By: Dirk B. Robertson MD
To meet the need discount 300mg wellbutrin amex anxiety 5 htp, she plans a manageable task: finding and reading one L2 article per week on chemistry until she develops a rapid reading rate and is able to identify and understand published research findings. In addition, she could use strategies such as skimming for the main points, reading carefully for supporting details, keeping a notebook for L2 scientific vocabulary, using the dictionary to look up difficult words, guessing the meaning of words from the context, and making a written outline or summary if needed. The well-orchestrated set of strategies used by Divna might be called a strategy chain, i. Positive Outcomes from Strategy Use In subject areas outside of L2 learning, the use of learning strategies is demonstrably related to student achievement and proficiency (Pressley & Associates, 1990). Research has repeatedly shown this relationship in content fields ranging from physics to reading and from social studies to science. In light of this remarkable association between learning strategy use and positive learning outcomes, it is not surprising that students who frequently employ learning strategies enjoy a high level of self-efficacy, i. In the L2 arena, early studies of so-called?goodlanguagelearners?(Naiman,Frohlich, Stern, & Todesco, 1975; Rubin, 1975) determined that such learners consistently used certain types of learning strategies, such as guessing meaning from the context. Those studies found that less able learners used strategies in a random, unconnected, and uncontrolled manner (Abraham & Vann, 1987; Chamot et al. In a study of learners of English in Puerto Rico, more successful students used strategies for active involvement more frequently than did less successful learners, according to Green and Oxford (1995). The same researchers also commented that the number and type of learning strategies differed according to whether the learner was in a foreign language environment or a second language setting. In their review of the research literature, Green and Oxford discovered that second language learners generally employed more strategies (with a higher frequency) than did foreign language learners. Strategy Instruction Research To increase L2 proficiency, some researchers and teachers have provided instruction that helped students learn how to use more relevant and more powerful learning strategies. The most effective strategy instruction appears to include demonstrating when a given strategy might be useful, as well as how to use and evaluate it, and how to transfer it to other related tasks and situations. Six Main Categories of L2 Learning Strategies Six major groups of L2 learning strategies have been identified by Oxford (1990). Cognitive strategies enable the learner to manipulate the language material in direct ways. Cognitive strategies were significantly related to L2 proficiency in studies by Kato (1996), Ku (1995), Oxford and Ehrman (1995), Oxford, Judd, and Giesen (1998), and Park (1994), among others. The other two studies involved the learning of Kanji by native English speakers (Kato, 1996) and the learning of various foreign languages by native English speakers (Oxford & Ehrman, 1995). Among native English speakers learning foreign languages, Purpura (1999) found that metacognitive strategies had "a significant, positive, direct effect on cognitive strategy use, providing clear evidence that metacognitive strategy use has an executive function over cognitive strategy use in task completion" (p. Memory-related strategies help learners link one L2 item or concept with another but do not necessarily involve deep understanding. Various memory-related strategies enable learners to learn and retrieve information in an orderly string.
Every attempt should be made to 300mg wellbutrin otc depression symptoms irritability preserve as long a length of the hilar structures as possible and to avoid de-vascularising the extra hepatic common duct. The ducts should not be ligated as this results in loss of length and possible ischaemia of the duct ends. The bleeding from cut ends of the ducts can be temporarily controlled with a small vascular clamp placed along the transected ducts or with fine sutures of 6. The cystic duct is similarly preserved as an alternative option for reconstruction in the presence of more than one duct within the graft (7,8). The artery is controlled with a small vascular clamp such as Ackland or Yasargil on the proximal end with a clip applied distally before division. Alternatively, a portacaval shunt can be performed at this stage depending on the surgeon and unit preference. There is no clear evidence as to the superiority of routine portacaval shunt; however, it reduces portal pressure and avoid mesenteric venous congestion (6,9,11). Finally, the right hepatic vein and combined stump of the middle and left hepatic veins are clamped and divided. Recent data suggest that retrograde flushing of the hepatic artery can help to reduce post-transplant cholestasis. Hepatic artery perfusion is avoided to prevent unnecessary manipulation of the intima and damage (13,14,15). The hilar plate with small caudate ducts need suturing with fine sutures, either 6. Specific attention is required for all large (>5 mm) veins draining the right anterior sector (segments 5 and 8) and for the inferior right hepatic vein. The most common grafts used for reconstruction are cadaveric donor iliac vein, iliac artery and cryopreserved vessels. Left lobe grafts may be small for size and hence every attempt to improve venous outflow by a wide anastomosis will help postoperative graft function (17). It is important to avoid redundancy between the two veins, as this results in kinking after post hypertrophy rotation. Incorporating surrounding liver parenchyma in some of the suture bites may help to reduce the laxity and kinking. Inferior right hepatic vein reconstruction is performed at this stage when required. Implantation of the middle hepatic vein branches reconstructed onto a graft is usually performed at this stage, but often deferred to the post-reperfusion phase. The left or right portal vein of the graft is anastomosed to the main portal vein of the recipient with a growth factor. Occasionally, the right or left portal vein of the recipient is used for anastomosis with the corresponding vessel on the donor graft (16). If the pressure remains persistently above 20 mmHg despite splenic artery ligation, an interposition portacaval shunt should be considered (11).
Other studies conducted at the University of Rochester over a 20 year period have shown that the presence or absence of cancer n a patient can be predicted on the basis of the feelings of "hopelessness" which the person has toward life in general discount wellbutrin 300 mg on-line depression symptoms heart palpitations. Studies of this sort have led to the development of a recognized specialty in psychosomatic medicine. Doctors now realize that the attitudes of their patients are just as significant as the symptoms of their disease. Carl Simonton - in addition to treating cancer patients with conventional radiation, chemotherapy, and surgery - has also used relaxation and visualization techniques. Carl Simonton (courtesy Thinking Allowed Productions) the patient is asked to meditate regularly three times a day for 15 minutes in the morning upon arising, around noon, and at night before going to bed. In the meditation exercise, the first couple of minutes are used to go into a state of relaxation, then once the body is completely relaxed, the patient visualizes a peaceful scene from nature. These white cells then break down the malignant cells which are then flushed out of the body. Finally, just before the end of the meditation, the patient visualizes himself well. The patient is instructed in the general principles of the immune mechanism and is shown photographs of other patients whose visible cancers-such as on the skin and mouth are actually responding to the treatment, getting smaller and disappearing. In a study of 152 patients, Simonton found the greatest success with those who were the most optimistic and committed to full participation in the entire therapeutic process. Furthermore, these patients also showed fewer distressing side-effects to the radiation therapy. However, further research and longer follow up studies are necessary before the medical establishment can form a conclusive judgement on the radical possibility of using psychological treatment to cure organic disease. Omega Seminar Techniques As an Omega Seminar trainer, I myself have had the opportunity to function as a mental healer of sorts. Founded over thirty years ago by John Boyle, the Omega seminar teaches a number of powerful techniques for accomplishing goals - predicated upon the assumption that one can access the power of the superconscious mind through the use of positive affirmations. Another technique from the Omega Seminar has consistently worked like magic to alleviate long-term, chronic pain such as that resulting from athletic or automotive injuries. I find a volunteer who is experiencing pain and ask them to visualize the pain as being a certain color. Once they have identified a color and a fruit, I ask them to imagine that the pain is shrinking in size (to a fruit of a slightly smaller size). As the pain shrinks in size, I 105 keep asking them to tell me what color it is (the color generally changes with size). After the pain has been reduced to about the size of a raisin (which can take from five to ten minutes of concentrated visualization), I ask them to shrink it further to the size of a matchhead - and then to imagine that they are simply flicking it away from their body. Inevitably, when the exercize is finished the pain is gone - at least temporarily. While these Omega techniques are far from a wholistic approach to deep healing, they clearly demonstrate the power of suggestion in dealing with pain and the control which we can exert over our state of well-being on a moment to moment basis.
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