in fair value on earnings to be incurred by the Group, nor does it consider the effect of favorable changes in market rates. Discontinued operations Discontinued operations include the operational results from the Alcon eye care devices business and certain Corporate activities attributable to the Alcon business prior to the spin-off, the gain on distribution of Alcon Inc. The Alcon eye care devices business researched, discovered, developed, manufactured, distributed and sold a broad range of eye care products. Alcon was organized into two global business franchises, Surgical and Vision Care.

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