Denise R. Sokos, PharmD, BCPS
- Adjunct Assistant Professor, Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
https://prabook.com/web/denise_r.sokos/1443092
Alcohol-focused spouse involvement and behavioral couples therapy: evaluation of enhancements to drinking reduction treatment for male problem drinkers pulse pressure and exercise purchase 100mg atenolol amex. Patients learn to track their thinking and activities and identify the affective and behavioral consequences of those thoughts and activities arrhythmia guidelines 2011 atenolol 50 mg low price. Patients then learn techniques to change thinking and behaviors that contribute to substance use blood pressure 160100 purchase 50mg atenolol free shipping, and to strengthen coping skills heart attack first aid buy atenolol 100mg overnight delivery, improve mood, interpersonal functioning and enhance social support. Primary therapeutic techniques include education of the patient about the treatment model, collaboration between the patient and therapist to choose goals, identifying unhelpful thoughts and developing experiments to test the accuracy of such thoughts, guided discovery (facilitating the patient in identifying alternative beliefs through the use of questions designed to explore current beliefs), interpersonal skill building through communication and assertiveness training, behavioral rehearsal, and role-play. In addition, treatment incorporates structured practice outside of session, including scheduled activities, self-monitoring, thought recording and challenging, and interpersonal skills practice. Cognitive-behavioral coping skills therapy has been shown to be effective with alcohol and drug dependent adults and adolescents but not consistently superior to other interventions (Czruchry et al 2003; Ball et al 2007; Carroll et al; Kaminer et al 2002). Brief motivational enhancement and coping skills interventions for heavy drinking. The use of contingency management and motivational/skillsbuilding therapy to treat young adults with marijuana dependence. Cognitive skills training: impact on drug abuse counseling and readiness for treatment. Cognitive-behavioral coping skills and psychoeducation therapies for adolescent substance abuse. The trials were conducted in a variety of geographic regions, treatment settings. Furthermore, the patients in those studies suffered from various substance-related problems and included homeless people as well as people of different ethnic or cultural backgrounds. Mesa Grande: A methodological analysis of clinical trials of treatments for alcohol use disorders. Either monetary or nonmonetary rewards are made contingent on objective evidence such as negative toxicology results. The most common form of contingencies provided to reinforce desired behaviors are vouchers with monetary value that can be redeemed for goods and services, specific material prizes, or draws from a "fishbowl" that contains cards which vary in their reinforcing value from simple praise to vouchers worth $1 to $100. Schedules (fixed or intermittent) and magnitude of reinforcement have varied and have implications for overall cost of clinical implementation. These approaches have shown consistent effectiveness with patients diagnosed with drug use disorders (Dutra et al. However, for most interventions, the magnitude of the effect observed at the end of treatment is not maintained in the months following treatment. A meta-analysis of voucher-based reinforcement therapy for substance use disorders. The therapeutic style using motivational interviewing elicits client reactions to assessment feedback, commitment to change and collaboration on development of an individualized change plan. Site matters: multisite randomized trial of motivational enhancement therapy in community drug abuse clinics. Brief Treatments for Cannabis Dependence: Findings from a Randomized Multisite Trial. Community program therapist adherence and competence in motivational enhancement therapy. Therapist interpersonal skill predicts client involvement within motivational interviewing sessions. Motivational enhancement therapy to improve treatment utilization and outcome in pregnant substance users. The therapist conveys the concept that addiction is a chronic, progressive and potentially fatal illness for which the only successful strategy is abstinence achieved one day at a time by following a 12-step program of recovery. The first part reviews relevant events of the last week (including urges to use, drinking behavior and recovery-oriented activities) and a homework assignment. The conclusion of the session includes a homework assignment and development of a plan for recovery-oriented activities (meeting attendance, sponsor contact). It assumes that alcoholism (or addiction) is a progressive illness that affects the body, mind, and spirit for which the only effective strategy for recovery is abstinence from alcohol (or other drugs). The individual can achieve complete abstinence one day at a time by following a 12-step program of recovery as outlined in the "Big Book" of Alcoholics Anonymous (c1935, 1955, 1976, 2001) and through fellowship with others in recovery through the 12 traditions of Alcoholics Anonymous. Participation in twelve step-based mutual help groups has been associated with improved outcome and reduction in healthcare costs in numerous observational studies (Humphreys et al, 2004). Patients in all three groups improved in the primary outcome measures of addiction severity, with no significant differences between the three groups.
Mankind has been obsessed with this strange addiction to royalty arteria jelentese purchase atenolol 100 mg fast delivery, power pulse pressure low diastolic generic atenolol 50mg amex, fame and fortune arteria 70 obstruida atenolol 100 mg online, an inherent trait of self improvement and carnal desire for power heart attack ft thea austin eye of the tiger atenolol 100mg mastercard. The evolution of this phenomenon has manifested itself in corporations with its pyramidal structures of the many serving the few. Prolific upon Planet Earth is the Age of Corporations that effectively allows anyone, even a slave, to become a "king" of a "dynasty". This inherent desire for wealth and power, and the bowing to its authority has remained through time because Earthlings are trained to bow down simply because they accept it for fear of not so doing. Even now nothing has really changed as unbelievable masses flock to see the Queen, the Presidents, the Pope, or anyone who has by force or by special skill attained a position of power and authority. They are immediately the one to be admired and followed without any regard for what their real purposes are. It has always been this way both in fact and fiction and it is still prevalent today. Only the means of controlling those required to fight, to create movements against opposition, to maintain the dynasty, to retain a position of greatness, has shifted in form at the lower reaches. But while the corporate dynasties play the game of thrones, nations maintain the might with armies called the military. And so it seems that the drive to superiority, to greatness relative to others, the need to satisfy the erotic needs of the human mind and form continue like a broken record. The broken record is an unending inventory of dynasties, civilizations, and cultures; and destruction. And now it is nations, corporations, governments that have risen and fallen like the natural cycle of growth and decay of all life on the planet. There are those who have attained special powers like the gods and the myths tell. There are those that have attained control of special information and power over others. There are those who have through heartless cold disassociation from the deed controlled through fear and death. As humanity supposedly became more "intelligent" so the gods and dynasty leaders had to adjust the techniques to continue the control and the preservation of their kingdoms. There are now countless dynasties and equivalents in kings and queens that hoarded wealth at the expense of those below them in their power hierarchy. Countless corporations, nations, kingdoms are as we have pointed out; pyramid structures of power and management have become the norm of power to satisfy those who create and run them. And the apparent belief of freedom has indeed been nurtured to as to continue the means by which dynasties can retain their existence. As pointed out before, it is all choice 37 and it is all just business that earthlings accept. And it is clear that there must be, in all this evolution, those who are better at this business than the others. Yet, in the end, if you believe you are free, then all this that is told here about slaves is meaningless for indeed one can have a decent life within the family, culture, nation, or world one is born into. On the other hand, many do not have much of a fruitful life, and know something is not right for them. The choices however to escape that trap which is not right seems so unattainable that all that can be done is to mumble in a beer or bury the head in the sand and attempt to disallow the issues into ones reality. For those the choice is there and the powerful information is there, but a trigger is needed to see that a choice does exist as in this book. Through various means, be it technology, special psychic powers, mysticism, occult, spiritual, knowledge, birth, or bloodlines, the gods and the global elite have managed to retain their power over others through time; and they have managed to retain their great kingdoms of wealth. Some have fallen, some have risen but there seems to be the ones that have held fast in their dominion. It is this group and their extraordinary march to the conquest of the ultimate empire of Planet Earth that is our topic. In a simple model, all gods, bloodlines, and humanity are evolving on a path; a simply at different stages of growth and evolution. And so it is now of interest to look at these royal bloodlines more closely to attempt to see what their secrets of success in maintaining their dynasties may be.
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Geopolitically blood pressure percentile by age buy atenolol 50mg on-line, growing humanitarian crises and regional conflict in the Middle East and North Africa will threaten to further undermine the credibility of international dispute resolution and human rights norms heart attack indigestion buy 50 mg atenolol otc. The sectarian nature of Iranian and Saudi regional competition hypertension 28 years old cheap atenolol 50mg free shipping, which promotes inflammatory rhetoric and allegations of heresy throughout the region arteria poplitea atenolol 100mg low cost, heightens these concerns. Democratic practices have expanded, civil society groups have proliferated, and public demand for better governance has become more urgent. Still, many African states continue to struggle with "big man" rule, patronage politics, and ethnic favoritism. Many leaders remain focused on political survival rather than reform-with some defying term limits. Global economic headwinds also threaten progress by keeping commodity prices low and foreign investment weak. Even some countries that have made progress toward democracy remain fragile and prone to violence accompanying elections. Rapid urbanization will stress infrastructure and increase visibility of elite corruption- fueling public frustration with services or opportunities. Some 75 to 250 million Africans will experience severe water stress, likely leading to mass migration. The progress of the past two decades-including an expanded middle class, increasingly vibrant civil society, and the spread of democratic institutions-suggests upside potential. The rate of malnourished children, for example, is higher in India than in Sub-Saharan Africa. Populism and sectarianism will intensify if Bangladesh, India, and Pakistan fail to provide employment and education for growing urban populations and officials continue to govern principally through identity politics. Human health, food security, infrastructure, and livelihoods will deteriorate from pollution, earthquakes and the effects of climate change, including shifting monsoon patterns and increasing glacier melt. Pakistan will seek to enhance its nuclear deterrent against India by expanding its nuclear arsenal and delivery means, including pursuing "battlefield nuclear weapons" and sea-based options. India, by contrast, will focus its attention on both Islamabad and Beijing- seeking military partnerships with Europe, Japan, the United States, and others-to boost its conventional capabilities while striving for escalation dominance vis-a-vis Pakistan. The presence of multiple nuclear powers with uncertain doctrine for managing at sea incidents between nuclear-armed vessels increases the risk of miscalculation and inadvertent escalation. Nuclear mating requirements for naval-based delivery vehicles remove a safety valve that until now has kept nuclear weapons stored separately from missiles in South Asia. This ultimate low-probability, high-impact event underscores the imperative of international cooperation and state attention to the issue. Terrorists will continue to justify their violence by their own interpretations of religion, but several underlying drivers are also in play. Within countries, the breakdown of state structures in much of the Middle East continues to create space for extremists. The ongoing proxy war between Iran and Saudi Arabia also is fueling Shia-Sunni sectarianism-with some militant groups further fracturing over religious differences. In addition, perceptions of "Western hegemony," remains a potent rallying cry for some groups, mobilized around striking the "far enemy. Prolonged conflicts and the information age allow terrorists to recruit and operate on a large scale, demonstrating the evolving nature of the threat. Militant Christianity and Islam in central Africa, militant Buddhism in Burma, and violent Hindutva in India will all continue to fuel terror and conflict. Religion will become a more important source of meaning and continuity because of increasing information connectedness, the extent of state weakness in much of the developing world, and the rise of alienation due to the dislocation from traditional work in the developed world. Rapid change and conditions of political and economic uncertainty, if not insecurity, will encourage many people to embrace ideologies and identities for meaning and continuity. The vast majority of believers will be peaceful, but those with extreme views will find likeminded followers and vulnerable recruits through information technologies. Most world religions-including Christianity, Islam, and Judaism, Buddhism, and Hinduism-have exclusionary aspects of doctrine that can be exploited in this way.
Studies to determine the strength or willingness of individuals to stick together and act as a unit have most consistently assessed the level of conflict blood pressure chart sheet generic atenolol 100mg on line, degree of interpersonal tensions hypertension juice recipe purchase 100 mg atenolol, facility and quality of communications arteria ileocolica purchase atenolol 50mg amex, collective perceptions of team health and performance of the group arrhythmia effects cheap atenolol 100 mg with amex, and the extent to which team members share perceptions or understandings concerning their operational contexts. Members of cohesive teams sit closer together, focus more attention on one another, show signs of mutual affection, and display coordinated patterns of behavior. Members of cohesive teams who have established a close relationship are more likely to give due credit to their partners. In contrast, those who do not have a close relationship within a team are more likely to take credit for successes and blame others for failure (Thompson, 1967). It is also important to note that team cohesion is distinct from individual morale. Risk of Performance Errors Due to Poor Team Cohesion and Performance, Inadequate Selection/Team Composition, Inadequate Training, and Poor Psychosocial Adaptation 59 Chapter 2 Human Health and Performance Risks of Space Exploration Missions Table 2-3. Summary of Findings Presented for Team Skills Training Source Predictor Outcome Context Evidence Type Guzzo et al. Indeed, although prescreening precludes individuals with personality or mood disorders from being selected, the likelihood that certain disorders may develop. Space flight evidence regarding cohesion and performance is limited by a paucity of objective team performance data. However, case studies, interviews, and surveys that have been done within the space flight realm provide evidence that issues pertaining to cohesion exist and are perceived as threats to effective operations. For example, breakdowns in team coordination, resource and informational exchanges, and role conflicts. Likewise, interviews and surveys that were conducted with flight controllers reveal that mission teams are commonly concerned with team member coordination and communications, and that interpersonal conflicts and tensions exist (Caldwell, 2005; Parke et al. We must again turn to other sources of empirical evidence to inform us of this relationship because space flight research is lacking in this regard. In medicine, research indicates that interpersonal conflicts, miscommunications, failures to communicate, and poor teamwork skills contribute significantly to the rate of medical errors (Baker et al. Four meta-analyses (Category I) that were conducted across industries as well as types of performance teams (work, military, sport, educational, project, etc. The authors of the first of these meta-analyses (Evans and Dion, 1991) found a positive correlation between cohesion and individual performance, but their study did not include group performance criterion measures. Mullen and Copper (1994), in addressing these limitations in a subsequent meta-analysis, found that cohesion positively affects performance. Mullen and Copper (1994) noted that successful performance also promotes cohesion. While most of the research on team cohesion and performance deals with the positive aspects of team attitudes, several studies investigated level of conflict and negative attitudes concerning the team as indicators of cohesion. De Dreu and Weingart (2003) note an important distinction is between interpersonal conflict and task conflict; i. Interpersonal conflict is generally found to be destructive to cohesion and, in turn, team performance; whereas task conflict can improve task performance. Interpersonal conflict is thus generally detrimental, as it appears to affect team cohesion. Some level of task-related conflict may be desirable, regardless of its affect on cohesion, because conflict can promote optimal performance. In Risk of Performance Errors Due to Poor Team Cohesion and Performance, Inadequate Selection/Team Composition, Inadequate Training, and Poor Psychosocial Adaptation 61 Chapter 2 Human Health and Performance Risks of Space Exploration Missions contrast, both aspects of cohesion. In a study that was conducted with Canadian military groups, path analysis showed that taskrelated cohesion was positively related to individual job satisfaction, interpersonal cohesion was negatively related to reports of psychological distress, and both types of cohesion were positively related to job performance (Ahronson and Cameron, 2007). Research that was conducted within Antarctic space analogs also investigated conflict, cohesion, and performance. In one survey of Expeditionary crews conflict that was measured as inter-member hostility was related to the poor ratings of member effectiveness that were meted out by supervisors (Vallacher et al. Positive team climate and cohesion helped to reduce interpersonal tensions, which, in turn, contributed to work satisfaction (Wood et al.
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