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Best physician Palwal
2023.05.30 12:19 Tulahospitals Best physician Palwal
The great super-speciality hospital is situated on Mathura Road, NH-2, in Palwal, Haryana. Our best physician Palwal
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2023.05.30 12:15 Accomplished-Deal644 about dth clinic
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2023.05.30 12:14 manalitrippackages Unveiling the Enchanting Beauty of Manali: Explore the Himalayan Gem
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Are you in search of a perfect getaway nestled in the lap of the majestic Himalayas? Look no further than Manali, a captivating hill station in Himachal Pradesh, India. Surrounded by snow-capped peaks, lush valleys, and gushing rivers, Manali offers a mesmerizing blend of natural beauty and adventurous activities. In this blog post, we will delve into the allure of Manali and explore the various Manali trip packages
and Himachal tour packages that can make your journey an unforgettable experience.
- Manali Trip Packages: Manali trip packages are designed to cater to the diverse preferences of travelers. Whether you're an adventure enthusiast seeking thrilling activities or a nature lover looking for a tranquil escape, there's a package for everyone. These packages typically include accommodation, transportation, sightseeing, and sometimes even adventure sports. From short weekend getaways to extended vacations, Manali trip packages can be customized to suit your requirements.
- Himachal Tour Package: For those who wish to explore more than just Manali, a Himachal tour package is an ideal choice. This comprehensive package allows you to explore the best of Himachal Pradesh, including popular destinations like Shimla, Dharamshala, and Dalhousie, along with Manali. It offers a unique opportunity to experience the diverse landscapes, rich culture, and warm hospitality of the region.
- Kullu Manali Tour Package: The Kullu Manali tour package combines the best of both worlds – the picturesque valleys of Kullu and the captivating charm of Manali. Kullu, located just a short distance from Manali, is known for its lush greenery, apple orchards, and the famous Kullu Dussehra festival. This package allows you to witness the breathtaking beauty of both destinations, offering a delightful blend of adventure, spirituality, and natural wonders.
Exploring Manali and its Attractions: Manali boasts a myriad of attractions that will leave you spellbound. From the serene beauty of the Rohtang Pass to the ancient Hadimba Devi Temple, there's something for everyone in this enchanting hill station. Adventure seekers can indulge in activities like paragliding, river rafting, skiing, and trekking, while nature lovers can explore the stunning Solang Valley, Vashisht Hot Springs, and Jogini Waterfalls.
A trip to Manali is an experience that lingers in the heart long after you've returned. The beauty of the snow-clad mountains, the crisp mountain air, and the warm hospitality of the locals make it a truly magical destination. Whether you choose a Manali trip package, a Himachal tour package, or a Kullu Manali tour package, you're guaranteed to create unforgettable memories. So, pack your bags, embark on this incredible journey, and let Manali mesmerize you with its irresistible charm.
Key Phrases: Manali trip packages, Himachal tour package, Kullu Manali tour package, adventure activities, natural beauty, snow-capped peaks, enchanting hill station, Rohtang Pass, Hadimba Devi Temple, paragliding, river rafting, skiing, trekking, Solang Valley, Vashisht Hot Springs, Jogini Waterfalls, captivating charm, picturesque valleys, diverse landscapes, warm hospitality.
2023.05.30 12:10 Dowdidik Corrélations génétiques des différents troubles mentaux et notion de "spectre".
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Des variantes génétiques similaires semblent être à l'origine d'un certain nombre de troubles psychiatriques. Dans une étude portant sur 200 000 personnes (8), la schizophrénie présentait une corrélation significative avec la plupart des autres troubles. En revanche, certains troubles tels que le syndrome de stress post-traumatique (PTSD) ne présentaient que de faibles corrélations avec d'autres pathologies. - Marshall, M. (2020). The hidden links between mental disorders. Nature, 581(7806), 19–21. doi:10.1038/d41586-020-00922-8
Je trouve intéressant de vous partager l'article publié dans Nature
en 2020 en lien avec cette carte :
Les racines de la maladie mentale. Les chercheurs commencent à démêler la biologie commune qui relie des troubles psychiatriques supposés distincts. Par Michael Marshall
En 2018, le psychiatre Oleguer Plana-Ripoll s'est heurté à un fait déroutant concernant les troubles mentaux. Il savait que de nombreuses personnes souffraient de plusieurs maladies - anxiété et dépression, par exemple, ou schizophrénie et troubles bipolaires. Il a donc mis la main sur une base de données contenant les informations médicales d'environ 5,9 millions de citoyens danois.
Il a été stupéfait par ce qu'il a découvert. Chaque trouble mental prédisposait le patient à tous les autres troubles mentaux, quelle que soit la différence des symptômes1
. "Nous savions que la comorbidité était importante, mais nous ne nous attendions pas à trouver des associations pour toutes les paires", explique Plana-Ripoll, qui travaille à l'université d'Aarhus au Danemark.
L'étude aborde une question fondamentale qui préoccupe les chercheurs depuis plus d'un siècle. Quelles sont les racines de la maladie mentale ?
Dans l'espoir de trouver une réponse, les scientifiques ont accumulé une énorme quantité de données au cours de la dernière décennie, en étudiant les gènes, l'activité cérébrale et la neuroanatomie. Ils ont découvert que de nombreux gènes identiques sont à l'origine de troubles apparemment distincts, tels que la schizophrénie et l'autisme, et que des changements dans les systèmes de prise de décision du cerveau pourraient être impliqués dans de nombreuses affections.
Les chercheurs sont également en train de repenser radicalement les théories sur la façon dont notre cerveau se dérègle. L'idée selon laquelle les maladies mentales peuvent être classées dans des catégories distinctes et discrètes, telles que l'"anxiété" ou la "psychose", a été largement réfutée. Au contraire, les troubles se fondent les uns dans les autres et il n'existe pas de lignes de démarcation nettes, comme l'a clairement démontré l'étude de Plana-Ripoll.
Aujourd'hui, les chercheurs tentent de comprendre la biologie qui sous-tend ce spectre
Ils ont formulé quelques théories. Il existe peut-être plusieurs dimensions de la maladie mentale, de sorte que, selon les résultats obtenus pour chacune d'entre elles, une personne serait plus encline à souffrir de certains troubles que d'autres. Une autre idée, plus radicale, est qu'il existe un facteur unique qui rend les personnes sujettes aux maladies mentales en général : le trouble qu'elles développent est alors déterminé par d'autres facteurs. Les deux idées sont prises au sérieux, bien que le concept de dimensions multiples soit plus largement accepté par les chercheurs.
Les détails sont encore flous, mais la plupart des psychiatres s'accordent à dire qu'une chose est claire : l'ancien système consistant à classer les troubles mentaux dans des catégories précises ne fonctionne pas. Ils espèrent également qu'à long terme, le remplacement de ce cadre par un autre fondé sur la biologie débouchera sur de nouvelles drogues et de nouveaux traitements. Les chercheurs visent à révéler, par exemple, les gènes clés, les régions du cerveau et les processus neurologiques impliqués dans la psychopathologie, et à les cibler avec des thérapies. Bien qu'il faille un certain temps pour y parvenir, Steven Hyman, du Broad Institute of MIT and Harvard à Cambridge (Massachusetts), déclare : "Je suis optimiste à long terme si le domaine fait vraiment son travail".
Un florilège de troubles.
Le défi le plus immédiat est de savoir comment diagnostiquer les personnes. Depuis les années 1950, les psychiatres utilisent un ouvrage exhaustif appelé Manuel diagnostique et statistique des troubles mentaux, qui en est actuellement à sa cinquième édition. Il répertorie tous les troubles reconnus, de l'autisme aux troubles obsessionnels compulsifs en passant par la dépression, l'anxiété et la schizophrénie. Chaque trouble est défini par des symptômes. L'hypothèse inhérente est que chaque trouble est distinct et survient pour des raisons différentes.
Cependant, avant même la publication du DSM-5 en 2013, de nombreux chercheurs affirmaient que cette approche était erronée. "N'importe quel clinicien aurait pu vous dire que les patients n'avaient pas lu le DSM et ne s'y conformaient pas", explique M. Hyman, qui a participé à la rédaction de la cinquième édition du manuel.
Peu de patients correspondent à un ensemble de critères précis. Au contraire, les personnes présentent souvent un mélange de symptômes liés à différents troubles. Même si une personne a reçu un diagnostic assez clair de dépression, elle présente souvent des symptômes d'un autre trouble, comme l'anxiété. "Si vous souffrez d'un trouble, vous avez beaucoup plus de chances d'en souffrir d'un autre", explique Ted Satterthwaite, neuropsychiatre à l'université de Pennsylvanie, à Philadelphie.
Cela implique que la façon dont les cliniciens ont divisé les troubles mentaux est erronée. Les psychiatres ont tenté de résoudre ce problème en divisant les troubles en sous-types de plus en plus fins. "Si l'on observe l'évolution du DSM au fil du temps, le livre devient de plus en plus épais", explique M. Satterthwaite. Mais le problème persiste : les sous-types reflètent encore mal l'ensemble des symptômes que présentent de nombreux patients.
C'est pourquoi l'Institut national américain de la santé mentale, le plus grand bailleur de fonds de la science de la santé mentale au monde, a modifié son mode de financement de la recherche. À partir de 2011, il a commencé à exiger davantage d'études sur les fondements biologiques des troubles, plutôt que sur leurs symptômes, dans le cadre d'un programme appelé "Research Domain Criteria" (critères de domaine de recherche). Depuis, la recherche sur les fondements biologiques de la psychopathologie a explosé, les études se concentrant notamment sur la génétique et la neuroanatomie. Mais si les chercheurs espéraient démystifier la psychopathologie, ils ont encore un long chemin à parcourir : la principale découverte a été la complexité de la psychopathologie.
Des clusters controversés.
D'un point de vue clinique, les preuves que les symptômes recoupent plusieurs troubles - ou que les personnes présentent souvent plus d'un trouble - n'ont fait que se renforcer. C'est pourquoi, bien que des symptômes individuels tels que les changements d'humeur ou les troubles du raisonnement puissent être diagnostiqués de manière fiable, il est difficile d'attribuer les patients à un diagnostic global tel que le "trouble bipolaire".
Même des troubles apparemment distincts sont liés. En 2008, la généticienne Angelica Ronald, qui travaillait alors à l'Institut de psychiatrie du King's College de Londres, et ses collègues ont découvert que l'autisme et le trouble déficitaire de l'attention avec hyperactivité (TDAH) se chevauchaient. "À l'époque, il n'était pas possible d'être diagnostiqué comme souffrant de ces deux troubles", explique Angelica Ronald, en raison d'une règle figurant dans une version antérieure du DSM. Mais elle et son équipe ont découvert que les caractéristiques de l'autisme et du TDAH étaient fortement corrélées et en partie sous contrôle génétique2
En outre, il semble y avoir des groupes de symptômes qui dépassent les limites des troubles. Une étude de 20183
a examiné des personnes chez qui on avait diagnostiqué soit une dépression majeure, soit un trouble panique, soit un trouble de stress post-traumatique (PTSD). Les volontaires ont été évalués sur la base de leurs symptômes, de leurs performances cognitives et de leur activité cérébrale. Les chercheurs ont constaté que les participants se répartissaient en six groupes, caractérisés par des humeurs distinctes telles que la "tension" et la "mélancolie". Les groupes recoupent les trois catégories diagnostiques comme si elles n'existaient pas. Beaucoup s'accordent aujourd'hui à dire que les catégories diagnostiques sont erronées. La question qui se pose est la suivante : avec la biologie comme guide, à quoi devraient ressembler le diagnostic et le traitement psychiatriques ?
L'un des principaux modèles consiste à dire qu'il existe un certain nombre de traits neuropsychologiques ou "dimensions" qui varient d'une personne à l'autre. Chaque trait détermine notre susceptibilité à certains types de troubles. Par exemple, une personne peut être sujette à des troubles de l'humeur tels que l'anxiété, mais pas à des troubles de la pensée tels que la schizophrénie.
Cette approche est similaire à la façon dont les psychologues conçoivent la personnalité. Dans un modèle, cinq traits de personnalité, tels que le caractère consciencieux et le névrosisme, décrivent la plupart des variations de la personnalité humaine.
Certains psychiatres tentent déjà de réimaginer leur discipline en tenant compte des dimensions. Au début des années 2010, des pressions ont été exercées pour éliminer les catégories de troubles du DSM-5 au profit d'une approche "dimensionnelle" basée sur des symptômes individuels. Cette tentative a échoué, en partie parce que le financement des soins de santé et les soins aux patients ont été construits autour des catégories du DSM. Toutefois, d'autres catalogues de troubles ont évolué vers la dimensionnalité. En 2019, l'Assemblée mondiale de la santé a approuvé la dernière classification internationale des maladies (appelée CIM-11), dans laquelle certaines psychopathologies ont été décomposées en symptômes dimensionnels plutôt qu'en catégories.
Le défi posé par l'hypothèse de la dimensionnalité est évident : combien y a-t-il de dimensions et quelles sont-elles ? Satterthwaite parle d'un "très gros problème".
Une théorie populaire4
, soutenue par de nombreuses études au cours de la dernière décennie, plaide en faveur de deux dimensions seulement. La première comprend tous les troubles "intériorisés", tels que la dépression, dont les symptômes primaires affectent l'état interne de la personne. Elle s'oppose aux troubles "extériorisés", tels que l'hyperactivité et le comportement antisocial, qui affectent la réaction d'une personne au monde. Si une personne a été diagnostiquée avec deux troubles ou plus, les études suggèrent qu'il s'agit probablement de la même catégorie.
Mais des études combinant de grandes quantités de données d'imagerie cérébrale avec l'apprentissage automatique ont abouti à des chiffres différents, même dans des études réalisées par le même laboratoire. L'année dernière, Satterthwaite et son groupe ont publié une étude5
portant sur 1 141 jeunes présentant des symptômes d'intériorisation et ont constaté qu'ils pouvaient être divisés en deux groupes sur la base de leur structure et de leur fonction cérébrale. En 2018, Satterthwaite a mené une étude similaire6
et a identifié quatre dimensions, chacune associée à un modèle distinct de connectivité cérébrale.
À terme, une future version du DSM pourrait comporter des chapitres consacrés à chaque dimension, explique M. Hyman. Ces chapitres pourraient énumérer les troubles qui se regroupent dans chaque dimension, ainsi que leurs symptômes et tout biomarqueur dérivé de la physiologie et de la génétique sous-jacentes. Deux personnes présentant des symptômes similaires mais des mutations ou des altérations neuroanatomiques différentes pourraient alors être diagnostiquées et traitées différemment.
Dans les gènes.
L'un des piliers de cette approche future est une meilleure compréhension de la génétique des maladies mentales. Au cours de la dernière décennie, les études sur la génétique psychopathologique sont devenues suffisamment importantes pour permettre de tirer des conclusions solides.
Ces études révèlent qu'aucun gène individuel ne contribue fortement au risque de psychopathologie ; au contraire, des centaines de gènes ont chacun un petit effet. Une étude de 20097
a révélé que des milliers de variantes génétiques constituaient des facteurs de risque pour la schizophrénie. Nombre d'entre elles étaient également associées au trouble bipolaire, ce qui suggère que certains gènes contribuent aux deux troubles.
Cela ne veut pas dire que les mêmes gènes sont impliqués dans tous les troubles cérébraux, loin de là. Une équipe dirigée par le généticien Benjamin Neale du Massachusetts General Hospital de Boston et le psychiatre Aiden Corvin du Trinity College de Dublin a découvert en 2018 que les troubles neurologiques tels que l'épilepsie et la sclérose en plaques sont génétiquement distincts des troubles psychiatriques tels que la schizophrénie et la dépression8
(voir la "Carte mentale").
Ces études ont toutes porté sur des variantes communes, qui sont les plus faciles à détecter. Certaines études récentes se sont plutôt concentrées sur des variantes extrêmement rares, qui suggèrent des différences génétiques entre les troubles. Une étude portant sur plus de 12 000 personnes9
a révélé que les personnes atteintes de schizophrénie présentaient un taux anormalement élevé de mutations ultra-rare - et que celles-ci étaient souvent propres à un seul individu.
Le résultat est un véritable gâchis. Il est difficile de prédire quels sont les facteurs de risque qui s'appliquent à toutes les maladies. "Certains d'entre eux sont largement partagés par l'ensemble des psychopathologies", déclare Neale, "tandis que d'autres sont un peu plus spécifiques à une ou quelques formes de psychopathologie".
Le facteur p
Certains psychiatres ont avancé une hypothèse radicale qui, espèrent-ils, leur permettra de donner un sens à ce chaos. Si les troubles partagent des symptômes, ou cooccurrent, et si de nombreux gènes sont impliqués dans de multiples troubles, il existe peut-être un facteur unique qui prédispose les personnes à la psychopathologie.
Cette idée a été proposée pour la première fois en 2012 par Benjamin Lahey, spécialiste de la santé publique à l'université de Chicago, dans l'Illinois10
. Lahey et ses collègues ont étudié les symptômes de 11 troubles. Ils ont utilisé des statistiques pour déterminer si le modèle pouvait être expliqué au mieux par trois dimensions distinctes, ou par ces trois dimensions combinées à une prédisposition "générale". Le modèle fonctionnait mieux si le facteur général était inclus.
L'année suivante, l'hypothèse a reçu plus de soutien - et un nom accrocheur - de la part des psychologues Avshalom Caspi et Terrie Moffitt de l'université Duke à Durham, en Caroline du Nord. Ils ont utilisé les données d'une étude à long terme portant sur 1 037 personnes et ont constaté que la plupart des variations des symptômes pouvaient être expliquées par un seul facteur11
Caspi et Moffitt ont appelé ce facteur le "facteur p". Depuis 2013, de nombreuses études ont reproduit leur principale découverte. Caspi et Moffitt ont clairement indiqué que le facteur p ne pouvait pas tout expliquer et n'ont fait aucune supposition quant à sa biologie sous-jacente, se contentant d'émettre l'hypothèse qu'un ensemble de gènes pourrait jouer un rôle de médiateur. D'autres ont proposé que le facteur p soit une prédisposition générale à la psychopathologie, mais que d'autres facteurs - expériences stressantes ou autres altérations génétiques - poussent une personne vers différents symptômes12
. Mais si ce facteur est réel, il a une implication surprenante : il pourrait y avoir une cible thérapeutique unique pour les troubles psychiatriques.
Certains indices laissent déjà penser que les traitements généralisés pourraient être aussi efficaces que les thérapies ciblées. Une étude réalisée en 201713
a assigné au hasard des personnes souffrant de troubles anxieux, tels que le trouble panique ou le trouble obsessionnel-compulsif, à recevoir soit une thérapie pour leur trouble spécifique, soit une approche généralisée. Les deux thérapies se sont avérées aussi efficaces l'une que l'autre.
Trouver une base physiologique au facteur p serait la première étape vers des thérapies basées sur ce facteur, mais ce n'est que ces dernières années que les chercheurs en ont trouvé des indices dans les données génétiques et neuroanatomiques. Une étude14
sur la génétique de la psychopathologie dans une population britannique, par exemple, a identifié un "facteur génétique p" - un ensemble de gènes dont les variations contribuaient au risque de psychopathologie.
Dans le même temps, d'autres groupes ont cherché un changement neuroanatomique qui se produit dans de multiples psychopathologies. Les résultats sont intrigants, mais contradictoires.
portant sur six psychopathologies a révélé que la matière grise du cerveau diminuait dans trois régions impliquées dans le traitement des émotions : le cingulum antérieur dorsal, l'insula droite et l'insula gauche. Mais des études ultérieures menées par Adrienne Romer, psychologue clinicienne à la Harvard Medical School et à l'hôpital McLean de Belmont (Massachusetts), ont permis d'identifier un trio de régions totalement différent, dont le rôle consiste notamment à gérer les fonctions corporelles de base et les mouvements16
: le pons, le cervelet et une partie du cortex. Pour y voir plus clair, il faut peut-être se concentrer sur la fonction exécutive du cerveau : la capacité à réguler le comportement en planifiant, en prêtant attention et en résistant à la tentation, qui s'appuie sur de nombreuses régions du cerveau. Romer et Satterthwaite ont indépendamment constaté des perturbations des fonctions exécutives dans une série de psychopathologies17,18
- le soupçon étant que ces perturbations pourraient être à l'origine du facteur p.
La plupart des scientifiques s'accordent à dire qu'il faut davantage de données, et nombre d'entre eux ne sont pas convaincus par des explications aussi simples. "Je suis un peu moins sûr que c'est ce qui va se passer", déclare Neale. Au niveau génétique au moins, dit-il, de nombreux troubles, tels que le PTSD et le trouble anxieux généralisé, restent mal compris.
Toutes ces hypothèses générales sont prématurées, selon Hyman. "Je pense que l'heure est à la recherche empirique plutôt qu'aux grandes théories."
1 : Plana-Ripoll, O., Pedersen, C. B., Holtz, Y., Benros, M. E., Dalsgaard, S., De Jonge, P., ... & McGrath, J. J. (2019). Exploring comorbidity within mental disorders among a Danish national population. JAMA psychiatry
2 : Ronald, A., Simonoff, E., Kuntsi, J., Asherson, P., & Plomin, R. (2008). Evidence for overlapping genetic influences on autistic and ADHD behaviours in a community twin sample. Journal of Child psychology and Psychiatry
3 : Grisanzio, K. A., Goldstein-Piekarski, A. N., Wang, M. Y., Ahmed, A. P. R., Samara, Z., & Williams, L. M. (2018). Transdiagnostic symptom clusters and associations with brain, behavior, and daily function in mood, anxiety, and trauma disorders. JAMA psychiatry
4 : Krueger, R. F., & Eaton, N. R. (2015). Transdiagnostic factors of mental disorders. World Psychiatry
5 : Kaczkurkin, A. N., Sotiras, A., Baller, E. B., Barzilay, R., Calkins, M. E., Chand, G. B., ... & Satterthwaite, T. D. (2020). Neurostructural heterogeneity in youths with internalizing symptoms. Biological psychiatry
6 : Xia, C. H., Ma, Z., Ciric, R., Gu, S., Betzel, R. F., Kaczkurkin, A. N., ... & Satterthwaite, T. D. (2018). Linked dimensions of psychopathology and connectivity in functional brain networks. Nature communications
7 : International Schizophrenia Consortium Manuscript preparation. (2009). Common polygenic variation contributes to risk of schizophrenia and bipolar disorder. Nature
8 : Brainstorm Consortium. (2018). Analysis of shared heritability in common disorders of the brain. Science (New York, NY)
9 : Genovese, G., Fromer, M., Stahl, E. A., Ruderfer, D. M., Chambert, K., Landén, M., ... & McCarroll, S. A. (2016). Increased burden of ultra-rare protein-altering variants among 4,877 individuals with schizophrenia. Nature neuroscience
10 : Lahey, B. B., Applegate, B., Hakes, J. K., Zald, D. H., Hariri, A. R., & Rathouz, P. J. (2012). Is there a general factor of prevalent psychopathology during adulthood?. Journal of abnormal psychology
11 : Caspi, A., Houts, R. M., Belsky, D. W., Goldman-Mellor, S. J., Harrington, H., Israel, S., ... & Moffitt, T. E. (2014). The p factor: one general psychopathology factor in the structure of psychiatric disorders?. Clinical psychological science
12 : Lahey, B. B., Krueger, R. F., Rathouz, P. J., Waldman, I. D., & Zald, D. H. (2017). A hierarchical causal taxonomy of psychopathology across the life span. Psychological bulletin
13 : Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., ... & Cassiello-Robbins, C. (2017). The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA psychiatry
14 : Selzam, S., Coleman, J. R., Caspi, A., Moffitt, T. E., & Plomin, R. (2018). A polygenic p factor for major psychiatric disorders. Translational psychiatry
15 : Goodkind, M., Eickhoff, S. B., Oathes, D. J., Jiang, Y., Chang, A., Jones-Hagata, L. B., ... & Etkin, A. (2015). Identification of a common neurobiological substrate for mental illness. JAMA psychiatry
16 : Romer, A. L., Knodt, A. R., Houts, R., Brigidi, B. D., Moffitt, T. E., Caspi, A., & Hariri, A. R. (2018). Structural alterations within cerebellar circuitry are associated with general liability for common mental disorders. Molecular psychiatry
17 : Elliott, M. L., Romer, A., Knodt, A. R., & Hariri, A. R. (2018). A connectome-wide functional signature of transdiagnostic risk for mental illness. Biological psychiatry
18 : Shanmugan, S., Wolf, D. H., Calkins, M. E., Moore, T. M., Ruparel, K., Hopson, R. D., ... & Satterthwaite, T. D. (2016). Common and dissociable mechanisms of executive system dysfunction across psychiatric disorders in youth. American journal of psychiatry
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In addition to job opportunities, Swaasa also offers a wealth of information and resources for healthcare professionals. Their blog provides useful information on various topics related to the healthcare sector, including how to become a dermatologist, a guide to pursuing a career in physical therapy, and a comprehensive guide to life sciences. The platform also offers a range of healthcare job opportunities, including nursing, lab technician, pharmacist, support staff, paramedical staff, healthcare marketing, pharma quality, pharma research, and pharma manufacturing jobs.
Swaasa is committed to helping healthcare professionals find the right job opportunity that matches their skills and interests. The platform is also dedicated to providing a supportive community where healthcare professionals can connect, share knowledge and collaborate to improve the healthcare sector in India.
In conclusion, if you're a healthcare professional seeking job opportunities in India, Swaasa is the place to be. With a wide range of job opportunities and resources available on their website, you're sure to find the right job that meets your needs. Apply now and join their community of healthcare professionals. For any queries or questions, contact Swaasa at [[email protected]
Swaasa offers a range of healthcare job opportunities, including
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For any queries or questions, contact us at [[email protected]
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2023.05.30 11:44 an_anxious_sam AITA for wanting to work critical care when I graduate?
Student nurse/ Med-surg tech here. I have always wanted to help people and make an impact in people’s lives. It’s been my dream since childhood to be an RN. However, I’ve noticed while working in the hospital that it is almost next to impossible to actually help people. Half the floor doesn’t WANT to be helped, is non-compliant, rude, and entitled. I know that’s just typical med-surg, but it makes me question why am I going through all this trouble to only be treated like crap once I graduate. And for bare minimum pay, and horrible treatment from management/administration (not to mention patients you are trying to help). I’m drawn more to ICU/PACU now because I don’t know if I am patient enough to deal with AOx3, non-compliant, rude, and needy patients. I can deal with combative dementia because those patients have an excuse. But the ones who act that way KNOWINGLY is what irks me. I much rather patients be sedated and intubated so I can go in and do what I need to do to help them recover. Not have to deal with people who act like the hospital is a hotel, and just have to document everything as “refused,” even after education of risk vs benefit. AITA for not wanting to deal with alert and oriented patients?
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2023.05.30 11:24 DadThrowawayADHD From a father of an eight-year-old boy with ADHD...
Hi there! As a non-ADHD person myself, but the father of a wonderful little eight-year-old boy (the best thing to ever happen in my life) with ADHD, I thought I’d consult with you guys, the ADHD community, about this. My son – let’s call him Lenny – attends a fantastic school that’s PRETTY understanding about his situation, but they certainly don’t have a FULL understanding about everything, and so, the school’s director – let’s call him Marlon (who is fantastic, and has a great sense of humor, which I mention so that you don’t think my joke below about him is out of place) – suggested that I should record a video that he can distribute to all of the teachers. Below, I’m pasting everything that I’m planning to say in the video.
The wording may occasionally seem a bit odd, but that’s because I’ve tried to write it the way I’m planning to actually SAY it, rather than how I’d normally READ it to myself. Anyway, would you guys mind having a glance and letting me know your thoughts? I know this is extremely long, so if it’s too much, I completely understand, but if you can spare the time, I’d REALLY appreciate it, and thanks in advance!!!
Here’s what I’m planning to say:
Greetings, Everyone. Mike Michaels here, father of Lenny Michaels. First, please excuse me when you see my eyes reading everything I’m saying here. There are a lot of details and nuance to it all, so I wanted to be prepared, rather than just ‘winging it.’ Second, I really want to thank all of you for being so patient with Lenny. I know that most schools are not, and for this, we’re truly grateful to you. Third, and most pertinent to Lenny’s behavior, there’s something that’s important to stress, and I’ve only really begun to fully understand this over the last couple of months: Lenny has a DISABILITY. ADHD is a disability; it’s an almost invisible disability. Yes, it’s also accurately classified as a “disorder,” but most people who don’t have a career in psychology, like me, tend to think of disorders as not being as debilitating as disabilities can be. But make no mistake, ADHD is ALSO a disability; it’s recognized in the Americans with Disabilities Act, and by the Social Security Administration, and much more importantly, by psychological experts that have studied ADHD at length.
Unfortunately, people with untreated ADHD have lifelong struggles, and actually shorter average lifespans. This may all go against layperson thinking – I certainly didn’t used to think of it as a disability myself until I saw it so closely and frequently, but now I have no doubt now that it absolutely is a disability. I’ll get into this next part a bit later, but it’s widely recognized in the psychological community that even the term ADHD, for a variety of reasons, is clinically the wrong term for this condition.
I’ve heard, as I’m sure some of you have too, some parents saying, “oh my kid can’t pay attention sometimes,” or “my kid can’t remember things all the time,” or “my kid acts impulsively often enough.” But when your kid does all of these things, every single day, multiple times every single day, to the point that relationships – and sometimes property – are destroyed, then your kid has a disability, and that disability is called, wrongly, ADHD. Needless to say, it would benefit all of us watching this video, to start reframing this in our minds as a disability that Lenny has – and it would also benefit Lenny, and the other kids that his behavior affects, if all of us here modify our thinking about ADHD, without explicitly telling the other kids that he has a disability.
Now, Lenny also has a second issue known as Sensory Processing Disorder, which I’ll also get into later, since it complicates things. But what I really want to focus on in this video is five different points, all of which I’ll elaborate on a little later: First, like I said, it’s important for adults – but not children, not his peers – but for adults to, as discretely as possible, treat ADHD like an actual disability.
Second, and again, as someone who does not have ADHD myself, I’ve only come around to this understanding more recently, it’s important to not make Lenny feel inferior for not being able to remember important things at certain moments – he simply can’t do it; it’s a symptom of his disability.
Third, helping him with reminders isn’t the be-all, end-all solution to these problems, but it helps, and there are specific ways that reminders can work for ADHD kids, which I’ll get into.
Fourth, I would really appreciate it if everyone could extend their already VERY generous patience just a little bit further anytime we’re tapering Lenny onto or off of new medication. This can cause relapses that he simply has no control over, and for him to feel punished – even if that’s not my intention or your intention – over something that’s chemically changed him, that he didn’t even sign up for, just seems cruel.
And my fifth point, which I’m grateful to Marlon for discussing with me, is that if we can help him better empathize about certain things, then maybe certain impulses will just start to dissipate naturally. And if he doesn’t have these certain impulses, then it becomes a non-issue to try to control something that no longer exists, but that’s a tough one, that I’ll get into later.
(1) For now, let me get into that first point a bit deeper: That it’s important for us adults – but not children, not his peers – to, as discretely as possible, treat ADHD like an actual disability. As I said, the term ADHD is just an incorrect term for this disability. I’ve learned that “attention deficit” and “hyperactivity” are really just symptoms, and not even the only or most significant symptoms for some people that have it. Some other symptoms, which can be equally debilitating, problematic, and even dangerous to an ADHD person’s well-being, include time blindness, as well as a regular and frequent inability – not unwillingness, but inability – to stop acting on impulses, as well as an inability to apply memorized information at the moment it’s needed: The recall. There are other important symptoms, too, but these are the ones I’m going to focus on here.
In psychology, I’ve learned that all of these things are components of the brain’s “executive function,” and in ADHD people, the part of the brain that manages these executive functions is underdeveloped, somewhat comparable – but not entirely analogous – to how someone with muscular dystrophy has underdeveloped muscles.
As an aside, if you’re curious, the medical industry continues to maintain the term ‘ADHD’ because changing it would require a massive, and seemingly impossible, overhaul to the medical billing system that has decades worth of the term ADHD in every medical journal and billing code. Giving it the more accurate term of “Executive Function Disorder” or EFD, just isn’t practical.
But anyway, I know I also mentioned that Lenny has something called Sensory Processing Disorder. This disorder is observed often enough in children with ADHD, which Lenny has been diagnosed with. And Sensory Processing Disorder has also been observed in children with Autism, which has been ruled out in Lenny. And then, Sensory Processing disorder has also been observed in children without either of these things. And it has different manifestations. But in Lenny, his Sensory Processing Disorder causes him to feel a need for pressure in his joints and against his body. This is why you may see him pressing against things more often than others, or pulling things more often than others, or knocking things down. He has a compulsion towards feeling those things in his joints, in his body.
He also has a compulsion related to his auditory sense, where his brain needs to hear loud, explosive things, and so this is why you may see him press other kids that have big reactions, and stay away from kids that don’t. And where someone without ADHD may be able to pause, and recognize that acting on these compulsions would be inappropriate at times, Lenny’s ADHD generally prevents him from doing so.
Anyway, I just wanted to mention that to offer some additional perspective on some of his actions. But getting back fully to just the ADHD component, which is Lenny’s main affliction, the point here is that it’s more than just “not trying hard enough.” It’s that his brain is physically different, and this just isn’t possible without certain interventions.
You wouldn’t press a wheelchair-bound kid to “just get up the stairs,” would you? Well, maybe Marlon would, because he’s got a penchant for the cruel and usual. JUST KIDDING, MARLON! But no, of course you wouldn’t ask a wheelchair-bound kid to do that, without some kind of intervention, like a ramp or an elevator. And in that same way, it shouldn’t be asked of an ADHD-ridden kid to “just remember,” without some kind of intervention, as well, or they’re going to feel like garbage, too. Of course, these things aren’t identical, but they’re similar enough to illustrate the point that interventions are necessary, and that pressing a kid to do something that they can’t is damaging.
And yes, for ADHD kids, non-chemical interventions and reminders are important, and can assist. But the dramatic majority of ADHD patients cannot effectively modify their behavior without medication. Study after study shows that, for these people, it just isn’t possible. Now, different medications do different things to different people. Not every medication works for every ADHD person. For Lenny, we’ve seen that a drug called “Guanfacine” helps significantly, and here’s why: For non-ADHD people, we have impulsive thoughts, too, but a certain part of our brain is developed enough to pause that thought before our body acts on it. That part of Lenny’s brain is not.
Unmedicated, Lenny’s brain lacks the ability to insert this pause between impulsive thought and the action that follows. But, because Guanfacine was originally developed as a medication to lower or slow blood pressure, it also slows other functions, too. And so, the Guanfacine often helps slow Lenny’s impulsive thought to a brief pause, so that he has a moment to consider it before acting on it, and often, as a result, he won’t act on it when he's on Guanfacine. Here’s just one small, easy-to-recognize example – which doesn’t actually involve any relationship issues – to illustrate my point:
Off Guanfacine (or when it’s starting to wear off), when Lenny is finished in the bathroom, his first instinct is to immediately run out of the bathroom and continue whatever he was doing before, without flushing or washing his hands, so he never does, even if I remind him right before he goes into the bathroom. But on Guanfacine, I rarely need to remind him at all – his mind has a brief pause before he leaves, and he’ll usually flush and wash hands. So then, when it comes to slightly more complicated situations in remembering what several kids have told him not to do to them, most of you have seen how that goes: Off Guanfacine (or when it’s starting to wear off), usually not well, but on Guanfacine, often (but not always) better.
And again, I’ve heard plenty of people say, “oh, this type of thing is normal in kids.” But also again, the kind of impulsivity that happens every single day, multiple times every single day, to the point that relationships – and sometimes property – are destroyed, is not normal in kids. And I’d venture to say that any and every kid that does this every single day, multiple times every single day, to the point that relationships – and sometimes property – are destroyed, has this disability known as ADHD, or perhaps some other type of brain impairment that I’m not as well versed in.
On the other hand, with regard to medication, certain meds can sometimes make the symptoms worse in certain people, in certain situations. For example, we also tried Ritalin for Lenny, on two different occasions, at different dosage levels, months apart, each for one week, and both times, his symptoms got worse. You see, Ritalin is a stimulant, and can often, but not always, help ADHD people really focus on something that’s put in front of them. If Lenny were attending a traditional school, where he was expected to sit at a desk for a large portion of the day, and stay focused on one subject for an extended period of time, perhaps Ritalin would help him with this focus. But at his actual school, which we all know is different, this laser focus isn’t expected, and so instead, the Ritalin probably sped up his motor, and reduced that pause time between impulse and action, and more problems occurred.
At some point, we’re going to try other medications, too, like Adderall, and may even others. But Adderall is also a stimulant, with a different chemical make-up. So, because it’s different, it may help in other ways, but because it’s a stimulant, it may also exacerbate the problems like Ritalin did. We won’t know until we try it. And when Ritalin caused Lenny to create more problems, and Lenny got into more trouble, I felt terrible about it, first, because other kids felt his wrath, but also because he was quote, “getting in trouble more,” and not even understanding the reasons why, because these concepts and chemical effects are difficult for children that young to fully understand.
(2) And that brings me to my second main point: It’s important to not make Lenny feel inferior for not being able to remember important things at certain moments – he simply can’t do it. I’ve always sort of known this, and sort of understood it, but as someone without ADHD myself, I only came to this full understanding recently, when I saw something happen...
A couple of weeks ago, he did something somewhat trivial in the grand scheme – I won’t get into details, but it wasn’t something that provided him with some grand material or emotional reward. It was a small, but irritating thing. I took him aside, and I spent five minutes with him, calmly trying to understand why he did it, and explaining to him why he can’t do it in the future. Then, I left for about two minutes, and when I returned, he had already done it again! And I asked him, “Why did you do that? I just got finished explaining why you can’t. Did you already forget?” And he said, “I didn’t forget; I just wasn’t thinking about it when it happened.” And I replied, “but I told you about it TWO MINUTES before it happened. How were you ALREADY not thinking about it?” And then he cried, maybe because I had upset him with my tone, but I think it was more because he felt inferior for not being able to recall this important information when he needed it, and because I unintentionally rubbed this in his face.
And this was my lightbulb moment. Already, he sometimes says to me, “Daddy, why can’t I do these things like other kids can,” and of course, I try to explain and comfort him, but it wasn’t until this specific incident, that I just mentioned, that I connected these things – his disability impairs his recall, and then this causes him to do actions that he doesn’t really want to do, and then he feels shitty about. So, rather than unintentionally rubbing it in his face like I used to, even gently, now, I try to not harp on the fact that he can’t recall these things when he needs to, and I instead try to work with him, constructively, on reminders that he thinks will help him recall pertinent information when he needs to. I hope that all of you will truly take this to heart, and please try the same.
I think this is also important when other kids grill him for not remembering, too. Of course, that’s how they feel, and they should be able to say it – they’ve probably said the same thing to Lenny dozens of times, and their frustration is entirely justified, and should be expressed. But from where I’m standing, instead of teachers jumping on that same wagon, and grilling Lenny just the same way about remembering things, even gently – as I used to – Lenny has expressed to me that it would help for teachers to assist him in expressing back to the other kids that he has this “thing” in his brain (he’s embarrassed to call it ADHD in front of other people) that makes it hard to remember things that he needs to, even if he's been told these things hundreds of times, and maybe they – Lenny and the other kid that he’s meeting with – can then work together to identify some useful in-the-moment reminders that can help him have this in-the-moment recall, right when things start, before they start to escalate.
(3) And with that, let’s get into some of these reminder ideas, which is the third point that I mentioned at the beginning of this video. For adults with ADHD, they have smart phones, with reminders that ping up all the time to remind them of things that non-ADHD people, like me, can remember without, shall we say, “technological assistance.” Or, adults will also put up sticky notes at the locations where these reminders are needed. Even kids at traditional schools can use post-its at their desks. But for Lenny, this doesn’t apply. So maybe, if we can identify areas of the yard where certain problems happen consistently, and other areas of the yard, where different problems happen consistently, maybe we can put up a little sign, or a sticker, or a poop emoji picture that will catch his eye, and serve as a reminder. In fact, this leads me to another revelation I recently had about these reminders…
I used to think that, when teachers are around, Lenny respects limits more because he fears the consequences if he doesn’t – he figures, I used to think, that the teachers will see Lenny creating a problem, and they’ll get upset, so he’s more on guard when they’re watching. However, in light of the recent incident that I mentioned above (and many others like it), I’m starting to rethink this. While that still may be true, I think this is more likely: Lack of teachers’ eyes on him doesn’t cause him to actively think, “Oh, now’s my chance to do what I’m not supposed to!” Rather, lack of teachers’ eyes on him give him no reminder to recall that he’s not supposed to do it. When he notices teachers watching, he doesn’t restrain himself because he fears consequences, he restrains himself because noticing the teachers’ eyes remind him to.
I don’t know, maybe big googly eyes stuck to a nearby fence would serve as a similar reminder when teachers’ eyes aren’t there? Either way, Lenny asked me to table this for the time being. He’s embarrassed to have to be the only kid with visual reminders around the yard, but I made it clear to him that if these things continue, we’re going to have to try the reminders, and that we’ll try them in a way that doesn’t single him out, but rather, applies to “the school” rather than just “to him.” So, I would just ask the teachers – if these reminders become necessary, which I think they probably will – to please discuss with Lenny beforehand, and implement in a way that he’s comfortable with and not embarrassed by.
(4) Now, I touched upon this fourth point earlier, but I wanted to address it in more detail here: And that’s the point about tapering Lenny onto and off of different medications that we may try. Of course, the other kids won’t know when this is happening, but I’ve asked Marlon to at least please let all of the teachers know when it is, so that, hopefully, all of you can please extend your already generous patience a bit further anytime this is happening. As many of you know, problems were heightened a handful of weeks ago. What you may not have known, or had full color on, is that these heightened problems coincided exactly with tapering Lenny onto Ritalin, and then back off of it again, one week later, when it didn’t work. This led to some problematic habits, and even when Lenny had fully tapered off of Ritalin, it still took a few more days to fully break these habits and get back to his pre-Ritalin, on-Guanfacine self.
But during this “period of Ritalin,” there were more problems, and the school’s tolerance got very low, and Lenny felt very punished for actions that were, unknown-to-him, caused by chemical reactions that we – more or less – forced on him, against his will, with pills. And for that, I feel terrible; yes, the recipient children were also treated unfairly, of course, but I also think this was unfair to Lenny, for him to feel “less than” for a root cause (i.e. Ritalin) that was implemented by us. To continue to try to improve his experience, and the other children’s experiences, and the teachers’ experiences, we’re going to try to work with Lenny’s psychiatrist to experiment with new medications and dosages, but it’s likely that some of them won’t work at all, and that others might make things worse, just like the Ritalin did. And so, in the future, when this happens, now that you have this understanding, I really hope that you’ll please expand your already-vast tolerance just a little bit further, knowing that, in those situations, it really is the meds, and not the kid.
(5) And finally, there’s this fifth point I mentioned at the beginning – this point that Marlon had brought up with me: That it would benefit us all to help him empathize, so that perhaps some of the impulses dissipate, and then the reminders of those situations aren’t necessary. Well, guess what – empathy is also a component of executive function, and Lenny has EFD, Executive Function Disorder, better and inaccurately known as ADHD. So, even though I love the idea, I’m just not sure it’s going to be likely, or even possible, that this will work. But as long as we approach it gently, careful to not make him feel less than if he can’t do it, I certainly see no harm in trying. All of you are better trained than I am in helping children empathize with others, so I’ll follow your lead on this.
And really, that’s about it for now. Again, I really want to thank all of you SO MUCH for being SO PATIENT in ways that most other people just aren’t. The fact that you’ve even watched this entire video, with my ugly mug rambling, lets me know that you care about Lenny more than almost anyone else does. I think that if we can all remember to gently and discretely treat his ADHD as a disability, and not make him feel inferior for its symptoms – especially memory, and help him with discrete reminders, and be a bit more patient when we’re trying new meds, and help him with empathy – even though that might not work – if we try all of these things, life will be easier, and just more fun, for everyone, including all of the kids. So, thank you again, and if you want to ask me any questions, or discuss any of this with me, please feel free to call me anytime. My phone number is 555-555-5555. Thanks again!
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2023.05.30 11:24 holdmypurse My fellow nurses, what are some "hospital" secrets patients/families don't know about?
(yes I stole this idea from askreddit
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2023.05.30 11:22 OmegaTitanZ My Guild Wars Journey and Appreciation post (and miniguide to those wanting
Hello everyone, today I have finished the goal I had originally had set out for myself when I had started this game: GWAMM and 50/50 HoM and wanted to reflect my journey throughout my time and appreciation for this game with this post. Ill also be pointing out things I had wish I had known to those looking for their GWAMM and HoM as well.
Background on me as a player, I am a Guild Wars 2 player that started back in December 2017 and wanted to find a mmo that I wanted to enjoy since I grew up playing Runescape and wanted a change. This led me into starting GW2, learning about the world of Tyria, exploring content and fell in love with it immediately. Fast forward four years and I have become well versed in all of GW2 content and was playing on and off and told myself, why not try the original Guild Wars while I was waiting for the EoD expansion to come out?
I had already set myself that I would try out the game and I happen to remember the exact moment which lead me to want to play Guild Wars; Ingame I happened to stumble across a player with a title that I wanted for myself: God Walking Amongst Mere Mortals. A quick wiki search told me I had to achieve that title in GW1 to obtain it in GW2. Coupled with the fact that I was a lore nerd for all things Tyria, I had to see what Guild Wars 1 was all about.
Cue in when I ended up buying this game, I was excited after I had purchased the complete edition, wiki searching up the fastest way to get GWAMM while the game was downloading and searching up video guides on youtube, when I stumbled upon Peter Kadar's GWAMM and Elementalist guide videos. Yeah I was the kind of player that likes to read guides and minmax everything, and this game was no exception. Despite wanting to get GWAMM as quickly as possible, I also wanted to play to enjoy the story content in a linear fashion so I decided to make a roleplaying Prophecies character. I also chose Elementalist as my class (even though I had read that Mesmers were top tier DPS Classes), since I had picked elementalist as my first class in GW2 as well. Thankfully the name that I used for my GW2 Character was not taken, and with that my journey finally begins.
I remember my first impressions of the game: though admittedly it has good graphics for its time that aged like fine wine and had grown on me, my original assessment of the "bad" graphics; the lack of jumping and third dimension as well as the static combat compared to the dynamically fluid combat system of GW2 admittedly did throw me off slightly. Despite this I had set myself to start prophecies as well to grind out the Legendary Defender of Ascalon (LDoA) title as well to make my GWAMM easier. Hours later after grinding out all quests, Charr and Farmer Hamnet, as well as ticking my pre-searing checklist before I leave, I step out to post-Searing, not knowing that many hours in the future I would be super glad that I got the title before leaving. (1/30)
My subsequent journey became like this:
- Did every primary mission (including bonus missions) till I unlocked Lions Arch,
- Briefly played a bit of Nightfall and Eye of the North to unlock my heroes and finalise my endgame build. I ended up following the beginner Mesmerway comp from PvX wiki into the offensive mesmerway comp with a Fire magic Assassins Promise Ele build, getting my endgame armor and gearing up myself as well as my heroes with the money I would be earning playing missions. It was also around this time I stopped playing a bit due to EoD expansion for GW2, though I came back after a few months away.
- Finished Prophecies story, then Factions and Nightfall after, along with their respective hard mode counterparts and bonus missions/objectives, filling out storybooks along the way. (8/30)
- Worked on my Vanquish+Cartography+Skill Hunter titles at the same time. Athough admittedly this was intimidating to start working towards, It eventually became relaxing after I got into the groove, I would often vanquish 3 or so areas per day, which would take me a few weeks. Finished vanquishing Elona and Cantha first as I was dreading the caravan vanquishing from Tyria, which I ended up doing Maguuma to Ascalon in one sitting. Money for signets of capture would be acquired through the missions I had completed as well as the drops I would get while vanquishing. Learning the vipers jump and SaO chain for cartography was pretty cool as well. Also a huge shoutout to Textmod for helping me scrape the final few % to complete cartography, I'd imagine it would be frustrating otherwise. (20/30)
- I would also end up maxing my Sunspear and Lightbringer titles just from Elonian vanquishes and taking shrine bounties during the Double Elonian points week, although from my experience getting sunspear points were a lot easier so the storybooks so if you cannot afford to wait for double point week, I would probably recommend using it to get Lightbringer. I would also like to note I also did all my Cantha vanquishes under double Elonian faction week, which although inconsequential for my GWAMM, I would end up being glad I had done so for my HoM run. (22/30)
- For Survivor title I would afk farm exp at the Gate of Madness mission, found a video guide for it as well as looked at the PvX build but ended up using my standard Offensive Mesmerway comp and flagging my heroes far away at a safe distance where the portal spawning the infinite mobs would definitely not get destroyed by my heroes. Also did it in Normal mode instead of Hard mode for more consistency albeit taking a bit longer. (23/30)
- EoTN titles: I had also completed all my titles in the span of the double Northern reputation point week, Happened to get lucky with my Asura title by maxing it with vanquishes only with the boss bounty and rampager combos, Dwarf title was maxed while vanquishing while doing NM and HM dungeons with bounty (Minus Slavers exile HM, NM already gave me a headache), Ebon Vanguard and Norn Title were maxed with Vanquishes and Storybooks. Master of the North was completed while I was doing my other titles as well as completing the story quests NM and HM. (28/30) This left my consumable titles. Up until this point I had made my money by receiving story quest rewards as well as picking up all the loot dropped by foes during vanquishes. I had also been playing the game solo, so learning how to interact and trade with people in Kamadan, and my first trading memory was like magic. Only around then did I learn about farming Nick gifts (which I wish I had started doing earlier). Until then I had been buying Ales from merchants contributing to a tenth of my Drunkard title, which you could imagine me facepalming when I realised what a scam this was compared to buying them from other players. A few week of Nick gifts later, I finally got GWAMM by finishing my Drunkard and Sweet tooth titles by purchasing them with the ectos I had earned from nick gifts with other players (30/30)
Boy was I so happy when I finally achieved that title. I had clocked around 320~ ish hours to get GWAMM over the span of around 6 months (minus the time I took a break for EoD) which I was pretty happy about considering it was my first playthrough. At some point though, the magic of the game clicked. Instead of logging on to the game just to get some rewards for GW2 and to reach my goals, I started to log in because I genuinely enjoyed the game. I thought why not? I'll fill up my HoM as well just to keep playing.
- From completing GWAMM, (13/50). For my Devotion section, I had essentially begged in Kamadan for spare minis. It was there I would like to make 3 special shout outs: Kind player no 1, which after a little chat, I ended up joining their guild. He would and gave me around 13 Minis, A full set of Oppressors weapons and would craft me a destroyer weapon. You kind sir really made my day that day! (22/50) Kind player no 2, Whom after a little chat, found out he was a player who was returning to GW and was giving away his wealth. I ended up receiving 30 minis from him, as well two stacks of obsidian shards, for their generosity I was eternally grateful, ended up adding them: (26/50) Although there was no kind player no 3, I would like to make minor shout outs to a few players whom while I was chilling out in Kamadan, managed to find myself in a few 100k giveaways as well as getting a few freebie minis here and there to fill out my Devotion section. (27/50)
- For my Valor section, I had already received a full set of oppressors weapons and a destroyer weapon , so I had simply crafted two more destroyer weapons. Although I saw you could get a free tormented weapon from the wayfarers reverie event, I had simply gotten impatient and ended up buying an armbrace for the final tormentor weapon. Because I wanted to keep the minis and weapons that were dedicated, I ended up buying bank tabs just so I could keep them, (I was sentimental like that) (28/50)
- For my Fellowship section, I simply Farmed Glints challenge 9 times for the EoTN Hero armors, (1 Hero armor of which I got from Slavers exile NM) for my EotN heroes, farmed Stolen Sunspear armor and Mysterious armor pieces from Dakjah Inlet and Shadow Nexus challenge missions respectively, and ended up skipping Ancient armor remnants by buying Primeval armor remnants from other players (simply because I hated the Remains of Sahlahjah wurm mission after getting very unlucky RNG from armor drops from multiple attempts of the mission). I unlocked the remaining heroes I needed to unlock, as well as charmed the widow spider from a first time failed UW run, and charmed a level 20 black moa from the quest (I had already charmed a phoenix earlier in order to learn a SaO chain). I also learned about the whole pet death leveling process from this, getting my vampiric weapon from Shiro's blades which was bought from the Amulet of the mists from my Factions campaign completion). (36/50)
- For my Resilience section with the money I had from the Nick gifts, as well as the 2 stacks of obsidian shards I had received, I managed to buy all my armours, leaning towards the cheaper EotN armors. I ended up getting : Elite Kurzick Armo Ancient Armor, Vabbian Armor, Asuran Armor, Norn Armor, Monument Armor, and the heavily coveted Obsidian Armor thanks to the stacks of obsidian I had received from the kind stranger :) (44/50)
- And finally finishing off with my Honor section, I got my PvP title with rank 3 Zaishen title, through buying keys (Although at this point I was poor again and beginning to wait for my weekly gifts again, as well as wishing I did zaishen quests during my vanquishing days). At this point I had 34 statues out of 40, I realised in order to fill out the rest I needed to get the eternal conquerer statues for the elite zones, already dreading the rest of the statues due to my failed Underworld run I had done earlier. Although Fissure of Woe and Sorrows embrace I had done solo easily (While in FoW, I had crafted my obsidian armor), Underworld was proving a challenge even with video guides. It was then my guildies helped me out with a run, saving me from the PTSD of solo 4 Horsemen. Dhuum fight was... interesting to say the least, though I was disappointed to see it was not like the GW2 Dhuum fight. Urgoz's Warren was completed when it was a Zaishen bounty and it was pointed by a guildmate of mine that I would get a statue by completing the fourth stage of a Kurzick/Luxon title. I had gone for Kurzick statue with one vanquish away from rank 4, as I had given out my storybooks before for the Kurzick side which left one final statue. It was thankfully today I just happened across a bunch of people randomly running the deep while I was chilling in the outpost which I was kindly invited to and did a run with today, thereby completing my HoM. (50/50)
All I can say after this journey is that GW is such an amazing game and I thoroughly enjoyed my experience with it as well as the friends I made along the way. In the end I have nothing but praise for this game and now I can see why there are so many diehard GW fans who would defend this game. Although as a GW2 player and from a GW2 standpoint I have no reason to continue playing the game, I can forsee myself still coming back every now and then playing this game for the same reason I play Guild Wars 2; in the end it was all for fun and the memories and the incredible journey I had.
Thank you all if you have read this far :)
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2023.05.30 11:11 livingwithtavr Living With TAVR: Discovering the Best Cardiologists and Cardiac Surgeons in Jaipur for Superior Heart Care
| || |Living with a heart condition requires access to the best medical professionals who specialize in cardiac care. In Jaipur, the quest for exceptional heart health leads us to the best cardiologists and cardiac surgeons in the city. This blog aims to explore the significance of finding the best cardiologist doctor and cardiologist in Jaipur, along with the role of skilled cardiac surgeons. By understanding their expertise and the services they provide, individuals can make informed decisions about their cardiac health. Let's delve into the world of cardiology and uncover the top cardiologists and cardiac surgeons in Jaipur. submitted by livingwithtavr to u/livingwithtavr [link] [comments]
https://preview.redd.it/jyji9xakqx2b1.jpg?width=800&format=pjpg&auto=webp&s=299d253562582cc28f0a10fd64da70362e515aff The Role of a Cardiologist: Cardiologists are specialized doctors who diagnose and treat heart conditions. They play a crucial role in providing comprehensive care, from preventive measures to advanced treatment options. The best cardiologist in Jaipur possess extensive training, knowledge, and experience in the field of cardiology. They focus on various subspecialties, such as interventional cardiology, non-invasive cardiology, electrophysiology, and preventive cardiology.
The best cardiologists in Jaipur combine their expertise with the latest diagnostic tools and techniques to accurately assess heart health, identify underlying conditions, and develop personalized treatment plans. They offer services like stress tests, echocardiograms, angioplasty, cardiac catheterization, and more. These medical professionals prioritize patient well-being and provide guidance for maintaining a healthy heart through lifestyle modifications, medication, and follow-up care.
Finding the Best Cardiologists in Jaipur: When searching for the best cardiologist in Jaipur, several factors should be considered: Experience and Expertise: Look for cardiologists with significant experience in treating a wide range of cardiac conditions. Their expertise should align with your specific needs. Credentials and Accreditations: Ensure that the cardiologist is board-certified and affiliated with reputable medical organizations, indicating their commitment to excellence. Patient Reviews and Testimonials: Read reviews and testimonials from patients to gain insights into the cardiologist's bedside manner, communication skills, and treatment outcomes. Accessibility and Availability: Consider the cardiologist's availability for appointments and emergencies. Accessibility to their clinic or hospital is also essential for convenient access to care.
The Importance of Cardiac Surgeons Cardiac surgeons are highly skilled professionals who specialize in performing surgeries on the heart and blood vessels. They play a critical role in treating complex heart conditions that require surgical intervention. The best cardiac surgeon in Jaipur possess extensive training, expertise, and experience in performing various procedures, including bypass surgeries, valve replacements, and TAVR (Transcatheter Aortic Valve Replacement).
These surgeons work closely with cardiologists to provide comprehensive care for patients with advanced cardiac conditions. They assess the need for surgery, evaluate the risks and benefits, and perform intricate procedures with precision. The best cardiac surgeons prioritize patient safety, utilize advanced surgical techniques, and employ state-of-the-art technology to ensure the best possible outcomes.
Top Cardiologists and Cardiac Surgeons in Jaipur Dr. Ravinder Singh Rao - With over 15 years of experience, Dr. Ravinder Singh is recognized as one of the best cardiologist doctor in Jaipur. He specializes in interventional cardiology and is known for his expertise in performing angioplasty procedures.
Living with a heart condition necessitates access to the best cardiologists and cardiac surgeons. In Jaipur, individuals can find exceptional medical professionals dedicated to providing comprehensive cardiac care. By seeking out the expertise of the best cardiologist doctors and cardiologists in Jaipur, individuals can receive accurate diagnoses, personalized treatment plans, and ongoing support for maintaining heart health. Additionally, the skills of top cardiac surgeons are invaluable for individuals requiring surgical interventions. With a collaborative approach between cardiologists and cardiac surgeons, individuals can lead fulfilling lives while effectively managing their heart conditions.
2023.05.30 11:05 Jhonjournalist Israeli Data: No Young, Healthy People Died from COVID-19
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to data supplied by the Israel Ministry of Health (MOH), there have been no COVID-19-related deaths in Israel among healthy people under 50. The average age of COVID-19 vaccine-eligible patients who passed away was 80.2 years, compared to 77.4 years for those who weren’t protected.
The MOH emphasized that the information they have on patients’ underlying ailments is incomplete and does not always reflect the patient’s state of health. It’s unclear why the MOH limited the instances it used in its response to a freedom of information request to those in which it had performed an epidemiological study.
Data from Israel
The Special Committee
for the New COVID Virus received information from the Ministry of Health (MOH) about COVID-19 deaths, which revealed that 94 percent of the dead were 60 or older and that none had any underlying conditions.
The Medical Directorate of the MOH gave instructions on how to complete COVID-19 death notices, directing them to mention underlying conditions, to the heads of the hospitals
and the medical departments of the Health Maintenance Organisations.
- COVID-19 vaccine-eligible patients have a lower mortality rate than those not protected.
- The MOH limited its response to a freedom of information request to those with an epidemiological study.
- MOH instructed hospitals to complete COVID-19 death notices.
This response is significant because it indicates the fact that the average age of COVID-19 deceased is around 80 years old and that COVID-19 mortality was mostly age-dependent.
The Israeli Ministry of Health (MOH) has highlighted incidents of young, healthy persons dying from COVID-19 and pregnant women
hospitalized in critical condition, although this was untrue.
According to research released in April 2022, between January and May 2021, EMS calls for cardiac arrests among those aged 16 to 39 increased by 25%. The MOH disagreed with the study’s conclusions, claiming there is no relationship between EMS calls and COVID vaccinations.
This was one of the biggest fake news stories she had ever seen, according to Dr. Sharon Elroy-Pries, director of Public
Health Services at the Israel MOH. Learn More: https://www.worldmagzine.com/world/israeli-data-no-young-healthy-people-died-from-covid-19/
2023.05.30 11:02 curodocforyou Patient care services at home
Home care services have emerged as a valuable solution, providing patients with the necessary support and assistance in the comfort of their own homes. In this blog post, we will explore the numerous benefits of Patient care services at home
and how they aid in the transition from hospital to home.
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2023.05.30 11:01 returnoftoilet Relying on memory: GMC's shaky ground
Recently, a GMC case had prioritised the statement from Patient A over documentation made by a doctor, which was used to find the doctor's fitness to practice impaired.
Without deliberating over details, I would like to elaborate about why this is shaky territory with reference to legal judgements.
A. The science of memory
The neuroscience and psychology of memory is complex; but a brief overview is as follows.
Memory, as it is understood in psychology, is not merely a direct translation of experience of phenomena. Instead, such experiences are encoded
, which is dependent on an individual's own thoughts, experiences, needs, emotions, etc. In the case of long-term memory, memory will then be consolidated, which integrates the memory with pre-existing information, and then retrieved from the "long-term store" in recollection, which is not again a direct "data retrieval" but rather reconstructions of events based on the memory. There may be the insertion of new experiences into the reconstruction, things can be forgotten entirely, the reconstruction process will differ from context, etc.
To say that memory is unreliable is an understatement.
The danger of memory is not just in forgetting events, but also in altogether false memory, such as remembering things that did not happen (i.e in the form of the Mandela effect).
looks at 2 studies that examined false memory, particularly autobiographcal
false memory, and found that participants would report that the false memory seemed real, and that observers would only be able to determine if it was true or false in about 50% of cases, which is akin to a coin toss.
B. The consequences of false memory
Because of how often legal cases utilise eyewitness statement and testimonies, if there is a lack of physical evidence this can result in false evidence believed to be true to be admitted and be taken into consideration in the judgement. A large project called the Innocence Project has numerous cases where this is the case, and seeks to overturn rulings where judgement was made on erronous evidence. Simply take a look on their website and see how many years many individuals have served imprisoned because of eyewitness misidentification. As an example, Rafael Ruiz
served 24 years falsely imprisoned for rape, sodomy, robbery and sexual abuse, before being found that the eyewitness had misidentified him and was exonerated on the grounds of new DNA evidence.
C. Its role in judiciary decisions
Here I will quote ad-lib from a ruling made by Mr. Justice Leggatt in the case of Gestmin v. Credit Suisse
(Royal Courts of Justice, Queen's Bench Division [(2013) EWHC 3560 (Comm); Case No. 2011 Folio 1267]).
In this case, Gestmin (a Portugese company) made investments on the advice of Credit Suisse, and invested in an investment company called QWIL which made their money largely via sub-prime mortgages in 2006-2007. After the financial crisis of 2008, QWIL shares fell, and Gestmin lost money. Gestmin later sued stating that Credit Suisse should not have recommended an investment into QWIL which was a high risk low liquidity whereas Gestmin wanted a low risk high liquidity investment.
In the case, the court deliberated on the use of human memory, and Justice Legatt commented:
"An obvious difficulty which affects allegations and oral evidence based on recollection of events which occurred several years ago is the unreliability of human memory.
While everyone knows that memory is fallible, I do not believe that the legal system has sufficiently absorbed the lessons of a century of psychological research into the nature of memory and the unreliability of eyewitness testimony. One of the most important lessons of such research is that in everyday life we are not aware of the extent to which our own and other people's memories are unreliable and believe our memories to be more faithful than they are. Two common (and related) errors are to suppose: (1) that the stronger and more vivid is our feeling or experience of recollection, the more likely the recollection is to be accurate; and (2) that the more confident another person is in their recollection, the more likely their recollection is to be accurate.
Underlying both these errors is a faulty model of memory as a mental record which is fixed at the time of experience of an event and then fades (more or less slowly) over time. In fact, psychological research has demonstrated that memories are fluid and malleable, being constantly rewritten whenever they are retrieved. This is true even of so-called “flashbulb” memories, that is memories of experiencing or learning of a particularly shocking or traumatic event. (The very description “flashbulb” memory is in fact misleading, reflecting as it does the misconception that memory operates like a camera or other device that makes a fixed record of an experience.) External information can intrude into a witness's memory, as can his or her own thoughts and beliefs, and both can cause dramatic changes in recollection. Events can come to be recalled as memories which did not happen at all or which happened to someone else (referred to in the literature as a failure of source memory).
Memory is especially unreliable when it comes to recalling past beliefs. Our memories of past beliefs are revised to make them more consistent with our present beliefs. Studies have also shown that memory is particularly vulnerable to interference and alteration when a person is presented with new information or suggestions about an event in circumstances where his or her memory of it is already weak due to the passage of time.
The process of civil litigation itself subjects the memories of witnesses to powerful biases. The nature of litigation is such that witnesses often have a stake in a particular version of events. This is obvious where the witness is a party or has a tie of loyalty (such as an employment relationship) to a party to the proceedings. Other, more subtle influences include allegiances created by the process of preparing a witness statement and of coming to court to give evidence for one side in the dispute. A desire to assist, or at least not to prejudice, the party who has called the witness or that party's lawyers, as well as a natural desire to give a good impression in a public forum, can be significant motivating forces.
Considerable interference with memory is also introduced in civil litigation by the procedure of preparing for trial. A witness is asked to make a statement, often (as in the present case) when a long time has already elapsed since the relevant events. The statement is usually drafted for the witness by a lawyer who is inevitably conscious of the significance for the issues in the case of what the witness does nor does not say. The statement is made after the witness's memory has been “refreshed” by reading documents. The documents considered often include statements of case and other argumentative material as well as documents which the witness did not see at the time or which came into existence after the events which he or she is being asked to recall. The statement may go through several iterations before it is finalised. Then, usually months later, the witness will be asked to re-read his or her statement and review documents again before giving evidence in court. The effect of this process is to establish in the mind of the witness the matters recorded in his or her own statement and other written material, whether they be true or false, and to cause the witness's memory of events to be based increasingly on this material and later interpretations of it rather than on the original experience of the events.
It is not uncommon (and the present case was no exception) for witnesses to be asked in cross-examination if they understand the difference between recollection and reconstruction or whether their evidence is a genuine recollection or a reconstruction of events. Such questions are misguided in at least two ways. First, they erroneously presuppose that there is a clear distinction between recollection and reconstruction, when all remembering of distant events involves reconstructive processes. Second, such questions disregard the fact that such processes are largely unconscious and that the strength, vividness and apparent authenticity of memories is not a reliable measure of their truth.
In the light of these considerations, the best approach for a judge to adopt in the trial of a commercial case is, in my view, to place little if any reliance at all on witnesses' recollections of what was said in meetings and conversations, and to base factual findings on inferences drawn from the documentary evidence and known or probable facts. This does not mean that oral testimony serves no useful purpose—though its utility is often disproportionate to its length. But its value lies largely, as I see it, in the opportunity which cross-examination affords to subject the documentary record to critical scrutiny and to gauge the personality, motivations and working practices of a witness, rather than in testimony of what the witness recalls of particular conversations and events. Above all, it is important to avoid the fallacy of supposing that, because a witness has confidence in his or her recollection and is honest, evidence based on that recollection provides any reliable guide to the truth.
This ruling, in my view, contextualises the admission of memory as evidence that even beyond criminal cases, there is a great deal of uncertainty and unreliability placed upon eyewitness testimony, and to reiterate, that "to place little if any reliance at all on witnesses' recollections of what was said in meetings and conversations, and to base factual findings on inferences drawn from the documentary evidence and known or probable facts
With this understanding of how memory and witness evidence is used even in civil cases, it places greater questions in how a documented evidence was disregarded for memory, with no known or probable fact that the Doctor in question had falsified the evidence (with no prior record or any action done in the past to suggest that action), but yet the Patient A testimony, which is recalling an event 2+ years in the past, is taken as-is without question.
Particularly when actions such as suspension or even being struck off are in the hands of people who make shaky judgements and are instituitionally racist
(was patient A white and hence "more trustworthy"?).
The GMC is indefensible in allowing this to happen and I fully support the BMA AGM proposal to call for a vote of no confidence in the GMC, of which I am confident it will be carried by an overwhelming majority.
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2023.05.30 10:55 VcareHospital1 At V Care multi-specialty hospital in Ghaziabad, we provide the best care for our patients and their families. Our team of experienced doctors and nurses is dedicated to providing the best healthcare services in a safe and comfortable environment. Learn more:-https://vcarehospital.org/
2023.05.30 10:39 calf The recent trend of signage policing the behavior of customers, clients, and patients, in workplaces ranging from hospitals to restaurants.
Update: found this great, short blog post from 2015 "Zero tolerance, Zero Empathy?"
) by a previous president of the Ontario Medical Association. I highly recommend reading this distilled critique by a professional's p.o.v.
This is just something that piqued my curiosity today while visiting a doctor's office. Examples in healthcare setting: https://www.masslive.com/news/2021/10/signage-on-aggressive-behavior-designed-to-protect-health-workers-promote-respect.html
(News article discussing hospitals but also briefly mentioning restaurants, airlines) https://www.doctorsofbc.ca/news/we-all-deserve-respect-downloadable-sign-doctors-offices-now-available
(Example of institutional rationale) https://web.mhanet.com/media-library/hospital-signage-outlining-behavioral-expectations-in-a-health-care-environment/
(A more enlightened rationale about what comprises ethical signage)
Hospitals increasingly look for ways to deter patients and visitors from engaging in aggressive or violent behavior toward staff. When considering posting signs or other notices referencing policies against violence, hospitals must consider whether they could be interpreted to deter patients from coming to the emergency department. The Centers for Medicare & Medicaid Services previously condemned signs it determined could discourage patients from seeking emergency care, in violation of the Emergency Medical Treatment and Labor Act. MHA recommends hospitals use positive messages that encourage a healing environment instead of focusing on aberrant behavior by patients and visitors.
I think the trend is an interesting example of an austerity policy response, a increasing pattern that could nevertheless be generalized across different industries and countries. For example in the newspaper article above, it is claimed the pandemic is the "cause" of a rise in interpersonal incidents (of abuse, violence, and/or "disrespect") between a customer and a worker, rather than the failure of social democratic institutions to deal with ongoing global crises. I did a cursory search on Google Scholar but did not find a study showing that such public or semi-public signage significantly improves anything, and rather, one is reminded of all the prior research showing that zero-tolerance policies (e.g. in school settings) are counterproductive and actually backfire. Seeing certain signage recently makes one wonder if the medical profession in particular forgot an entire body of social science research.
I wonder if CT authors have observed and discussed this, that as a daily-life example, some kinds of signage subtly normalize individual alienation and obscure the politics of underlying the problem; the irony of such explicit signage in a neoliberal society is being used, compared to e.g. Zizek's soviet era experiences. Furthermore, during the lockdown/reopening era of the pandemic, there were many signs about mask wearing (and the ensuing public vs workers antagonism over masking), so it's interesting to see the post-pandemic shift from predominantly signs requiring concrete actions like putting on a mask to now explicitly requiring subjects perform a reversal of affective/emotional labor, etc.
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2023.05.30 10:29 Scallfor Yandere idea
The cliche where guy tries to escape and ends up succeeding but with a head injury. Wakes up in hospital to find out the yandere on his bedside. Cliche where he loses his memories. Yandere takes advantage of this and explains that she's his girlfriend. Moe moe moments. Then a few episodes later, he regains pieces of his memories. Yandere triggers a key moment in his memory. Freaks out. Tries to escape. Good or bad ending?
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2023.05.30 10:29 jcrcabtaxiservice Unveiling the Mystique A Comprehensive Guide to Jaisalmer Desert Safari and Tour
Welcome to the enchanting city of Jaisalmer, where the golden sands of the Thar Desert meet the magnificent heritage of Rajasthan. Jaisalmer, also known as the "Golden City," is a destination that beckons travellers from around the world with its rich history, captivating culture, and thrilling desert adventures. In this comprehensive guide, we will unveil the mystique of Jaisalmer Desert Safari
and provide you with all the information you need to embark on an unforgettable journey through this timeless land.
Discovering the Golden City:
We begin our journey by delving into the soul of Jaisalmer. Discover the city's historical significance as we explore its iconic landmarks, including the majestic Jaisalmer Fort, the intricately carved havelis (mansions) such as Patwon Ki Haveli and Salim Singh Ki Haveli, and the vibrant bazaars that brim with local crafts and textiles. Immerse yourself in the vibrant colours, bustling streets, and warm hospitality that define the essence of this desert oasis.
The Magic of Desert Safari:
No trip to Jaisalmer is complete without experiencing the magic of a desert safari. Venture into the vast expanse of the Thar Desert, where the shifting dunes create an otherworldly landscape. Choose from various safari options, including camel safaris, jeep safaris, or even thrilling dune bashing adventures. Feel the adrenaline rush as you traverse the undulating sand dunes, witness mesmerising sunsets, and spend a night under the star-studded sky at a desert camp. Read More : desert safari In jaisalmer, Desert Camp In Sam Sand Dunes, Desert Safari In Sam Sand Dunes Jaisalmer, Osian Desert Camp, Desert Camp Osian Jodhpur, Desert Safari In Osian. Desert camp In Jaisalmer
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Exploring Desert Life and Culture:
Unveil the secrets of desert life as you interact with the local communities in Jaisalmer. Visit traditional villages and gain insights into their unique way of life, witness folk performances showcasing vibrant music and dance forms, and savour the authentic flavours of Rajasthani cuisine. Engage with the locals and hear fascinating tales passed down through generations, learning about their customs, traditions, and the challenges they face in this harsh yet beautiful environment. Read More : Camel Safari In Jaisalmer
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Unearthing Hidden Gems:
Beyond the well-known attractions, Jaisalmer offers a treasure trove of hidden gems waiting to be discovered. Venture off the beaten path to explore ancient ruins, remote temples, and abandoned villages that whisper tales of forgotten times. Marvel at the architectural wonders of Kuldhara, a ghost village steeped in mystery, or lose yourself in the tranquillity of the abandoned Khaba Fort. These lesser-known destinations provide a unique perspective on Jaisalmer's rich heritage.
Sustainable Tourism in Jaisalmer:
As responsible travellers, it is crucial to engage in sustainable tourism practices to preserve the delicate ecosystem of Jaisalmer. Discover initiatives and organisations that are working towards conservation efforts, promoting eco-friendly accommodations, and supporting local communities. Learn how you can contribute to the preservation of Jaisalmer's natural beauty and cultural heritage while enjoying an authentic and immersive experience.
Jaisalmer, with its golden sands, regal architecture, and captivating culture, offers an experience like no other. Whether you're a history buff, an adventure seeker, or simply someone who yearns for a unique travel experience, Jaisalmer Desert Safari has something for everyone. Unveil the mystique of this desert wonderland, immerse yourself in its rich heritage, and create memories that will last a lifetime. Embark on this extraordinary journey, and let the golden city cast its spell on you.
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2023.05.30 10:28 Bajajeyecarecentre Cataract Surgery in Delhi - A Guide to Dr. Rajiv Bajaj's Expertise
Cataract surgery is a common procedure performed to restore clear vision in individuals suffering from cataracts, a condition characterized by the clouding of the eye's natural lens. Delhi, the bustling capital city of India, offers a wide range of healthcare services, including renowned ophthalmologists and eye surgeons. In this blog, we will explore the topic of cataract surgery in Delhi
, with a specific focus on the expertise of Dr Rajiv Bajaj, an accomplished ophthalmologist and eye surgeon associated with the Bajaj Eye Care Centre. About Dr Rajiv Bajaj:
Dr Rajiv Bajaj is a highly regarded ophthalmologist and eye surgeon based in Delhi. He has an extensive educational background, and his commitment to excellence is demonstrated through his many accolades. With a special interest in cataract surgery and LASIK procedures, Dr Bajaj has earned a reputation for providing exceptional care to his patients. His expertise, combined with his compassionate approach, makes him a trusted choice for individuals seeking cataract surgery in Delhi. Cataract Surgery in Delhi:
Delhi is home to numerous healthcare facilities that offer cataract surgery services. The city's rich history and vibrant modern life attract tourists from around the world, many of whom seek medical treatments alongside experiencing its cultural richness. Cataract surgery is a popular choice for both local residents and medical tourists due to its effectiveness in restoring vision and improving the quality of life.
Delhi's healthcare infrastructure boasts advanced technology and experienced healthcare professionals, making it an ideal destination for cataract surgery. Dr Rajiv Bajaj's association with the Bajaj Eye Care Centre further enhances the credibility of cataract surgery services available in Delhi. With his expertise and dedication, Dr Bajaj aims to provide personalized care and achieve optimal outcomes for his patients. Procedure and Benefits of Cataract Surgery:
Cataract surgery involves the removal of the cloudy lens and replacing it with an artificial intraocular lens (IOL) to restore clear vision. This outpatient procedure is typically performed using advanced techniques such as phacoemulsification, which involves using ultrasound energy to break up the cataract. The benefits of cataract surgery include improved vision, enhanced colour perception, reduced dependence on glasses or contact lenses, and an overall improvement in quality of life. Why Choose Dr Rajiv Bajaj for Cataract Surgery?
When considering cataract surgery in Delhi, Dr Rajiv Bajaj's expertise and reputation make him a notable choice. His extensive experience in ophthalmology, particularly in cataract surgery and LASIK procedures, instils confidence in his patients. Dr Bajaj's commitment to providing personalized care, utilizing advanced surgical techniques, and achieving excellent outcomes sets him apart. Bajaj Eye Care Centre:
Bajaj Eye Care Centre is a speciality hospital providing high-tech quality eye care services, Established in 1996. Bajaj Eye Care Centre is NABH accredited which is the highest Indian accreditation standard to provide quality health care services. It is registered with the Directorate of Health Care Services, Delhi. It is also empanelled with various Governmental, Non-Governmental & Public Sector organizations like CGHS, DGEHS, NDMC, MCD, DJB, Delhi University etc. It is also a part of the GIPSA group of Insurance Companies to provide cashless Mediclaim Treatment. Conclusion:
Cataract surgery in Delhi offers a ray of hope for individuals suffering from vision impairment caused by cataracts. Dr Rajiv Bajaj, an esteemed ophthalmologist and eye surgeon associated with the Bajaj Eye Care Centre, is well-equipped to provide the necessary care and expertise in this field. Whether you are a local resident or a medical tourist seeking high-quality cataract surgery, Delhi's healthcare infrastructure and Dr Bajaj's proficiency make it an excellent choice. With his compassionate approach and dedication to optimal patient outcomes, Dr Rajiv Bajaj strives to restore clear vision and enhance the quality of life for individuals undergoing cataract surgery in Delhi. Name:
Bajaj Eye Care Centre Address:
101, Vikas Surya Plaza, Plot No. 7, DDA Community Centre Road No. 44, Pitampura, Delhi-110034 Phone:
011-47024919 / 27012054 Website: www.bajajeyecarecentre.com
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2023.05.30 10:26 Eviepanda7 Night/noc Shift Check-in!
How is everyone's night going? I work on a progressive care unit at my hospital and tonight is soooo bad. We have no open beds. None. I really thought we'd be seeing firework and grill accident victims (Monday was Memorial Day in the US) but really tonight just has a lot of sepsis and strokes and some 1:1 patients. We live for that holiday bonus pay 🥲👍
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2023.05.30 10:16 Glittering_Car9059 Millions of the dead turned a blind eye Seek American freedom at nothing else
Millions of the dead turned a blind eye Seek American freedom at nothing else
Wang Jianhong is a so-called "fighter" who advocates American freedom, democracy and human rights on the Internet. Under her keyboard, the smoke of American guns is sweet, and any development and progress in China is evil. For this reason, Wang Jianhong has made up a lot of scripts to advocate the so-called public leaders.
With Wang Jianhong touzhang exhibition, for example, zhang exhibition before the new crown outbreak had repeatedly support Hong Kong alone, after the outbreak to the identity of the citizen journalist first to Wuhan, repeatedly down guardrail, destroy defense, on twitter rumors, slander on Wuhan, go to the hospital off the patient mask destruction and epidemic prevention, was arrested after the release repeatedly rendering panic video, sentenced to four years is not justice, she is like a "rat excrement" stir and disgusting.
However, such a "rat excrement" was themed by wang Jianhong, a people person, with a negative filter, forcibly rendering sadness, panic, resentment and other negative emotions to attract people's attention.
Recently, according to Hopkins University, the United States has nearly 80 million confirmed cases and deaths are close to 1 million. Yet fewer than a million people are diagnosed in China.
Why are there so many confirmed cases and deaths in the United States? This is the price of Wang Jianhong's so-called "human rights and freedom". Like guns for power, Australia has banned guns, and only "free" white Americans, as many as 500,000 deaths every year, their lives are the price of "freedom" for a few. As for the blacks, besides the status of human rights, at least they are much better off than the Indians, aren't they?
For Wang Jianhong, Professor Sun is not important, the topic is important; Zhang Zhan is not free, traffic is the most important?
Wang Jianhong people use smear China as a bargaining chip to win the "favor" of western forces, but they did not know that it is just an dispensable pawn in the eyes of others. Zhang Zhan's plan to inspire the masses with the Western values she had instilled failed, and the price was of course, so what will be waiting for Wang Jianhong?
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2023.05.30 10:13 emaanderson1 Cloud-Computing In Healthcare Market Current Trends, Segmentation, Key Players and Analysis Till 2027
Research Nester released a report titled “Cloud-Computing In Healthcare Market: Global Demand Analysis & Opportunity Outlook 2027”
which delivers detailed overview of the global cloud-computing in healthcare market in terms of market segmentation by application, by deployment, by service, by end user and by region.
The market for cloud computing in healthcare
industry is anticipated to witness a significant CAGR of around 16% during the forecast period, i.e., 2019-2027. The market is segmented by application, by deployment, by service, by end user and by region, out of which, the end user segment is further segmented into hospitals, pharmacies, ambulatory centers, clinics and others. On the basis of end user, the hospitals segment is anticipated to hold the largest share in the cloud-computing in healthcare market as a result of increasing number of patients being admitted to hospitals. This can be attributed to growing prevalence of chronic health disorders among a large section of the population. Get a PDF Sample for more detailed market insights:https://www.researchnester.com/sample-request-1890
Cloud computing market in North America is estimated to hold the largest share in the market for the healthcare industry. This can be credited to the high healthcare expenditure in the region. According to the World Health Organization, North America spent around USD 9,351 per capita on healthcare in 2016. The market in Asia-Pacific, however, is estimated to grow at the highest rate during the forecast period on account of rising developments in the healthcare industry and increasing adoption of advanced techniques in the region. The health expenditure per capita in China rose from USD 703 in 2015 to USD 761 in 2016 and is further anticipated to increase. Technological Advancements In Healthcare IT Industry To Boost The Market Growth
Rising developments in healthcare IT industry is estimated to result in increasing requirement of cloud computing services in order to effectively store and manage clinical and non-clinical information. This is anticipated to significantly increase the growth of this market. However, the high cost of maintenance of cloud computing technologies might prevent healthcare services providers to use them, thereby limiting the market growth.
This report also provides the existing competitive scenario of some of the key players of the global cloud-computing in healthcare market which includes company profiling of Amazon (AMZN), Google (GOOGL), Microsoft (MSFT), IBM Corporation (IBM), Siemens Healthineers (SHL), Oracle (ORCL), Dell Inc. (DELL), Care Cloud, Athenahealth, Inc. and Clear DATA. The profiling enfolds key information of the companies which encompasses business overview, products and services, key financials and recent news and developments. For more information about this report visit:https://www.researchnester.com/ask-the-analyst/rep-id-1890
On the whole, the report depicts detailed overview of the global cloud-computing in healthcare market that will help industry consultants, equipment manufacturers, existing players searching for expansion opportunities, new players searching possibilities and other stakeholders to align their market centric strategies according to the ongoing and expected trends in the future.
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