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Kenuvis Romero

Journal of Cerebral Blood Flow & Metabolism - Multiple Microvascular and Astroglial 5-H... - 0 views

www.nature.com/...9590586a.html

shared by Kenuvis Romero on 23 Jun 13 - No Cached
  • Physiologic and anatomic evidence suggest that 5-hydroxytryptamine (5-HT) neurons regulate local cerebral blood flow and blood-brain barrier permeability.
  • capillary endothelial cells exhibited mRNA for the h5-HT1D and for the 5-HT7 receptors whereas microvascular smooth muscle cells, in addition to h5-HT1D and 5-HT7, also showed polymerase chain reaction products for h5-HT1B receptors. Expression of 5-HT1F and 5-HT2A receptor mRNAs was never detected in any of the microvascular cell cultures. In contrast, messages for all 5-HT receptors tested were detected in human brain astrocytes with a predominance of the 5-HT2A and 5-HT7 subtypes. In all cultures, sumatriptan inhibited (35–58%, P < .05) the forskolin-stimulated production of cyclic AMP, an effect blocked by the 5-HT1B/1D receptor antagonists GR127935 and GR55562. In contrast, 5-carboxamidotryptamine induced strong increases (≥ 400%, P < .005) in basal cyclic AMP levels that were abolished by mesulergine, a nonselective 5-HT7 receptor antagonist. Only astroglial cells showed a ketanserin-sensitive increase (177%, P < .05) in IP3 formation when exposed to 5-HT. These results show that specific populations of functional 5-HT receptors are differentially distributed within the various cellular compartments of the human cortical microvascular bed, and that human brain astroglial cells are endowed with multiple 5-HT receptors. These findings emphasize the complex interactions between brain serotonergic pathways and non-neuronal cells within the CNS and, further, they raise the possibility that some of these receptors may be activated by antimigraine compounds such as brain penetrant triptan derivatives.
Randy Yerrick

TEDxYouth@ValVerde - Michael Horton - Science Misconceptions - YouTube - 16 views

www.youtube.com/watch

LAI532F16

shared by Randy Yerrick on 26 Sep 16 - No Cached
  • Randy Yerrick on 26 Sep 16
     
    Michael Horton discusses many common science misconceptions that students often ask.  I think it is interesting he mentioned people at a higher level believing we have blue blood because of the way it is drawn in textbooks. 
Gwen Buck

That's a Fact - 2 views

vimeopro.com/...44961385

science facts Bible resources

shared by Gwen Buck on 03 Jul 12 - No Cached
  • Gwen Buck on 03 Jul 12
     
    Paleontologists dig up all kinds of fossils, mostly just small bones or sea shells. But occasionally they discover unusual fossils, like squid with ink, lizards with skin, or even a T. Rex with blood!
Kenuvis Romero

Psilocybin (magic mushrooms) - 0 views

flipper.diff.org/...4384

shared by Kenuvis Romero on 23 Jun 13 - No Cached
  • The biosinthetic path that allow Psilocybin to be produced by mushrooms is as follow:
  • The several analogyes with triptophan aminoacid, with whom psilocybin has common origines are probably at the base of psilocybin ability to induced psychedelich alteration on humans.
  • Amino acids, including tryptophan, act as building blocks in protein biosynthesis. In addition, tryptophan functions as a biochemical precursor for many compounds like serotonin Serotonin (a neurotransmitter), synthesized via tryptophan hydroxylase. Serotonin, in turn, can be converted to melatonin (a neurohormone), via N-acetyltransferase and 5-hydroxyindole-O-methyltransferase activities
  • ...15 more annotations...
  • it's been noticed that psilocyn can indirectly raise dopamine concentration withing the basal ganglia.
  • Almost 50% of oral psilocybin is absorbed by stomach and gut; from here is lead to liver, where it's converted in psilocin, pharmacologically active form, that can furtherly be glucoronated and escreted with urine or converted in other psilocinics metabolites.
  • In rats, the median lethal dose (LD50) when administered orally is 280 milligrams per kilogram (mg/kg), approximately one and a half times that of caffeine. When administered intravenously in rabbits, psilocybin's LD50 is approximately 12.5 mg/kg
  • traces of the compund can be detected in unine even after 7 days.
  • Clinical studies show that psilocin concentrations in the plasma of adults average about 8 µg/liter within 2 hours after ingestion of a single 15 mg oral psilocybin dose; psychological effects occur with a blood plasma concentration of 4–6 µg/liter. Psilocybin is about 100 times less potent than LSD on a weight per weight basis, and the physiological effects last about half as long.
  • Within 24 hours from administration 65% of the alucinogen is escreted by urine, while another 15-20% is excreted by bile and feces.
  • Monoamine oxidase inhibitors (MAOI) have been known to prolong and enhance the effects of psilocybin. Alcohol consumption may enhance the effects of psilocybin, because acetaldehyde, one of the primary breakdown metabolites of consumed alcohol, reacts with biogenic amines present in the body to produce MAOIs related to tetrahydroisoquinoline and β-carboline. Tobacco smokers can also experience more powerful effects with psilocybin, because tobacco smoke exposure decreases levels of MAO in the brain and peripheral organs.
  • This could lead to a lower usage o f glucose, but the same study admitted an increase glucose usage by the whole brain cell, meaning a differente use of this sugar while the drug is having effects.
  • use of MRI (functional magnetic resounance) showed that the decresed blood flow associate with decreasing in neural activity. A simple explanation for this unexpected situation could be the serotoning agonist action of psilocybin, action that seems to be focused more on 5-HT receptors than on 5-HT2A.
  • psilocibyn is able to act as a 5-HT agonist binding directly its receptors.
  • augmented glucose consumption in several brain regions; this lead to the conclusion that psilocybin is some way able to modify the physiological glucosal metabolic rate of our body
  • The strong inibition of the PCC is now thought to be most significant action of psilocybin on neural disaccoppiation
    • Kenuvis Romero
      Kenuvis Romero on 23 Jun 13
       
      Lower brain glucose metabolism is linked with increased capacity for working memory.
  • Psilocybin comprises approximately 1% of the weight of Psilocybe cubensis mushrooms, and so nearly 1.7 kilograms (3.7 lb) of dried mushrooms, or 17 kilograms (37 lb) of fresh mushrooms, would be required for a 60-kilogram (130 lb) person to reach the 280 mg/kg LD50 value.
  • psilocybin can cause anxiety and increased heart rate and BP which is very counter- productive for someone on metoprolol and micardis.
  • propose the possibility to use psilocybin as a palliative therapy for terminal illness like cancer but also as a real antidepressive active principle available for the family of the patient. The rational is foundable in the fact that we usually administer SSRI as antidepressive agents, so psilocibyn sholud be useful in this purpose for its selective agonist action on 5-HT2A receptors
Kenuvis Romero

This is your brain on psilocybin… | The Scicurious Brain, Scientific American... - 0 views

blogs.scientificamerican.com/...is-is-your-brain-on-psilocybin

shared by Kenuvis Romero on 23 Jun 13 - No Cached
  • the authors cite a large body of literature characterizing 5-HT2a agonism resulting in pyramidal cell inhibition in cortical areas via excitation of GABAergic interneurons that synapse on pyramidal cells.
  • increased blood deoxygenation levels is concretely correlated with neuronal action-potentions; inhibition of neurons results in less APs and thus less blood flow. BOLD contrasts are the basis of fMRI studies–all of them would be invalidated if this were refuted.
Bill Kuykendall

Your Brain on Computers - Attached to Technology and Paying a Price - NYTimes.com - 55 views

www.nytimes.com/...07brain.html

shared by Bill Kuykendall on 08 Jun 10 - Cached
  • Scientists say juggling e-mail, phone calls and other incoming information can change how people think and behave. They say our ability to focus is being undermined by bursts of information. These play to a primitive impulse to respond to immediate opportunities and threats. The stimulation provokes excitement — a dopamine squirt — that researchers say can be addictive. In its absence, people feel bored.
  • “The technology is rewiring our brains,” said Nora Volkow, director of the National Institute of Drug Abuse and one of the world’s leading brain scientists. She and other researchers compare the lure of digital stimulation less to that of drugs and alcohol than to food and sex, which are essential but counterproductive in excess.
  • While many people say multitasking makes them more productive, research shows otherwise. Heavy multitaskers actually have more trouble focusing and shutting out irrelevant information, scientists say, and they experience more stress.
  • ...1 more annotation...
  • The nonstop interactivity is one of the most significant shifts ever in the human environment,
Holly Barlaam

University of Oklahoma Histology - 35 views

ouhsc.edu/histology

anatomy physiology histology tissue practicals body systems

shared by Holly Barlaam on 02 Oct 11 - No Cached
  • Holly Barlaam on 02 Oct 11
     
    In each topic, you will find a laboratory exercise, and brief description of the histological material. Includes cytology, epithelium, connective tissue, cartilage, bone and bone formation, blood, hematopoeisis, muscle, nervous tissue, cardiovascular system, lympathic and immune system, integument, upper GI, lower GI, liver, gallbladder, pancreas, respiratory system, urinary system, endocrine, male reproductive, female reproductive
Martin Burrett

Life After Exams - 7 views

ukedchat.com/...life-after-exams

ukedchat discussion exams behaviour management

shared by Martin Burrett on 10 May 18 - No Cached
  • Martin Burrett on 10 May 18
     
    "We are currently deep in the middle of exam season here in the UK, but the end is in sight. But what do you and your pupils do with this strange time after exams when so much of your time effort (blood and sweat). Do you revel in the limbo and become demob happy, or full throttle to the end of the year? In this session of #UKEdChat we discuss your plans and opinions to 'life after exams'."
Roland Gesthuizen

Hacktivities - 11 views

hivenyc.org/hacktivityGrid.html

technology icebreaker hacking

shared by Roland Gesthuizen on 30 Mar 13 - No Cached
  • An icebreaker is an activity that gets the blood pumping, forms connections between learners, and introduces a topic. There are thousands of different ways to introduce a topic and get learners interacting with each other.
  • A Diving In activity is one that gives pointed instruction to participants on tools or procedures.
  • A Hands on Hacking activity is a practical activity that allows learners to delve deeper into the essential questions of your session
  • Roland Gesthuizen on 30 Mar 13
     
    "This page lists all the Icebreaker, Diving In and Hands on Hacking Hacktivities found in the various Hacktivity Kits."
Holly Barlaam

Malaria Lifecycle Part 1: Human Host | Walter and Eliza Hall Institute of Medical Research - 50 views

www.wehi.edu.au/...ia_lifecycle_part_1_human_host

anatomy physiology biology science medical malaria mosquito host red blood cells immune disease

shared by Holly Barlaam on 03 Dec 11 - No Cached
  • Holly Barlaam on 03 Dec 11
     
    EXCELLENT video on malaria lifecycle showing how the parasite infects a human host
Jennie Snyder

Atul Gawande: How Do Good Ideas Spread? : The New Yorker - 36 views

www.newyorker.com/...130729fa_fact_gawande

Innovation

shared by Jennie Snyder on 01 Aug 13 - No Cached
  • Why do some innovations spread so swiftly and others so slowly
  • Consider the very different trajectories of surgical anesthesia and antiseptics, both of which were discovered in the nineteenth century.
  • The first public demonstration of anesthesia was in 1846.
  • ...18 more annotations...
  • nsisted that he had found a gas that could render patients insensible to the pain of surgery.
  • The idea spread like a contagion, travelling through letters, meetings, and periodicals. By mid-December, surgeons were administering ether to patients in Paris and London. By February, anesthesia had been used in almost all the capitals of Europe, and by June in most regions of the world.
  • On October 16, 1846, at Massachusetts General Hospital, Morton administered his gas through an inhaler in the mouth of a young man undergoing the excision of a tumor in his jaw.
  • Four weeks later, on November 18th, Bigelow published his report on the discovery of “insensibility produced by inhalation” in the Boston Medical and Surgical Journal.
  • There were forces of resistance, to be sure. Some people criticized anesthesia as a “needless luxury”; clergymen deplored its use to reduce pain during childbirth as a frustration of the Almighty’s designs.
  • Yet soon even the obstructors, “with a run, mounted behind—hurrahing and shouting with the best.” Within seven years, virtually every hospital in America and Britain had adopted the new discovery.
  • Sepsis—infection—was the other great scourge of surgery. It was the single biggest killer of surgical patients, claiming as many as half of those who underwent major operations
  • nfection was so prevalent that suppuration—the discharge of pus from a surgical wound—was thought to be a necessary part of healing.
  • In the eighteen-sixties, the Edinburgh surgeon Joseph Lister read a paper by Louis Pasteur laying out his evidence that spoiling and fermentation were the consequence of microorganisms. Lister became convinced that the same process accounted for wound sepsis.
  • Lister had read about the city of Carlisle’s success in using a small amount of carbolic acid to eliminate the odor of sewage, and reasoned that it was destroying germs. Maybe it could do the same in surgery.
  • During the next few years, he perfected ways to use carbolic acid for cleansing hands and wounds and destroying any germs that might enter the operating field.
  • The result was strikingly lower rates of sepsis and death.
  • Far from it.
  • Surgeons soaked their instruments in carbolic acid, but they continued to operate in black frock coats stiffened with the blood and viscera of previous operations—the badge of a busy practice.
  • hey reused sea sponges without sterilizing them.
  • It was a generation before Lister’s recommendations became routine and the next steps were taken toward the modern standard of asepsis—that is, entirely excluding germs from the surgical field, using heat-sterilized instruments and surgical teams clad in sterile gowns and gloves.
  • Maybe ideas that violate prior beliefs are harder to embrace. To nineteenth-century surgeons, germ theory seemed as illogica
  • The technical complexity might have been part of the difficulty. Giving Lister’s methods “a try” required painstaking attention to detail.
Ed Webb

On Uncle Sam's role in public schools, Republicans have it backward - Yahoo! News - 0 views

news.yahoo.com/...yzimmerman05

shared by Ed Webb on 05 Feb 09 - Cached
  • And NCLB takes a surprisingly narrow view of "proficiency" itself, measuring it by standardized tests alone. As any teacher could tell you, such tests frequently fail to capture the real achievement – and the real deficiencies – of flesh-and-blood children. But when it comes to assessment, it's Washington's way or the highway.
    • Ed Webb
      Ed Webb on 05 Feb 09
       
      And here is the true, hideous damage that NCLB has done. This unidimensional assessment approach is now seeping into higher ed, too. Anti-educational. No child unlabeled.
Julie Dillard

What is Smallpox | Edward Jenner Museum, Gloucestershire - 19 views

www.jennermuseum.com/...smallpox.html

cjhs epidemic virus world infection smallpox

shared by Julie Dillard on 05 Mar 11 - No Cached
  • enters the body through the lungs and is carried in the blood to the internal organs, which it infects.
  • e virus variola
  • Julie Dillard on 05 Mar 11
     
    ELA Epidemics Research
Angela Hagan

Aspirin stimulates insulin - 6 views

www.diabetesdaily.com/...271-aspirin-stimulates-insulin

shared by Angela Hagan on 11 Mar 11 - No Cached
  • AbstractNormal subjects and patients with adult-onset diabetes received 10 gm. of aspirin in four days. On the fourth day, the fasting serum glucose and the glucose response to oral glucose were decreased in both groups. These changes were associated with increased levels of serum insulin and pancreatic glucagon, although the glucagon responses to oral glucose were unchanged. In the diabetic patients, aspirin therapy was followed by a decreased glucose response to I.V. glucose and by the appearance of an early insulin peak, which could not be demonstrated before treatment. Aspirin did not affect the I.V. glucose tolerance in normal subjects, although it did enhance the early insulin peak. A decrease in the fasting levels of free fatty acids was noted in both groups, whereas the fasting level of triglycerides decreased only in the diabetic patients. Cholesterolemia did not change in either group. A few preliminary observations indicate that, in normal subjects, ibuprofen and ketoprofen, two other presumed prostaglandin inhibitors, did not affect fasting glycemia, glucose tolerance, or the insulin response to glucose. No changes were noted after the administration of placebo. Last A1C 4.8No Rx, Diet modification, exercise, Supps and HerbalsI am a retired HYPOGLYCEMIC Reply With Quote 11-08-2010 #2 trinitarian3n1 D.D. Family Moderator Join Date November 2007 Location In the mitten, USA Age 41 Posts > 100 About T2 dx 3/07, tx w/very lo carb D&E Met, bolus R Blog Entries 127 That's a hefty dose of aspirin. John C.A clean house is the sign of a broken computer.Last HgbA1c - 5.5% 2/2011 Reply With Quote 11-08-2010 #3 MCS D.D. Family Join Date August 2010 Posts > 100 About T2, trying to live a healthy life Yes it is, 650mg 4 times a day. I wonder if they did that to make sure they had a response and if there is a break point of some lower dose. I am on 325 once a day now. Been that high in the past for other things, lots of ringing in the ears when you get that high of a dose. Last A1C 4.8No Rx, Diet modification, exercise, Supps and HerbalsI am a retired HYPOGLYCEMIC Reply With Quote 11-08-2010 #4 furball64801 D.D. Family Join Date December 2009 Posts > 100 About type 2 25 yrs mother aunt type 2 thin 50 yrs Blog Entr
  • The therory is that it helps to regenerate the once turned off Beta cells, not over working the exiting ones. This is just one article I found, they are many, most of them concern Salsalate a drug used for arthritis. It works by lowering the inflammation of the liver and pancreas. Lowers IR, its a pretty interesting concept based largerly on inflammation of one muscles and organs. Originally Posted by jeanne wagner i know for heart health they recommend the baby 81 mg a day. I would think you wouldn't have a stomach lining left if you took that on a daily basis. Also just because it stimulates insulin doesn't mean it is a good thing. Sulfonyureas also overstimulate insulin and there is some thought they lead to beta cell burnout. I think it is better to find things like metformin that make you more sensitive to the insulin you naturally make. Last A1C 4.8No Rx, Diet modification, exercise, Supps and HerbalsI am a retired HYPOGLYCEMIC Reply With Quote 11-08-2010 #7 MCS D.D. Family Join Date August 2010 Posts > 100 About T2, trying to live a healthy life Here is a few more articles concerning NSAID's and insulin if you are interested.http://www.annals.org/content/152/6/346.abstracthttp://onlinelibrary.wiley.com/doi/1...026.x/abstracthttp://www.theannals.com/cgi/content/abstract/44/7/1207 Last A1C 4.8No Rx, Diet modification, exercise, Supps and HerbalsI am a retired HYPOGLYCEMIC Reply With Quote MCS was thanked for this post by: Nan-OH 11-08-2010 #8 CalgaryDiabetic D.D. Family Join Date June 2009 Location Calgary,Canada Posts > 100 About diabetic since 1997, on insulin 2000 Guarantied tummy ulcer with so much aspirin. Reply With Quote 11-09-2010 #9 MCS
k moses

The Saudi explanation for Jamal Khashoggi's death is a fable. Still Trump plays along. ... - 2 views

www.washingtonpost.com/...8-8c22-fa2ef74bd6d6_story.html

shared by k moses on 20 Oct 18 - No Cached
  • As Mr. Trump surely knows, the new Saudi cover story is contradicted not just by evidence collected by Turkish authorities and by journalists but also by the reporting of the U.S. intelligence community. All point to Mohammed bin Salman as the instigator of a premeditated, cold-blooded and brutal murder, followed by the dismemberment of Mr. Khashoggi’s body. As The Post’s Shane Harris reported, CIA officials have listened to an audio recording in the possession of Turkish officials they say backs up their account that Mr. Khashoggi was murdered minutes after entering the consulate by a team of 15 men. The Post has identified five of those men as probable members of the crown prince’s personal security detail.
    • k moses
      k moses on 20 Oct 18
       
      Again ... Its sort of excellent that Trump has dropped all subtlety on dealing with the relationship of the USA and The House of Saud, ... I sure hope it revives the questions that were raised about 15 of the 19 plane hijackers were Saudis and their origins and funding were not subjected to scrutiny,
meghankelly492

(PDF) A Systematic Review of Treatments for Music Performance Anxiety - 2 views

www.researchgate.net/..._for_Music_Performance_Anxiety

world Music

shared by meghankelly492 on 15 Sep 19 - No Cached
  • Four other studies (three of which are dissertations) assessed behavioral treatments forMPA on music students. Grishman (1989) and Mansberger (1988) used standard musclerelaxation techniques, Wardle (1969) compared insight/relaxation and systematic desensi-tisation techniques, and Deen (1999) used awareness and breathing techniques
  • A systematic review of all available treatment studies for music performance anxiety was undertaken.
  • reported that 24% of musicians frequently suffered stage fright, defined in this study as themost severe form of MPA, 13% experienced acute anxiety and 17% experienceddepression.
  • ...24 more annotations...
  • 59% of musicians in symphony orchestras reported performance anxiety severe enough toimpair their professional and/or personal functioning.
  • A recent study indicated that MPA is not limited to orchestralmusicians, showing that opera chorus artists are also prone to high levels of performanceanxiety
  • However, since not allperformers suffer the same degree of MPA, or indeed report the same levels of occupationalstress, individual differences in a range of psychological characteristics are likely to accountfor variations in the degree to which musicians experience symptoms
  • A large number of treatment modalities (e.g., behavioral, cognitive, pharmacological andcomplementary) has been developed for music performance anxiety (MPA)
  • However, areview of this literature indicates that the field is still in its infancy with respect to theconceptual and theoretical formulations of the nature of MPA and its empiricalinvestigation.
  • Anxiety may be triggered by conscious,rational concerns or by cues that trigger, unconsciously, earlier anxiety producingexperiences or somatic sensations.
  • These findings suggest that multi-modal interventions are needed toaddress the multiple difficulties experienced by test anxious individuals.
  • with some focusing on behavioral change, some on cognitivechange, others on reduction of physiological symptoms through the use of pharmacotherapy,and some on idiosyncratic formulations
  • For drug studies, the keywords were beta-blocker [Beta blockers block the effect ofadrenaline (the hormone norepinephrine) on the body’s beta receptors. This slows downthe nerve impulses that travel through the heart. As a result, the resting heart rate is lower,the heart does not have to work as hard and requires less blood and oxygen
  • Brodsky (1996) and Nube´(1991) were most useful.
  • The interventionsassessed included systematic desensitization, progressive muscle relaxation, awareness andbreathing and behavioural rehearsal
  • In summary, behavioral treatments do appear to be at least minimally effective in thetreatment of MPA, although the heterogeneity of the treatment approaches employedmakes it difficult to isolate consistent evidence for the superiority of any one type ofbehavioral intervention
  • Two studies (see Tables II and IV) assessed the therapeutic effect of cognitive techniquesalone on MPA.
  • A dissertation by Patston (1996) reported a comparison of cognitive (e.g.positive self-talk, etc.) and physiological strategies in the treatment of MPA. No significantimprovements on vocal and visual manifestations of performance anxiety were found foreither treatment or control groups. However, the sample consisted of only 17 operastudents who were not specifically selected on the basis of their MPA severity, and theintervention was conducted by the author, a singer and teacher, who had no training inpsychology.
  • Three studies (see Table III) assessed the therapeutic effect of cognitive-behavioralstrategies on MPA. Harris (1987), Roland (1993), and Kendrick et al. (1982) all reportedthat standard CBT techniques were effective in the treatment of MPA in studentsspecifically selected for study because of the severity of their MPA.
  • Harris (1987) and Roland(1993) reported that CBT led to reductions in state anxiety as measured by the STAI,although Kendrick et al. (1982) failed to find a significant difference between treatment andcontrol groups on this measure.
  • The evidence for improvements in MPA following CBT is quite consistent, althoughfurther studies with larger samples are needed to confirm this evidence.
  • Beta-blockers have become increasingly popular among performers in recent years. Forexample, Lockwood (1989), in a survey of 2,122 orchestral musicians, found that 27% usedpropranolol to manage their anxiety prior to a performance; 19% of this group used thedrug on a daily basis.
  • Nube´ (1991) identified nine studies examining the effects of various beta-blockers(Atenolol, Metopolol, Nadolol, Oxprenolol, Propranolol, Pindolol) on MPA.
  • The findings regarding the effects of beta blockers on otheroutcome measures were less conclusive.
  • A rigorous definition of MPA is needed to advance treatment. However, defining MPA as asocial anxiety (social phobia) using criteria set out in DSM-IV-TR (APA, 2000) as theinclusion criteria may be too restrictive, particularly if the musician presenting for treatmentexperiences MPA as a focal anxiety (ie does not meet other criteria for social anxiety).
  • Few ofthe intervention studies reviewed acknowledged that performers need a certain amount ofarousal or anxiety to maximise their performance.
  • None of the studies could be pooled in a meta-analysis primarily because too fewprovided sufficient data to calculate effect sizes, use of diverse subject groups andtreatments, duration and intensity of treatment, and use of disparate outcome measures
  • In conclusion, the literature on treatment approaches for MPA is fragmented, incon-sistent, and methodologically weak. These limitations make it difficult to reach any firmconclusions about the effectiveness of the various treatment approaches reviewed. Forsignificant progress to be made, future research will require a clear definition of MPA,consistency and strength in methodology, and the development of robust and appropriateoutcome measures.
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