The talk proposes using an historical perspective to discuss transcranial magnetic stimulation (TMS) for treating major depressive episodes. It outlines 3 historical steps: (1) 18th century electrical brain stimulation experiments in psychiatry, (2) late 20th century validation of repetitive TMS as focal brain stimulation, and (3) using 21st century neuroimaging-guided TMS to better target stimulation and account for neuroanatomical variability between patients. MRI-guided TMS has shown better outcomes than conventional 5cm localization methods alone. Future directions include optimizing individualized "electrical brain interaction" through real-time neuroimaging.
This document discusses reasons why repetitive transcranial magnetic stimulation (rTMS) may not be effective for some patients with depression. It focuses on two less classical factors of variability: neuroanatomical variability and neurofunctional variability. Specifically, it suggests that rTMS effectiveness could be improved by targeting specific hypometabolic brain regions identified by PET or fMRI for each patient, rather than uniformly targeting the left dorsolateral prefrontal cortex, given evidence that the location of brain abnormalities varies across individuals with depression.
Benchmarking is a management tool that can provide competitive advantages when utilized properly. There are two types of benchmarking - metrics which focus on quantifiable data, and practices which take a more holistic view of processes. Benchmarking can also be done internally against a company's own best performances, or externally against competitors. When partnering with foreign firms, requesting that partners become ISO 9000 certified can provide a framework for quality control that is globally recognized.
The document provides instructions for an aspiring writer to practice different figurative language and stylistic devices to make their story more interesting. The writer is tasked with creating examples of different devices like synecdoche, metonymy, zeugma, anaphora, euphemism, irony, and anastrophe by responding to prompts or links provided. Once practiced with the examples, the writer must incorporate all the devices into a short story of at least two pages and submit it for review to help make their writing more stylish for their publisher.
El documento define la ofimática como la automatización de las comunicaciones y procesos que se realizan en una oficina a través de hardware y software que permite crear, manipular, almacenar y transmitir información digitalmente. Luego menciona algunas suites de ofimática como Gnome Office, OpenOffice.org, Siag Office y KO Office. Finalmente, resume brevemente la historia de Microsoft Office, notando que apareció en 1989 para Mac y Windows en 1990 y originalmente incluía Word, Excel y PowerPoint.
The document discusses various risks in retirement planning such as longevity risk, market volatility, inflation, and sequencing of returns. It provides simulations showing the probability of different portfolio allocations meeting income needs over a 25-year retirement and the likelihood of funds lasting to different ages. The key risks retirees face include running out of money, healthcare costs, and inflation eroding purchasing power. Managing these risks requires intelligent diversification among stocks, bonds, and funds.
Paralelo recursos casacion forma - fondo y recurso de nulidad Derecho procesa...cristianuretadiaz
1. La casación en la forma y en el fondo son recursos destinados a invalidar resoluciones judiciales ante tribunales superiores. 2. La casación en la forma busca invalidar sentencias por vicios procesales, mientras que la casación en el fondo alega errores de derecho que influyeron en el fallo. 3. Ambos recursos se interponen por escrito y pueden dar lugar a la invalidación de la resolución recurrida o a su confirmación.
This document provides information about training courses offered by Agilent Technologies, including:
- Classroom training courses on topics like gas chromatography, liquid chromatography, mass spectrometry, and atomic spectroscopy offered at Agilent's Customer Education Center in Germany.
- Customized on-site training that can combine standard Agilent course material with lab-specific information.
- On-site consulting for assistance with method development and application optimization.
- A table listing specific courses along with their duration, location, price, and scheduled dates throughout 2016.
This document discusses reasons why repetitive transcranial magnetic stimulation (rTMS) may not be effective for some patients with depression. It focuses on two less classical factors of variability: neuroanatomical variability and neurofunctional variability. Specifically, it suggests that rTMS effectiveness could be improved by targeting specific hypometabolic brain regions identified by PET or fMRI for each patient, rather than uniformly targeting the left dorsolateral prefrontal cortex, given evidence that the location of brain abnormalities varies across individuals with depression.
Benchmarking is a management tool that can provide competitive advantages when utilized properly. There are two types of benchmarking - metrics which focus on quantifiable data, and practices which take a more holistic view of processes. Benchmarking can also be done internally against a company's own best performances, or externally against competitors. When partnering with foreign firms, requesting that partners become ISO 9000 certified can provide a framework for quality control that is globally recognized.
The document provides instructions for an aspiring writer to practice different figurative language and stylistic devices to make their story more interesting. The writer is tasked with creating examples of different devices like synecdoche, metonymy, zeugma, anaphora, euphemism, irony, and anastrophe by responding to prompts or links provided. Once practiced with the examples, the writer must incorporate all the devices into a short story of at least two pages and submit it for review to help make their writing more stylish for their publisher.
El documento define la ofimática como la automatización de las comunicaciones y procesos que se realizan en una oficina a través de hardware y software que permite crear, manipular, almacenar y transmitir información digitalmente. Luego menciona algunas suites de ofimática como Gnome Office, OpenOffice.org, Siag Office y KO Office. Finalmente, resume brevemente la historia de Microsoft Office, notando que apareció en 1989 para Mac y Windows en 1990 y originalmente incluía Word, Excel y PowerPoint.
The document discusses various risks in retirement planning such as longevity risk, market volatility, inflation, and sequencing of returns. It provides simulations showing the probability of different portfolio allocations meeting income needs over a 25-year retirement and the likelihood of funds lasting to different ages. The key risks retirees face include running out of money, healthcare costs, and inflation eroding purchasing power. Managing these risks requires intelligent diversification among stocks, bonds, and funds.
Paralelo recursos casacion forma - fondo y recurso de nulidad Derecho procesa...cristianuretadiaz
1. La casación en la forma y en el fondo son recursos destinados a invalidar resoluciones judiciales ante tribunales superiores. 2. La casación en la forma busca invalidar sentencias por vicios procesales, mientras que la casación en el fondo alega errores de derecho que influyeron en el fallo. 3. Ambos recursos se interponen por escrito y pueden dar lugar a la invalidación de la resolución recurrida o a su confirmación.
This document provides information about training courses offered by Agilent Technologies, including:
- Classroom training courses on topics like gas chromatography, liquid chromatography, mass spectrometry, and atomic spectroscopy offered at Agilent's Customer Education Center in Germany.
- Customized on-site training that can combine standard Agilent course material with lab-specific information.
- On-site consulting for assistance with method development and application optimization.
- A table listing specific courses along with their duration, location, price, and scheduled dates throughout 2016.
Este documento presenta el cronograma de entregas para tres cortes de una clase, incluyendo parciales, presentaciones y trabajos independientes. En el primer corte en marzo se incluyen la entrega de un balance general y estado de resultados, una presentación sobre compañías mal administradas y un trabajo sobre la bolsa de valores colombiana. En abril, el segundo corte contempla un parcial, presentación sobre estados financieros y un trabajo de portafolio de inversión. Finalmente, en mayo, el tercer corte comprende un parcial
esta presentación trata de enseñar un poco sobre la clasificación de las roscas y la compatibilidad entre ellas. también hablamos un poco sobre las normas que las rigen
El documento describe las principales causas del fracaso de las pequeñas y medianas empresas (PYMES) en México. Estas incluyen una mala planeación y estrategias, falta de conocimiento previo sobre cómo administrar un negocio, mala gestión de recursos financieros y operaciones, y falta de innovación. Además, señala que la mayoría de las PYMES quiebran dentro de los primeros cinco años debido a estos factores relacionados con la administración.
The document summarizes an AGM management presentation made by Orbite on June 22, 2016. It discusses the status of construction of Orbite's high-purity alumina plant, including commissioning activities completed and next steps. It also provides an update on Orbite's commercial activities including sample shipments and qualification processes with customers. The presentation outlines challenges faced during construction and adjustments that will be made going forward, including appointing a new COO. Finally, it discusses opportunities for waste monetization through extracting valuable materials from waste stockpiles and partnerships.
Este documento contiene hojas de inspección para escaleras y escaleras de mano en una fábrica. Resume los tipos de escaleras, defectos comunes y consideraciones de mantenimiento. También incluye secciones para inspeccionar edificios, maquinaria, equipos, herramientas y aparatos mecánicos, identificando áreas seguras e inseguras.
The document discusses the Island Gold Mine site visit that took place on May 27, 2015. It includes an agenda for the visit with presentations on workforce health and safety, sustainability and community, geology and exploration, operations, and development plans. Safety protocols are reviewed for the underground tour, mill tour, core shack and other areas of the site visit. Statistics on the mine's workforce, health and safety performance, environment and community programs are also presented.
2015 A "volcanic" year (active volcanoes)Makala D.
The document lists dates and locations of volcanic activity from various volcanoes around the world between January and December 2015. Specifically, it mentions eruptions and activity at Mount Etna, Villarrica volcano, Tongan volcano, Mount Sinabung, Piton de la Fournaise volcano, Kilauea volcano, Momotombo volcano, Colima volcano, and Calbuco volcano during this time period. All photos are credited to their original authors.
This document discusses neurofeedback, which uses EEG activity to provide cognitive training. It summarizes that neurofeedback is based on early research showing that EEG activity relates to mental states and can be conditioned. The document outlines the five steps of neurofeedback training, which involves EEG recording, real-time data analysis, extracting a parameter of interest, presenting feedback to the subject, and cognitive training to modify the parameter. It discusses using neurofeedback to target biomarkers related to mental disorders like ADHD.
Este documento presenta el cronograma de entregas para tres cortes de una clase, incluyendo parciales, presentaciones y trabajos independientes. En el primer corte en marzo se incluyen la entrega de un balance general y estado de resultados, una presentación sobre compañías mal administradas y un trabajo sobre la bolsa de valores colombiana. En abril, el segundo corte contempla un parcial, presentación sobre estados financieros y un trabajo de portafolio de inversión. Finalmente, en mayo, el tercer corte comprende un parcial
esta presentación trata de enseñar un poco sobre la clasificación de las roscas y la compatibilidad entre ellas. también hablamos un poco sobre las normas que las rigen
El documento describe las principales causas del fracaso de las pequeñas y medianas empresas (PYMES) en México. Estas incluyen una mala planeación y estrategias, falta de conocimiento previo sobre cómo administrar un negocio, mala gestión de recursos financieros y operaciones, y falta de innovación. Además, señala que la mayoría de las PYMES quiebran dentro de los primeros cinco años debido a estos factores relacionados con la administración.
The document summarizes an AGM management presentation made by Orbite on June 22, 2016. It discusses the status of construction of Orbite's high-purity alumina plant, including commissioning activities completed and next steps. It also provides an update on Orbite's commercial activities including sample shipments and qualification processes with customers. The presentation outlines challenges faced during construction and adjustments that will be made going forward, including appointing a new COO. Finally, it discusses opportunities for waste monetization through extracting valuable materials from waste stockpiles and partnerships.
Este documento contiene hojas de inspección para escaleras y escaleras de mano en una fábrica. Resume los tipos de escaleras, defectos comunes y consideraciones de mantenimiento. También incluye secciones para inspeccionar edificios, maquinaria, equipos, herramientas y aparatos mecánicos, identificando áreas seguras e inseguras.
The document discusses the Island Gold Mine site visit that took place on May 27, 2015. It includes an agenda for the visit with presentations on workforce health and safety, sustainability and community, geology and exploration, operations, and development plans. Safety protocols are reviewed for the underground tour, mill tour, core shack and other areas of the site visit. Statistics on the mine's workforce, health and safety performance, environment and community programs are also presented.
2015 A "volcanic" year (active volcanoes)Makala D.
The document lists dates and locations of volcanic activity from various volcanoes around the world between January and December 2015. Specifically, it mentions eruptions and activity at Mount Etna, Villarrica volcano, Tongan volcano, Mount Sinabung, Piton de la Fournaise volcano, Kilauea volcano, Momotombo volcano, Colima volcano, and Calbuco volcano during this time period. All photos are credited to their original authors.
This document discusses neurofeedback, which uses EEG activity to provide cognitive training. It summarizes that neurofeedback is based on early research showing that EEG activity relates to mental states and can be conditioned. The document outlines the five steps of neurofeedback training, which involves EEG recording, real-time data analysis, extracting a parameter of interest, presenting feedback to the subject, and cognitive training to modify the parameter. It discusses using neurofeedback to target biomarkers related to mental disorders like ADHD.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
1. The talk will propose an historical point of view
Specifically for the case of Major Depressive Episode, the first
major therapeutic goal set for TMS
With 3 historical steps
From
Step 1 18th Century: Historical Background
Electrical Brain “Stimulation” in Psychiatry
P
L
A
N
Step 2 End of the 20th Century :
Validation of rTMS treatment as a focal brain stimulation
To
Step 3
21-22th Century: Future Proposition
Electrical Brain “Interaction” in Psychiatry
2. In 1993, first use of TMS in patient with Depression
Two cases reports of a single pulse
TMS (not repetitive) applied over
the whole cortex with a circular coil
250 single pulses / day
10 days
5-30 % motor threshold
S
T
Depression intensity
E
P
Possible antidepressant effect for
one patient 2
50% efficacy!
Encouraging result!
But did not stimulate a specific
focal brain region
Höflich et al. 1993
3. Why to stimulate a focal brain region in depression ?
Sadness Happiness
More happy
TMS may affect mood states
Less sad
☐ DLPFC Right ☐ DLPFC Right
Studies of rTMS to prefrontal structures
have shown a lateralized effect on mood in
normal (healthy) volunteers
Less happy
George et al. 1996, Pascual Leone et al. 1996.
More sad
DLPFC Left DLPFC Left
S
T
E
P
Left frontal lobe is involved in the L R L R
2
pathogenesis of depression
Lesion and imaging studies suggest that left
prefrontal lobe dysfunction is linked to
depression
George et al. 1994.
Healthy Depressed
Martinot et al. 1990
4. In 1995, first proof of efficacy of rTMS in depression
The “George Team”
Open study of 6 patients
rTMS applied over the left DLPFC
20 2s trains of rTMS at 20 Hz
800 pulses / day S
T
Continued if response after 5 days E
P
80 % motor threshold
Depression intensity
2
Significant improvement
One complete improvement :
Encouraging result!
George et al. 1995
5. In 1996, first controlled study of rTMS in depression
The “Pascual Leone Team”
Multiple cross-over, randomized,
placebo-controlled trial with 17
patients
rTMS applied over the left DLPFC
Depressed
20 10s trains of rTMS at 10 Hz
S
2000 pulses / day T
E
P
5 days (5 conditions)
2
90 % motor threshols
Significant improvement
Less
depressed
6 non responders patients (35 %)
Pascual-Leone et al. 1996
6. Many controlled studies and 11 Meta analysis
since 1996 Pascual-Leone trial
2007
rTMS is an efficacy and sure focal brain
stimulation treatment
The U.S. Food and Drug Administration
(FDA) has approved rTMS for patients
who have not responded to one adequate trial of
2010
antidepressant medication (2007)
S
T
Thus 2007
E
P
The question is not 2
Is rTMS effective for the treatment of
depression ? 2008
But
Why rTMS is not effective for all
patients with depression ? 2011
7. Why rTMS is not effective for some patients with
depression ?
There are two classical But we will focus on two less
factors of variability classical factors of variability
a c
Clinical Stimulation Neuro-anatomical Neuro-functional
variability Parameters variability variability S
variability T
Age E
P
Motor threshold
Treatment
refractoriness Number of pulse Anatomical … 2
precision on the Step 3
Duration of Frequency
EDM left DLPFC ?
MRI guided rTMS
Micoulaud-Franchi et al., submitted
Micoulaud-Franchi and Vion-Dury, 2011
8. Neuro-anatomical variability: the 5 cm standard method
5 cm method
5 cm anterior on a
parasagital line 5cm
Optimal surface site for
activation of the controlateral
Abductor Policis Brevis (APB)
S
T
rTMS is supposed to be E
P
applied to the left DLPFC
2
according to a method
based on a presumed
coordinates (Talairach 45°
Atlas)
George et al. 1995
Pascual Leone et al. 1996
9. 5 cm standard method Neuro-anatomical variability
The small black dots indicate the optimal sites
for abductor pollicis brevis muscle
stimulation over the motor cortex
The larger dots indicate the
rostral coil positions
S
T
E
P
2
Herwig et al., 2001
A considerable variability occurs with the 5cm standard method
11. Future rTMS should probably use MRI guided rTMS in
order to limit neuro anatomical variability
The “Fitzgerald Team”
Randomized trial of 51 patients
rTMS applied over the left DLPFC
with either standard 5cm method
or using a neuronavigational
method (BA9 and 46)
S
30 5s trains of rTMS at 10 Hz T
1500 pulses / day
Depression intenstity
E
Standar
d rTMS P
3 weeks
2
100 % motor threshold MR
I gu
ided
rTM
S
Significantly better improvement
for the MRI guided rTMS group
Fitzgerald et al. 2009
12. Second step :
Neuro-anatomical MRI guided rTMS
Electrical Brain Focal Electrical Brain More
Stimulation in Focal Stimulation in
psychiatry psychiatry
S
T
E
P
2
Electrical Brain Global
Camphor Stimulation in
Metrazole psychiatry