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One-third of a refraction course in the second year of optometry school was offered in a blended format womens health group tulsa ok buy 70mg alendronate fast delivery. We evaluated student understanding pregnancy nausea relief discount alendronate 35 mg on-line, preparation for laboratory sessions and satisfaction menstrual cycle 9 days late alendronate 70 mg. The final exam scores comparing online and in-class topics were not significantly different from 2011 to menopause exercise alendronate 35mg low price 2012. It uses technology to enhance teaching and can increase interaction between faculty and students. There is improved access to the information and greater convenience because the students are able to view the information multiple times and at any time. Finally, technology allows ease of communication between students and between student and professor. There are conflicting results from studies that attempt to objectively compare test results from traditional vs. Students traditionally meet for one hour of lecture per week and participate in a two-hour hands-on lab each week. Two multiple-choice examinations are given through the semester to assess knowledge, and students are required to demonstrate proficiency of the skills they have learned with a Volume 39, Number 2 / Winter/Spring 2014 Optometric Education 58 hands-on assessment. Due to the combination of lecture and laboratory time, it was felt that this class was an ideal place to implement blended learning in the optometry curriculum. Here, the traditional lecture time is replaced by computer modules, and the face-toface teaching is done in the laboratory setting. The results of our study will aid optometric educators in integrating this technology in their curriculum. The traditional lectures were kept as similar to the previous year as possible so we could compare student performance. Each video segment was followed by a quiz to assure students understood the content. Students were required to watch the videos and receive a perfect score on all quizzes prior to the start of their lab time. However, they were required to retake the quiz until they got 100%, otherwise no credit was given. The students were not required to attend class the weeks that they participated in the blended learning, but they were required to attend lab every week. Two in-class multiple-choice tests occurred through the semester, as well as the hands-on proficiency assessment. Optometric Education Example from the Moodle Website the first of three retinoscopy modules is shown. Each online topic during the semester starts with an area where the students can discuss the topic (Retinoscopy Discussion). The total estimated time for each topic can be determined by adding the estimated times for each module. Finally, the video is available by clicking the play button, followed by a link to the quiz. Figure 1 59 Volume 39, Number 2 / Winter/Spring 2014 In addition to completing the blended learning modules, the students were required to meaningfully participate in discussion boards. Students were encouraged to post questions that stimulated a meaningful conversation, participate in the conversations, and read the posts. The instructor posted questions and responded to discussion questions intermittently when it was necessary to clarify or correct information given by other students or to stimulate further discussion. As was done in previous years, for all in-class topics a pre-written outline was given to students explaining details of how to perform the procedures. First, we compared performance on the final exam from previous years when no blended learning took place. Finally, students were given extra credit to participate in a survey to determine their thoughts regarding the blended learning experience. Test Results of the 2011 and 2012 Final Exam for In-Class and Online Delivery Median 2011 Class questions 2012 Class questions 2011 Online questions 2012 Online questions 2011 Diff between online - class 2012 Diff between online - class Differences between online/class 2012-2011 0. Of these, 30 questions covered topics from week eight to week 12, and the remaining 10 questions covered topics from week one to week seven. Eight questions were not included in the analysis either because the question covered material that was presented both in class and online or because the lecture was delivered by a different inOptometric Education structor than the person that delivered the information the previous year. The mean score for questions that pertained to information presented online was 88.

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These recommendations draw on a body of research that has documented the outcomes of insurance coverage for cessation women's health clinic mount vernon wa discount 35mg alendronate with visa, including its cost-effectiveness menstruation leg cramps order alendronate 70mg free shipping. This research has also helped to womens health specialists alendronate 70mg amex identify the levels of coverage that influence tobacco cessation pregnancy knee pain cheap alendronate 70mg mastercard. More recently, several studies have examined the utilization of cessation treatments covered by health insurance, especially cessation medications, and how this has changed over time. Initial findings from these analyses suggest that cessation treatments continue to be underused, especially among Medicaid populations, and utilization varies considerably across states (Babb et al. Healthcare Insurance Policies After 2010, several national levers were added to make tobacco use and dependence treatment a part of healthcare. Even with these new regulatory levers, many national plans are not yet providing the required coverage (Kofman et al. Chapter 7 provides an in-depth discussion of private and public health insurance coverage for the treatment of tobacco use and dependence. E-cigarette aerosol has been shown to contain markedly lower levels of harmful constituents than conventional cigarette smoke (National Academies of Sciences, Engineering, and Medicine 2018). Accordingly, interest remains in policies and approaches that could maximize potential benefits of these devices while minimizing potential pitfalls posed by the devices at the individual and population levels, including concerns about initiation among young people. It is also important to note that the landscape of available e-cigarette products has rapidly diversified since their introduction in the United States in 2007, including the introduction of "pod mod" e-cigarettes that have dominated the e-cigarette marketplace in recent years (Barrington-Trimis and Leventhal 2018; Office of the U. This section highlights salient issues about how e-cigarettes may influence cessation, which is reviewed in more depth in Chapter 6. Implications of E-Cigarette Characteristics for Smoking Cessation Nicotine delivery through inhalation, as is the case with cigarette smoking, results in rapid nicotine absorption and delivery to the brain. The pharmacokinetics of nicotine delivery varies across products and is influenced by user topography, with some, but not all, e-cigarette products providing nicotine delivery comparable to conventional cigarettes (National Academies of Sciences, Engineering, and Medicine 2018). Other features of e-cigarettes that may enhance their appeal to smokers of conventional cigarettes include the ways in which they mirror some of the sensorimotor features of conventional cigarette smoking, including stimulation of the airways, the sensations and taste of e-cigarette aerosol in the mouth and lungs, the hand-to-mouth movements and puffing in which e-cigarette users engage, and the exhalation of aerosol that may visually resemble cigarette smoking. However, when considering e-cigarettes as a potential cessation aid for adult smokers, it is also important to take into account factors related to both safety and efficacy. Although e-cigarette aerosol generally contains fewer toxic chemicals than conventional cigarette smoke, all tobacco products, including e-cigarettes, carry risks. These factors include appealing flavors, high concentrations of nicotine, concealability of use, and widespread marketing through social media promotion and other channels (Barrington-Trimis and Leventhal 2018). Notably, the novelty, diversity, and customizability of e-cigarettes appeal to youth (Chu et al. Surgeon Introduction, Conclusions, and the Evolving Landscape of Smoking Cessation 23 A Report of the Surgeon General General n. Although this type of product may be appealing to adult smokers seeking e-cigarettes with potentially greater nicotine delivery, the potency and appeal of such products can also make it easier for young people to initiate the use of nicotine and become addicted (Office of the U. Therefore, it is important to continue (a) monitoring the findings of research on the potential of e-cigarettes as a smoking cessation aid and (b) evaluating the positive and negative impacts that these products could have at the individual and population levels, so as to ensure that any potential benefits among adult smokers are not offset at the population level by the already marked increases in the use of these products by youth. Summary Once erroneously considered a habit that could be broken by simply deciding to stop, nicotine addiction is now recognized as a chronic, relapsing condition. The prevalence of cigarette smoking in the United States has declined steadily since the 1960s; however, as of 2017, there were still more than 34 million adult current cigarette smokers in the United States (Wang et al. However, the reach and use of existing smoking cessation interventions remain low, with less than one-third of smokers using any proven cessation treatments (behavioral counseling and/or medication) (Babb et al. A majority of smokers still attempt to quit without using such treatments, contributing to a failure rate in excess of 90% (Hughes et al. Medications and behavioral interventions with increasing levels of efficacy and sophistication are becoming more widely available, but there is considerable room for improvement. Further, the challenge of getting behavioral and pharmacologic interventions to be used concurrently and disseminated more broadly to the public has only been partially solved. Full integration of treatment for nicotine dependence into all clinical settings-including primary and specialty clinics, hospitals, and cancer treatment settings-can benefit from increases in barrier-free health insurance coverage. Combining health service systems and electronic media platforms for the delivery of smoking cessation interventions has emerged as one promising method to increase reach of smoking cessation treatment to smokers. Clinical-, system-, and population-level strategies are increasingly taking a more holistic approach to decreasing the prevalence of smoking, with interventions designed to increase quit attempts and enhance the chances of success.

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This term is used in training and teaching when subjects are provided with knowledge of their results breast cancer drug discount 70mg alendronate with mastercard. Repetition is another key element in promoting motor learning and is applicable to women's health center fort qu'appelle discount alendronate 70 mg mastercard manual rehabilitation-when working in the neurological dimension the pattern used during the treatment should be repeated many times women's health center at shands cheap 35mg alendronate with mastercard. Manual events that elicit a single motor response will be ineffective in promoting longterm neuromuscular adaptation menopause what to expect effective alendronate 35mg. The manual event must be similar to normal functional movement: the closer the manual pattern is to daily patterns, the greater the potential that this movement will transfer to daily activities. Movement that is nonphysiological or nonfunctional will fail to transfer to normal daily use. If the patient cannot raise an arm to eat, rehabilitation should simulate this movement. If walking is affected, treatment should imitate the neuromuscular patterns of walking. Manual approaches that are rich in these elements will be highly effective in influencing motor processes in the long term. Techniques that are missing any number of these code elements are unlikely to be therapeutically effective in this dimension. Furthermore, it promotes activity that is functional in nature and similar in pattern to the athletic pursuit of the individual. The question that arises next is what are therapists rehabilitating when working within the neurological/neuromuscular dimension? For example, the athlete who has sprained an ankle may keep up his or her exercise and sports pursuits and yet, when tested, still demonstrate motor losses (these losses are known to be the maintaining factors behind reinjury and Motor complexity Composite Abilities Balance, motor relaxation, coordination, fine control, reaction time, transition rate Synergetic Abilities Co-contraction and reciprocal activation Contraction Abilities Force (static and dynamic), velocity, and length Figure 16-3 Motor abilities arranged according to their level of complexity. Synergistic abilities are also about onset timing between muscle groups and the duration of contraction. Composite abilities-coordination, reaction time, fine control, balance, motor relaxation, and motor transition rate the sensory abilities are as follows: Position sense (static and dynamic)-the ability to identify the position and change of position of a single joint 265 Spatial orientation-the ability to identify the position and change of position of a whole limb (several joints) Composite sensory ability-the ability to integrate sensory information from exteroceptive and proprioceptive sources for the execution of movement, such as balance Over the past decade, tests have been developed to assess these sensory-motor abilities. Table 16-1 Sensory-Motor Abilities: Description, Tests, and Their Re-abilitation Description the ability to produce and control sufficient contraction force and control its level. Tests For static force use standard muscle testing methods to gauge muscle strength. For dynamic force ask the patient to perform an arc of movement while resisting that movement. In both tests endurance can also be tested by a longer duration of muscle contraction in the static test and several repetitions of the movement in the dynamic test. Re-abilitation Static force can be re-abilitated by straightforward resistive-type movement. Resistance can be applied manually by the practitioner alternating between static and dynamic movement, continuously varying the starting angles of the forces applied. For example, in the arm, instruct the patient to elevate the arm against resistance (dynamic phase). This can be combined with continuously changing the position of the whole of the upper limb. Change variables, such as limb position, by therapist moving hands apart to new positions. Sensory-Motor Ability Motor Abilities Force (dynamic or static) Velocity the ability to control the rate of contraction. Length the ability to produce movement and sufficient forces at the end ranges of movement. The ability to control the active stability of joints including onset timing and duration of activation of synergistic muscles. The patient is instructed to repeat the movement but at a progressively increasing rate. Co-contraction (dynamic or static stabilization) Static control: Instruct the patient to "stiffen the joint" and apply fine perturbations to the limb at increasing rates and in different directions. The therapist challenges this movement by sudden lateral pushes to the moving limb. Change variables, such as limb position, resistive force (either dynamic or static), and velocity.

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