Industrial hygiene is the science of evaluating, anticipating, and preparing for potentially hazardous workplace conditions. Shield’s industrial engineers use state-of-the-art testing and monitoring equipment to evaluate existing conditions related to the work environment. Our industry-leading technology allows us to measure workers’ exposure to chemicals or other hazardous materials and suggests proper controls. Working in tandem with Shield’s experienced environmental engineers, environmental site investigators, and certified laboratory partners, clients can stay in front of potential workplace issues.
Indoor Air Quality
Indoor air quality is a major concern in manufacturing and industrial operations. Respirable Dust, Total Dust, Toxic levels of certain chemical vapors can expose workers to unsafe atmospheres and exceed federal standards for permissible exposure limits. Shield’s experienced industrial scientists can help you measure and monitor the air quality at your site and ensure the area remains safe for employees and reduce owner liability.
Mold and Moisture Assessment
Mold is ubiquitous but may lead to severe respiratory distress in sensitive individuals. Shield’s state-of-the-art mold testing equipment and moisture monitoring tools will give you an accurate picture of the mold situation in your facility. If moisture intrusion is resulting in a mold issue, Shield will work with you to identify the proper remediation and treatment techniques that will result in a healthy building environment and test the facility to assure mold and moisture is at an acceptable level.
Lead paint, frequently used in buildings construction prior to the 1980s, can be toxic and may lead to certain cancers. If you’ve got concerns about lead paint or other contaminants at your facility or jobsite bring in Shield’s team of experienced industrial hygiene professionals to give you an evaluation of conditions.
Noise levels in industrial facilities can be harmful to workers. OSHA requires employers supply their employees with hearing protection if your facility exceeds 85 decibels on the basis of a time weighted average. OSHA also requires a Hearing conservation program be implemented and maintained for facilities with hearing protection issues. Shield Engineering can work with your managers to test the current noise levels at your facility and suggest controls to assure you have a safe workplace.
Contact Shield’s Industrial Hygiene Experts
Call Shield today to find out more about our industrial hygiene services intended to protect your workers as well as the work environment. It’s never too early to start putting smart safety practices in place.


This month I returned to the gym after almost nine months off. I’d been doing body weight exercises and stretches at home as well as walking and running, but I wanted to get back to lifting. I wanted to do flys, which make my deltoids look amazing, and leg presses, which I can easily do up to 200 pounds. I wanted to feel strong and tough and like no one could fuck with me.
Unfortunately, I forgot how uncomfortable and ill-made gym equipment is. Much of it seems to be made for people that are 6’ tall or, at least, for no one shorter than 5’6”. Many of the machines have bulky pads that you’re supposed to rest your elbows on or lean on. Instead, these pads jam into my nipples, squish my boobs, and force me to overextend my sides. They are uncomfortable and unwieldy, which is probably why I almost never see women on them.
Instead, you’re much more likely to see women doing cardio or occasionally free weights. There are always several women walking along the track or rocking out to Zumba or going onto their second hour on the treadmill. My gym has a women-only room, which is where I usually see women doing free weights – despite the fact that the area is a third the size of the regular weight area with maybe a fourth of the machines and equipment.
While lifting is still seen as somewhat taboo among women (Oh, my God, what if it bulks me up like a man??? That is impossible, ladies. You don’t have enough testosterone. This is true for biological and transgender ladies.), it’s still the best way to get fit and, yes, lose weight. Lifting burns calories and builds muscles, which burn calories even when you’re not lifting as well as boost your metabolism. They stabilize and support you, making it easier to do cardio or any regular activity – housework, taking care of kids, walking for long periods of time, sports, dancing, throwing around heavy boxes, whatever – and can be a serious ego booster. Have you ever squatted with a 50 lb bar on your back? You feel like goddamn She-Ra.
I’ve brought up this issue with the management but considering the same 10 treadmills have been out-of-service since I was last at the gym, I highly doubt they’re going to do anything about it. Even if they actually wanted to, I’m not sure what they could do. A quick Internet search doesn’t show any equipment brand specifically made for women other than whatever’s being hawked by Jillian Michaels and the Thighmaster. This is such a shame because refusing to adapt gym equipment for women’s physiological needs is keeping half the population from being able to work out, which means that we’re also not being as healthy as we could be. Until then, I guess we just get to deal with our feet not being able to touch the ground, squeezing our boobs behind handles, and jamming machine parts into our thighs – which, by the way, really hurts.


Introduction - Personal and Social Competence
The Department of Education, Training and Employment (DETE) defines Personal and Social Competence as a general capability within the Australian Curriculum which identifies age-appropriate concepts that can be taught throughout the years of schooling in:
- social awareness;
- social management.
Students with well developed social and emotional skills find it easier to manage themselves, relate to others, develop resilience and a sense of self-worth, resolve conflict, engage in teamwork and feel positive about themselves and the world around them. The development of personal and social capability is a foundation for learning and for citizenship.
~ excerpt from ACARA - F-10 Curriculum
In the Australian Curriculum, students develop personal and social capability as they learn to understand themselves and others, and manage their relationships, lives, work and learning more effectively. The capability involves students in a range of practices including recognising and regulating emotions, developing empathy for others and understanding relationships, establishing and building positive relationships, making responsible decisions, working effectively in teams, handling challenging situations constructively and developing leadership skills.
The Australian Education system is continuously working on ways to provide effective education for our students.
Yoga in Education
When used in education, yoga is a system that teaches self-awareness, self-care and self-management by tuning into the body, the breath and the mind. The practice of yoga reduces stress, achieves emotional balance and enhances cognition.
Yoga provides an opportunity to create an inclusive environment where students with differing abilities and adults can be joyfully involved. When everyone feels included in a process he/she experiences enhanced social interaction, learning, focus, confidence, expression and play.
Yoga Tools For Schools Programs
Yoga Tools For Schools Professional Development Training Programs inspire educators to model and share Yoga Tools to nourish, balance and support teaching and learning during class time, with no extra space or equipment required.
Our trainings are two fold ... to support educators personally and also to support the learning experience for students.
The purpose of Yoga Tools For Schools Professional Development Training Programs is to:
- Understand that yoga is a mind-body system about honouring and supporting oneself in order to be the best one can be
- Empower educators to use Yoga Tools along with students to model the importance of self-care and experience the benefits of yoga breaks
- Inspire educators to use Yoga Tools to support and improve productivity during lesson time rather than use yoga as a supplemental activity
- Introduce educators to Yoga Tools with the intention to nourish, balance and support teaching and learning.
As an introduction to Yoga Tools and the benefits of Yoga in general, we offer our Wellbeing Workshops to all educators, staff, parents and carers associated with the participating schools/organisations/centres.
Promote self-awareness, self-care and self-management at your school or organisation by practising and sharing Yoga Tools.
In order to better support the needs of educators and educational institutions, Yoga Tools For Schools Inc. is learning how educators are currently implementing self-awareness and self-management strategies.
Subsequently, in addition to our Professional Development Trainings & Wellbeing Workshops, Yoga Tools For Schools Inc. are developing further programs such as In-Service Programs to suit the needs of schools and other educational institutions.
These programs will provide support to educational institutions, forming part of their Wellbeing Framework.
We would love your feedback if you wish to share! Contact us with any comments or suggestions you may have. Thank-you in advance as any input is invaluable.


Yesterday at a press conference it was announced that the two American Ebola patients were being released from Emory University Hospital after nearly three weeks of undergoing intensive treatment. Upon his release, a joyful and relieved Dr. Kent Brantly called his recovery “miraculous” and thanked God for sparing his life. Dr. Brantly’s faith is personal to him and I respect the strength of his beliefs. He expressed his thoughts on the nature of his treatment and recovery. Here are mine.
It was not a miracle. If one is to believe what we are told about all-powerful and triumphant gods, a miracle is an easy thing for a deity. And what happened to these two patients, and what is so lacking for those suffering in Africa, was anything but easy. It was too big, too long in the making, and too much a work in progress for it to be so blithely dismissed as a “miracle”. It was outstanding care by a highly trained staff of medical professionals. It was the state-of-the-art healthcare facilities at a top-flight university. It was public and private funding for medical research. It was biologists and epidemiologists and internists and nurses and lab technicians and orderlies. It was government-sponsored research into disease transmission, control and treatment. It was decades of advances in patient care. It was nursing schools and medical schools, some private, some public, all recipients of tax dollars through a variety of grants and direct funding under state budgets. It was a combined several thousand years of collective study, research and experience embodied in the healthcare and administrative personnel and support staff. It was rigorous high school biology and chemistry programs. It was teaching evolution without which any understanding of or advances in the biological sciences is impossible. It was prioritizing education at all levels in the STEM fields, but it was also valuing education and training in the humanities and social sciences as it is those areas of study that produce the policy professionals who can more deeply understand, predict, document and describe human responses and motivations during times of extreme challenge and duress. It was thousands of hours in laboratories observing, experimenting, failing and trying again to comprehend a disease and formulate treatments. It was family and social groups that fostered a sense of responsibility to the human community. It was individual moments of insight and teamwork spread over decades. It was federal agencies and private research foundations and universities and biotech corporations. It was hard work and fierce dedication to a common goal of helping these dangerously ill people to become well again while preventing the spread of a killer.
Perhaps given the complexity of the web of factors that coalesced to result in the two missionaries’ recovery from Ebola, one could be forgiven for ascribing it mere miracle status. But this mind-set lets us off the hook. It says we don’t have to work so hard or spend so much time and money, pay so much attention and maintain such a commitment to the education, exploration and discovery that underlie medical successes, technological achievements and social progress. Taken to an extreme, which is not out of the question in this time of corporations as religious entities, government-sponsored prayer, creationism in science classes, and religious exemptions from public health mandates, along with an anti-government movement that aggressively slashes funding for scientific research, education and social programming, we could anticipate the breakdown of this vast supportive web of knowledge, information, education, development and treatment. And celebratory press conferences like the one at Emory University Hospital would be a thing of the past. Because there would be no “miracles.”


Dr. Akaki Tsilosani MD, PhD is a world-renowned hair transplantation expert, Fellow of the International Society of Hair Restoration Surgery (FISHRS), Member of the Asian Association of Hair Restoration Surgery (AAHRS), Member of World FUE Institute (WFI), Honorary Member of the Ukrainian Hair Research Society, Member of Georgian Society of Plastic Reconstruction and Aesthetic Surgery (GeoPRAS), and Faculty of the American Academy of Aesthetic Medicine (AAAM). For more than 22 years Dr. Tsilosani has been working in the field of hair transplantation. During this time, he has performed over 12,000 successful hair restoration surgeries.
Dr. Akaki Tsilosani is the author of 42 scientific publications and 6 inventions in the field of hair transplantation. During 2002-2010, Dr. Tsilosani specialized in FUT giga sessions and dense packing. In 2008, he reached the density of 100 FUs in 1cm squared without decreasing the survival rate (92%), setting a new world record. In 2012, Dr. Tsilosani conducted a giga-session on a record scale - 9,688 follicular units (grafts) were transplanted in a single 11-hour session. These records remain unbeaten to this day.
In an effort to maximize the donor supply of patients in 2006, Dr. Tsilosani began combining FUT and FUE methods in a single session. Together with Robert True (USA) and Marcio Crisóstomo (Brazil), he is recognized as a pioneer of FUT and FUE combination techniques.
In 2010, Dr. Tsilosani was the first surgeon in Europe who performed a Long Hair Transplantation surgery, which nowadays are a significant part of his work.
In addition to his scientific studies and private practices, Dr. Tsilosani has been teaching and training his colleagues from all over the world since 2009. Dr. Tsilosani conducts hair transplantation training courses not only in his institute in Georgia, but also in partner clinics in Russia and Ukraine. In addition, Dr. Tsilosani leads and supervises large workshops as a faculty of the American Academy of Aesthetic Medicine in Dubai and Kuala-Lumpur. He has trained more than 400 doctors who are now successfully practicing in their respective countries.


As more of the world has switched to virtual meetings, online conferences, and video events, it’s no surprise that medicine is adapting to a new virtual landscape.
Telehealth means delivering health care, information, and education using digital technologies like video conferencing. This article will explore the benefits of telehealth and show you what tools you need to make it a reality in your practice.
Telehealth is when a medical practitioner offers health care services remotely using tools like video conferencing, phone calls, and other virtual tools. Telehealth has been around for a while, but it has exploded in popularity in the past few years.
McKinsey & Co, a management consulting firm, recently estimated that $250 billion of US healthcare spending would shift to telehealth. The growth in telehealth popularity is linked to the COVID-19 pandemic. Many patients were reluctant to visit clinics and hospitals in person during the height of the health crisis. There has also been greater support for telehealth by insurance organizations.
Telemedicine is the practice of delivering medical care services at a difference. Telemedicine offers significant potential to improve medical care for many people. For example, people with limited mobility may use telemedicine to ask questions, receive advice, and speed up their medical care. In addition, people in rural or isolated areas may use telemedicine to access specialized doctors, nurses, and other professionals who do not live in their local community.
Drawing a clear distinction between telehealth vs. telemedicine is challenging. Some people and organizations use these terms interchangeably. That said, there is an emerging difference between them.
Telehealth is the broader term that can cover services, information, and education, monitoring provided by doctors, nurses, and volunteers. The fact that telehealth services could be performed by a variety of people, not just medical doctors, is one reason why telehealth can be more affordable. In addition, a telehealth service might provide general-purpose health information like answering questions about vaccines.
Telemedicine involves providing clinical health care services remotely. For example, a patient with a chronic health condition like diabetes may meet with their doctor for a regular checkup. Telemedicine can also include more complex procedures. For instance, medical professionals have used telemedicine to perform surgery remotely. This type of remote work is a cost-effective way to increase access to medicine. According to Healthcare IT News, certain medical specialties like neurosurgery and urology have seen higher rates of telemedicine usage.
Setting up telehealth services takes careful planning, the right technology, and creative thinking. Fortunately, there are several models of telehealth services that you can study to inform your approach. Before diving into specific technologies and methods, it is important to understand restrictions.
Restrictions on telehealth services take several forms. First, there are insurance restrictions – not all health insurance providers support telehealth providers in the same way as traditional health providers. In the US, Medicare coverage for telehealth has recently evolved. For instance, you can get coverage for virtual check-ins, e-visits, and a few other kinds of telehealth services (e.g., renal dialysis and some emergency department visits). Confirming what telehealth services are covered is an important first step in setting up telehealth services.
The next restriction is practical: not all medical and health care procedures can be performed at a distance. For instance, a doctor video visit might make sense for a patient being monitored in some cases like post-surgery follow-up. However, in other situations, telehealth services might not be suitable. For example, a doctor video session cannot take blood or other tissue samples for testing.
The final type of restriction to understand includes skills and regulatory matters. It is unwise to assume that all patients and healthcare professionals have access to the same technology. Likewise, technology skills are likely to vary. When a patient is suffering, they may have difficulty interacting with telehealth providers. As you plan, your suite of telehealth services, training guides, videos, and other support resources may be needed. Without these resources, your patients and stakeholders may not be able to access telehealth providers when needed.
Resource: To speed up the process of creating your training for doctor video calls, check out our guide: Video Meeting Checklist: How-To Host Video Conferences.
Setting up telehealth services requires several technologies. Review the following tips and see if your organization has the right tools in place.
A doctor video meeting forms the core of many telehealth offerings. Therefore, it is wise to spend time testing different video platforms. Consider factors like how many attendees can join the consultation. At a minimum, there will usually be two participants in a doctor video meeting (i.e., the doctor and the patient). However, additional participants like the patient’s spouse and the doctor’s assistant or nurse may also join the call.
When you select a video meeting platform for telehealth services, there are a few more criteria to keep in mind. Telehealth services involve discussing sensitive information like illnesses, symptoms, and treatment plans. To keep this information safe, a high level of security and privacy protection is essential. Look for platforms that meet GDPR (General Data Protection Regulation) requirements. While not created for telehealth services specifically, using a GDPR video meeting solution is helpful. Meeting GDPR expectations means that the tool has to take substantial measures to protect personal data.
To make your video calls easy to use, telehealth providers need high-quality audio and video tools. Fortunately, most modern laptops and smartphones include webcams and microphones. On the patient side, telehealth providers should strive to be flexible. Let patients use whatever tools they have available. That includes offering the option for dial-in by phone if that is what patients want.
When it comes to the healthcare provider side of the meeting, invest in the best tools you can afford. For example, take a look at the light situation in your office. When possible, take advantage of natural light on video calls. When natural light is not available, putting a lamp or ring light behind your webcam makes it easier to see your face.
In addition to lighting, purchasing noise-canceling headphones and a microphone is a smart decision. These additional pieces of equipment are especially important when you offer telehealth services in a group setting. When there are other telehealth conversations happening nearby, it is wise to take steps to protect patient confidentiality. When feasible, close the door to your workspace during doctor video calls.
Tip: The best audio and video equipment in the world is useless if you don’t know how to turn it on. Before you join your next video call, use the tips we have in the following article: Quick Tips to Test Your Webcam And Microphone. For example, there are free websites you can use to verify if your webcam is working before you start a video meeting.
A broadband Internet connection is critically important for most telehealth services, especially those involving video. In 2015, the Federal Communications Commission recommended the following minimum broadband speeds: 25 megabit download speed and three megabit upload speed. You can use a service like Speedtest.net to check your Internet speed. If your Internet speed is low, you may need to upgrade your Internet service or get closer to your Internet router.
Assuming telehealth services are new for your organization, starting small makes sense. Start by offering services that lend themselves to a video call. For example, you might start off by offering drop-in calls with your nurse staff. Alternatively, your approach to telehealth services might emphasize following up with patients with chronic illnesses.
Once you choose the specific telehealth services you want to launch, promote those services to your patients. Post about your new telehealth services on social media, on your website, and put up signs about it in your location.
Finally, make time for continuous improvement and measurement of your telehealth services. Every 90 days, reach out to patients, doctors, and other users to gather feedback. Ask them about what is working and what is not working in your organization’s approach to telehealth services. The feedback you receive will help you to make your telehealth services even better.
Now that you know the answer to “What is telehealth?” your next step is clear. Discuss whether and how to offer telehealth services to your community. In most cases, the fastest and easiest way to get started is to offer doctor video meetings.


Our culture is largely one of competition and chaos, so I am always seeking out those who are working to spread the light from a place of compassion and creativity. I recently spoke with spiritual guide Kelly Knaub, a healer, reiki practitioner and yogi, about her journey and her mission to help women heal from burn-out. Kelly’s powerful work and words are so inspiring and uplifting, I wanted to find out more…
How did you get into reiki and kundalini yoga?
The truth is, I never planned on getting into either one. I had practiced yoga for nearly two decades off and on, with about 10 of those years spent studying under a Kripalu yoga teacher. My plan was to get certified in Kripalu, the yoga of compassion (which I still hold close to my heart). I had been renting out a space at Golden Bridge Yoga in New York for about a year and a half for a 12-step support group meeting I had started for people who grew up in alcoholic homes. Although I loved the energy of the space, I had no interest in Kundalini yoga (also known as the yoga of awareness). In fact, I have to be completely honest—I had judged it as weird and a bit “cultish.” Eventually, I got to a point in my life where I had completely burned myself out and was experiencing a full-blown crisis, physically, emotionally, and spiritually. I knew that I had to let go of some of the many responsibilities I had on my plate to give myself time to heal. When I gave up my weekly support group commitment, I decided to try a class at Golden Bridge since I figured I wouldn’t be going back. Those 90 minutes changed my life. I fell completely in love with it. It provided healing on every level that I hadn’t before experienced with any other style of yoga. Shortly before I took that class I had a dream that I traveled to the spiritual realm, where everyone was dressed in white. I had gone there seeking help. Certain things I dreamt revealed themselves as I stepped onto my Kundalini yoga path. Several weeks later I received an intuitive insight to sign up for teacher training, and the rest is history 🙂
My path to Reiki is somewhat similar. Not long after I began yoga teacher training, I was still struggling with my physical health—a severe (chronic stress-related) GI infection that I had been battling for nearly 8 months—so I decided to try Reiki. I booked a session with a practitioner who lived not far away in Brooklyn and was astounded at how intense I could feel it in my energetic channels (it was very tingly!) and how completely peaceful I felt when I left. She happened to be teaching a Level I and II Reiki course the following week, so I signed up and got certified. Within two weeks of giving myself daily Reiki treatments (as well as an herbal protocol I embarked on under the guidance of a naturopath after antibiotics failed), my infection cleared up for the first time ever. Since then, I have studied with two other Reiki masters, learning techniques for utilizing intuitive practices with Reiki and also getting certified in Shamanic Reiki, which incorporates shamanic practices and earth-based wisdom. I also had dreams about Reiki before I ever received it or started practicing. I get a lot of guidance in my dreams.
What services do you offer your clients and how are those services unique?
Right now I offer a 12-week, one-on-one mentorship, The Divine Journey Home, which helps women who are stressed or burned out heal and connect with their soul’s purpose. All of us—every single one of us—came to this earth with a purpose and I truly feel called to help other women get in touch with that. It’s also great for women who already have clarity on their purpose but want support and guidance in staying connected to it. It’s a unique program in that it uses a variety of healing tools: Kundalini yoga and meditation, Reiki, shamanic practices, handcrafted aromatherapy products for energetic support, and exercises such as journaling, self-care rituals, guidance in creating a spiritual practice, creative visualization, and more. The classes and sessions are available in-person in Brooklyn or through Skype or Google Hangouts. People often tend to think that long distance healing work is not as effective or powerful, but I know from firsthand experience that it is. I’m currently studying long-distance with Sandra Ingerman, a pretty renowned shamanic teacher, with classmates all over the world, and I’ve had some of my most powerful journeys that way. It’s energy that we’re working with, after all.
Can you talk about some benefits of working with you?
I’m passionate about helping women see that whatever challenge they’re facing — whether it’s burnout, crisis, ill health, or simply lack of play time — can become an opportunity for growth and even their greatest blessing. I help them connect with their intuition, transform negative beliefs that are standing in their way, and create strong self-care and spiritual practices. Another huge component is helping them move through any fear that’s holding them back and to get clear on what steps they need to take to create a life that feels fully aligned with their purpose. I also want to note that “purpose” is often misunderstood as this one set thing that we have to “figure out.” I have learned that purpose has way more to do with who we are being in the world than with what we are doing. Our work will likely evolve over time—the key is staying connected to our authentic selves. Aligned action can flow from there. So this is really about peeling away the layers to uncover your true self and to create a life that reflects that truth.
What was/is your vision for the work that you do?
My vision has definitely evolved. My initial idea was to start a small line of aromatherapy products. Over time, I got clearer on my purpose and realized that I felt called to help women on their own healing and spiritual paths. In the end, I found a way to combine all of my passions, including the aromatherapy products! My vision now is to help other women raise their consciousness and wake up to who they really are. It’s especially important to me in light of everything that’s going on in the world—there’s so much fear, anger, and negativity permeating the collective consciousness right now. But there is also a lot of hope and a lot of love. People are coming together.
What do you practice each day?
I practice Kundalini yoga & meditation every morning, which I’m fascinated by because before, when I did other styles of yoga, I always struggled with a daily practice. It was always something I resisted and just couldn’t seem to make stick. My experience with Kundalini yoga has been so different. I call it “energetic hygiene.” It’s like brushing my teeth. I can’t imagine starting my day without it.
Can you recommend an inspiring book or movie?
I watched the movie “Finding Joe” not too long ago and that was pretty inspiring. It’s a documentary about Joseph Campbell’s theory of the hero’s journey (or shall we say the heroine’s journey?) and following your bliss. I streamed it through my Gaia subscription, which I highly recommend. It’s like Netflix for the spiritually-minded.
Discover more about Kelly Knaub and her work here:


According to Feeding America®, 5.5 million people age 60 and older are food insecure and 1 in 6 Americans could go hungry during the COVID-19 pandemic. Food insecurity is a major social determinant of health, and seniors' ability to access food due to mobility and transportation limitations is increasing as a result of the pandemic.
Centene provides Medicare Advantage plans to nearly one million members across the country with solutions tailored to adults aged 65 years or older. Our health plans have implemented a number of measures to help members access care and address social determinants of health while keeping the needs of an aging population top-of-mind. In May, Centene announced cost-sharing would be waived for in-network primary care, behavioral health, and telehealth, while expanding over-the-counter and meal benefits for Medicare members.
As part of Centene’s commitment to addressing non-medical barriers to care, WellCare, a wholly-owned subsidiary of Centene, offers its WellCare's Community Connections Help Line — a toll-free, nationwide number — that encourages members to voice their needs. Between March 1 and June 30, the Help Line fielded more than 4,000 calls from Medicare members. Food assistance was the most requested service (34 percent) followed by medication assistance (26 percent) and transportation (14 percent). Continuing Centene’s history of innovation, new solutions were developed and implemented.
One recent enhancement is Centene's partnership with Shipt, a same-day delivery service. The program enables Medicare Advantage members to access groceries and everyday essentials safely and conveniently. Shipt-enrolled members can have essential supplies delivered directly to their homes, helping seniors avoid unnecessary trips to the store that could expose them to the novel coronavirus. The benefit is available to more than 200,000 WellCare members across 23 states and provides free monthly Shipt memberships to eligible members for the remainder of 2020.
This partnership is one example of Centene's ability to keep members’ needs at the forefront while increasing health-focused solutions. It's especially important that vulnerable populations receive access to services that will help them succeed. For more information on Centene's response to the COVID-19 pandemic, visit our COVID-19 Resource Center.


The Future of Healing: Shifting From Trauma Informed Care to Healing Centered Engagement
Shawn Ginwright Ph.D.
From time to time, researchers, policy makers, philanthropy and practitioners all join together in a coordinated response to address the most pressing issues facing America’s youth. I’ve been involved with this process for long enough to have participated in each of these roles. I recall during the early 1990s experts promoted the term “resiliency,” which is the capacity to adapt, navigate and bounce back from adverse and challenging life experiences. Researchers and practitioners alike clamored over strategies to build more resilient youth.
In the early 2000’s the term “youth development” gained currency and had a significant influence on youth development programs, and probably more importantly how we viewed young people. Youth development offered an important shift in focus from viewing youth as problems to be solved to community assets who simply required supports and opportunities for healthy development. Since that time, a range of approaches have influenced how we think about young people, and consequently our programmatic strategies. I have, for the most part, attempted to nudge and cajole each of these approaches to consider the unique ways in which race, identity and social marginalization influence the development of youth of color.
More recently, practitioners and policy stakeholders have recognized the impact of trauma on learning, and healthy development. In efforts to support young people who experience trauma, the term “trauma-informed care” has gained traction among schools, juvenile justice departments, mental health programs and youth development agencies around the country. Trauma informed care broadly refers to a set of principles that guide and direct how we view the impact of severe harm on young people’s mental, physical, and emotional health. Trauma informed care encourages support and treatment to the whole person, rather than focusing on only treating individual symptoms or specific behaviors.
Trauma-informed care has become an important approach in schools and agencies that serve young people who have been exposed to trauma, and here’s why. Some school leaders believe that the best way to address disruptive classroom behavior is through harsh discipline. These schools believe that discipline alone is sufficient to modify undesired classroom behavior, but research shows that school suspensions may further harm students who have been exposed to a traumatic event or experience (Bottiani et al., 2017). Rather than using discipline, a school that uses a trauma informed approach might offer therapy, or counseling to support the restoration of that student’s well-being. The assumption is that the disruptive behavior is the symptom of a deeper harm, rather than willful defiance, or disrespect.
While trauma-informed care offers an important lens to support young people who have been harmed and emotionally injured, it also has its limitations. I first became aware of the limitations of the term “trauma-informed care” during a healing circle I was leading with a group of African American young men. All of them had experienced some form of trauma ranging from sexual abuse, violence, homelessness, abandonment or all of the above. During one of our sessions, I explained the impact of stress and trauma on brain development and how trauma can influence emotional health. As I was explaining, one of the young men in the group named Marcus abruptly stopped me and said, “I am more than what happened to me, I’m not just my trauma”. I was puzzled at first, but it didn’t take me long to really contemplate what he was saying.
The term “trauma informed care” didn’t encompass the totality of his experience and focused only on his harm, injury and trauma. For Marcus, the term “trauma informed care” was akin to saying, you are the worst thing that ever happened to you. For me, I realized the term slipped into the murky water of deficit based, rather than asset driven strategies to support young people who have been harmed. Without careful consideration of the terms we use, we can create blind spots in our efforts to support young people.
While the term trauma informed care is important, it is incomplete. First, trauma informed care correctly highlights the specific needs for individual young people who have exposure to trauma. However, current formulations of trauma informed care presumes that the trauma is an individual experience, rather than a collective one. To illustrate this point, researchers have shown that children in high violence neighborhoods all display behavioral and psychological elements of trauma (Sinha & Rosenberg 2013). Similarly, populations that disproportionately suffer from disasters like Hurricane Katrina share a common experience that if viewed individually simply fails to capture how collective harm requires a different approach than an individual one.
Second, trauma-informed care requires that we treat trauma in people but provides very little insight into how we might address the root causes of trauma in neighborhoods, families, and schools. If trauma is collectively experienced, this means that we also have to consider the environmental context that caused the harm in the first place. By only treating the individual we only address part of the equation leaving the toxic systems, policies and practices neatly intact.
Third, the term trauma-informed care runs the risk of focusing on the treatment of pathology (trauma), rather than fostering the possibility (well-being). This is not an indictment on well-meaning therapists and social workers many of whom may have been trained in theories and techniques designed to simply reduce negative emotions and behavior (Seligman 2011). However, just like the absence of disease doesn’t constitute health, nor the absence of violence constitute peace, the reduction pathology (anxiety, anger, fear, sadness, distrust, triggers) doesn’t constitute well-being (hope, happiness, imagination, aspirations, trust). Everyone wants to be happy, not just have less misery. The emerging field of positive psychology offers insight into the limits of only “treating” symptoms and focuses on enhancing the conditions that contribute to well-being. Without more careful consideration, trauma informed approaches sometimes slip into rigid medical models of care that are steeped in treating the symptoms, rather than strengthening the roots of well-being.
What is needed is an approach that allows practitioners to approach trauma with a fresh lens that promotes a holistic view of healing from traumatic experiences and environments. One approach is called healing-centered, as opposed to trauma-informed. A healing centered approach is holistic involving culture, spirituality, civic action and collective healing. A healing-centered approach views trauma not simply as an individual isolated experience, but rather highlights the ways in which trauma and healing are experienced collectively. The term healing-centered engagement expands how we think about responses to trauma and offers more holistic approach to fostering well-being.
The Promise of Healing Centered Engagement
A shift from trauma informed care to healing centered engagement (HCE) is more than a semantic play with words, but rather a tectonic shift in how we view trauma, its causes and its intervention. HCE is strength based, advances a collective view of healing, and re-centers culture as a central feature in well-being. Researchers have pointed out the ways in which patients have redefined the terms used to describe their illnesses in ways that affirmed, humanized and dignified their condition. For example, in the early 1990s AIDS activists challenged the term “gay-related immune deficiency” because the term stigmatized gay men and failed to adequately capture the medical accuracy of the condition. In a similar way, the young men I worked with offered me a way to reframe trauma with language that humanized them, and holistically captured their life experiences.
A healing centered approach to addressing trauma requires a different question that moves beyond “what happened to you” to “what’s right with you” and views those exposed to trauma as agents in the creation of their own well-being rather than victims of traumatic events. Healing centered engagement is akin to the South African term “Ubuntu” meaning that humanness is found through our interdependence, collective engagement and service to others. Additionally, healing centered engagement offers an asset driven approach aimed at the holistic restoration of young peoples’ well-being. The healing centered approach comes from the idea that people are not harmed in a vacuum, and well-being comes from participating in transforming the root causes of the harm within institutions. Healing centered engagement also advances the move to “strengths-based’ care and away from the deficit based mental health models that drives therapeutic interventions. There are four key elements of healing centered engagement that may at times overlap with current trauma informed practices but offers several key distinctions.
· Healing centered engagement is explicitly political, rather than clinical.
Communities, and individuals who experience trauma are agents in restoring their own well-being. This subtle shift suggests that healing from trauma is found in an awareness and actions that address the conditions that created the trauma in the first place. Researchers have found that well-being is a function of the control and power young people have in their schools and communities (Morsillo & Prilleltensky 2007; Prilleltensky & Prilleltensky 2006). These studies focus on concepts such as such as liberation, emancipation, oppression, and social justice among activist groups and suggests that building an awareness of justice and inequality, combined with social action such as protests, community organizing, and/or school walk-outs contribute to overall wellbeing, hopefulness, and optimism (Potts 2003; Prilleltensky 2003, 2008). This means that healing centered engagement views trauma and well-being as function of the environments where people live, work and play. When people advocate for policies and opportunities that address causes of trauma, such as lack of access to mental health, these activities contribute to a sense of purpose, power and control over life situations. All of these are ingredients necessary to restore well-being and healing.
· Healing centered engagement is culturally grounded and views healing as the restoration of identity.
The pathway to restoring well-being among young people who experience trauma can be found in culture and identity. Healing centered engagement uses culture as a way to ground young people in a solid sense of meaning, self-perception, and purpose. This process highlights the intersectional nature of identity and highlights the ways in which culture offers a shared experience, community and sense of belonging. Healing is experienced collectively, and is shaped by shared identity such as race, gender, or sexual orientation. Healing centered engagement is the result of building a healthy identity, and a sense of belonging. For youth of color, these forms of healing can be rooted in culture and serves as an anchor to connect young people to a shared racial and ethnic identity that is both historical grounded and contemporarily relevant. Healing centered engagement embraces a holistic view of well-being that includes spiritual domains of health. This goes beyond viewing healing only from the lens of mental health, and incorporates culturally grounded rituals, and activities to restore well-being (Martinez 2001). Some examples of healing centered engagement can be found in healing circles rooted in indigenous culture where young people share their stories about healing and learn about their connection to their ancestors and traditions, or drumming circles rooted in African cultural principles.
· Healing centered engagement is asset driven and focuses well-being we want, rather than symptoms we want to suppress.
Healing centered engagement offers an important departure from solely viewing young people through the lens of harm and focuses on asset driven strategies that highlight possibilities for well-being. An asset driven strategy acknowledges that young people are much more than the worst thing that happened to them, and builds upon their experiences, knowledge, skills and curiosity as positive traits to be enhanced. While it is important to acknowledge trauma and its influence on young people’s mental health, healing centered strategies move one step beyond by focusing on what we want to achieve, rather than merely treating emotional and behavioral symptoms of trauma. This is a salutogenic approach focusing on how to foster and sustain well-being. Based in positive psychology, healing centered engagement is based in collective strengths and possibility which offers a departure from conventional psychopathology which focuses on clinical treatment of illness.
· Healing centered engagement supports adult providers with their own healing.
Adult providers need healing too! Healing centered engagement requires that we consider how to support adult providers in sustaining their own healing and well-being. We cannot presume that adulthood is a final, “trauma-free” destination. Much of our training and practice is directed at young peoples’ healing but rarely focuses on the healing that is required of adults to be an effective youth practitioner. Healing is an ongoing process that we all need, not just young people who experience trauma. The well-being of the adult youth worker is also a critical factor in supporting young peoples’ well-being. While we are learning more about the causes and effects of secondary on adults, we know very little about the systems of support required to restore and sustain well-being for adults. Healing centered engagement has an explicit focus on restoring, and sustaining the adults who attempt to heal youth- a healing the healers approach. Policy stakeholders should consider how to build a systems that support adult youth worker’s well-being. I have supported organizations in creating structures like sabbaticals for employees or creating incentives like continuing education units for deeper learning about well-being and healing.
A Note for Practice and Policy
Marcus’s comments during our healing circle “I am more than what happened to me” led me to question our approach to trauma. What blind spots do we have in our approaches to supporting young people who experience trauma? How might the concepts which are enshrined in our language limit rather than create opportunities for healing? What approaches might offer “disruptive” techniques that saturate young people with opportunities for healing and well-being?
The fields of positive psychology and community psychology offers important insight into how policy makers, and youth development stakeholders can consider a range of healing centered options for young people. Shifting from trauma informed care or treatment to healing centered engagement requires youth development stakeholders to expand from a treatment-based model, which views trauma and harm as an isolated experience, to an engagement model which supports collective well-being. Here are a few notes to consider in building healing centered engagement.
· Start by building empathy
Healing centered engagement begins by building empathy with young people who experience trauma. This process takes time, is an ongoing process and sometimes may feel like taking two steps forward, and three steps back. However, building empathy is critical to healing centered engagement. To create this empathy, I encourage adult staff to share their story first, and take an emotional risk by being more vulnerable, honest, and open to young people. This process creates an empathy exchange between the adult, and the young people which is the foundation for healing centered engagement (Payne 2013). This process also strengthens emotional literacy which allows youth to discuss the complexity of their feelings. Fostering empathy allows for young people to feel safe sharing their experiences and emotions. The process ultimately restores their sense of well-being because they have the power name and respond to their emotional states.
· Encourage young people to dream and imagine!
An important ingredient in healing centered engagement is the ability to acknowledge the harm and injury, but not be defined by it. Perhaps one of the greatest tools available to us is the ability to see beyond the condition, event or situation that caused the trauma in the first place. Research shows that the ability to dream and imagine is an important factor in fostering hopefulness, and optimism which both of which contributes to overall well-being (Snyder et al. 2003). Daily survival and ongoing crisis management in young people’s lives can make it difficult for them to see beyond the present.
The greatest casualty of trauma is not only depression and emotional scares, but also the loss of the ability to dream and imagine another way of living. Howard Thurman pointed this out in his eloquent persistence that dreams matter. He commented, “As long as a man [woman] has a dream, he [she] cannot lose the significance of living” (p. 304). By creating activities and opportunities for young people to play, reimagine, design and envision their lives this process strengthens their future goal orientation (Snyder et al. 2003). These are practices of possibility that encourage young people to envision what they want to become, and who they want to be.
· Build critical reflection and take loving action.
Healing and well-being are fundamentally political not clinical. This means that we have to consider the ways in which the policies and practice and political decisions harm young people. Healing in this context also means that young people develop an analysis of these practices and policies that facilitated the trauma in the first place. Without an analysis of these issues, young people often internalize, and blame themselves for lack of confidence. Critical reflection provides a lens by which to filter, examine, and consider analytical and spiritual responses to trauma. By spiritual, I mean the ability to draw upon the power of culture, rituals and faith in order to consistently act from a place of humility, and love. These are not cognitive processes, but rather ethical, moral and emotional aspects of healing centered engagement.
The other key component, is taking loving action, by collectively responding to political decisions and practices that can exacerbate trauma. By taking action, (e.g. school walkouts, organizing peace march, or promoting access to healthy foods) it builds a sense of power and control over their lives. Research has demonstrated that building this sense of power and control among traumatized groups is perhaps one of the most significant features in restoring holistic well-being.
Concluding Remarks: The Future of Healing
I ran into Marcus at a street fair in Oakland not long ago. He was excited to see me and wanted to share with me that he was in a new relationship so he introduced me to his girlfriend. “This is my friend Michelle”! He introduced her with a sense of pride, and accomplishment. He also shared with me that he had enrolled in a program that was training him to become a medic. As we chatted for a while in the warm sun, dodging children, and fast walking parents, he leaned toward me and whispered, “yeah Dr. G, I’m not entirely healed, but I’m hopeful”. I smiled, gave him a “brotha hug” and we departed ways.
I suppose, that if we had more time to chat he would have explained that healing is a process that we navigate for a lifetime. He might have shared with me that the future of his healing journey had just begun. Seeing him again, holding hands, sipping a soda with his new girlfriend was a powerful reminder, that he was so much more than the trauma he had experienced. As practitioners, researchers and policy stakeholders we need to listen and learn from young people who have insights that can advance how we think about trauma and healing. Shifting to healing centered engagement offered new questions, and strategies about how to support young people who experience trauma. Healing centered engagement is just a step toward a more holistic, and humanistic framework to support young people who have been harmed. Such an approach encourages us to think and act more boldly about how to restore young people and create places where they can truly flourish.
Dr. Shawn Ginwright is Associate Professor of Education, and African American Studies at San Francisco State University and the author of Hope and Healing in Urban Education: How Activists are Reclaiming Matters of the Heart.
Learn more about becoming a Certified Healing Centered Engagement Practitioner here.
Bottiani, J. H., Bradshaw, C. P., & Mendelson, T. (2017). “A Multilevel Examination of Racial Disparities in High School Discipline: Black and White Adolescents’ Perceived Equity, School Belonging, and Adjustment Problems,”. Journal of Educational Psychology, 109(4), 532–545.
Martinez, M. E. (2001). “The Process of Knowing: A Biocognitive Epistemology”. The Journal of Mind and Behavior, 22(4), 407–426.
Morsillo, J., & Prilleltensky, I. (2007). “Social Action With Youth: Iinterventions, Evauation, and Psychopolitical Validity”. Journal of Community Psychology, 35(6), 725–740.
Potts, R. (2003). “Emancipatory Education Versus School-Based Prevention in African American Communities”. American Journal of Community Psychology, 31(1/2), 173–183.
Prilleltensky, I. (2003). “Understanding, Resisting, and Overcoming Oppression: Toward Psychopolitical Validity”. American Journal of Community Psychology, 31(1/2), 195.
Prilleltensky, I. (2008). “The Role of Power in Wellness, Oppression and Liberation: The Promise of Psychopolitical Validity”. Journal of Community Psychology, 36(2), 116–136.
Prilleltensky, I., & Prilleltensky, O. (2006). Promoting well-being : linking personal, organizational, and community change. Hoboken, N.J.: John Wiley.
Seligman, M. E. P. (2011). Flourish : a visionary new understanding of happiness and well-being (1st Free Press hardcover ed.). New York: Free Press.
Sinha, J. W., & Rosenberg, L. B. (2013). “A Critical Review of Trauma Interventions and Religion Among Youth Exposed to Community Violence”. Journal of Social Service Research, 39(4), 436–454. doi: 10.1080/01488376.2012.730907
Snyder, C. R., Shane, J. L., Hal, S. S., Kevin, L. R., & David, B. F. (2003). “Hope Theory, Measurements, and Applications to School Psychology”. School Psychology Quarterly, 18(2), 122–139.


Hi, I'm Heather, a Registered Dietitian living in Vancouver, BC. As a dietitian, I love all things food - eating, cooking, experimenting, sharing. I really believe that good nutrition is an investment in your future: You might not see the benefits right away but in the long run it's worth every penny. Think of nutrition like a good insurance policy. That being said, I'm a firm believer in the 80-20 rule... enjoyment is important and I love my wine and chocolate!
I am a serious nerd when it comes to nutrition and exercise - I can chat about these topics all day, and I often do - it makes me that excited! Two of my happy places are in the kitchen and in the gym. The gym is like my meditation... my place to turn my brain off and live in the physical. My kitchen is my way of being creative - I wasn't blessed with other artistic skills (my friends can attest to this), but creating and adapting recipes does the trick. When I'm not working or learning, I enjoy adventuring. My favourite places in the world are on top of any mountain, or being snuggled inside by a fire.
I also love spending time in my mom's kitchen (much nicer than mine) and my dad's garden (shown below). My parents have been a huge influence on my path in life, and for that I am grateful. They have always been strong role models for living a healthy lifestyle, and encouraged the importance of exercise and nutrition right from when I was young. Not only that, but they always encouraged me to shoot for the stars. They even listen to my advice sometimes and let me test my recipes on them.
Before I became a dietitian I completed a degree in exercise and health physiology - partly because I love learning about how the human body works, and partly because I wanted to learn how to help people become healthier or stay healthy before they get sick!
I know nutrition and exercise aren't the only pieces of the puzzle, but they are two very important pieces. I believe that everyone deserves a chance to enjoy the healthiest life possible for them, and I want to help people get there. Being proactive about your health is so important. Yes, genetics play a role, but we live in a society where more and more people have diseases caused by poor lifestyle choices each year. Sadly, so many of us take our health for granted and wait until we are sick to think about it - don't be one of those people! Find things in life that you love that also love you back in the long-term benefit kind of way.
As a dietitian I spend a lot of my time reviewing blood work, medications, supplements, food intake and medical histories. Most importantly I spend time talking with clients - to understand where they're at, how they got there, and where they want to be. Then I get to translate all this nutrition stuff into food! Together, we come up with a specific nutrition plan to meet their individual medical and dietary needs.
I love what I do, but I also love my life outside of work. When I'm not working you'll find me on an outdoor adventure, playing in my kitchen, or enjoying a good conversation with friends over a glass of wine or a cup of coffee. Nothing beats the feeling of being on top of a mountain or laughing so hard my abs hurt. I will spend my life finding things that bring me purpose and joy, and I hope this blog will be one of them!
You might be wondering - what's the difference between a Registered Dietitian and Nutritionist (Holistic or other)? While you might hear some dietitians call themselves nutritionists, not all nutritionists can call themselves dietitians. "Nutritionist" is an unregulated term in Canada and in the US, meaning anyone can call themselves a "Nutritionist." A nutritionist may have very little education, and their 'designation' is not regulated by any governing body. Nutritionists can't work in hospitals and aren't clinically trained to treat patients with acute or chronic diseases. A Registered Dietitian is a licensed professional required to hold at minimum a 4 year bachelor's degree from a government-accredited University. In addition to their university education, they are also required to complete a 1 year post-graduate internship as well as passing a national board licensing exam to become licensed. They are regulated by a governing body and held to strict standards of practice just as other designated professionals are (doctors, nurses, lawyers, physiotherapists). Read more.


UV-C applications in a variety of areas
UV-C technology is used for disinfecting water and air in an environmentally friendly and safe way. So it can also be used in a variety of areas in both the recreational and industrial markets. VGE B.V. develops and manufactures UV-C equipment and filters that can be used in these sectors. Below we give a list of the various UV-C applications in the fields of water disinfection and filtration.
Swimming pool: UV-C equipment
UV-C technology is an environmentally friendly and safe way of disinfecting pool water. It protects swimmers against pathogens such as moulds, viruses and bacteria. As a result, the use of chlorine and other chemicals can be kept to a minimum. UV-C also breaks down chloramines. This gets rid of the unpleasant odour of chlorine and helps prevent physical symptoms such as red eyes and irritation of the skin and airways.Read more
Pond: UV-C disinfection and filters
By combining our passion for safe, healthy and clear pond water with top-notch knowledge of technology, we have for years made leading UV-C and filter equipment for the (koi) pond market. These products are marketed under the brand name Xclear. Xclear UV-C units and filters provide a healthy, clear pond without the use of chemicals.Read more
Industry: water disinfection
UV-C radiation is ideal for killing harmful bacteria, moulds and other dangerous micro-organisms in water. We therefore find UV-C equipment in the treatment of drinking water and wastewater and in the food industry.


Data from ALLHAT which led to the discontinuation of the doxazosin-treatment arm of the study indicated that users of doxazosin had 25% more cardiovascular events and were twice as likely to be hospitalized for congestive heart failure compared to users of chlorthalidone. However, these two drugs were found to be similarly effective in preventing heart attacks and in reducing the risk of death from all causes. Multum Information Services, Inc. Opdivo can cause certain side effects by changing the way your immune system works. These side effects can cause symptoms in many different parts of your body. Some side effects may need to be treated with other medicine, and your cancer treatments may be delayed or stopped altogether. cheap atopica 50 mg
Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of doxazosin in children with use in other age groups. Therapeutic Equivalence-Related Terms, Pharmaceutical Equivalents generally will be coded AB if a study is submitted demonstrating bioequivalence. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown.
Some medicines called "alpha-blockers" are used to treat high blood pressure. Cardura XL is not for the treatment of high blood pressure. Cardura is a prescription medicine that contains doxazosin mesylate and is called an "alpha-blocker". Your doctor may need to adjust your medications to minimize this risk. If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Doxazosin the active ingredient contained in Cardura is generally well-tolerated. Side effects are usually mild to moderate in intensity and may resolve with continued therapy.
Sashida, Y. Steroidal saponins from the underground parts of Ruscus aculeatus and their cytostatic activity on HL-60 cells. Additionally, TRUVEN HEALTH MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Truven Health does not assume any responsibility or risk for your use of the Truven Health products. The petition claimed that Pfizer has refused to publicize the drug's dangers in order to protect its profits.
Severe allergic reactions rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; chest pain; fainting; irregular heartbeat; prolonged, painful erection; severe or prolonged dizziness or headache; shortness of breath; swelling of the ankles, feet, or hands; vision changes. Doxazosin is a prescription drug indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes, including this drug. The information on this page is not a substitute for the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that a drug or drug combination is safe, effective or appropriate for any given patient. Drugs. Remember that your doctor has prescribed this because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication not have serious side effects. Fulton B, Wagstaff J, Sorkin EM "Doxazosin: an update of its clinical pharmacology and therapeutic applications in hypertension and benign prostatic hyperplasia. Before you start treatment, your doctor will perform tests to make sure nivolumab is the best treatment for your type of cancer. It is not known if doxazosin is excreted in human breast milk. Use of Cardura XL in nursing mothers is not recommended. If you suspect may be worsening urinary leakage or even causing it, let your doctor know about all the medicines you take, both prescription and over-the-counter. That way, your doctor can help determine whether these medicines should be adjusted or stopped, or if a treatment should be modified. In this study, the only study in which weekly evaluations were made, significant improvement with CARDURA vs. placebo was seen after one week. You should see a benefit from this drug within 1 to 2 weeks. Tell your doctor if your condition does not improve or if it worsens for example, your remain high or increase, or your symptoms worsen. Cardura is indicated for the treatment of the signs and symptoms of BPH. According to the petition, "An enhanced risk of due to the misinformed use of Cardura as a 'first-line' treatment is not tolerable where there are cheaper, more effective treatments or combinations of drugs that may be used and the adverse consequences are potentially critical.
There have been rare reports of symptoms of blockage in the digestive tract in patients with prior history of narrowing or blockage of the digestive tract. It is not known if Cardura XL is safe and effective in children. Doxazosin mesylate works on a specific type of muscle found in the prostate, causing it to relax. This in turn decreases the pressure within the prostate, thus improving the wflow of urine and your symptoms. Do not stop taking any medications without consulting your healthcare provider. National Foundation. You can also develop a relaxing ritual, such as reading a book or listening to soothing music. Patients treated with doxazosin during the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial ALLHAT had a greater likelihood of developing congestive heart failure. Your doctor will not prescribe the extended-release tablet form of this medicine for high blood pressure. It can only be used in men for benign enlargement of the prostate. IFIS. IFIS can happen during eye surgery to people who are taking or have taken alpha-blockers such as Cardura XL. If you have an eye surgery for a clouding of the eye cataract planned, tell your eye doctor that you are using Cardura XL or have taken an alpha-blocker before. The most likely manifestation of overdosage would be hypotension, for which the usual treatment would be intravenous infusion of fluid. As doxazosin is highly protein bound, dialysis would not be indicated. The sheer size of the study adds to the NHLBI's recommendations, which just relate to effectiveness. Kaplan SA, Soldo KA, Olsson CA "Effect of dosing regimen on efficacy and safety of doxazosin in normotensive men with symptomatic prostatism: a pilot study. Before you start taking doxazosin mesylate. This may not be a complete list of all interactions that may occur. Ask your health care provider if Cardura XL extended-release tablets may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine. According to a new study, an alpha-blocker drug, called Cardura, is less effective for treating high blood pressure than the diuretic chlorthalidone, and Cardura does not protect patients from developing heart failure as well as the diuretic. Food Effect: As illustrated in Figure 1, the plasma C max and AUC were approximately 32% and 18% higher, respectively, after Cardura XL was administered in the fed state compared with the fasted state. Bringing up the topic of urinary incontinence with your doctor or your spouse is never easy; most people are at least a bit embarrassed. But open communication can help you find out about the causes of incontinence and whether your medications may be contributing. salbutamol
If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease. No in vivo drug-drug interaction studies have been performed to assess the effect of concomitant medications on the pharmacokinetics of Cardura XL or to assess the effect of Cardura XL on the pharmacokinetics of other drugs. In vitro studies suggest that doxazosin is a substrate of CYP 3A4. Cardura, is common but can also be serious. This may cause you to faint, or to feel dizzy or lightheaded. Your risk of having this problem may be increased if you take Cardura with certain other medicines that lower blood pressure including PDE-5 inhibitors. Your healthcare provider may monitor your blood pressure while you take Cardura. Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health and perhaps your life at risk. Opdivo is usually given once every 2 to 3 weeks. Your doctor will determine how long to treat you with this medicine. And it said that the higher rate of with Cardura patients didn't indicate that Cardura caused heart failure, but simply that the diuretic had a beneficial effect on cardiac events. Troffa C, Manunta P, Dessifulgheri P, Pazzola A, Sabino G, Patteri G, Tonolo G, Pupita G, Glorioso N, Gitti M, Rappelli A "Efficacy and tolerability of doxazosin alone or in combination with chlorthalidone in essential hypertension. CARDURA is indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes, including this drug. Swallow Cardura XL extended-release tablets whole. Do not break, crush, or chew before swallowing. minti.info losartan
Evans M, Perera PW, Donoghue J "Drug induced psychosis with doxazosin. The pharmacokinetics of Cardura XL is different from that of doxazosin IR. Cardura XL provides a controlled release of doxazosin over a 24-hour period. Store at room temperature between 59-86 degrees F 15-30 degrees C away from light and moisture. not store in the bathroom. Keep all medicines away from children and pets. You may notice the tablet shell in your stool. This is normal and not a cause for concern. As with any other non-deformable material, caution should be used when administering Cardura XL to patients with preexisting severe gastrointestinal narrowing pathologic or iatrogenic. There have been rare reports of obstructive symptoms in patients with known strictures in association with the ingestion of another drug in this non-deformable extended release formulation. Markedly increased GI retention times, as may occur in patients with chronic constipation, can increase systemic exposure to doxazosin and thereby potentially increase adverse reactions. The incidence of adverse events has been ascertained from worldwide clinical trials in 965 BPH patients. Guarrera, P. M. Traditional phytotherapy in Central Italy Marche, Abruzzo, and Latium. These highlights do not include all the information needed to use VIAGRA safely and effectively. See full prescribing information for VIAGRA. It is not known if Cardura is safe and effective in children. Butcher's broom might speed up the nervous system, increase blood pressure, and make the heart beat fast. Stimulant medications can also speed up the nervous system, increase blood pressure, and make the heart beat fast. Taking butcher's broom with stimulant medications might cause too much stimulation. This might make the blood pressure go too high or the heart beat too fast. If you are also taking a drug to treat erectile dysfunction-ED or pulmonary hypertension such as sildenafil, tadalafil your blood pressure may get too low which can lead to dizziness or fainting. Your doctor may need to adjust your medications to minimize this risk. Your healthcare provider may have you checked for prostate cancer before you start taking and while you take CARDURA. In addition to the use of the medicine your doctor has prescribed, treatment for your high blood pressure may include weight control and care in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet. Langdon CG, Packard RS "Doxazosin in hypertension - results of a general practice study in 4809 patients. feldene discount at walmart
Cardura XL and possibly result in lower plasma concentrations. Rauwald, H. W. and Grunwidi, J. Rauwald HW, Grunwidi J. Ruscus aculeatus extract: unambiguous proof of the absorption of spirostanol glycosides in human plasma after oral administration. If you are switching from another form of doxazosin to this extended-release form, be sure to follow your doctor's instructions closely. What is doxazosin mesylate, and how does it work mechanism of action? Patients should inform their eye surgeon that they are taking doxazosin. To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. Doxazosin mesylate can cause a sudden drop in blood pressure after the VERY FIRST DOSE. If doxazosin mesylate is helping you, you should notice an effect within 1 to 2 weeks after you start your medication. Doxazosin mesylate has been studied in over 900 patients for up to 2 years and the drug has been shown to continue to work during long-term treatment. Even though you take doxazosin mesylate and it may help you, doxazosin mesylate may not prevent the need for surgery in the future. Duration of therapy: Continue therapy until disease progresses or unacceptable toxicity occurs. If you have any questions about Cardura, please talk with your doctor, pharmacist, or other health care provider. Continue to take Cardura XL extended-release tablets even if you feel well. Do not miss any doses. In addition to delaying the worsening of the condition, Proscar and Cardura in combination relieved symptoms better than either drug alone.
As a result, the panel struggled to find a way to deal with the concerns over the drug's safety. Panel guest Marvin Konstam, MD, said, "There is something going on here. Dizziness; drowsiness; headache; heartburn; light-headedness; stomach upset; weakness. Disclaimer: The indications, uses and warnings for individual medications outside the USA are determined by local regulatory bodies in each country or region. The Drugs. The following adverse events have been identified during post-approval use of doxazosin. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. In March 2000, the NIH announced the suspension of a large-scale study of Cardura that it was funding with Pfizer. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. ED called a phosphodiesterase type 5 PDE-5 inhibitor. The use of Cardura with PDE-5 inhibitors can lead to a drop in blood pressure or to fainting. Older adults may be more sensitive to the side effects of this drug, especially drowsiness. In Egypt, tablet formulation sold as Duracin produced by Biopharm group for research and the drug industry, Dosin by Eipico and Doxazocine by Multi-Apex. The inactive ingredients for all tablets are: microcrystalline cellulose, lactose, sodium starch glycolate, magnesium stearate and sodium lauryl sulfate. Your blood pressure should be checked when you start taking doxazosin mesylate even if you do not have high blood pressure hypertension. Your doctor will discuss with you the details of how blood pressure is measured. Before prescribing Cardura XL, your healthcare provider may examine your prostate gland and do a blood test called a prostate specific antigen PSA test to check for prostate cancer. Prostate cancer and BPH can cause the same symptoms. Prostate cancer needs a different treatment. Do not start, stop, or change the dosage of any medicines without your doctor's approval. lioresal pills price
Once you learn how to do correctly ask your or internist for help you can do them nearly anytime -- even while driving a car or watching TV or sitting at your desk. The following adverse reactions have been identified during post-approval use of CARDURA. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. The panel, the FDA's Cardiovascular and Renal Drugs Advisory Committee, voted against recommending that any cautionary message should go to patients. Bioavailability is approximately 65%, reflecting first-pass metabolism of doxazosin by the liver. The effect of food on the pharmacokinetics of Cardura was examined in a crossover study with twelve hypertensive subjects. Reductions of 18% in mean maximum plasma concentration C max and 12% in the area under the concentration-time curve AUC occurred when Cardura was administered with food. Neither of these differences is clinically significant. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval. In one placebo-controlled trial in normal volunteers, the administration of a single 1 mg dose of doxazosin IR on day 1 of a four day regimen of cimetidine 400 mg twice daily resulted in a 10% increase in the mean AUC of doxazosin, a 6% increase in mean C max of doxazosin, and no significant change in mean half-life of doxazosin. Based upon the differences in dose and formulation, the applicability of these results to Cardura XL is unknown. Otherwise, the interaction potential with other inhibitors or substrates of CYP enzymes has not been determined. Pharmacodynamic interactions between Cardura XL and anti-hypertensive medications or other vasodilating agents have also not been determined. Other parts of the NIH blood pressure drug trial are still under way, but the FDA doesn't have access to data that the expert panel said was crucial in trying to craft any cautions on the drug. The trial isn't scheduled to conclude until next March. Marcelon, G. Effects of Ruscus extract on the internal diameter of arterioles and venules of the hamster cheek pouch microcirculation. J Cardiovasc. Your doctor may increase your dose slowly to as much as 16 mg once a day. atorvastatin online finland
Signs of low blood pressure include fainting, dizziness, and lightheadedness. FDA product labels and may differ in countries outside the USA. Every effort has been made to ensure that the information provided on this page is accurate, up-to-date and complete, but no guarantee is made to that effect. Drugs. Vanscheidt W, Jost V, Wolna P, et al. Efficacy and safety of a Butcher's broom preparation Ruscus aculeatus L. extract compared to placebo in patients suffering from chronic venous insufficiency. Cardura XL doxazosin mesylate extended release tablets is available as 4 mg white, imprinted with CXL 4 and 8 mg white, imprinted with CXL 8 tablets. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. not stop any for your unless told to do so by your doctor. Stopping your medications could allow the to spread more rapidly. Do not use Opdivo if you are pregnant. It could harm the unborn baby. Use effective birth control to prevent pregnancy while you are using this medicine and for at least 5 months after your last dose. Cardura. However, infrequently, symptomatic postural hypotension has also been reported later than a few hours after dosing. As with other alpha-blockers, there is a potential for syncope, especially after the initial dose or after an increase in dosage strength. Advise patient how to avoid symptoms resulting from postural hypotension and what measures to take should they develop. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Diuretics decrease blood pressure by increasing urination. Cardura XL is used to treat the symptoms of benign prostatic hyperplasia BPH. Cardura XL may help to relax the muscles in the prostate and the bladder which may lessen the symptoms of BPH and improve urine flow. Doxazosin is available only with your doctor's prescription. flomax
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Improving venous tone and capillary sealing. TLC Analyses of Major Saponins from Ruscus aculeatus. Like other alpha 1-adrenergic blocking agents, doxazosin has a greater effect on blood pressure and heart rate in the standing position. acnotin
What Is Doxazosin and How Does It Work? What are the possible side effects of doxazosin Cardura, Cardura XL? These drugs often are used in combination with other drugs to treat when first-line medicines alone do not control blood pressure. They might be used if a person is in a hypertensive crisis. Messerli FH "Implications of discontinuation of doxazosin arm of ALLHAT. In these two studies, the cumulative incidence of hypotension appeared to be age related. atarax online pills
Less common side effects include drowsiness. If any of these effects persist or worsen, tell your doctor or promptly. Intraoperative Floppy Iris Syndrome IFIS has been observed during cataract surgery in some patients on or previously treated with alpha 1 blockers. This variant of small pupil syndrome is characterized by the combination of a flaccid iris that billows in response to intraoperative irrigation currents, progressive intraoperative miosis despite preoperative dilation with standard mydriatic drugs, and potential prolapse of the iris toward the phacoemulsification incisions. The patient's surgeon should be prepared for possible modifications to their surgical technique, such as the utilization of iris hooks, iris dilator rings, or viscoelastic substances. There does not appear to be a benefit of stopping alpha 1 blocker therapy prior to cataract surgery.
Read the Patient Information Leaflet if available from your before you start taking and each time you get a refill. If you have any questions, ask your doctor or pharmacist. Scott PJ, Hosie J, Scott MG "A double-blind and cross-over comparison of once daily doxazosin and placebo with steady-state pharmacokinetics in elderly hypertensive patients. What are the possible side effects of CARDURA?


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Somatic Experiencingwas developed by Dr. Peter Levine especially for re-negotiating and healing the after-affects of traumatic events. It is also a profound way of working through deep conditioned patterns that may have been necessary for survival at one time but are now inhibiting aspects of your life such as your health, happiness, joy, relationships, and fulfillment. Direct work with mindful attention to the body brings the nervous system back into regulation, positively affecting mood, confidence, and the capacity to meet life’s current challenges with dynamic presence and resilience.
Somatic Experiencing is a widely respected, innovative, body-centered approach to emotional healing & trauma resolution developed by Dr. Peter Levine, based upon over 35 years of research and study into stress and trauma. SE is a unique approach, which draws upon the latest scientific research of how our triune autonomic nervous system mobilizes to respond to threat. SE is modeled off of animals in the wild, who engage innate, instinctive, physiological processes to discharge the massive fight, flight, and freeze energies associated with survival. As a result wild animals are rarely traumatized, even though their lives are routinely threatened.
Although humans have virtually the same innate self-regulating mechanisms as animals, we often override or inhibit these processes thwarting our own capacity to heal and recover from trauma. When we fail to discharge the high levels of arousal associated with survival these massive energies stay trapped in our neuromuscular and central nervous systems and wreak havok on our bodies and minds. It is this trapped energy that develops into a whole constellation of post-traumatic symptoms including pain, anxiety, anger, depression, intrusive thoughts and imagery, physical illness, and cognitive impairments. Somatic Experiencing provides the steps needed to reconnect people with the innate wisdom of their bodies. Through focused conscious awareness of bodily sensations clients are able to access these restorative physiological patterns, resolve their traumatic symptoms, and re-engage in life with renewed optimism, vitality, creativity, resilience, and joy. Somatic Experiencing is an integrative mind-body approach to dealing with stress, anxiety and trauma issues. It utilizes somatic awareness and mindfulness as a primary orientation.
Somatic Experiencing (SE) is different from other therapeutic modalities in that it engages focused awareness of bodily sensations to engage innate self-regulation and healing. SE is not talk therapy. SE helps the individual develop body awareness to "renegotiate" and heal trauma rather than relive or re-enact trauma. It does this by titrating traumatic material with highly resourced states while maintaining awareness of the bodily "felt sense," and allowing time and space for the highly aroused survival energies to be safely experienced and gradually discharged. SE naturally builds greater and greater inner resiliency, self-regulation, and wellness.
The basic principles and concepts of Somatic Experiencing:
Titration - In Somatic Experiencing, slow is considered fast. When trauma occurs in our life, it comes at us at a pace that is too fast, too much, too soon. Trauma is an experience that overwhelms the normal capacity of our nervous system and we are unable to integrate the experience. Titration, is a concept in chemistry where one tiny drop of a volatile substance is added to another volatile substance, allowing time for the chemical reaction to take place and integrate into the whole before introducing another drop. If the two substances were combined without titration an explosive and volatile destabilizing reaction would take place. But if they are added in a slow and titrated way, much like we do in SE, we only get little reactions, and ones that the nervous system is able to integrate. (In chemistry, after hundreds of little titrations these two substances reach critical mass and transform into two inert or harmless substances). As the nervous system is given time and space to integrate each titration, healing occurs without re-traumatization and without further destabilization. In our culture and society we are accustomed to talk therapy and telling the story. However, when unresolved trauma is concerned, we often overwhelm the capacity of our nervous system again and again in the retelling, and our brain and physiology mobilizes to respond to these events that, although in the past, are still present in our body. Titration refers to the process of taking small steps and proceeding slowly to tap into this trapped arousal and provide enough time and space for these small titrations to be integrated, moving the nervous system closer and closer to critical mass, stabilization, transformation of the trauma into an inert substance. When the trauma occurred too much happened too fast and too intense. Slowing it down, taking breaks and stretching time are therefore important therapeutic tools to process trauma safely.
Resourcing - In Somatic Experiencing it is essential in working with Trauma to ground the person in resources, before navigating the traumatic terrain. SE focuses on developing and expanding the resource-repertoire of our clients in the safety of the therapeutic environment. Learning how to experience resources in our bodies enable us to work with trauma symptoms safely. Resource can be akin to grabbing on to a tree and getting to higher ground before unleashing floodgates of trauma, and titration can be akin opening the floodgates only a little at a time. Without a stable ground to hold onto, one can easily be swept away by the strong prevailing current of trauma and re-enactment. In Somatic Experiencing resources or conflict free states are grounded in the client's body as positive (or neutral) sensorimotor states. It is not just visual imagery, but rather visual kinesthetic sensory experience. It is not just thinking of a safe place, but experiencing the feeling of safety in the body now. When one has access to internal sensory experiences of inner strength, support, peace, love, connection with nature, determination, connection with friends, one has found an internal higher ground and one has more capacity to digest, heal and integrate the traumatic experience safely and gently.
Pendulation - The healthy nervous system is constantly in a state of expansion and contraction, called pendulation. We want our clients to have this kind of flexibility and fluidity. The SE practitioner assists clients to start pendulation. One of the tools used is looping between resources or conflict free states and small titrations of traumatic material. This process of looping kick starts the natural self-regulation of the nervous system and a natural rhythm of pendulation. Traumatized people often don't trust the pendulation when it begins to happen. When the energy starts to release or change they often cognitively judge the process, or perceive the contraction in the body as an internal threat, and the client goes into increased arousal (or fear) over the process. By assisting the client to understand the natural physiological processes of the body and to observe these processes with curiosity rather than fear, the nervous system is able to click into self-regulation and begin digesting and discharging traumatic energy from the body. An SE session generally begins with establishing a resourceful, positive state, then it carefully approaches the outermost edges of the traumatic experience. Once the client begins to gently touch into difficult events or feelings the practitioner helps make sure that he/she/they only takes small "bites" of this material as the nervous system can handle and supports the naturally occurring return of pendulation within the body. SE practitioners watch for physical signs indicating the release which may come in various forms such as small shivers, deep breaths, hot or cold flashes. Then, it takes time for the client to reorient to the present, the here and now, and resources or conflict free states. This natural rhythm and flow is self-regulation of our nervous system as it digests traumatic material in the body, and it is important to allow sufficient time to establish a positive connection in the here and now before entering another movement into the traumatic state.
Common benefits of Somatic Experiencing and resolution of trauma:
- Reduce/alleviate chronic physical pain and recurring tension.
- Transforms negative, abusive, and overwhelming experiences, (even if they occurred many, many years ago.)
- Become more present and engaged in life.
- Increase resilience to future stressors.
- Restore sense of optimism and hope.
- Increase confidence/sense of personal empowerment.
- Feel more integrated, coherent, and whole.
- Develop greater sense of clarity and purpose.
- Foster natural spiritual connectedness.
- Increase ability to focus and concentrate.
- Greater sense of peace, ease and calm (in both your body and your life.


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