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#spaced-repetitions
if, over your lifetime, you will spend more than 5 minutes looking something up or will lose more than 5 minutes as a result of not knowing something, then it’s worthwhile to memorize it with spaced repetition.
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Spaced Repetition for Efficient Learning · Gwern.net
Piotr Woź­niak was being opti­mistic or we’re bad at writ­ing flash­cards, so we’ll dou­ble it to 5 min­utes. That’s our key rule of thumb that lets us decide what to learn and what to for­get: <span>if, over your life­time, you will spend more than 5 min­utes look­ing some­thing up or will lose more than 5 min­utes as a result of not know­ing some­thing, then it’s worth­while to mem­o­rize it with spaced rep­e­ti­tion. 5 min­utes is the line that divides trivia from use­ful data.57 (There might seem to be thou­sands of flash­cards that meet the 5 minute rule. That’s fine. Spaced rep­e­ti­tion can acco




#spaced-repetitions
don’t use spaced repetition if you need it sooner than 5 days or it’s worth less than 5 minutes
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Spaced Repetition for Efficient Learning · Gwern.net
nce there would be 2 or 3 rep­e­ti­tions in that peri­od, pre­sum­ably one would do bet­ter than 50% in recall­ing an item. 5 min­utes and 5 days seems like a mem­o­rable enough rule of thumb: ‘<span>don’t use spaced rep­e­ti­tion if you need it sooner than 5 days or it’s worth less than 5 min­utes’. Overload One com­mon expe­ri­ence of new users to spaced rep­e­ti­tion is to add too much stuff - triv­i­al­i­ties and things they don’t really care about. But they soon learn the curs




The musician and comedian Martin Mull has observed that “writing about music is like dancing about architecture”.
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our civilization over the past 60 years, and those changes seem like just the beginning. This essay is a small contribution to understanding how such changes happen, and what is still possible. <span>The musician and comedian Martin Mull has observed that “writing about music is like dancing about architecture”. In a similar way, there's an inherent inadequacy in writing about tools for thought. To the extent that such a tool succeeds, it expands your thinking beyond what can be achieved using




This takes advantage of a fundamental fact about human memory: as we are repeatedly tested on a question, our memory of the answer gets stronger, and we are likely to retain it for longer The literature on this effect is vast. A useful entrée is: Gwern Branwen, Spaced Repetition for Efficient Learning. .
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d so on. After just five successful reviews the interval is at four months. If the user doesn't remember at any point, the time interval drops down one level, e.g., from two weeks to five days. <span>This takes advantage of a fundamental fact about human memory: as we are repeatedly tested on a question, our memory of the answer gets stronger, and we are likely to retain it for longer The literature on this effect is vast. A useful entrée is: Gwern Branwen, Spaced Repetition for Efficient Learning.. This exponential rise perhaps seems innocuous, but it's transformative. It means that a relatively small number of reviews will enable a user to remember for years. With the time taken




This is the big, counterintuitive advantage of spaced repetition: you get exponential returns for increased effort.
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akes about 4 or so hours to read, this suggests that a less than 50% overhead in time commitment can provide many months or years of retention for almost all the important details in the essay. <span>This is the big, counterintuitive advantage of spaced repetition: you get exponential returns for increased effort. On average, every extra minute of effort spent in review provides more and more benefit. This is in sharp contrast with most experiences in life, where we run into diminishing returns.




The more transformative the tool, the larger the gap that is opened.
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an inherent inadequacy in writing about tools for thought. To the extent that such a tool succeeds, it expands your thinking beyond what can be achieved using existing tools, including writing. <span>The more transformative the tool, the larger the gap that is opened. Conversely, the larger the gap, the more difficult the new tool is to evoke in writing. But what writing can do, and the reason we wrote this essay, is act as a bootstrap. It's a way of




Flashcard 6004207127820

Question
What makes these subjects difficult?
Answer
[default - edit me]

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill
Unknown title
accounts often regale (and intimidate) readers with quotes from famous physicists in the vein of: “anyone who thinks they’ve understood quantum mechanics has not understood quantum mechanics”. <span>What makes these subjects difficult? In fact, individually many of the underlying ideas are not too complicated for people with a technical background. But the ideas come in an overwhelming number, a tsunami of unfamiliar







Definicja 1.1 (iloczyn skalarny). (Standardowym) iloczynem skalarnym w R n nazy- wamy funkcję R n × R n 3 (x, y) 7−→ hx, yi := n X i=1 x i y i ∈ R . Jak wiadomo z wykładów Algebry Liniowej, iloczyn skalarny jest dwuliniowy (liniowy względem każdej zmiennej z osobna), symetryczny (tzn. hx , yi = hy, xi dla wszystkich
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Natomiast dowolny ruch chaotyczny, np. ruchy Browna, czy wszelkie postacie ruchu postępowego są przykładami ruchu nie będącego ruchem drgającym.
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istnieje położenie równowagi trwałej (tzn. istnieje minimum energii potencjalnej, a więc istnieje siła zwrotna przywracająca stan równowagi), 2. układ ma bezwładność (dla układów mechanicznych jest to masa), 3. układ nie traci energii (nie ma żadnych sił oporu)
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dx Ud k =
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#GarjoDyspnee #Medecine #Pneumologie
Dyspnea is a common and often debilitating symptom that affects up to 50% of patients admitted to acute, tertiary care hospitals and a quarter of patients seeking care in ambulatory settings.
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ea The Dyspneic Patient: Connecting Pathophysiology to Neural Mechanism Dyspnea Measurement Evaluation and Treatment Evaluation Treatment Research Priorities Conclusion Go to: Executive Summary <span>Dyspnea is a common and often debilitating symptom that affects up to 50% of patients admitted to acute, tertiary care hospitals and a quarter of patients seeking care in ambulatory settings. The presence of dyspnea is a potent predictor of mortality, often surpassing common physiological measurements in predicting the clinical course of a patient. Respiratory discomfort may




#GarjoDyspnee #Medecine #Pneumologie
Specific physiological processes may be linked to corresponding sensory descriptors, the best characterized of which are sensations of work or effort, tightness, and air hunger/unsatisfied inspiration
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oblem. Major conclusions of the Statement include: A wide range of information arising from numerous sensory afferent sources (Table 2) contributes to multiple sensations of dyspnea (Table 3). S<span>pecific physiological processes may be linked to corresponding sensory descriptors, the best characterized of which are sensations of work or effort, tightness, and air hunger/unsatisfied inspiration. ○ Sensory–perceptual mechanisms underlying sensations of work or effort in breathing are similar to those underlying similar sensations in exercising muscle. ○ Tightness is relatively




#GarjoDyspnee #Medecine #Pneumologie

TABLE 3.

DESCRIPTORS FOR AIR HUNGER COMMONLY CHOSEN FROM LISTS

Urge to breathe (115) Unsatisfied inspiration (83)
Like breath hold (115) Feeling of suffocation (115)
Starved for air (115) Need for more air (37)
Hunger for air (115) Breath does not go in all the way (37)
Breaths felt too small (115) Cannot get enough air (58)
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uctures Trigeminal skin receptors Facial skin cooling Chest wall joint and skin receptors Tidal breathing motion Open in a separate window *Reviewed, for example, in References 24–26 and 39–41. <span>TABLE 3. DESCRIPTORS FOR AIR HUNGER COMMONLY CHOSEN FROM LISTS Urge to breathe (115) Unsatisfied inspiration (83) Like breath hold (115) Feeling of suffocation (115) Starved for air (115) Need for more air (37) Hunger for air (115) Breath does not




#GarjoDyspnee #Medecine #Pneumologie
evidence has emerged that dyspnea is a predictor of hospitalization (13) and mortality in patients with chronic lung disease (14), and in some cases is more closely correlated with 5-year survival than forced expiratory volume in 1 second (FEV1) (15). Dyspnea is also more closely associated with cardiac mortality than angina (16).
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nnually (10, 11). More than 10 years have elapsed since the American Thoracic Society published a consensus statement on mechanisms, assessment, and management of dyspnea (12). Since that time, <span>evidence has emerged that dyspnea is a predictor of hospitalization (13) and mortality in patients with chronic lung disease (14), and in some cases is more closely correlated with 5-year survival than forced expiratory volume in 1 second (FEV1) (15). Dyspnea is also more closely associated with cardiac mortality than angina (16). There has been enormous growth in knowledge about the neurophysiology of dyspnea. In addition, there has been growing interest in the potential use of dyspnea as a patient-reported outc




#GarjoDyspnee #Medecine #Pneumologie
We define dyspnea as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity,”
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r peer review. Based on initial peer review, revisions were completed in Spring 2011 and finalized in a meeting at the 2011 ATS International Conference prior to resubmission. Go to: Definition <span>We define dyspnea as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity,” as was suggested in the 1999 ATS consensus statement (12). Since that definition was proposed, however, substantial evidence has accrued that (1) distinct mechanisms and afferent pathwa




#GarjoDyspnee #Medecine #Pneumologie
(1) distinct mechanisms and afferent pathways are reliably associated with different sensory qualities (notably work/effort, tightness, and air hunger/unsatisfied inspiration), (2) distinct sensations most often do not occur in isolation, and (3) dyspnea sensations also vary in their unpleasantness and in their emotional and behavioral significance
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tively distinct sensations that vary in intensity,” as was suggested in the 1999 ATS consensus statement (12). Since that definition was proposed, however, substantial evidence has accrued that <span>(1) distinct mechanisms and afferent pathways are reliably associated with different sensory qualities (notably work/effort, tightness, and air hunger/unsatisfied inspiration), (2) distinct sensations most often do not occur in isolation, and (3) dyspnea sensations also vary in their unpleasantness and in their emotional and behavioral significance. We also reaffirm the corollary statement that the experience of dyspnea “derives from interactions among multiple physiological, psychological, social, and environmental factors, and m




#GarjoDyspnee #Medecine #Pneumologie
Perception entails conscious recognition and interpretation of sensory stimuli and their meaning. Therefore, as is the case with pain, adequate assessment of dyspnea depends on self-report
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environmental factors, and may induce secondary physiological and behavioral responses,” (12) but we emphasize strongly that dyspnea per se can only be perceived by the person experiencing it. <span>Perception entails conscious recognition and interpretation of sensory stimuli and their meaning. Therefore, as is the case with pain, adequate assessment of dyspnea depends on self-report. Because dyspnea is a symptom (i.e., perception of an abnormal or distressing internal state), it must generally be distinguished from signs that clinicians typically invoke as evidence




#GarjoDyspnee #Medecine #Pneumologie
Distinctive sensory qualities are important in considering the physiological mechanisms underlying the breathing discomfort, but the definition of dyspnea should be neutral with respect to any particular quality
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spnea, we have avoided using terms such as “difficult,” “labored,” or “heavy” breathing because they may or may not characterize the experience of a particular patient at a given point in time. <span>Distinctive sensory qualities are important in considering the physiological mechanisms underlying the breathing discomfort, but the definition of dyspnea should be neutral with respect to any particular quality. Dyspnea is a complex symptom that potentially warns of a critical threat to homeostasis and thus frequently leads to adaptive responses (such as resting or seeking medical care). Protr




#GarjoDyspnee #Medecine #Pneumologie
There is evidence that different physiological derangements lead to qualitatively different sensations (27, 2932), and attention to these qualities may be helpful in the evaluation of the cause and treatment of the patient's discomfort
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common that multiple afferent inputs contribute to the sensation(s) experienced by patients, and it is unlikely that any laboratory stimulus reproduces exactly what patients perceive (27, 28). <span>There is evidence that different physiological derangements lead to qualitatively different sensations (27, 29–32), and attention to these qualities may be helpful in the evaluation of the cause and treatment of the patient's discomfort. Having perceived the symptom, the individual evaluates its personal meaning. Depending on the circumstances in which breathing discomfort occurs and the history of similar sensations,




#GarjoDyspnee #Medecine #Pneumologie
With encouraging support from family, friends, and health care providers, symptoms may not seem so bad, and disabilities may be overcome or ameliorated
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g discomfort and remain active. Humans are social animals, and the environment in which they live often has a significant effect on how they perceive their capabilities and their self-concepts. <span>With encouraging support from family, friends, and health care providers, symptoms may not seem so bad, and disabilities may be overcome or ameliorated. Alternatively, social isolation or withdrawal may breed discouragement, frustration, loneliness, or depression, which may further decrease functional performance and quality of life. W




#GarjoDyspnee #Medecine #Pneumologie
In addition to traditionally defined sensory afferents, information on the state of respiration is available from respiratory motor areas of the brain, which can send an ascending copy of their descending motor activity to perceptual areas (corollary discharge)
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t sensory mechanisms. Sources of Sensory Afferent Information Sensory afferent sources available for respiratory sensation (e.g., reviewed in References 24–26, 39–41) are summarized in Table 2. <span>In addition to traditionally defined sensory afferents, information on the state of respiration is available from respiratory motor areas of the brain, which can send an ascending copy of their descending motor activity to perceptual areas (corollary discharge). The role of corollary discharge has been well described in the limb motor control literature (42–44). The respiratory motor system, however, is unusual in having both automatic (brains




#GarjoDyspnee #Medecine #Pneumologie
Perceptions of work and effort probably arise through some combination of respiratory muscle afferents and perceived cortical motor command or corollary discharge (50). Similar mechanisms give rise to sensations of work and effort from exercising limb muscles (reviewed in References 42 and 51)
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e performance (27, 31, 32). Respiratory muscle afferents project to the cerebral cortex, and subjects report sensations localized to respiratory muscles when the work of breathing is high (49). <span>Perceptions of work and effort probably arise through some combination of respiratory muscle afferents and perceived cortical motor command or corollary discharge (50). Similar mechanisms give rise to sensations of work and effort from exercising limb muscles (reviewed in References 42 and 51). During exercise, a variety of physiological adaptations match alveolar ventilation to metabolic demand in healthy, normal persons. As the intensity of exercise increases, individuals g




#GarjoDyspnee #Medecine #Pneumologie
As long as sensations of increased work or effort in breathing and the achieved ventilation are consistent with expected responses to exercise, they are not necessarily unpleasant (52, 53), and may not even be the primary reason for stopping
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ation to metabolic demand is approached, afferent mechanoreceptor feedback signals that breathing is appropriate to the prevailing respiratory drive, and breathing distress is minimal (52, 53). <span>As long as sensations of increased work or effort in breathing and the achieved ventilation are consistent with expected responses to exercise, they are not necessarily unpleasant (52, 53), and may not even be the primary reason for stopping. However, breathing discomfort is much greater in patients with cardiopulmonary disease and frequently limits exercise (52). Perception of breathing effort or work can be produced in th




#GarjoDyspnee #Medecine #Pneumologie
“Tightness” is commonly experienced during bronchoconstriction (27, 6569). Some studies suggest that chest tightness is the dominant experience in the early stages of an asthma attack, but as airway narrowing worsens, patients also report work/effort and air hunger/unsatisfied inspiration (65, 68).
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ary discharge (42, 64). However, there is no evidence, as yet, that experimental alterations adequately reproduce the sensations experienced by patients with cardiopulmonary disease. Tightness. <span>“Tightness” is commonly experienced during bronchoconstriction (27, 65–69). Some studies suggest that chest tightness is the dominant experience in the early stages of an asthma attack, but as airway narrowing worsens, patients also report work/effort and air hunger/unsatisfied inspiration (65, 68). Bronchoconstriction gives rise to both a sense of tightness and added physical work of breathing (65, 70); however, blocking pulmonary afferents can diminish tightness (71). In laborato




#GarjoDyspnee #Medecine #Pneumologie
There is also evidence in patients with asthma that perception of increased work/effort does not respond as rapidly as tightness to treatment with nebulized albuterol (67), suggesting that work/effort may be more related to increased respiratory motor output needed to overcome airflow obstruction (e.g., due to inflammation), whereas tightness may be more specifically related to stimulation of airway receptors. Together, these findings suggest that tightness arises from pulmonary afferents rather than being a work-related sensation
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external resistive loads (68) or during cardiopulmonary exercise testing (73). Mechanical ventilation can eliminate the sense of excessive respiratory work but does not diminish tightness (74). <span>There is also evidence in patients with asthma that perception of increased work/effort does not respond as rapidly as tightness to treatment with nebulized albuterol (67), suggesting that work/effort may be more related to increased respiratory motor output needed to overcome airflow obstruction (e.g., due to inflammation), whereas tightness may be more specifically related to stimulation of airway receptors. Together, these findings suggest that tightness arises from pulmonary afferents rather than being a work-related sensation. Air hunger/unsatisfied inspiration. A perception of not getting enough (or of needing more) air, which has been variously labeled as air hunger, unsatisfied inspiration, or an unpleasa




#GarjoDyspnee #Medecine #Pneumologie
A perception of not getting enough (or of needing more) air, which has been variously labeled as air hunger, unsatisfied inspiration, or an unpleasant urge to breathe, can be induced experimentally by increasing inspiratory drive (e.g., with exercise, hypercapnia, or hypoxia), especially if the capacity to satisfy the increased ventilatory demand is limited.
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stimulation of airway receptors. Together, these findings suggest that tightness arises from pulmonary afferents rather than being a work-related sensation. Air hunger/unsatisfied inspiration. <span>A perception of not getting enough (or of needing more) air, which has been variously labeled as air hunger, unsatisfied inspiration, or an unpleasant urge to breathe, can be induced experimentally by increasing inspiratory drive (e.g., with exercise, hypercapnia, or hypoxia), especially if the capacity to satisfy the increased ventilatory demand is limited. As the demand for ventilation exceeds the capacity to provide it (which occurs only at very high levels of exercise in healthy individuals but is common in patients with cardiopulmonary




#GarjoDyspnee #Medecine #Pneumologie

[Air hunger]

Similar sensations have been reported during symptom-limited exercise testing by patients with restrictive (32) or obstructive (31, 32, 65) lung disease (in particular, when dynamic hyperinflation restricts inspiratory capacity among the latter)

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ng exercise (82, 83), or limiting the volume available at the airway opening (46, 81, 84), giving rise to sensations of air hunger (82), inspiratory difficulty, or unsatisfied inspiration (83). <span>Similar sensations have been reported during symptom-limited exercise testing by patients with restrictive (32) or obstructive (31, 32, 65) lung disease (in particular, when dynamic hyperinflation restricts inspiratory capacity among the latter) (31, 52, 53, 65, 66, 79, 85–88). Air hunger/unsatisfied inspiration is intensified by stimuli that increase spontaneous ventilatory drive (84, 89, 90), such as hypoxia, hypercapnia, aci




#GarjoDyspnee #Medecine #Pneumologie
Air hunger/unsatisfied inspiration is intensified by stimuli that increase spontaneous ventilatory drive (84, 89, 90), such as hypoxia, hypercapnia, acidosis, and signals arising from exercise-related drive (91, 92), especially if ventilatory response is constrained (52, 53).
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ents with restrictive (32) or obstructive (31, 32, 65) lung disease (in particular, when dynamic hyperinflation restricts inspiratory capacity among the latter) (31, 52, 53, 65, 66, 79, 85–88). <span>Air hunger/unsatisfied inspiration is intensified by stimuli that increase spontaneous ventilatory drive (84, 89, 90), such as hypoxia, hypercapnia, acidosis, and signals arising from exercise-related drive (91, 92), especially if ventilatory response is constrained (52, 53). The preponderance of evidence suggests that information on the spontaneous respiratory motor drive of the brainstem (induced, for example, by hypoxia or exercise) is conveyed to the cer




#GarjoDyspnee #Medecine #Pneumologie
In contrast, increased voluntary motor drive to respiratory muscles, which originates in the cerebral cortex (95, 96), predominantly evokes a perception of respiratory effort (58, 61), which, in healthy volunteers, is not as unpleasant as air hunger (97).
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conveyed to the cerebral cortex as corollary discharge (e.g., 47, 93, 94). When this is not matched by an adequate ventilatory response, individuals perceive air hunger/unsatisfied inspiration. <span>In contrast, increased voluntary motor drive to respiratory muscles, which originates in the cerebral cortex (95, 96), predominantly evokes a perception of respiratory effort (58, 61), which, in healthy volunteers, is not as unpleasant as air hunger (97). Mechanoreceptors in the lungs, airways, and chest wall provide afferent information about achieved pulmonary ventilation and can inhibit (relieve) air hunger/unsatisfied inspiration (98




#GarjoDyspnee #Medecine #Pneumologie
Mechanoreceptors in the lungs, airways, and chest wall provide afferent information about achieved pulmonary ventilation and can inhibit (relieve) air hunger/unsatisfied inspiration (98103)
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scles, which originates in the cerebral cortex (95, 96), predominantly evokes a perception of respiratory effort (58, 61), which, in healthy volunteers, is not as unpleasant as air hunger (97). <span>Mechanoreceptors in the lungs, airways, and chest wall provide afferent information about achieved pulmonary ventilation and can inhibit (relieve) air hunger/unsatisfied inspiration (98–103). In animal models of emphysema, pulmonary stretch receptor discharge is decreased (104). Pulmonary stretch receptor activation alone provides potent relief (100), independent of vagal i




#GarjoDyspnee #Medecine #Pneumologie
Unsatisfied inspiration or air hunger is not specific to any particular disease or stimulus
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However, these studies were performed before it was discovered that transplanted lungs are re-innervated quickly, and thus may have overestimated the contribution of chest wall receptors (112). <span>Unsatisfied inspiration or air hunger is not specific to any particular disease or stimulus. It has been reported in quadriplegic patients in response to increased partial pressure of carbon dioxide (Pco2) (47), decreased tidal volume (100), or methacholine challenge (66), as




#GarjoDyspnee #Medecine #Pneumologie
A consistent finding across experimental exercise and clinical studies is that patients with a variety of conditions (or normal subjects with chest wall corseting) report greater difficulty and discomfort during inspiration compared with expiration (inspiratory difficulty)
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idiopathic hyperventilation are significantly more likely than healthy control subjects to report perceptions of air hunger when recalling perceptions of breathing at the end of exercise (113). <span>A consistent finding across experimental exercise and clinical studies is that patients with a variety of conditions (or normal subjects with chest wall corseting) report greater difficulty and discomfort during inspiration compared with expiration (inspiratory difficulty) (31, 32, 36, 52, 70, 79, 83, 85, 113, 114). Naïve experimental subjects exposed to a variety of similar stimuli have chosen descriptors listed in Table 3 (37, 58, 83, 115). Although rel




#GarjoDyspnee #Medecine #Pneumologie
This suggests that, in susceptible individuals, air hunger may occur even in the absence of reduced ventilatory capacity. Factors such as excessive ventilatory drive or impaired perception of achieved ventilation may play a role. There also may be a role for increased sensitivity to CO2 (which may, in turn, have a component of genetic predisposition) or excessive response to cerebral alkalosis or hypoxia due to hyperventilation-induced hypocapnia (118, 124)
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eneral population (121–123), but similar clustering of descriptors has been reported in patients with idiopathic hyperventilation (113) who do not have cardiopulmonary or neuromuscular disease. <span>This suggests that, in susceptible individuals, air hunger may occur even in the absence of reduced ventilatory capacity. Factors such as excessive ventilatory drive or impaired perception of achieved ventilation may play a role. There also may be a role for increased sensitivity to CO2 (which may, in turn, have a component of genetic predisposition) or excessive response to cerebral alkalosis or hypoxia due to hyperventilation-induced hypocapnia (118, 124). Whatever term is used to characterize this cluster of related descriptors, it is not merely the awareness that breathing has increased, as that is not necessarily uncomfortable (93). R




#GarjoDyspnee #Medecine #Pneumologie
A core pattern has emerged: dyspnea activates cortico-limbic structures (134143) that also subserve interoceptive awareness of homeostatic threats such as thirst and hunger (144148) or pain (134, 137140, 149152)
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contributes as much to the image as the test condition. Nonetheless, some important conclusions can be drawn from several studies that have produced similar results using different approaches. <span>A core pattern has emerged: dyspnea activates cortico-limbic structures (134–143) that also subserve interoceptive awareness of homeostatic threats such as thirst and hunger (144–148) or pain (134, 137–140, 149–152). Recent reviews provide a comprehensive analysis of both the power and limitations of these techniques (141, 153). Using PET imaging of the forebrain, Banzett and coworkers (134) report




#GarjoDyspnee #Medecine #Pneumologie
There is good evidence that opioid drugs reduce dyspnea (see E valuation and T reatment ). Laboratory studies in healthy subjects show that opioids reduce the discomfort of air hunger (166) but not the discomfort of work or effort (167).
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ngside this symptom. Over the long run, results of neuroimaging studies may contribute to developing more effective therapeutic strategies for the dyspneic patient. Opioid Modulation of Dyspnea <span>There is good evidence that opioid drugs reduce dyspnea (see Evaluation and Treatment). Laboratory studies in healthy subjects show that opioids reduce the discomfort of air hunger (166) but not the discomfort of work or effort (167). Opioids likely act both by depressing spontaneous respiratory drive (thus reducing corollary discharge), and by modulating cortical activity, as they do in pain. Decreased insular activ




#GarjoDyspnee #Medecine #Pneumologie
Opioids likely act both by depressing spontaneous respiratory drive (thus reducing corollary discharge), and by modulating cortical activity, as they do in pain
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reduce dyspnea (see Evaluation and Treatment). Laboratory studies in healthy subjects show that opioids reduce the discomfort of air hunger (166) but not the discomfort of work or effort (167). <span>Opioids likely act both by depressing spontaneous respiratory drive (thus reducing corollary discharge), and by modulating cortical activity, as they do in pain. Decreased insular activation in response to breath-holding has been observed after opiate administration (162), and it is possible that further imaging experiments will ascertain the s




#GarjoDyspnee #Medecine #Pneumologie
In addition to laboratory, radiographic, and clinical studies, the words or phrases patients use to describe the quality of the breathing discomfort ( Table 3 ) may provide insight into the underlying pathophysiological mechanisms (27, 2932, 36).
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these are receptors that are postulated to lie in muscles and that are stimulated by changes in the metabolic milieu of the tissue that result when oxygen delivery does not meet oxygen demand. <span>In addition to laboratory, radiographic, and clinical studies, the words or phrases patients use to describe the quality of the breathing discomfort (Table 3) may provide insight into the underlying pathophysiological mechanisms (27, 29–32, 36). Chest tightness may be relatively specific for dyspnea due to bronchoconstriction (30, 67, 68, 74, 132). Sensations of “air hunger” and “inability to get a deep breath,” which probably




#GarjoDyspnee #Medecine #Pneumologie
Chest tightness may be relatively specific for dyspnea due to bronchoconstriction ( 30, 67, 68, 74, 132). Sensations of “air hunger” and “inability to get a deep breath,” which probably represent the combined effects of increased drive to breathe and limited tidal volume, are commonly seen in association with dynamic hyperinflation (31, 86) and other conditions characterized by restrictive mechanics (e.g., heart failure or pulmonary fibrosis). Sensations of effort, suffocation, and rapid breathing have been found to characterize CO2-induced panic attacks in patients diagnosed with panic disorder (119), but are nonspecific (200)
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l studies, the words or phrases patients use to describe the quality of the breathing discomfort (Table 3) may provide insight into the underlying pathophysiological mechanisms (27, 29–32, 36). <span>Chest tightness may be relatively specific for dyspnea due to bronchoconstriction (30, 67, 68, 74, 132). Sensations of “air hunger” and “inability to get a deep breath,” which probably represent the combined effects of increased drive to breathe and limited tidal volume, are commonly seen in association with dynamic hyperinflation (31, 86) and other conditions characterized by restrictive mechanics (e.g., heart failure or pulmonary fibrosis). Sensations of effort, suffocation, and rapid breathing have been found to characterize CO2-induced panic attacks in patients diagnosed with panic disorder (119), but are nonspecific (200). There also may be linguistic and cultural differences in how patients characterize their symptoms (201–203), especially symptoms of affective distress (201), and some patients have dif




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Although supplemental oxygen improves mortality in chronically hypoxemic patients with COPD, there are conflicting data about its ability to relieve breathlessness (220224)
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r se (as opposed to approval for treatment of diseases in which dyspnea may be a prominent symptom), and even when evidence of efficacy exists, the magnitude of the benefit is variable. Oxygen. <span>Although supplemental oxygen improves mortality in chronically hypoxemic patients with COPD, there are conflicting data about its ability to relieve breathlessness (220–224). A beneficial effect of oxygen could be related to changes in chemoreceptor stimulation, the resulting changes in breathing pattern (225, 226), and/or stimulation of receptors related t




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Oxygen therapy may be useful for patients with advanced heart or lung disease, in particular those who are hypoxemic at rest or with minimal activity (204, 212, 213, 224, 230)
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of receptors related to gas flow through the upper airway (227, 228). Thus, symptomatic benefit may not be confined to patients who meet Medicare guidelines for supplemental oxygen (225, 229). <span>Oxygen therapy may be useful for patients with advanced heart or lung disease, in particular those who are hypoxemic at rest or with minimal activity (204, 212, 213, 224, 230). Heliox. As a result of their decreased density, helium-containing gas mixtures reduce the resistance to airflow, which in turn may decrease the work of breathing, reduce the severity o




“The term mindful learning is used here in a very specific way, drawn from the concept of mindfulness that I defined in an earlier book by that name. A mindful approach to any activity has three characteristics: the continuous creation of new categories; openness to new information; and an implicit awareness of more than one perspective. Mindlessness, in contrast, is characterized by an entrapment in old categories; by automatic behavior that precludes attending to new signals; and by action that operates from a single perspective. Being mindless, colloquially speaking, is like being on autopilot. In Mindfulness, I described the benefits of a mindful approach for our psychological and physical well-being. For instance, elderly adults given mindfulness treatments were shown to live longer than their peers who were not given such treatments. In this book I use the concept of mindfulness as a lens through which to explore its importance in the world I know best, teaching and learning.”
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THE SEVEN PERVASIVE MYTHS “Certain myths and fairy tales help advance a culture by passing on a profound and complex wisdom to succeeding generations. Others, however, deserve to be questioned. This book is about seven pervasive myths, or mindsets, that undermine the process of learning and how we can avoid their debilitating effects in a wide variety of settings. 1. The basics must be learned so well that they become second nature. 2. Paying attention means staying focused on one thing at a time. 3. Delaying gratification is important. 4. Rote memorization is necessary in education. 5. Forgetting is a problem. 6. Intelligence is knowing ‘what’s out there.’ 7. There are right and wrong answers.”
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For instance, elderly adults given mindfulness treatments were shown to live longer than their peers who were not given such treatments. In this book I use the concept of mindfulness as a lens through which to explore its importance in the world I know best, teaching and learning.”
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gle perspective. Being mindless, colloquially speaking, is like being on autopilot. In Mindfulness, I described the benefits of a mindful approach for our psychological and physical well-being. <span>For instance, elderly adults given mindfulness treatments were shown to live longer than their peers who were not given such treatments. In this book I use the concept of mindfulness as a lens through which to explore its importance in the world I know best, teaching and learning.” <span>

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