This document discusses youth substance abuse and dating violence prevention. It notes the co-occurrence of these issues and the importance of targeting multiple related problems. Effective prevention requires understanding risk factors like child maltreatment history and trauma symptoms, as well as motivational stages and alternative reinforcers. The Youth Relationships Project targets relationships skills and social action to reduce dating violence among high-risk child welfare youth. Broad surveillance is needed to assess prevention program impact at the community level.
Presentation by Daniel Flannery, Ph.D. given at the 2010 RWJF LFP Annual Meeting in St. Paul, MN
This presentation will present recent research on the links between brain development and neurochemistry, mental health and violence. We will compare traditional treatment programs that focus separately on perpetrators, victims and witnesses with examples of specific, innovative, multi-systemic treatment models that providers have employed in an attempt to break the cycle of violence. Our discussion will revolve around several video vignettes and principles of Trauma-Informed care.
Participants will address the challenges of pilot-tested, “evidence-based practice” versus the “practice-based evidence” of community programs. Treatment challenges related to co-morbid functioning of high-risk individuals will be discussed including substance use, offending, mental health, family functioning and academic achievement. Examples of specific innovative treatment models and local and national data on multi-system involved youth and intervention outcomes will be provided. We will also consider the difficulties and benefits of working in collaborative, community-based coalitions to effect change and how this movement has been affected by policy, resources, and increased demands for accountability.
Brianna is a 12 year old, African-American child. Client was sexually and physically abused by her father beginning at age 8 until 11. She has been locked in the closet multiple times and sometimes without food and water. This client has also witnessed her father physically abuse her mother and her younger brother on numerous occasions. Brianna has been diagnosed with Post Traumatic Stress Disorder and Depression. Client often has negative feelings about herself, isolates herself from others, does not trust many people, has flashbacks of her attacks, refuses to leave her room, barely and eats.
Wekerle CIHR Team - Child Sexual Abuse & Adolescent Development: Moving from ...Christine Wekerle
Child Sexual Abuse & Adolescent Development: Moving from Trauma To Resilience - Findings from The Maltreatment and Adolescent Pathways (MAP) Research Study
Presentation by Daniel Flannery, Ph.D. given at the 2010 RWJF LFP Annual Meeting in St. Paul, MN
This presentation will present recent research on the links between brain development and neurochemistry, mental health and violence. We will compare traditional treatment programs that focus separately on perpetrators, victims and witnesses with examples of specific, innovative, multi-systemic treatment models that providers have employed in an attempt to break the cycle of violence. Our discussion will revolve around several video vignettes and principles of Trauma-Informed care.
Participants will address the challenges of pilot-tested, “evidence-based practice” versus the “practice-based evidence” of community programs. Treatment challenges related to co-morbid functioning of high-risk individuals will be discussed including substance use, offending, mental health, family functioning and academic achievement. Examples of specific innovative treatment models and local and national data on multi-system involved youth and intervention outcomes will be provided. We will also consider the difficulties and benefits of working in collaborative, community-based coalitions to effect change and how this movement has been affected by policy, resources, and increased demands for accountability.
Brianna is a 12 year old, African-American child. Client was sexually and physically abused by her father beginning at age 8 until 11. She has been locked in the closet multiple times and sometimes without food and water. This client has also witnessed her father physically abuse her mother and her younger brother on numerous occasions. Brianna has been diagnosed with Post Traumatic Stress Disorder and Depression. Client often has negative feelings about herself, isolates herself from others, does not trust many people, has flashbacks of her attacks, refuses to leave her room, barely and eats.
Wekerle CIHR Team - Child Sexual Abuse & Adolescent Development: Moving from ...Christine Wekerle
Child Sexual Abuse & Adolescent Development: Moving from Trauma To Resilience - Findings from The Maltreatment and Adolescent Pathways (MAP) Research Study
Assessing and managing risk for violence among juveniles is an important forensic task. Clinical judgement is never sufficient for this important job. This presentation outlines methods of assessing and managing risk of violence among young people.
You have been tasked with orienting new registered nurses in the emergency department in your hospital about how to manage child abuse and neglect cases. The orientation should cover child abuse and neglect definitions, prevention, detection, intervention and treatment, reporting, and interdisciplinary resources.
Contributors: Frank Putnam, MD, UNC at Chapel Hill, NC
William Harris, PhD, Children’s Research and Education Institute
& New School for Social Research, NYC, NY
Alicia Lieberman, PhD, UCSF, San Francisco, CA
Karen Putnam, PhD, UNC at Chapel Hill, NC
Lisa Amaya-Jackson, MD, Duke University, Durham, NC
Talk given at Youth-Nex, at the University of Virginia. During the last decade, there have been significant advances in social and emotional learning (SEL) research, practice, and policy. This talk will highlight key areas of progress and challenges as we broadly implement school-family-community partnerships to foster positive behavioral, academic, and life outcomes for preschool to high school students. My goal for this presentation is to provide a foundation to foster group discussion about future priorities for the next decade.
Risk Reduction Through Family Therapy (RRFT)BASPCAN
An integrative approach to treating substance use problems and PTSD among maltreated youth.
Carla Kmett Danielson PhD
Medical University of South Caolina
Powerpoint accompanying workshop session from the Homeless and Housing Coalition of Kentucky's 2013 conference. Presented by Tim Welsh
Trauma is a common occurrence in the lives of homeless individuals and can have a significant impact on one’s
ability to function. This training will help participants identify signs of trauma and ways in which they can engage
in trauma-informed practice with clients
Assessing and managing risk for violence among juveniles is an important forensic task. Clinical judgement is never sufficient for this important job. This presentation outlines methods of assessing and managing risk of violence among young people.
You have been tasked with orienting new registered nurses in the emergency department in your hospital about how to manage child abuse and neglect cases. The orientation should cover child abuse and neglect definitions, prevention, detection, intervention and treatment, reporting, and interdisciplinary resources.
Contributors: Frank Putnam, MD, UNC at Chapel Hill, NC
William Harris, PhD, Children’s Research and Education Institute
& New School for Social Research, NYC, NY
Alicia Lieberman, PhD, UCSF, San Francisco, CA
Karen Putnam, PhD, UNC at Chapel Hill, NC
Lisa Amaya-Jackson, MD, Duke University, Durham, NC
Talk given at Youth-Nex, at the University of Virginia. During the last decade, there have been significant advances in social and emotional learning (SEL) research, practice, and policy. This talk will highlight key areas of progress and challenges as we broadly implement school-family-community partnerships to foster positive behavioral, academic, and life outcomes for preschool to high school students. My goal for this presentation is to provide a foundation to foster group discussion about future priorities for the next decade.
Risk Reduction Through Family Therapy (RRFT)BASPCAN
An integrative approach to treating substance use problems and PTSD among maltreated youth.
Carla Kmett Danielson PhD
Medical University of South Caolina
Powerpoint accompanying workshop session from the Homeless and Housing Coalition of Kentucky's 2013 conference. Presented by Tim Welsh
Trauma is a common occurrence in the lives of homeless individuals and can have a significant impact on one’s
ability to function. This training will help participants identify signs of trauma and ways in which they can engage
in trauma-informed practice with clients
Check out these stunning photos taken during SES Lighting's LED Lighting Project at the renowned California Tennis Club. Notice the difference in the lighting from the original Metal Halide lighting to the completed LED. SES always specs their Tennis Lighting to USTA Standards!
seslighting.com
At SES Lighting, we are experienced in all types of Parking Garage LED Lighting Projects. Check out the following photos from a recently completed job!
Bullying is a unhealthy behavior with multiple manifestations. It does not discriminate against the age, ethnicity, belief system, lifestyle, and level of well-being of an individual. This unhealthy behavior usually starts early in life. Individuals can potentially exhibit and or be victimized by bullying. Most cases are underreported and not detected while the solutions exist to reduce the incidence and the prevalence of this common phenomenon. Targeting bullying in childhood and adolescence is a great determinant of healthier learners, but also of healthier and productive adult citizens.
This webinar was developed by Child Trends in 2015 for the Office of Adolescent Health (OAH) as a technical assistance product for use with OAH grant programs.
Community Care Live (May 2014) Presentation by Richard Cross and Linda Moss
Five Rivers Child Care attended Community Care and gave a talk on Trauma and Attachment informed practice for children in residential and foster care. It was felt to be so helpful that it was repeated in the afternoon and generated many queries from practitioners.
When a child has been abused and neglected they have often suffered physical trauma directly or by witnessing it with others and we now know that this impedes their physiological development and their brain capacity - they suffer emotional and physical developmental delays and have problems with learning.
Foster carers and residential staff at Five Rivers are being trained on an ongoing basis as research informs our practice, to help work with the traumatised child. In addition a child will often have problems with poor attachment, the two making each other worse. Our work helps us identify the types of help a child needs while they are in placement and gives us 'every day' ways of working - even by the non-professional therapist.
This being part of the professional therapeutic team is what helps Five Rivers get results for the children they care for. It is part of what makes our carers commit to above and beyond what many will do.
Five Rivers challenges the local authorities to make commitments to their children's placements to allow sufficient time to work with the children and make a real difference.
Where there are good partnership relationships this has really benefited the children in their residential and fostering placements. We have excellent successes in placements lasting well despite being sorely tested.
Child Maltreatment and Intra-Familial ViolenceClinical Soc.docxbartholomeocoombs
Child Maltreatment and Intra-Familial Violence
Clinical Social Work with Urban Children Youth & Families
Child
Maltreatment
Broad definition that encompasses a wide
range of parental acts or behaviors that
place children at risk of serious or physical
or emotional harm
It is defined by law in each state
Labels used in state statutes vary
Categories of
Abuse
• Neglect
• Physical Abuse
• Sexual Abuse
• Emotional Abuse
Neglect
Definition of Neglect
The failure of a parent, guardian,
or other caregiver to provide for a
child’s basic needs. This can also
include failure to protect them
from a known risk of harm or
danger.
Examples of Neglect
Child is frequently
absent from school
Begs or steals food
or money
Lacks needed
medical or dental
care, immunizations,
glasses, etc.
Consistently dirty
and has severe body
odor
Lacks sufficient
clothing for the
weather
Abuses alcohol or
drugs
States that there is
no one at home to
provide care
Physical Abuse
Examples of Physical Abuse
• Visible unexplained burns, bites,
bruises, broken bones, or black eyes
• Has fading bruises or other marks
noticeable after an absence from
school
• Seems frightened of the parents and
protests or cries when it is time to go
home
• Shrinks at the approach of adults
• Reports injury by a parent or another
adult caregiver
Definition of Physical Abuse
The non-accidental physical injury of a
child
Sexual Abuse
Definition of Sexual Abuse
Anything done with a child for the
sexual gratification of an adult or
older child
Examples of Sexual Abuse
Has difficulty walking or
sitting
Suddenly refuses to
change for gym or to
participate in physical
activities
Reports nightmares or
bedwetting
Experiences a sudden
change in appetite
Demonstrates bizarre,
sophisticated, or
unusual sexual
knowledge or behavior
Becomes pregnant or
contracts a sexually
transmitted disease
Runs away
Emotional Abuse
Definition of Emotional Abuse
A pattern of behavior that impairs
a child’s emotional development
or sense of self-worth
Examples of Emotional Abuse
• Shows extremes in behavior
• Inappropriately adult or infantile
• Is delayed in physical or
emotional development
• Has attempted suicide
• Reports a lack of attachment to
the parent
Protective Factors
• Protective factors are conditions or attributes of individuals, families,
communities, or the larger society that, when present, promote wellbeing and
reduce the risk for negative outcomes
• Parental Resilience
• Social Connections
• Knowledge of Child Development
• Concrete Support In Times of Need
• Social and Emotional Competence of the Child
Intra-Family Violence
• Intra-family violence: a pattern of abusive behaviors by one family member against
another.
• Domestic and family violence occurs when someone tries to control their partner or
other family members in ways that intimidate or oppress them.
ISPCAN Jamaica 2018 - The Impact of Domestic Violence on Children's Functioni...Christine Wekerle
The Impact of Domestic Violence on Children's Functioning: Care Planning Approaches to Foster Trauma-Informed Care
Shannon Stewart, Yasmin Garad, Natalia Lapshini
Risk Factors for Child Maltreatment Types of Maltr.docxmalbert5
Risk Factors for Child
Maltreatment
Types of Maltreatment
Physical abuse – nonaccidental injury
inflicted by a caregiver
Sexual abuse – the use of a child for the
sexual gratification of an adult
Psychological maltreatment
◦ Includes emotional abuse and emotional neglect
Neglect – act of omission
◦ Physical neglect
◦ Medical neglect
◦ Educational neglect
Types of Factors
Potentiating: increase risk for maltreatment
Compensatory: buffers, decreases risk
------------------------------------------------------
Transient – temporary
◦ Temporary unemployment, loss of a loved one
Enduring – ongoing; chronic
◦ Chronic unemployment; untreated mental health
issues
------------------------------------------------------
Applied to each level of analysis
http://faculty.weber.edu/tlday/1500/systems.jpg
Levels of Analysis of Each Instance of
Maltreatment
Macrosystemic: broad cultural values and beliefs
in the larger society
Exosystemic: social structures that form the
immediate context in which families and
individuals function (e.g., neighborhood, school)
Microsystemic: environmental setting that
contains the developing person (e.g., family,
classroom)
Ontogenetic: factors within the child
Macrosystemic Issues
Acceptability of violence
◦ Levels of violent crime, presence of weapons
◦ Levels of violence in media
◦ Acceptance of corporal punishment
Sexualization of children
Individualism
◦ Focus on nuclear family both fully responsible for and
controlling of children
◦ Geographical isolation of families with children
Values/definitions of work
Exosystemic Issue:
Poverty
Poverty as a stressor: inadequate resources,
feelings of disempowerment (becomes a
microsystemic issue)
Poverty places individuals in less safe
environments, requiring more parental effort to
protect
Poverty places individuals in resource scarce
environments
Increasingly poor urban areas are places to which
people are not committed - less sense of
community
Microsystemic Issues
History of abuse in parents
Mental illness in parents
Substance abuse in parents
Domestic violence
Problematic parenting practices
Lack of social support
Mental Health Issues in Parents
Mental illness impacts childrearing
Mental health issues increase risk of
substance abuse, especially in women
Personality disorders are thought to be
most common mental health problem
◦ Core component of an individual’s way of
perceiving the world
◦ Often go unrecognized as mental illness
among child welfare workers
History of Child Abuse in Parents
Child abuse in parents may result in
mental health issues (depression, PTSD)
Attachment impairment
Lack of modeling of appropriate parenting
behaviors
Substance Abuse
Direct physical effects on fetus
◦ Critical issue: should prenatal maternal
substa.
Bullying and depression among transgender youthRachel Watkins
Bullying is a relevant issue for this population and we must find ways to advocate for them in order to increase their safety. This presentation will discuss the negative impacts of bullying as well as clinical applications for this population.
ISPCAN Jamaica 2018 - Personality-targeted Interventions for Building Resilie...Christine Wekerle
Personality-targeted Interventions for Building Resilience against Substance Use and Mental Health Problems among Adolescents Involved in Child Welfare System
Hanie Edalati, Patricia Conrod
INDIGENOUS YOUTHS’ RELATIONSHIPS WITH WATER: TRAUMA, ADVOCACY & RESILIENCEChristine Wekerle
Indigenous communities often experience disproportionate access to clean, safe drinking water. For youth water insecurity may lead to adverse mental health effects, referred to as 'water anxiety'. However, water resilience actions such as advocacy and youths' responsibilities to water, may have the potential to mitigate potential mental health effects associated with 'water anxiety'.
Positive psychology evolved from a recognition that the clinical encounter is often over-focused on concerns and problems, and that positive actions may not have a central role in the treatment plan. With youth, many issues - treatment compliance, help-seeking, impulsive self-harm, high risk-taking - may be ameliorated with a plan of positive actions. The technology that are youths' worlds may deliver some of these therapeutics. Resilience may be galvanized when inner resources interacts with external resources. This talk will introduce the evidence-based components of a resilience in youth App, JoyPop, and open discuss for research use in clinical populations.
ISPCAN Jamaica 2018 (CIHRTeamSV) - Investigating the Path from Child Maltreat...Christine Wekerle
Investigating the Path from Child Maltreatment to Alcohol Problems in a Sample of Child Welfare-Involved Youth
Sherry Stewart, Tristan Park, Kara Thompson, Mohammed Al-Hamdani, Amanda Hudson, Christine Wekerle, Savanah Smith (CIHRTeamSV)
ISPCAN Jamaica 2018 (CIHRTeamSV) - Improving Health and Behavioral Outcomes a...Christine Wekerle
Improving Health and Behavioral Outcomes among Sexually Victimized Male Youth: A Qualitative Investigation Among Trauma Treatment Providers
Ashwini Tiwari, Christine Wekerle, Andrea Gonzalez (CIHRTeamSV)
Adolescence is a key period for intervention among at-risk populations of youth, as this is when risk-taking behaviors tend to emerge. The Sustainable Development Goals for achieving 2030 youth health targets outline two issues central to reduce risks of gendered violence, sexual violence (SV) and adolescent sexual risk taking: (1) gender equity and (2) mental health promotion education. Only half of women reported having the autonomy to make their own decisions regarding sexual relations, usage of contraception and access to health care services. In developing countries women and children are extremely vulnerable to sexual violence which thereby places them at increased risk for contracting STIs from the perpetrator, as well as pregnancy as a result of SV. Undocumented minors; unaccompanied minors; refugees; child soldiers; youth post natural disasters; orphans; street-involved youth; and youth without parental care or financial means who are exposed to dangerous people or places are most vulnerable to sexual violence. UNICEF states that ending cases of new HIV infections by 2030 is unlikely, due to large concentrations of new infections occurring in areas where transactional sex, child sexual exploitation, drug use, street involved youth and SV are prevalent. Adverse Childhood Experiences (ACEs), which include forms of childhood maltreatment, increase the risk of contracting STIs. In particular, sexual abuse is linked with increased likelihood for risky sexual behavior, making victims vulnerable to poor sexual health outcomes.7 Protecting youth from exposure to SV and providing adolescents with sexual and mental health education are central to promoting resilience in youth.
Resilience Knowledge Mobilization and the ResilienceInYouth AppChristine Wekerle
This presentation outlines an exploratory knowledge mobilization study where research-based and evidence-based posts were shared on instagram (@resilienceinyouth) to see if instagram was a feasible outlet for resilience knowledge mobilization. Research conducted by researchers in the CIHRTeamSV grant was shared on instagram via links to ResearchGate. The development of a resilience-based app for youth is described and an overview of its features is given.
Wekerle-Ron Joyce Centre Grand Rounds-Boy's and men's health: Child sexual ab...Christine Wekerle
Defines sexual violence and gives info. on prevalence rates, examines emotion dysregulation in at-risk youth, child sexual abuse research findings, and introduces a developing resilience-based app for at-risk youth.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Innovations in Prevention: Youth Substance Abuse & Dating Violence
1. Innovations in Prevention:
Youth Substance Abuse & Dating Violence
Christine Wekerle, Ph.D.
The University of Western Ontario
cwekerle@uwo.ca
“ Violence in intimate relationships can be
one…in which great intensity of positive
longing, anger, and fear may be combined
with a lack of felt security, lapses in
attention, dysfluent communication, and
unregulated arousal.” (Lyons-Ruth & Jacobvitz, 1999)
2. Similar Examples:
Different Outcomes
• Developmental context – relationships
• Perhaps type of relationship - attachment
• Topographically similar events
• Functionally similar behaviours – to a point
• Affectively similar – to a point
• Good cognitive awareness of event
• How to change? Motivation to change?
• Would change or self-correction occur on
its own?
3. Natural Reduction Processes
Teens who stop drinking (D’Amico et al., 2001; Brown, 2001)
1. Independent Effort (willpower, forced myself)
2. Structured Activity (sports, hobbies, church)
3. Social Support (family, new friends)
• High school binge-drinkers who refrained from binging
(past 3 months) in college did not differ in drinking
milestones or severity of substance use from current
bingers
• Natural reducers in college were, on average, 3 years
older, more likely to be married, regular church go-ers,
greater belief in ability to resist social pressure to drink,
less ambivalence about changing drinking, and expected
alcohol to enhance their personal experiences less
(Vik et al., 2003)
4. Universal Prevention
Interventions that target the whole population that
has not been identified on the basis of individual risk
Goal = to decrease the number of new cases
(decrease incidence of disorders)
• 52% of youth have no risk behaviors (OSDUS,
2003)
• A minority of high school youth may volunteer for
intervention on drinking prevention (e.g., 10% of
4500 students in 3 schools, D’Amico et al., 2001)
Query: How to reach more youth? (e.g., building
into school curriculum; use medical settings)
5. Selected Prevention
Interventions that target individuals or sub-groups
with at-risk status
Goal= to lower the number of established cases
(decrease prevalence of disorder)
• 20% of children/youth experience past year
mental disorder symptoms and 75-80% of these
fail to receive services (USDHHS, 1999)
• 28% of youth report 1 problem behaviour
• 10% of youth report 3-4 problems
(OSDUS, 2003)
6. Key Windows of Opportunities
1. Perinatal and Early Childhood
Programs targeting parents, infants,
young children
2. Education Programs targeting
school-age children and teens
7. Distal Factor: Child Maltreatment
Effective parenting is the most powerful way to reduce youth
problem behaviours (Kumpfer & Alvarado, 2003)
Child maltreatment may be the single most preventable and
intervenable contributor to child and adult mental illness
(DeBellis, 2003)
Violence victimization is associated with a lower age of
drinking initiation (Nagy & Dunn, 1999)
You know the only people who are always sure about
the proper way to raise children? Those who’ve
never had any. Bill Cosby
8. Substance-Abusing Caregivers
Reported to Child Welfare
– Poverty (income < $15,000, OR=1.6)
– Multiple moves in the past 6 months (3+, OR=5.2)
– Unsafe housing (OR=1.9)
– Minority racial status (Aboriginal OR=3.4; Other
Minority OR=1.4)
– Low caregiver education (OR=1.9)
– Criminal activity (OR=4.8)
– Involvement in a violent relationship (OR=3.8)
– History of childhood maltreatment (OR=3.2)
– Mental (OR=2.8) and physical (OR=2.6) health
issues
– Lack of social supports (OR=2.6)
9. Canadian Incidence Study of Reported Child Abuse & Neglect:
Caregiver Substance Abuse
65%decrease
OR: 0.35; CI: 0.14, 0.90*
61%increase
OR: 1.61; CI: 1.17, 2.21*
155%increase
OR: 2.55; CI: 1.90, 3.42*
6%decrease
OR: 0.94; CI: 0.63, 1.41
-150%
-100%
-50%
0%
50%
100%
150%
200%
Physical abuse Sexual abuse Neglect Emotional abuse
ChildMaltreatment Type
%increase/decreaseinriskformaltreatmentin
associationwithcaregiversubstanceabuse
age & sexof the child + the caregiver's characteristics accounted for *p>0.05
10. Child Maltreatment & Prevention
– Lack of adoption of evidenced-based
parenting programs by community
agencies (Kumpfer & Alvarado, 2003)
– Child welfare youth important, but under-
attended subpopulation for prevention
– Need to show change in child abuse rates
due to prevention parallel change in
adolescent risk behavior rates in same
community/population
11. Assessing Impact:
Community Report Card
• Useful tool for impact evaluation Create a relevant
surveillance system beyond problem behavior rates
e.g., percentage of schools with prevention
programs; youth recreation space; rate of youth
unemployment, per capita spending on support
services
• Link data bases that track health services utilization
with community child abuse reporting rates,
educational testing outcomes
• see Strike, C., Goering, P., & Waslylenki, D. (2002). A population health framework for
inner-city mental health. Journal of Urban Health: Bulletin of the New York Academy of
Medicine, 79, S13-S20.
12. Effective Prevention:
What You Need To Know & Why
Baserates of problem behaviour
Outcome Targets
Inter-relationships of behaviours
Multiple Targets
Developmental trajectories
Developmentally-
timed intervention
Explanatory factors: Mediators
Change Targets
Contextual factors: Moderators
Matching to sub-
groups
13. Baserates: Youth Substance Abuse &
Dating Violence
• 21% males; 17% females report hazardous
drinking
• 24% report drunkenness past month
• 26% binge drink past month
• 10%, 2-3 binge episodes/month
• 8% weekly; 4% daily marijuana use (OSDUS,
CAMH, 2003)
• 8.9% physically assaulted in dating
relationship past year
• 11.9% females; 6.1% males ever forced into
sexual intercourse (YRBSS, CDC, 2003)
• 19% emotional abused (ADDHealth, Carver
et al., 2003)
17. Change Targets: Motivation
Motivational Interviewing= Client-centered, directive
method for enhancing intrinsic motivation to change by
exploring and resolving ambivalence (Miller & Rollnick, 2002)
• Motivation regarded as a state not trait
• Non-”hard” confrontational yet directive
• Responsibility for change rests with youth
• Highlights the need to consider motivation explicitly as
a target in prevention programming
Motivation for what specifically?
• Pre-use: motivation to abstain or delay use
• Once engaged: to refuse, to avoid, to reduce, to do healthier
alternative
18. Motivational Interviewing Key Tool:
Decisional Balancing
Develop Ambivalence about Use
• Tailored to stage-of-change
• Discrepancy=motivation
• Discussion on pros and cons of
use (likes/dislikes)
• Providing normative feedback
• Imagine future if behavior stay
same or were to change (future
goals)
• Help client identify and clarify their
own goals and values so that
discrepancy is related to what is
important to the teen
• Teen presents the reasons for
change
19. Change Targets:
Pattern of Reinforcers
• Behavioral Choice Theory: Draws attention to the relative
reinforcement attained from behavior within the context of other
reinforcers that predicts substance use/aggression (preference,
Vuchinich, 1995)
Factors that influence consumer behavior:
– Direct constraints on access to the reinforcer (e.g., if
dating partner leaves when threatens aggression; can’t
acquire alcohol due to being under legal age of drinking)
– Availability of alternative reinforcers and constraints on
access to them (e.g., talk to friend about conflict and friend
is readily available; exercise instead of use alcohol with
highly valued exercise readily available)
20. Mediators: PTSD Symptomatology
DSM- IV Symptom Classes:
(1) Re-experiencing: recurrent, intrusive thoughts;
bad dreams*; sense of re-living*; physiological
reactivity and psychological distress* at cue
exposure
(2) Avoidance/Numbing*: avoid thoughts, feelings,
places, people, activities related to trauma*; gaps
in recall; feeling detached; feeling problems;
pessimism about future
(3) Arousal: sleeping, anger, irritability, startle*,
hypervigilance, concentration difficulty
* Higher among chronic, abused youth (Fletcher,
2003)
21. Cross-lagged Structural Model Of Trauma Symptoms As A Predictor Of
Child Maltreatment And
Dating Violence For Boys, Adjusted To Include Independent Mediator
Paths For Emotional Abuse
Time 1 Time 2
.23**
.62**
.32**
Child Mal-
treatment
Trauma
Symptoms
Trauma
Symptoms
Dating
Violence
Dating
Violence
Emotional
Abuse
Emotional
Abuse
.25**
.25**
.38** .41**
22. Cross-lagged Structural Model Of Trauma Symptoms As A Predictor
Of Child Maltreatment And Dating
Violence For Girls, Adjusted To Include
Independent Mediator Paths For Anger
Time 1 Time 2
.23**.22*
.75**
.58**
.20**
.19**
.52**
Child Mal-
treatment
Dating
Violence
Dating
Violence
Trauma
Symptoms
Trauma
Symptoms
Anger Anger
.25**
.16*
23. Dating Violence Prevention:
The Youth Relationships Project
Rationale: Youth with a child maltreatment history at greater risk
for relationship violence
Target Age: Mid-adolescence (age 14-17) [By age 14, 55% had
romantic relationship; by 17, 80% had romantic relationship,
Carver et al., 2003]
Targets: (1) concept of relationships
(2) relationships skills
(3) social action (mastery via advocacy)
Program: 18 sessions (2-hr) coeducational group format,
coeducational facilitation – semi-structured manual
Results: Reduced dating violence involvement, Reduced PTSD
symptomatology within a RCT design with child welfare youth
(Wolfe, Wekerle et al., 2003)
24. Youth Prevention Information Sources
(see American Psychologist, 2003, vol. 58)
Lists of Effective Prevention Programs:
Center for Substance Abuse Prevention
Centers for Disease Control and Prevention
National Institute on Drug Abuse
US Department of Education Office of Safe and
Drug-Free Schools
Surgeon General’s Office
Office of Juvenile Justice and Delinquency
Prevention
25. Conclusions
• Need to consider utility of dual or multi-targeting targets for
prevention based on demonstrated co-morbidities
• Need for broader surveillance on dating violence behaviors
• Need for teen violence prevention to consider applicability of
effective substance abuse prevention components e.g.,
motivational interviewing, beliefs about/motives for aggression
• Need for substance abuse prevention to consider issues
stemming from violence work, such as child maltreatment
history, PTSD
• Need to understand better SES, gender, ethnicity/culture as
moderators of outcome and adaptation to important subgroups
e.g., child welfare youth
• Need to demonstrate efficacious prevention through population
surveillance
Editor's Notes
Change in peer group and greater parental engagement support youth in reducing their drinking (Stice et al., 1998)
Many ER injury presentation involve substance use (e.g. motor vehicle accident) with youth showing initial heightened affect, long ER wait can be capitalized to create a “teachable moment” eliciting ambivalence from teens about their alcohol use and promote interest in reducing dangerous drinking
LST – gr. 7, 15-17 classes (45 minutes) middle or junior high school; 10 booster sessions in gr. 8; 5 booster sessions in gr.9 (some aspects of dating – skills related to dating relationships); Teacher’s Manual and Student Guide (Princeton Health Press) (facilitated by regular classroom teacher, older peer leader, outside health care professional); effective for smoking, alcohol, marijuana, illicit drugs, beginning to examine aggressive and violent behavior e.g. program effects emerged at 6 mo. follow-up for reduced heavy drinking, recent drinking, getting drunk within RCT. Program effects observed at 6 year follow-up. Tested with Hispanic, African-American youth.
Gilbert J. Botvin, Institute for Prevention Research, Cornell University Medical College, NY – most extensively evaluated substance abuse, school-based prevention, with over 15 years of research
You can also have a layering strategy where you test the effects of a selected prevention for high-risk youth with and without also receiving a universal prevention (Coping Power program, Lochman, Wells, & Murray targeting aggression) where you can consider the potential added benefit to the high-risk youth and the benefit to the wider population (Tolan & Goran-Smith, 2002)
Robust risk factors males – motivation for substance use “to get drunk”
Baserates are a characteristics of a population, epidemiological (population-based sampling) needed to garner baserates rather than selection of studies
e.g., factors that yielded a high proportion of true positives to false positives for marijuana users include family characteristics, mixed drug use, prior marijuana use (want to capture likely users)
Factors yielding a larger proportion of true positives to false positives (want to maximize users) drug attitudes and prior intentions was the best predictor
Derzon, J., & Lipsey, MW (1999). What good predictors of marijuana use are good for: A synthesis of research. School Psychology International, 20, 69-85.
Precontemplation = no problem identification and/or has no intention of changing
Contemplation = problem identification but no action plan
Preparation = problem identification, motivation or readiness for change, early action steps
Action = demonstrated behavior change; early maintenance
Maintenance = maintained behavior change over time
In this last session, clients are introduced to the stages of change and made aware of the process of change. Changes made during First Contact are reinforced, by having clients identify where they were initially compared to where they are now. In addition, clients engage in planning for getting to the next stage and identify what might be useful for them in the future.
Open-ended questions encourage teens to generate all their likes and dislikes about the behavior (drinking, being aggressive with partner) and to talk about the effects of the behavior that matters most to them (e.g., what’s the worst thing that they could imagining happening)
What do you like? Dislike? Most important thing? Worst thing?
“So although drinking beer helps you relax and enjoy yourself, it also can make you do things that you wish you hadn’t”
“So although swearing get’s you partner’s attention, it also makes you feel like you haven’t really respected her”
“If you decided to change, what do youth think would become easier in your life?”
“What is the teen willing to do next..Where does this leave you now?”
“On a scale of 1-10, how interested are you in____? What do you think would have to happen to increase that number?”
Reinforcers for refusing to use substances or aggression greater than for engaging in behavior
TSCC – anger subscale “getting mad and can’t calm down”
The YRP may benefit from a motivational interviewing component – readiness to change, with personalized feedback
