Monday, May 29, 2006

stress management : Diagnosis and management of post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is an anxiety disorder that occurs following exposure to a traumatic event. The disorder has not been extensively studied in primary care; however, the events of September 11, 2001, raised both public and professional awareness of PTSD. Many more cases may now be diagnosed in family practice patients, because they are more apt to disclose information to their physicians and because physicians are more aware of the diagnosis. One study (1) estimated that 11.8 percent of patients presenting to a primary care clinic met the diagnostic criteria for PTSD.

Patients with PTSD use health care resources more often than patients without PTSD, including those who have other anxiety disorders. (1,2) Because of frustrations in diagnosing and managing their patient's recurrent medical complaints, some physicians characterize patients with PTSD as "difficult" or "heart-sink" patients--that is, patients who evoke "an overwhelming mixture of exasperation, defeat, and sometimes plain dislike." (3) Prompt recognition and effective treatment of PTSD can greatly benefit these patients, their families, and those who work with them.


The psychologic effects of trauma have been described throughout military history. Da Costa syndrome ("soldier's heart"), which is characterized by cardiac symptoms associated with irritability and increased arousal, was described in veterans of the American Civil War. During World War I, it was hypothesized that "shell shock" resulted from brain trauma caused by exploding shells. During World War II, terms such as "combat neurosis" and "operational fatigue" were used to describe combat-related symptoms.

The Vietnam War significantly influenced the current concept of PTSD. In 1980, the Diagnostic and Statistical Manual of Mental Disorders, 3d ed. (DSM-III) (4) established criteria for the diagnosis of PTSD. Modifications were made in subsequent editions. (5,6) This article reviews the current diagnostic criteria for PTSD as contained in the 4th edition, text revision (DSM-IV-TR) (7) and focuses on diagnosis and management, including the detection and treatment of comorbidities.

A precipitating traumatic event is necessary, but not sufficient, to make the diagnosis of PTSD. The criteria for diagnosis specify factors concerning the victim's perception of the trauma as well as the duration and impact of associated symptoms, including persistent re-experiencing of the traumatic event, marked avoidance of usual activities, and symptoms of increased arousal (Table 1). (7)

Before a diagnosis of PTSD can be made, symptoms must last for at least one month and must significantly disrupt normal activities. In persons who have survived a traumatic event, an anxiety syndrome that lasts for less than one month is termed "acute stress disorder"; this condition requires three or more dissociative symptoms in addition to the persistent symptoms associated with PTSD. Symptoms of PTSD that last less than three months indicate an acute condition. A delayed picture occurs in patients who begin experiencing symptoms six months or more after the traumatic event. (7)

The diagnosis of PTSD may be difficult to make for many reasons. Patients may not recognize the link between their symptoms and an experienced traumatic event; patients may be unwilling to disclose the event; or the presentation may be obscured by depression, substance abuse, or other comorbidities. (8) Direct, empathic, and nonjudgmental questioning is recommended when physicians take a patient history. For example, the physician might ask, "Have you ever been attacked or threatened?" or, "Have you ever been in a severe accident or natural disaster?" (8)

Making a connection between a patient's symptoms and a trauma that occurred in childhood may be particularly difficult to establish. An appropriate question to establish this connection is, "Many people are troubled by frightening events that occurred in their childhood. Do you have this problem?" (9)

A screening questionnaire for PTSD reportedly has a sensitivity of 80 percent and a specificity of 97 percent for the diagnosis of PTSD. (10) Examples of the questions include: "Do you have diminished interest in activities"; "Do you have problems sleeping?"; and "Do you find it hard to feel or show affection for others?" (10)
American Family Physician, Dec 15, 2003 by Bradley D. Grinage

stress management: Instant stress relieve

Instant stress relieve

TRY THIS TECHNIQUE ONCE A DAY, or whenever you feel stress mounting. It takes less than 15 minutes to relieve stress. Pick a focus word or phrase (such as "one" or "peace"), sit quietly in a comfortable position and close your eyes. Relax your muscles, progressing from your feet to your calves, thighs, abdomen, shoulders, neck and head. Breathe slowly, and say your focus word silently as you exhale. Continue for at least 10 minutes. Don't stand up right away; continue sitting quietly for a minute or so, then open your eyes and sit another minute before rising.--G.O.


* pick a focus word

* sit quietly

* close your eyes

* relax your muscles

* breathe slowly

* repeat your focus word

Shape, Dec, 2005
COPYRIGHT 2005 Weider Publications
COPYRIGHT 2005 Gale Group

stress management: managing stress is simple

My kind of meditation: managing stress is simple—once you put your mind to it.

During a recent checkup, my blood pressure registered slightly high and my doctor blamed stress. Weeks later, my massage therapist got straight with me: "There's nothing physically wrong with you," she said. "You just need to learn to manage stress."

Manage stress. A simple phrase. A verb and an object. But such an oxymoron. If stress could be managed, it wouldn't be stressful, would it?

The realization that I wasn't managing stress very well immediately spiked my anxiety. I started reading up on stress, and each article ended with tidy bullet points: Meditate. Visualize. Repeat a mantra. Imagine your boss in a clown suit. The advice seemed helpful but somehow incomplete.

But I give the techniques a try anyway. I'm at the office and my eyes are closed. I'm breathing like a Lamaze instructor (puff, puff, puff) because I'm not quite sure how I'm supposed to be breathing. And I'm picturing the seashore. A wave comes in. Swish. A wave goes out. Swish.

Then a creature flutters next to my vital organs. It's my pager. Two seconds later, a head appears over my cubicle wall: My boss (code-named Dilbert, because of a striking physical resemblance) is following up on his page in case I missed it. The seashore vanishes, and my neck muscles make tiny fists.

I decide to consult the most reliable source I can reach before Dilbert opens his mouth: Microsoft Bookshelf Basics. Meditate: To reflect on; contemplate. To plan in the mind; intend. And so I learn meditating isn't about going blank or pretending to be somewhere else. It's about using your mind.

This appeals to me. I like my brain. It has served me well most of my life, and I feel more comfortable using it to fight stress rather than trying to shut stress out. My brain hits the "pause" button, and Dilbert's looming head is momentarily suspended in my mind.

"So what exactly are you feeling right now?" my brain asks me, as Dilbert lurks outside my cube.

"Hmmm, I'd says it's ... tremendous time pressure," I answer myself.

"What's he asking for? Something urgent? A defibrillator?"

"A report."

"A report. No wonder he's excited. And what are you going to do about it?"

I'm finding that often the answer to that question is "nothing." If, as Shakespeare wrote, sleep knits up the raveled sleeve of care, then meditation orders the cluttered closet of life. More often than not, just mentally picking up my raveled sleeve and hanging it somewhere is all I need to do to de-stress. For example, most of Dilbert's manufactured crises now go in a drawer labeled "Artificial Emergencies."

The process of meditation took conscious effort at first but now comes almost naturally. And although the seashore visualization technique didn't work, I did develop a mantra of sorts of my own. It's sbbbbbb.

In my mind it's the soothing sound a mother makes to hush her fretful baby. And, when stress levels rise and Dilbert's face pops into view, it's a reminder to be quiet and listen. The inner voice might have something to say.
SAMANTHA BALDWIN is growing more reflective in Brooklyn, N.Y.

Tuesday, May 16, 2006


Ever wish your music library and all of your playlists could be the star of your next party? The Apple Stereo Connection Kit with Monster Cable is the answer. Everything you need to connect your iPod to your home stereo is included. And to make sure you're getting the most out of your music, the kit even includes a Monster Cable.

Just place the iPod Dock in a convenient spot, plug in the iPod Power Adapter and connect it to the dock with the supplied iPod Dock Connector to FireWire Cable. Plug the Monster Cable into the mini-stereo line out connection on the back of the dock and then into any available audio input on your home stereo receiver. Dock your iPod and rock the house!

© 1999-2006 Super Warehouse All Rights Reserved.

Saturday, May 13, 2006

The Receiver

The audio/video (a/v) receiver and amplifier assembly in a home theater does the same job as the receiver and amplifier assembly in any stereo system: It receives signals from various input devices, like a VCR, DVD player or satellite dish. It interprets and amplifies those signals and then sends them to output devices -- your television and sound system. A home theater a/v receiver and amplifier assembly actually combines several different components. Some even have a DVD or other media player built in. You can generally assemble a superior home theater system by buying the components separately, but most people buy one unit that does all these jobs because it is more cost effective.

The receiver's components are:

Audio/video inputs for video sources (DVD player, DVR)
Surround-sound decoder (aka signal processor)
Power amplifiers for each sound channel
Outputs for speakers and television
The path of the audio and video is pretty straightforward. The source component (DVD player, DVR, etc.) feeds a signal to the receiver unit. You choose which input component you want to feed to your output unit, and the preamplifier selects this signal and amplifies its line level a little bit.
The receiver sends the video on to your television and sends the audio to the decoder. The decoder sorts out the different sound channels from the video signal, and then sends the information to amplifiers for each sound-channel output. These amplifiers are connected to the appropriate speaker or speakers.

Digital decoders and analog decoders handle the job differently. Digital surround sound is quite simple: When a company is producing a Dolby Digital® program, for example, they encode six separate audio channels, specifically balanced for a Dolby Digital speaker setup. A Dolby Digital surround-sound decoder recognizes these different channels and sends them to the appropriate speakers.

Analog surround sound is something else altogether. The different analog surround-sound channels are actually extracted from the two standard audio channels that make up any ordinary stereo signal. This is commonly called 4-2-4 processing because the encoder essentially takes the rear and front channels and works them into the ordinary stereo channels, and a surround-sound decoder separates the four channels out again. See How Surround Sound Works for more information.

There are a wide range of audio/video receivers available. These receivers are often sold with all the speakers you need, as a complete home theater system. These systems run as low as $250 and as high as $2,500.

One of the most important differences between audio/video receiver models is what surround-sound formats they support.

by Tom Harris and Tracy V. Wilson

Wednesday, May 10, 2006

Little Differences Mean a Lot

If you've been reading this column for long, you know that there are little differences within games, optional rules that make a difference in your shot to win.

You know that in blackjack you're better off if the dealer stands on all 17s rather than hitting soft 17, and you know to walk away from tables that pay 6-5 on blackjacks instead of 3-2. You know that a roulette wheel with just a single zero has a lower house edge than one with both a zero and double zero.

Throughout the table pits, there are subtle differences between games. Not all Let It Ride tables are created equal, nor are all craps tables or Three Card Poker tables. There are pitfalls to avoid, little things that might send a player in the know off to a different game, or even a different casino.

Let's check out a few:

AGGREGATE LIMITS: In table games with big jackpots, some casinos put an "aggregate limit" on winnings --- no matter how much you wager, and no matter how good the hand, the payoff can only be as high as the limit. That's most common in Let It Ride. You start with three bets in that game, and have the option during play of pulling the first two back. If you leave all three in play and hit a big hand --- well, that's where the aggregate limit sometimes comes in.

The big payoff comes on a royal flush, Ace through 10 of the same suit. That usually pays 1,000-1, although other pay tables are available. So if you make three $5 wagers and let them all ride, a royal flush brings you $15,000. With three $10 wagers, a royal is worth $30,000 --- unless you bump up against an aggregate limit.

I've seen casinos put a $15,000 aggregate limit on winnings. You'll get the full payoff if you bet $5 per spot, but not with $10 wagers.

What to do? Before you play Let It Ride, check to see if there's an aggregate limit on winnings. If there is, size your bets accordingly, so you don't have to settle for partial payoffs should that miracle hand appear.

ODDS-FOR-1 vs. ODDS-TO-1: You're at a craps table, get caught up in the excitement and just have to have that Yo-leven. (I never go with Yo myself; the house edge on the one-roll proposition on 11 is just too high.)

It's a low minimum table, with $1 propositions, so you toss out a buck. Sure enough, the next roll is 11. What do you get back?

At a casino that pays odds-to-1, you get $16 --- $15 in winnings, plus your $1 wager. But some houses pay odds-for-1, and will give you $15 instead --- your wager is included in the payoff on a table that says the 11 pays 15-for-1.

House edges on one-roll propositions are high anyway, but odds-for-1 send them soaring. On 3 or 11, payoffs of 15-to-1 leave a house edge of 11.1 percent. At 15-for-1, that edge zooms to 16.67 percent. On 2 or 12, a 30-to-1 payoff gives the house a 13.89 percent edge. At 30-for-1, the edge is, yes, 16.67 percent. Ouch.

PAY TABLES: Just as video poker players have had to learn to watch pay tables for the best deals, table players are faced with pay table variations on the stud poker-based games that have flooded the pits in recent years.

Take Three Card Poker as an example. In the Pair Plus portion of the game, the original pay table brings 40-1 on a straight flush, 30-1 on three of a kind, 6-1 on a straight, 4-1 on a flush and even money on a pair. The house edge is 2.32 percent --- one of the better deals you'll get on table games introduced in the last decade or so.

But casinos have several options on which pay table to offer. Worst for the player is one that is the same as the original on all hands but one: On flushes, it pays only 3-1 instead of 4-1. That one small change more than triples the house edge, to 7.28 percent.

Nearly every poker-based table game that includes a pay table has such variations. In Four Card Poker, which has been gaining popularity and floor space in the last year, the best pay table on the Aces Up bet returns 50-1 on four of a kind, 40-1 on a straight flush, 9-1 on three of a kind, 6-1 on a flush, 4-1 on a straight, 2-1 on two pair and even money on a pair of Aces. The house edge is just 1.98 percent.

The worst pay table actually gives you a little carrot by raising two pair to 3-1, but then hits you with the stick of dropping three of a kind to 7-1 and flushes to 5-1. As in Three Card Poker, the house edge more than triples, this time to 6.15 percent. In between, there are several other available pay tables.

What's a player to do? Learn the best pay tables. If you're not getting the top of the line game, think twice, or three times, before betting your money.

By John Grochowski

Sunday, May 07, 2006

Why Asian Food Saves You Money

Even though the economy is fairly strong, you still may want to save money and both Asian markets and Thai food can help. For a number of reasons, Asian markets are one of the cheapest places to buy groceries, even many of those groceries you normally buy in western supermarkets. Then, when you get home, you will find an average Thai meal with rice is significantly less expensive than a meat-centric western meal.

Asian Markets Are Almost Always Cheaper
Most Asian markets (except Japanese and Korean) are far less expensive item for item than western supermarkets, primarily because of a lack of branding or promotion and great economies of scale.

Unsophisticated Retail Tactics
Almost no Asian market owners spend money or time on such consumer spending optimizers as fliers, advertising, competitive pricing strategies, market research, information systems, shelf-space positioning strategies, frequent shopper club memberships, or interior decorating.

Western supermarket chains do not do these nice activities because they like you! Supermarkets do these things to bring you in the store and because they generate more revenue than they cost to perform. That extra profit comes from your pocket.

Market's Economies of Scale
Economies of scale kick in in major cities with a large concentration of Asian people. There are frequently one or two major Asian markets that have more shoppers per square feet than any western supermarkets I've ever seen. Visit the fresh fish counter in a major Asian stores in a city like Boston or San Jose just to see the massive volume sold. I remember from some market research a couple years ago, in the US, the average Asian and Hispanic shopper buys more groceries and cooks from scratch more frequently than the average western shopper. Volume drives down prices.

Weak Asian Brands
Frequently, foods made in Asia are sold very inexpensively in their home country due to weak branding, low labor costs and extreme price competition. This bruising competition is carried abroad at every stage in the wholesale chain keeping prices low.

Almost No Product Advertising
Asian branded products are not advertised internationally. When you buy TV and print advertised products, like those from General Mills or Kraft, you pay about 7% in direct advertising expenses and frequently far more for "brand value". If companies don't spend on ads, you don’t learn the differences between brands without trying them yourself, but you also don’t have to pay for their ads.

Overall Savings
When you visit an Asian market, you will find that these factors drive the price of many of the vegetables, fruit, fish and meat you normally buy to 10-30% below standard western supermarket prices. When you buy Asian products, you will frequently save even more than you would on a comparably produced western item.

Copyright 1999-2006 ThaiTable and it's principals All Rights Reserved

Wednesday, May 03, 2006

Can Gulf Coast refineries handle another Katrina?

Ask any oil and gas industry analyst and they'll tell you the problem isn't getting oil out of the ground, it's all about refining it.

There hasn't been a refinery built in the United States since 1976, and 46 percent of the total barrels of oils refined daily in the country come from Texas, Louisiana, Alabama and Mississippi.

In other words, there's a big hurricane bull's-eye on much of the lifeblood and livelihood of the nation.

Refineries have been welcomed for decades in the Gulf area, which explains the high concentration.

And when catastrophic events such as Hurricane Katrina occur, the country suffers strong economic effects.

Can Gulf Coast refineries handle another Katrina?

The industry may find out faster than it would've liked, as Hurricane Rita is on a path to test the coast of Texas.

Density in the Gulf is an issue, along with major ports, pipelines and crude supplies, said Ed Murphy of the American Petroleum Institute in Washington, D.C. The weather is a major factor, and another factor is that they haven't been able to expand refineries.

The addition of refineries probably won't happen anytime soon, Murphy said.

Building a refinery today is somewhere between difficult and impossible, he said. The regulations are unclear, and even companies that expand refineries often are fined. It's a big issue on the local, state and federal levels. You need a long series of events to happen.

Tom Price, vice president of investor relations at Chesapeake Energy, said refineries once sprouted where they were wanted, and that made for a heavy concentration of refineries in the Gulf area.

What happened was that people had an attitude to make sure to stay in an area that already had an appetite for refineries, Price said.

Some other areas want refineries, but it's a battle from the start.

Cushing, a town about 75 miles northeast of Oklahoma City, is a good example, Price said.

The area has had refineries for 50 years plus and they want to build one, he said. In looking at refineries, I see two types of people: the NIMBYs (Not In My Back Yard), and in towns like Cushing, you have what I call PIMBYs (Please, In My Back Yard). When you look at jobs, it's a no-brainer.

Price said that if towns such as Cushing got what they wanted, some of the emphasis would be taken off the Gulf states.

by Jerry Shottenkirk

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