buy custom Heart and Blood Vessels essay

purchase custom Heart and Blood Vessels paper 1. Complete the accompanying plan of blood dissemination in human heart. Right chamber through the tricuspid valve to the correct ventricle through the Pulmonary valve to the aspiratory trunk, to the semi lunar for oxygenation, to the pneumonic veins once again into the left chamber of the heart, through the mitral valve into the left ventricle, through the left semi lunar valve into the courses, that provisions fundamental blood to the body and afterward deoxygenated blood returns into the correct atria by means of tricuspid valve, unrivaled vena cava and substandard vena cava aspiratory conduit. 2. The pulsating of human heart (cardiovascular cycle) legitimately mirrors the electrical conduction framework inside the heart (ECG). Portray what occurs in the cardiovascular cycle in the accompanying circumstances: a. Preceding P wave: Senatorial hub fires causing the withdrawal of atria. Before this hearts resting period no electrical movement is performed and muscles unwind to fill the atria with blood. b. During P wave: At the sinoatrial hub the constriction of heart muscle begins. It keep going for 0.08 seconds. P wave hinders the procedure of depolarization toward the end. c. Following P wave: The P-R section happens quickly the P wave happens. This P-R section is time travel to arrive at the ventricles from SA. After this the QR complex happens. d. During QRS wave: the depolarization wave developments is delineated through the QRS complex. It makes huge upward spikes. The QRS complex shows the conduction depolarization waves simultaneously. e. During the T wave: It is the last intelligible wave in a cycle on ECG. Hearts re-polarization is spoken to here. It implies that ventricles have sent the blood to the body and heart goes to reset itself for the following cycle (Elaine 696). 3. Assume an individual has a pulse of 70bpm and has a stroke volume (SV) of 70ml. A negative inotropic specialist (any substance that diminishes contractility of heart) lessens the SV to 50 ml. What might the new pulse must be to keep up the equivalent cardiovascular yield? Pulse: 70bpm Stroke Volume SV: 70 ml Heart yield = HR x SV = 70x70 =4900 ml/min SV after decrease = 50 ml Cardiovascular Output: pulse x Stroke Volume = 70 x 50, 3500 ml/min or 3.5 L/min New Heart rate = Cardiac yield/Stroke Volume = 4900/50 = 98bpm 4. A 55-year-old male was admitted to the medical clinic with cardiovascular breakdown. He grumbles of expanding brevity of breath on effort and expecting to rest on three cushions around evening time. On physical appraisal, the medical attendant discovers that his lower legs and feet are swollen. Which of these manifestations reflect left-sided cardiovascular breakdown and which reflect right-sided cardiovascular breakdown? Answer: The left sided cardiovascular breakdown happens because of decrease in heart yield of blood vessel blood. Different manifestations of left ventricular disappointment incorporate as the hypoxia, snaps, cyanosis, exhaustion, dyspnea, paroxysmal nighttime, raised aspiratory and narrow wedge pressure. Right side cardiovascular breakdown happens because of weight gain. Subordinate pitting edema is additionally seen in patients feet and lower legs. This edema is vanished for the time being nevertheless spreads in different tissues. Different side effects of right side cardiovascular breakdown incorporate the shortcoming, jugular vein distension, regurgitating, and sickness, raised and focal venous weight (Barbara and Nancy 426). Utilize the accompanying indication to take care of the issue: - Think about the ordinary progression of blood inside the heart - Now figure, what will occur if the left half of the heart isn't siphoning appropriately. Where will the blood pool up. Presently attempt to consider the manifestations the patients may understanding due to pooled up blood. - Repeat every one of these means for the correct side of heart also. 5. Becky, age 2, was brought into the world with an opening in her interventricular septum (ventricular septal deformity or VSD). Taking into account that the circulatory strain in the left ventricle is fundamentally higher than the pulse in the correct ventricle, foresee the impact of VSD on Beckys 10 focuses a. pneumonic BP: The VSD makes the more noteworthy weight on two ventricles, it is higher in left ventricles than right ventricles. The VSD permits the oxygenated blood to spill out of the left ventricle to right ventricle. In right ventricle the weight is low and blended blood the streams to circle into lungs. It isn't evident in newborn child at the hour of birth since left ventricular and right ventricular weights are equivalent. As the kid develops the privilege ventricular weight diminishes and blood shunts from left ventricular to right ventricular. Becky will experience the ill effects of the event of cyanosis and biventricular cardiovascular breakdown. Chest divider will get noticeable and coming about into expanded danger of pneumonia for Becky. b. foundational pulse. Fundamental pulse is upset because of impacts of VSD in a baby like Becky. VSD isn't shut in Becky so blood streams under higher tension into supply routes and veins become thicker. Right ventricular works extra to control the high blood volume and lungs get the additional circulatory strain. Lungs are forever harmed because of this circulatory strain. Clarify why? 6. In light of the subject of circulatory strain and the components controlling pulse, for every one of the given circumstances, portray the foreseen impact on circulatory strain and the physiological premise (thinking) of your reaction; a. A high salt eating regimen: kidneys are the organs to control the degree of salts in our body. At the point when admission level of salt is high then kidneys can't control the degree of salt and it winds up into circulation system. Salt requires more water into blood which results into increment volume of water. This builds the volume of blood and circulatory strain is additionally raised. It is additionally noticed that hypertrophy is connected with unreasonable measure of NaCl. b. A blow on head that harms (handicaps) the vasomotor focus: The procedure of vasoconstriction is constrained by the vasomotor focus in cerebrum. This procedure of vasoconstriction manages the circulatory strain. At the point when this vasomotor focus is impaired them inappropriate vasoconstriction may cause the expansion in circulatory strain and hypertension. c. Hypothalamic tumor bringing about abundance ADH creation: There are two causes behind it. Right off the bat, it makes the kidneys to hold more volume of water which builds the circulatory strain. Furthermore, it makes the veins crush down and causing the pulse to go up. Because of height of ADH, kidneys begin to hold extreme volume of water coming about into development of plasma volume. This development in plasma volume causes the circulatory strain to increment 7. Edema (growing because of increment in interstitial liquid) is a typical clinical issue. On one of your first long periods of initial clinical experience, you experience three patients who all have extreme edema for various reasons. Your test is to clarify the reason for edema. Note: For each situation, attempt to clarify the edema regarding either an expansion or reduction in one of the four weights that cause mass stream at vessels (allude to slide # 76-80 of ppts.) a. To start with, you experience Mrs. Taylor in clinical ward anticipating a liver transplant. What is the association between liver disappointment and her edema? Insight: consider job of liver in creating plasma proteins. Osmotic positional of plasma drops coming about into drop of plasma protein fixation. Vessels assimilate less liquid of interstitial. This state of plasma protein decrease turns into the reason for edema. Liver disappointment additionally causes the diminished union of plasma protein. The people with liver disappointment have the disabled blend of egg whites which causes decline in colloidal osmotic weight. Edema is additionally evolved because of absence of amino acids required for the amalgamation of plasma proteins (Carol 165). b. Next, you follow an inhabitant to obstetric ward, where Mrs. So is encountering untimely work. Which of the weights that drive mass stream may be adjusted here? Indication: What influence the growing uterus may be having A pregnant lady may feel the work torments rashly before multi week of pregnancy since cervix opens before the time because of uterine withdrawal. Child conceived may confront the medical issues, yet medication, new innovation and examination the infant gets sound. These ladies have the cervical irregularities. There are different elements which cause the modification in blood volume in pregnancy. Cardiovascular yield additionally influences the ordinary conveyance. c. At long last, you are called to crisis, where Mr. Herera is in anaphylactic stun. Which of the weights that drive mass stream may be modified here? Indication: In anaphylactic stun, the vessels become exceptionally cracked. In anaphylactic stun the liquid development in the body tissues which results into an edema. This happens because of high osmotic weight in vessels and low osmotic weight in tissues. Blood needs to arrive at the tissues however it diffuses once again into vessels. In anaphylactic stun blood from sides is forestalled to enter the vessels, tissues are gulped and persistent terminates. The blood circulatory framework has been talked about in this paper. A related numerical is likewise part of this paper. Purchase custom Heart and Blood Vessels exposition

Joy Daycare Marketing Plan

Delight childcare promoting technique and how it lines up with its showcasing objectives Advertising is a fundamental advertising device particularly for new organizations. Promoting empowers an organization to increase items/administrations mindfulness among possible shoppers (Fisk, Grove John, 2008). On the off chance that successfully executed, publicizing is equipped for expanding deals and producing enormous revenues.Advertising We will compose a custom report test on Joy Daycare Marketing Plan explicitly for you for just $16.05 $11/page Learn More However, the dubious part is the means by which to think of viable methodologies particularly for independent company like Joy childcare focus. The primary showcasing objective for Joy childcare focus is to build its piece of the overall industry consistently with a focused on development pace of 10% p.a. To accomplish this goal, with we will draw in the administrations of a site facilitating supplier to guarantee that the business ke eps up on-line nearness. This methodology was picked in light of the fact that most guardians are leading their exercises (shopping, classes) on the web, along these lines they are probably going to be searching for youngster care administrations through a similar medium. Besides, flyers, handouts and business cards bearing Joy childcare logo will be structured and deliberately disseminated inside the area. How the viability of the publicizing will be estimated According to Fisk, Grove and John (2008), the adequacy of promoting methodologies ought to be estimated dependent on the underlying targets for doing this battle. Delight childcare publicizing and special techniques were structured so as to advise clients about our administrations and by so doing build deals. Also, special methodologies fortify brand picture among existing clients. We will test mindfulness dependent on the quantity of enquiries we get from potential clients looking for additional data. Besides, the brand pict ure and deals target will be estimated dependent on the quantity of asks we get by means of the different correspondence mediums provided in the adverts. Besides, we will likewise catch up to build up whether these asks means deals. Limited time techniques that might be utilized notwithstanding promoting The inside will configuration caps, shirts, mugs and bookmarks bearing Joy childcare logo and contact subtleties, circulate them among existing guardians, and give them additional ones to take to their companions. We will consistently lead ordinary network tidy up exercises and solicitation guardians to welcome different families. A Christmas show for kids the two individuals and non-individuals will be sorted out. Estimating consumer loyalty for Joy childcare administrations According to Hayes (2008), consumer loyalty is the way to organizations achievement. Elevated level of consumer loyalty has been related with expanded client dedication which in the long run builds a business p iece of the overall industry and productivity. Moreover, significant level of consumer loyalty advances informal promoting, while low fulfillment will prompt assistance/item exchanging (Hayes, 2008). On this note, a consumer loyalty measure in this manner turns into a basic device in promoting since an advertiser needs to keep track on whether their item/administration is living up to their client desires (Fisk, Grove John, 2008).Advertising Looking for report on business financial aspects? How about we check whether we can support you! Get your first paper with 15% OFF Learn More To start with, the middle will present a client care work area that will encourage client care reviews. Furthermore, two surveys will be structured. The primary survey is for new clients and they will be given to unseasoned parents on the principal day. This poll will contain basic inquiries where guardians will be mentioned to list their assumptions regarding kid care administrations. The subsequent poll will be managed to proceeding with clients whereby they will be approached to state what they like or don't care for about Joy childcare administrations. Inquiries in this subsequent poll will be intended to gauge four degrees of consumer loyalty; Satisfaction dependent on the nature of our preparation programs Satisfaction dependent on the adaptability of our working hours Satisfaction dependent on our staff neighborliness Satisfaction and devotion for example okay prescribe Joy childcare to different guardians? Why (not)? These answers will be evaluated on a week after week premise, to guarantee that we are bundling Joy childcare focus alluringly to our clients. How holes in client desires and encounters will be tended to Customer fulfillment is an individual’s assessment of an item/administration dependent on biased desires (Fisk, Grove John, 2008). Despite the fact that we attempt to keep up significant level of client support, a few cases of administration disappointment may be inescapable because of conditions outside our ability to control. On this note, the accompanying systems will be received to encourage administration recuperation (Fisk, Grove John, 2008). Obviously, every parent inside our objective market has his/her own assumption regarding the sort of pre-school preparing programs they would wish their youngsters to get. Thusly, it is normal that a few occasions of disappointments are probably going to emerge. To contain this probable consumer loyalty disappointment, it is upon Joy childcare client care delegate to cause the guardians to comprehend why our picked educational plan is superior to the rest in the market. Euphoria childcare will work an adaptable calendar that is probably going to be reasonable over the whole objective market. To address staff invitingness hole, we will guarantee that our staff get consistent preparing in client assistance. In particular, a client care agent will consistently be available to arrangement will extraordinary instances of client disappointment. For example, a kid may get injured inside our premises and an incensed parent connects with our staff in terrible scene. In such a circumstance, the client care delegate will attempt to contain the parent, and as a major aspect of our obligation to contain administration disappointment, half of the doctor's visit expenses will be provided food for by Joy childcare center.Advertising We will compose a custom report test on Joy Daycare Marketing Plan explicitly for you for just $16.05 $11/page Learn More References Fisk, R. P., Grove, S. J. John, J. (2008). Intuitive administrations promoting. Boston: Cengage learning. Hayes, B. E. (2008). Estimating consumer loyalty and dedication: overview configuration, use, and factual investigation techniques. Milwaukee, Wi: ASQ Quality Press. This report on Joy Daycare Marketing Plan was composed and presented by client Jillian Farmer to help you with your own examinations. You are allowed to utilize it for examination and reference purposes so as to compose your own paper; in any case, you should refer to it appropriately. You can give your paper here. Euphoria Daycare Marketing Plan

Act 2, Scene 3 of A Raisin in the Sun

Act 2, Scene 3 of 'A Raisin in the Sun' Investigate this plot rundown and study manage for Lorraine Hansberrys play, A Raisin in the Sun, which gives a review of Act Two, Scene Three. One Week Later - Moving Day Scene Three of the second demonstration of A Raisin in the Sun happens seven days after the occasions of Scene Two. It is moving day for the Younger family. Ruth and Beantha are making a minute ago arrangements before the movers show up. Ruth relates how she and her significant other, Walter Lee, went out to see a film the past night - something they have not done in an extremely lengthy timespan. The sentiment in the marriage appears to have been revived. During and after the film, Ruth and Walter clasped hands. Walter enters, loaded up with satisfaction and expectation. As opposed to past scenes during the play, Walter currently feels enabled - just as he is at last controlling his life its appropriate way. He plays an old record and hits the dance floor with his significant other as Beneatha makes jokes about them. Walter messes with his sister (Beneatha otherwise known as Bennie), guaranteeing that she is excessively fixated on social liberties: WALTER: Girl, I do trust you are the main individual throughout the entire existence of the whole human race to effectively program yourself. The Welcoming Committee The doorbell rings. As Beneatha opens the entryway, the crowd is acquainted with Mr. Karl Lindner. He is a white, bespectacled, moderately aged man who has been sent from Clybourne Park, the prospective neighborhood of the Younger family. He requests to talk with Mrs. Lena Younger (Mama), however since she isn't home, Walter says that he handles the vast majority of the privately-owned company. Karl Lindner is the administrator of an inviting panel - an affiliation that invites newcomers, however that additionally manages tricky circumstances. Dramatist Lorraine Hansberry depicts him in the accompanying stage headings: He is a delicate man; insightful and to some degree worked in his way. (Note: In the film form, Mr. Lindner was played by John Fiedler, a similar on-screen character who gave the voice of Piglet in Disneys Winnie the Pooh kid's shows. That is the way tentative he is intended to appear.) Yet, in spite of his delicate characteristics, Mr. Lindner speaks to something extremely deceptive; he represents a huge part of 1950s society who were accepted they were not clearly bigot, yet unobtrusively permitted prejudice to flourish inside their locale. In the end, Mr. Lindner uncovers his motivation. His council needs their neighborhood to stay isolated. Walter and the others become extremely furious about his message. Detecting their aggravation, Lindner quickly clarifies that his board needs to purchase the new house from the Youngers, so the dark family will make a solid benefit in the trade. Walter is unnerved and offended by Lindners suggestion. The director leaves, unfortunately saying, You simply cant power individuals to change their hearts child. Straightforwardly after Lindner ways out, Mama and Travis enter. Beneatha and Walter teasingly clarify that the Welcoming Committee of Clybourne Park cant barely stand by to see Mamas face. Mom in the end gets the joke, however she doesn't think that its interesting. They wonder why the white network is so against living close to a dark family. RUTH: You ought to hear the cash those people raised to purchase the house from us. All we paid to say the very least. BENEATHA: What they think we going to do - eat em? RUTH: No, nectar, wed em. Mother: (Shaking her head.) Lord, Lord, Lord... Mother's Houseplant The focal point of Act Two, Scene Three of A Raisin in the Sun movements to Mama and her houseplant. She readies the plant for the huge move with the goal that it wont get injured all the while. When Beneatha inquires as to why Mama would need to keep that raggedy-looking old thing, Mama Younger answers: It communicates me. This is Mamas method of reviewing Beneathas tirade about self-articulation, yet it additionally uncovers the fondness Mama feels for the suffering houseplant. What's more, despite the fact that the family may kid about the battered state of the plant, the family firmly has confidence in Mamas capacity to support. This is clear by the Moving Day blessings they give to her. In the stage bearings, the endowments are portrayed as: a pristine shining arrangement of instruments and a wide cultivating cap. The dramatist likewise notes in the stage headings that these are the primary presents Mama has gotten outside of Christmas. One may feel that the Younger family is on the cusp of a prosperous new life, yet there is one more thump at the entryway. Walter Lee and the Money Loaded up with apprehensive expectation, Walter inevitably opens the entryway. One of his two colleagues remains before him with a calming articulation. His name is Bobo; the missing colleague is named Willy. Bobo, in calm urgency, clarifies the troubling news. Willy should meet Bobo and travel to Springfield to rapidly get an alcohol permit. Rather, Willy took all of Walters venture cash, just as Bobos life investment funds. During Act Two, Scene Two, Mama endowed $6500 to her child, Walter. She trained him to put 3,000 dollars in an investment account. That cash was intended for Beneathas school training. The remaining $3500 was for Walter. In any case, Walter didnt simply put away his cash he gave every last bit of it to Willy, including Beneathas divide. When Bobo uncovers the updates on Willys selling out (and Walters choice to leave the entirety of the cash in the hands of a rascal), the family is crushed. Beneatha is loaded up with anger, and Walter is wroth with disgrace. Mom snaps and over and over smacks Walter Lee in the face. In an unexpected move, Beneatha really stops her moms ambush. (I state shock move since I expected Beneatha to participate!) At long last, Mama meanders around the room, reviewing how her better half had functioned himself to death (and all evidently to no end.) The scene closes with Mama Younger admiring God, requesting quality.

Alternative and Historical Photographic Techniques †Free Samples

Question: Examine about the Alternative and Historical Photographic Techniques. Answer: Presentation: The three chose photos for the option photographic strategies have been utilized are from Brian Taylors photography arrangement The Art of Getting lost. Three photos are Stevens Creek, California, Sycamore Leaves, Los Gatos Creek and Saguaros, Papago Mountains, Arizona. The photos are cuts of different scenes that give nearly painting like impression. The guideline methods that the craftsman utilized are the Gum Bichromate Printing Process and Cyanotype procedure of the nineteenth century. So as to accomplish the material quality the craftsman applied numerous layers of gum and brush emulsions. Brian Taylor settled on the methods for the arrangement after he chose and took the photos carefully. The excursion from the photo to a tastefully solid elective photo is long. The essential strategy that Brian Taylor utilizes is the imaginative multicolor gum bichromate strategies (Persinger 2014). The photos are high quality with natural components and the contacts of flaws are conscious. In the bichromate procedure the high contrast negatives are uncovered and changed into shading prints gradually, layer by layer. The way toward making the photos begins with tonally revising the advanced negatives of the photos of nature he took. Cyanotypes print an overwhelming enough watercolor paper is made from the negative. This makes the base layer on which the craftsman plays with different alternatives. Ammonium Dichromate was blended in with Gum Arabic and Gouache shade of craftsmen decision and secured on the paper. At that point the covered negative was re uncovered. This procedure of g um application was rehashed on various occasions for singular photos. By following those strategies every photo of the arrangement began as a watercolor paper sheet where the craftsman applied a Cyanotype emulsion layer. The papers at that point were contact printed with the assistance of a full negative. The craftsman at that point uncovered the papers in the daylight for numerous occasions. Subsequently the photos transformed into Prussian blue. For the photos of The Art of Getting lost the Brian Taylor utilized Winson Newton Green Gouache shading with the Gum bichromate emulsion and again daylight was utilized in the contact print process (Briantaylorphotography.com 2017). During the second presentation the pictures get a greenish tone that we find in the photos. In the third introduction the craftsman utilized earthy colored shades and uncovered those in the daylight that gave the photographs a warm inclination with the earthy colored tone of the wilderness woods. At last the cr aftsman uncovered the photos in dark to set up the dim shadows of the forested areas, branches and leaves. The craftsman needed to make new photos with a specific verifiable quality with documented worth and the customary procedures goes past the advanced procedure and set up a third spot through the montage of convention and current methods. The craftsman required needed more opportunity from the impediment of the computerized world which could give him progressively imaginative fulfillment. These down to earth methods make uncommon photos that add diversely to the specialists portfolio. The contemporary accessible strategies could be utilized with such customary methods causes the craftsman to hone his abilities and investigate additional opportunities. Reference Briantaylorphotography.com. (2017).The Art of Getting Lost : Brian Taylor. [online] Available at: https://www.briantaylorphotography.com/index.php?/ventures/craft of-getting-lost/[Accessed 10 October 2017]. Persinger, T. ed., 2014.Photography Beyond Technique: Essays from F295 on the Informed Use of Alternative and Historical Photographic Processes. CRC Press.

Service organization analysis services marketing plan on a service Essay

Administration association examination administrations promoting plan on a help organization - Essay Example The bank is one of the biggest in the nation and has nearness in excess of 50 nations. The office picked for this situation is the bank's web banking administrations. The bank has an entrenched division for this and gives complete data in its site pages. The qualities of administrations advertising regarding this division is given in the paper. Important advertising speculations concerning administrations showcasing is likewise given. A diagram of the web banking administration of the bank is likewise given. This is trailed by the web banking industry in the nation. Significant contenders of the bank are likewise given. The web use and propensities for general society are likewise included. The bank is in a decent position in regards to this since the utilization and infiltration of the web is one of the most noteworthy on the planet. The bank's greatest test is convert the clients to be progressively dynamic in web banking. One significant perspective, to be specific assistance recu peration is additionally talked about. It appears that ANZ Bank is definitely mindful of this factor and has chalked out all around spread out designs for client support and fulfillment. The association chose for the administration advertise examination is ANZ Bank. ANZ bank (Australia and New Zealand Banking Group Limited) is an Australia based significant banking and budgetary establishment. It renders administrations of home credits, vehicle advances and business advances to its clients. Web banking and telephone banking is its exceptional highlights. Charge cards and bank accounts are additionally offered by it to the clients. It completed protection benefits too. Primary methodology of ANZ Bank is offering a scope of items fitting with various requirements of clients in a superior helpful manner. Reserve funds and venture records of ANZ convey serious loan fees. ANZ online saver causes clients to deal with their own records through on the web. (ANZ, 2008). ANZ bank is perceived as a significant worldwide banking and monetary administrations bunch in Australia and New Zealand and remembered for the 50 rundown of top 50 banks on the planet. It began its working in 1830s by opening office in Melbourne. (ANZ: History, 2008). Business Strategies of ANZ Bank: For supporting in the exceptionally serious financial industry in Australia, the ANZ Bank has acknowledged great corporate administration and straightforwardness as the basics of its business. For directing the business dynamic on the correct way the bank has demanded explicit implicit rules guaranteeing organization esteem. The Board of Directors is commonly answerable for the corporate administration and coordinating the monetary presentation. It has organization approach of cement legit and moral conduct of the hierarchical individuals. ANZ is an individual from the Code of Banking Practice, which determine principles of good financial practice. (ANZ: Corporate Governance). Attributes of administration advertising: Advertising can be of items, administrations or both. On account of administrations, there are a few attributes that make it not quite the same as item showcasing. They are alluded to as the IHIP qualities to be specific immaterialness, heterogeneity, indistinguishability and perishability. (Lovelock, 2004, p.3). Administrations are impalpable and not at all like an item, an individual can't see or contact them. Heterogeneity implies that a similar help given to various clients will unique in relation to one another. The administration experience of clients on a specific assistance will be

Effective Alcoholism Treatments

Effective Alcoholism Treatments Addiction Alcohol Use Print Effective Alcoholism Treatments By Buddy T facebook twitter Buddy T is an anonymous writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism. Learn about our editorial policy Buddy T Medically reviewed by Medically reviewed by Steven Gans, MD on November 08, 2015 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on October 14, 2019 Getty Images More in Addiction Alcohol Use Binge Drinking Withdrawal and Relapse Children of Alcoholics Drunk Driving Addictive Behaviors Drug Use Nicotine Use Coping and Recovery Thanks to years of research, doctors and health professionals now have a full menu of options to treat alcohol use disorders.?? Building on this progress, scientists continue to work on new medications and discover new ways to improve the effectiveness, accessibility, quality, and cost- ­effectiveness of treatment for people who have alcohol use disorders. Standing on the Shoulders of Giant Studies on  Treatment of Alcohol Use Disorders A massive study published in 2006 followed more than 1,300 study participants at 11 academic locations over a three-year period to determine what combination of treatment, medication, and counseling was the most effective for treating alcohol abuse disorders.?? The Combining Medications and Behavioral Interventions for Alcohol Dependence (COMBINE) study produced some surprising results when it revealed that one of the newer medications used for the treatment of alcoholism failed to improve treatment outcomes on its own.?? As shown in COMBINE, no single medication or treatment strategy is effective in every case or in every person. Anti-Alcohol Drugs Revia, Vivitrol and Campral The study did find that when combined with a structured outpatient medical management intervention consisting of nine brief sessions conducted by a healthcare professional that the alcohol-deterrent medications Revia and Vivitrol (naltrexone)  and up to 20 sessions of alcohol counseling were equally effective treatments for alcoholism.?? These results demonstrate that either naltrexone or specialized alcohol counselingâ€" with structured medical managementâ€" is an effective option for treating alcohol dependence, said Mark L. Willenbring, M.D., director, division of treatment and recovery research, National Institute of Alcohol Abuse and Alcoholism. Although medical management is somewhat more intensive than the alcohol dependence interventions offered in most of todays health care settings, it is not unlike other patient care models such as initiating insulin therapy in patients with diabetes mellitus. The study found that combining another alcohol-deterrent drug Campral (acamprosate)  with the medical management program did not improve outcomes. Campral did not perform better than the placebo or dummy pill. This finding stumped researchers since previous studies performed in Europe using Campral had yielded positive treatment outcomes. COMBINE Study Highlights After 16 weeks, the COMBINE study showed overall positive outcomes for study participants.?? All groups studied substantially reduced drinking during treatment. Overall percent days abstinent tripled, from 25 to 73 percent, and alcohol consumption per week decreased from 66 to 13 drinks, a decrease of 80 percent.Patients who received medical management plus either Revia or Vivitrol (naltrexone) or specialized counseling showed similarly improved outcomes of alcohol abstinence (80 percent) compared with patients who received medical management and placebo pills (75 percent).Patients who received Revia or Vivitrol reported less craving for alcohol.Adding either Revia or Vivitrol or specialized alcohol counseling to medical management almost doubled the chance to do well. Combined Behavioral Intervention for Alcoholism Treatment Combined behavioral intervention (CBI)â€" which includes counseling integrated cognitive-behavioral therapy, motivational enhancement, and techniques to enhance mutual help group participationâ€"has shown beneficial outcomes in studies.??   The Use of Medication in Treating Alcohol Use Disorders According to research, medications seem to be a positive part of the winning combination of alcohol use disorders. And, it is underused as a method for treating alcoholism.?? The most robust finding in the study is that those receiving any medication did much better than those who received no pills at all, says Professor Barbara Mason, Scripps Research Institute, and an author of the study. This should be a wake-up call. With less than one percent of those seeking help for alcohol dependence receiving a prescription, medication is underutilized. Medication for alcoholism can offer patients an advantage for their recovery, especially in a real-world setting. The Sinclair Method In 2001, David Sinclair, Ph.D., a researcher in Finland claimed an 80 percent cure rate for alcohol dependence when anti-alcohol drugs Revia or Vivitrol are prescribed according to his Sinclair Method. Dr. Sinclairs research has been published in the peer-reviewed journals  Alcohol and Alcoholism  and the  Journal of Clinical Psychopharmacology.?? The Sinclair Method is the standard treatment protocol for alcohol dependence in Finland, the method is also used in the U.K., but the method has yet to catch on in the United States.   With the Sinclair Method, people only take Revia or Vivitrol before  drinking  and never otherwise.?? Revia and Vivitrol are not like other anti-alcohol drugs that cause  intense sickness and hangover sensations when taken with alcohol. The change in behavior only appears over time. With the Sinclair Method, Revia or Vivitrol is taken one hour before drinking alcohol. At the end of four to six months of treatment with the Sinclair Method, 80 percent of people who had been overusing alcohol is either drinking moderately or abstaining entirely.?? The way it works is when people normally drink alcohol, endorphins are released into the brain, and this reinforces the behavior of drinking alcohol. Revia and Vivitrol block the feel-good endorphins. Much like when Pavlovs dogs were presented with food when a bell was rung, these dogs became conditioned to salivate at the sound of the bell alone. However, when these dogs continued to be presented with the ringing bell and no food, the salivating stopped. It is believed that the main reason the Sinclair Method has not caught on in the U.S. is two-fold. In the U.S., 12-step programs seem to dominate treatment plans prescribed by doctors, that, and doctors do not like that the Sinclair Method encourages people with alcohol dependency problems to continue drinking.??

Oklahoma Regents Release Statement After Waiver Loss

posted on September 3, 2014 Oklahoma State Regents for Higher Education Chancellor Glen D. Johnson released the following statement today regarding the Regent’s role in certifying our PASS standards College- and Career-Ready,which could enable Oklahoma to reapply for the NCLB waiver: At the State Regents’ meeting today, I provided an update on our goals with respect to higher education’s timeline to complete a comprehensive and efficient review of the K-12 Priority Academic Student Skills (PASS) standards, as required by HB 3399. Under the provisions of the legislation, the State Regents are tasked with the responsibility to certify whether or not the PASS standards for English and Language Arts (ELA) and math meet college and career readiness standards. To discharge their responsibilities under HB 3399, the State Regents have assembled groups of campus subject matter experts with experience in developing and reviewing ELA and math standards to assess the alignment of PASS standards with the ACT College and Career Readiness Standards. The team reviewing the math PASS standards initially met on  July 21, 2014. The team reviewing the ELA PASS standards initially met on July 29, 2014. These teams are conducting a thorough analysis, which will include the identification of any deficiencies and recommended improvements, if needed. As a part of this process, the State Regents are currently engaging consultants from the Southern Regional Education Board (SREB) to participate in the review, to provide additional expertise, and to validate the process and recommendations. As the standards review process continues to unfold, the findings and recommendations of the committees and consultants may identify additional work that could require more time. HB 3399 does not direct the State Regents to meet a particular timeline. Each step of this review will be executed as efficiently as possible without compromising the integrity of the process. Our goal is to complete the review process and present a final report to the State Regents for consideration and approval at their  October 16  meeting. Michelle WatersI am a secondary English Language Arts teacher, a University of Oklahoma student working on my Master’s of Education in Instructional Leadership and Academic Curriculum with an concentration in English Education, and a NBPTS candidate. I am constantly seeking ways to amplify my students’ voices and choices.