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Complementary And Alternative Medicine Assessment Tool

Measuring Learners Knowledge Structure in Online Learning An overview with Kyung Kim

There are several existing automatic writing assessment tools, for supporting free text responses in an online course, however such tools are typically used both for a summative purpose, and based on linguistic assessment, and also implemented only in the english language, so our project will develop a formative structure writing assessment tool, applicable to any language, by integrating our existing two offline software tools.Our fully developed software will be able to immediately convert online learner writing into pathfinder networks, which are hypothesized to represent the knowledge structures of the learner.So, based on our empirical evidence.

Carried out in various kinds of learning environments across several languages, is integration approach is a useful and usable way to capture and visually represent the content, knowledge structure of a learner.So in this project, we will examine the changes in the online learners' knowledge structure over time.For that we will pilot run this software in diverse online courses across nations including, korea, japan, netherlands, and the us.For example, a student will be able to submit a written assignment in their native language, and they can see their.

Body in Pain

Gtgt it can spike to the point to where it will knock you on your knees and put you in bed.Gtgt pain we all feel it.But for millions with chronic pain, it lingers for months, even years.Gtgt it is like ten times worse than a toothache.Gtgt from the ymca volunteer, to the marine wounded in iraq, and a mother struggling to continue her mission to save abused animals.Follow three stories of people in pain.Gtgt it just eats away at you.It devours you, and eventually it can take your soul.

Gtgt explore different treatments.And weigh the risks and benefits of prescription drugs.Gtgt the use of painkillers in the united states has become an epidemic.Gtgt we will have a panel of experts and portraits of patients as we discover what happens to the body in pain.Gtgt funding for body in pain comes from the Donald j.Goodman ruth weber goodman philanthropic fund of the cleveland foundation.The margaret clark morgan foundation.The mcgregor foundation.The woodruff foundation.And the community foundation of lorain county.Gtgt my name is lisa novak, i am.

38 years old.I run a nonprofit animal shelter.No animal is to be left behind.That is our motto.No animal is to be left behind.We deal with a lot of animals that are abused by people.A lot of cruelty that occurs.This year so far, the rescue organization, the volunteers have saved 263 animals.I know chronic pain.I know the suffering that occurs and i know the pain that comes with it.I was working at an animal hospital, i was lifting a 120pound dog.

The dog fell and i ended up ripping my abdomen and getting multiple hernias.No matter how much i rubbed my side or my leg or tried to apply heat, you couldn't it was a deep penetrating pain.Almost like being stabbed.Chronic pain, it takes away everything.I think it makes you feel inadequate.It causes depression.I think your children are impacted more because they do not understand.At one time you were doing something and now you are broken.I ended up having to sell my home because i was not making.

The income that i was.I gave up almost everything just to try to survive.Gtgt raise your hand up to you.Gtgt my name is yvonne wood, i am 62, and i know the whole nightmare of chronic pain.In 2002, i was diagnosed with serious arthritis in both knees.At one point it was so bad that i was in a wheelchair.I was immobile.It affected my work in the fact that i was an office manager.I was not able to move around.I was not mobile.

Because of the fact that i could not do the job that i was responsible for doing, i retired in 2002 on disability.It is like a throbbing, nagging, gnawing pain.It is there while you are sleeping.There is no comfort level.You sit up, you have pain.You lay down, you have pain.Have you ever had a toothache where the pain is just throbbing like a pulsating pain it was just that painful.Chronic pain affects your whole lifestyle.It affects the way you live and it affects the choices that you.

Make.As to how you do things on a daily basis.It affects you mentally, also.It is so painful that you do not want to be bothered with people.It isolates you.Gtgt i am derick young from warren, ohio.In iraq in 2005 i was wounded in an explosion and since that time i have lived with chronic back pain.I enlisted in the marine corps after high school in 1998.In 2005, i was part of operation iraqi freedom.I was deployed with the third italian the third battalion.

25th marines weapons company.Headquarters is over in burke park, ohio.The public will remember us as being the unit with heavy losses in early august 2005.Our mission was to patrol the roadways and support any of the foot movements.And to disrupt any type of insurgent activity within the anbar province of iraq.On may 7, 2005, at approximately 330 in the morning, we were returning from the patrol.I was the vehicle commander and i sat on the right front seat.There were five of us total in that vehicle.

That is when my vehicle ran over antitank mines.You hear ringing, things are slow.Some things you remember, some things you do not remember.It is kind of hard exactly to say how i was feeling at that time.It was somewhat of a state of confusion.And you just go into react mode.You rely on your training.The other guys were wounded a lot worse than me.And so i wanted to make sure they were the priority.I had some lacerations, some back injuries.From nerve damage in my legs, concussion.

it just like with any veteran, everybody has different symptoms and a different diagnosis, whether it is ptsd, traumatic brain injury, chronic back pain like myself.There is a combination of emotional and physical pain.Gtgt so, chronic pain really derails people.It really changes people's lives. Tabah, you are ahead of pain management at metro health.You have seen everything under the sun when it comes to this.Gtgt kay, that is absolutely true.I have seen a lot and treated a lot of patients.What comes to my mind first is the case, after i did my cardiac.

Surgery at the cleveland clinic and i switched to anesthesiology and critical care.There was a case at southwest hospital, i got a patient in a coma after committing suicide, the patient expired.The police brought with him his memoir.Principally, his diary about what has happened to him.When i read his writing, it was because of chronic back problems that he had.And he became isolated from his family and his community.And he lost his job.This sad story by itself, for me as a surgeon when i.

Considered pain as principally a temporary thing, you give them a couple percocet after surgery, a couple pain medications, everything is gone.I had never seen the impact on the patient, society, or the family like this case i experienced 20 years ago.Gtgt it can be riveting to patients and families. Jeffrey janata, you are a psychologist and you have studied pain for 20 years, you have treated a lot of patients.Tell us how this kind of chronic pain we are talking about is different than the kind of pain you have when you cut your.

Finger.Gtgt we all experience pain.Pain in an acute sense is the body's warning sign that has been injured.In that sense, pain can be very helpful.It is helpful, otherwise we would not known that we have hurt ourselves.Chronic pain, by contrast, is that system now gone into a sustained mode.Chronic pain is defined as an unpleasant and emotional sensory experience that persists over months and months.Typically, we classify it as being six months or more.That now has taken on a life of its own.

Where the body stays in a cycle of experiencing pain.Even independent of and originating injury.Gtgt there are many different causes of chronic pain.That is very much the case in our three profile patients.Gtgt here.Gtgt whether it is feeding or grooming, working with animals is a 247 job.Something lisa novak was able to fully embrace until she encountered debilitating leg pain.Gtgt it was literally going to be the end of the shelter, the end of what i have been doing my entire life, and the end of.

Saving animals.Gtgt lisa was in pretty bad shape as far as her pain.It was interfering with her daily living activities.She had a little boy at home and she could not care for her family.She could not care for her animals.Novak's current , a pain specialist, suspects novak's leg pain might have resulted from nerve damage suffered during hernia surgery.Gtgt the medical treatment i received actually cause more pain.I was hoping for a cure and instead i got a problem.Gtgt s say the nerve damage can occur in up to 10 of.

Operations for hernias or other surgeries involving the ribs or chest.Gtgt an operation can sometimes accidentally damage small nerves that are hard to see during surgery.That may be cut.Sometimes it could be from the retractor, it could be from positioning during surgery.Gtgt nerve damage pain is called neuropathic.It is different from other types of pain.Normal pain, also called acute pain, is protective.And results from intact nerves doing their job to let the body know something is wrong.Let's say you cut your finger.Sensing trouble, the body's defense system issues a red.

Alert, an inflammatory response that causes nerve endings at the injured site to send a pain signal to the brain.Gtgt so the pain signal travels from the skin along special nerve fibers, all the way up through the spinal cord.From there, it is conducted into the brain.Gtgt the pain subsides as the finger heals.But in neuropathic pain, damaged nerves malfunction.They are basically nerves gone wild.They continued firing pain signals to the brain without any connection to an outside injury.Gtgt you may be feeling pain in your chest or in your arm even.

Though there is no injury to the chest or the arm.Gtgt lisa novak has neuropathic pain.The first She saw prescribed strong narcotics.Novak opted not to take them.Instead of drugs, novak would try several different treatments over the next six years.For novak, the only relief has come from a new freezing treatment.In a procedure known as cryoablation, s guide treatment probes to the problem area.Gtgt as you can see, here is a ball at the tip of the pro, that ice ball is laced very close to the nerve.

By freezing and thawing, we denature small proteins inside the nerve.By denaturing the proteins, we essentially kill the function of the nerve.Or kill the pain for a while.Gtgt i have life again.It is like giving me back my life.Gtgt s cautioned that cryoablation does not work for everyone.And novak will likely require repeat procedures.Gtgt hey! gtgt hey.Gtgt for now, novak is once again functioning and able to keep the animal shelter open.Gtgt i only have a bad day every once in a while.

Versus a bad day all the time.Nice throw, bud.Gtgt nine years ago, at age 53, yvonne wood was losing her independence due to debilitating pain in her knees.Gtgt i could not walk without a cane or a crutch.Otherwise, i was in a wheelchair.Even though i was at home, i could very well have been in a nursing home.I was not capable of doing anything for myself.Gtgt close to 50 million americans have some kind of arthritis.Wood has a severe form known as rheumatoid arthritis.

The lubricating fluid in then knee produces excess chemicals that wreak havoc on the cartilage, the cushion for the joint.Gtgt the excess of fluid has chemicals in it that start eating away at the cartilage.It kind of creates a cascade effect.Enlargement of the joint, destruction of cartilage, loss of cartilage, painful motion of the joint, limitation of the joint.And then the patient gets progressive destruction of that joint.Gtgt eventually, both of wood's knees had to be replaced.But joint replacement surgery only offers a partial solution.

Patients also need to take medications to try and manage both the pain and progression of rheumatoid arthritis.Lifestyle changes also are usually necessary, which in wood's case includes losing weight.Gtgt it is a struggle because i do have a problem with my portion control.Pain will cause you to eat, yes it will.It does.And if you are not able to get out of the house, whatever is in the house, you are going to eat it.If you are in pain, you go to the refrigerator and say oh i.

Will eat this and maybe i will feel better.Gtgt weight does play a role.What we see in arthritic joints is for every one pound of weight that a patient loses, about four pounds to five pounds of weight are taken off the joint.If you have a patient who loses 10 pounds of weight, they essentially are taking off 40 pounds of weight from their knee joint.Gtgt 5, 6 gtgt one of the most useful exercises for arthritis sufferers is water aerobics.It helps reduce weight, and the resistance of water helps.

Strengthen muscles without stressing joints.And there is an added benefit for almost any exercise.Gtgt it helps the body produce various chemicals that are actually self generating painkillers that our body can produce.It can only be produced by doing exercise.We cannot artificially give all those chemicals to our patients.Gtgt unfortunately, studies show that people with arthritis, those most likely to benefit from exercise, are the least likely to do it.Yvonne wood wants other chronic pain sufferers to know, working through the pain of exercise is.

Worth it.Gtgt even though some days are worse than others and i might have pain, i pushed my way through and do the pain.Generally afterwards, i feel a lot better.And had i given into the pain and not done anything, i would have felt a lot worse.Gtgt one knee up, one knee back.Gtgt the third battalion 25th marines touched home to a hero's welcome.During the ohio regiment's seven month deployment to iraq, it lost 48 members.Another 241 were wounded.Derick young was one of them.

With his humvee flattens in an explosion, young was left with wounds.Despite his injury, he completed his tour.Gtgt just because you are hurt does not mean the war stops.Your back hurts, you're tired, so what deal with it and move on.Gtgt being on the battlefield or individual or civilian life, most back pain stems from a combination of factors.The discs, the cushions between our vertebrate, naturally start to degenerate around age 30.The joins in the spine may also become inflamed due to arthritis.Such changes can be compounded by military training and or.

Traumatic injuries.Like the explosion derick young experienced.Young suffers from a combination of spinal problems, including several herniated discs.The jellylike center of the disc moves out of place and presses on nerves in the spinal area.Gtgt the yellow parts of the nerves gtgt yes, these are the nerve roots coming out.And then the more they are irritated, the more often and comment the shooting pain down the lake.Gtgt depending on the type of day, it could be an aching pain, just an annoying type pain.

Some days you are bedridden.It is like riding a roller coaster, you have your highs and lows, but you never stop.Gtgt young's injuries caused him to be medically retired as a staff sergeant at age 29.Once a marine, always a marine.It took a while for young's strong warrior attitude to surrender to the fact that he needed help learning to cope with chronic pain.Gtgt it was limiting to me to where i was feeling so worthless, so to speak, i was not able to do the things that i.

Like to do.I was not able to move around the way i wanted to.Something needed to be done.Gtgt on your worst day, how bad is your pain gtgt on my worst day, probably right around a seven.Gtgt young eventually sought help from the louis stokes cleveland va.Gtgt i am mixing steroids with local anesthetic and saline.Gtgt using radioactive dye and advanced scanning technology, the injects a steroid and a numbing agent into the area of young's spine.Gtgt you will feel a little pressure here.

Gtgt the goal of the epidural injections, what people refer to as nerve blocks, is to address the neuropathic pain that is coming from the nerve.The nerve sometimes is firing constantly.And what the steroids can do is reduce the repeated and sometimes spontaneous firing of these nerve fibers.Gtgt nerve block injections only work temporarily.But they got young functioning enough so he could work out again.Exercise helps build strong cord muscles to support the spine.As you can see from these stories, managing chronic pain is a multifaceted proposition.

Freezing nerves, spinal injections, physical therapy, surgery, as well as complementary and alternative therapies like acupuncture, are a few of the many strategies specialists are using.There is also nutrition therapy.Gtgt we know that low magnesium in our bodies can cause an increased perception of pain.Gtgt and the use of pain psychologists.Gtgt the definition of pain is that it is a physical and emotional experience.That shows the importance of the mindbody connection and that those hats are making a contribution to what the person is experiencing on a daily basis.

Gtgt but probably none of these approaches is as common or as controversial as the use of prescription painkillers.Narcotics known as opioids.Lisa novak chose not to take them.Gtgt i have a 10 year old son, i do not want to be doped up.I want to be able to be levelheaded and not put on narcotics.Gtgt retail sales of opioids likes oxycontin and vicodin nearly doubled in a recent 10 year period.Yet their use to treat chronic pain remains clouded.Gtgt while effective for a subset of patients, they can be.

Detrimental for another large proportion of those patients.And therefore, their use has to be judged very, very carefully.Gtgt is that happening gtgt unfortunately, no.There is not enough education for the practitioners in medical schools and nursing schools.Practitioners are not taught who are the patients that should not be receiving these medications.And when to be careful with these medications.Gtgt Mchaourab generally steers clear of prescribing opioids, especially for veterans.Gtgt the veterans coming from iraq and afghanistan they are young, they have significant musculoskeletal injuries, and.

They have all of these chronic pain complaints.But it is complicated by the presence of ptsd in a large number of them.There is a great set up for them to obtain these medications and end up staying on them.While the right thing, and the right treatment is not being offered.Gtgt many pain specialists are open to using opioids.At least as temporary tools for managing chronic pain.There is widespread agreement on one thing patients need to lower their expectations.Most will not see their chronic pain go away completely.

In fact, many will only get a small amount of longterm relief, no matter what treatment is used.That is true for drugs or any of the other therapies we have mentioned.As one analyst put it, chronic pain relief is an oxymoron.Gtgt pain is always going to be there.If i let it limit me in the things that i like to do, it is going to affect my quality of life.I will not let that happen.Gtgt so, medicine is the most common way to treat chronic pain.

And there is a whole gamut of medicines.We are going to focus this discussion on the use of opioids.Vicodin, oxycontin, narcotics like that.Even though none of our profile patients use them, they are an important part of treatment.We're not going to be talking about their illegal use when they are diverted and sold on the street.We want to discuss their legitimate use for chronic pain patients.Let's start with the benefits. Tabbaa, what do you see as some of the benefits of using these drugs.

Gtgt there is no doubt about it that opioids therapy was one of the most oldest therapies that has been used by humanity since 3500 years b.C.Until now, it is the same medication derived from opium.These medications are very effective in controlling pain.We know it is very effective in controlling acute pain.In chronic pain scenarios, it is a great medication if it is used in the proper population and in the proper patients, and in the proper scenarios.Give them a window to achieve functionality so that they can.

Improve their activities in advance to a second level of their life.Gtgt Janata, what do you see as the benefit gtgt the benefit is we can provide patients who are in pain with a window of opportunity they can use to engage their own activity and the pursuit of healing.Gtgt it is like a transition tool.Gtgt if you can relieve pain enough that patients can exercise, that they can engage in recreation, reengage in social activity, go back to were, engage with their families.Now you have created a system that gets the patient on the.

Road to healing more quickly.Gtgt what are some of the risks gtgt opioids are medications, it is funny that many elderly patients, for example, will say we give them vicodin, they come back and say Tabbaa, i do not want it.The constipation is more horrible than pain, i would prefer to die in pain rather than have constipation.One of the examples of how horrible the side effects are for certain people.We know there are some patients who develop something called opioid induced hyperalgesia.That means they become more sensitive to pain, despite the.

Fact that they are getting large doses of morphine or pain medication.The more medication you give them, they become more sensitive to stimuli that causes their pain.Gtgt they can make pain worse gtgt yes.Now, we have respiratory suppression.A patient may end up having significant respiration, especially in obese patient with sleep apnea.You give them these opioids and they can stop breathing.Gtgt breathing problems.Gtgt sexual dysfunction is another thing that happens with chronic usage.Gtgt Janata, what are other risks gtgt three major risks the hyperalgesia Tabbaa.

Mentioned, opiates can make pain worse.The second is that we unnecessarily are providing an opportunity to expose a vulnerability to addiction in a population that may not otherwise be exposed to it.We have too be able to address and assess that risk up front, which can be hard to do.And the third is that chronic pain is accompanied in the majority of cases by depression.And depression can masquerade or a company the symptoms of pain.Or be expressed as pain.And so the risk is that if you apply a central nervous system.

Depressant like an opiate to someone who is already depressed, it can make the depression worse.Gtgt so they can feed off each other in a negative way.Gtgt yes.Gtgt no matter what treatment, whether it is the opioids, whether it is a surgical intervention, it seems like the patient really has to take an active role in this whole picture.Gtgt when we think about the importance of optimizing function.If we use any medical treatment, opiate or any other, it has to be in the service of optimizing function.

And so we can create a quid pro quo, a patient uses an opiate but also engages themselves in the active pursuit of health.Gtgt the bottom line there is no magic pill to manage chronic pain.Here's the take away, if you or a family member suffers from chronic pain.Number one, you will likely never be completely pain free.Number two, you can't be passive, patients have to take an active role in treatment.And finally, chronic pain management requires a multifaceted approach.Which often includes lifestyle changes as well as therapies for.

The mind, body, and soul.Gtgt to learn more about chronic pain, visit our website at health.Ideastream.Org.There you will find web exclusive material exploring complementary and alternative remedies for pain, including massage and acupuncture.A report on migraines.View special content provided by our partner, net wellness, a consumer health website offered as a public service from medical schools at case western reserve university, the university of cincinnati, and the ohio state university.There is also a place to share your experience with chronic pain.Go to health.Ideastream.Org.Watch, listen, and.

Fairy Tale Science And Placebo Medicine Complementary And Alternative Medicine CAM

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Utilization Of Drumming For Native Americans With Substance Use Disorders

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The PROMIS Of Pain Assessment In The Military

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