#This Is A Meme Page Not A Diagnostic Tool
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It has been debunked that adhd meds improve focus and productivity in those without adhd. Studies showed neurotypicals who take adderall for the stimulant effect to do homework are actually less accurate and rank their productivity as higher than it really was. Itâs more a placebo effect than anything. They may feel side effects of the stimulant (insomnia, for example, making it easier to stay awake), but do not focus on their tasks any better. Just fyi in regard to that one post. Misinformation is the reason I wasnât diagnosed and suffered far longer than necessary until almost 30
Well TIL
Good.
They don't deserve extra focus and productivity, they got the lion's share already.
I hope their Ritalin fuelled dissertation sucked, and their house re-model was crappy.
#This Is A Meme Page Not A Diagnostic Tool#I am a person with ADHD#the neurotypical experience is not my forte
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HubSpot
HubSpot is software that enables inbound marketing to be carried out efficiently. The software includes tools for various areas of online marketing.
HubSpot software overview
HubSpot creates the conditions for a company to be found by prospects. The software makes optimal use of the various sub-disciplines of online marketing to generate leads. At the same time, HubSpot includes the ability to measure, analyze, and incrementally improve marketing efforts.
HubSpot features
The software includes the following functions, among others:
Blogging: Creating blog posts with greater success by integrating SEO and lead-generation tools
Social Inbox: Help prioritize communication via social networks, determine the ROI of social media marketing, and history for each contact associated with the company
SEO Tools:Â keyword research, competitor monitoring, diagnostic tools, backlink tracking
Lead generation tools: landing pages, call-to-action buttons, forms, lead management
Email Marketing Tools
Customer acquisition tools: sending personalized emails, marketing automation, evaluations, connection to Salesforce Sync
This video provides an overview of HubSpotâs features.
HubSpot benefits
HubSpot brings a variety of benefits to users. It is an all-in-one software package. All modules do not work independently of each other but mesh seamlessly with each other. The manufacturer of the software offers different packages for companies of different sizes so that the financial outlay remains within limits. Each package comes with unlimited technical support.
The HubSpot plans
HubSpot is offered in three versions: Basic, Professional and Enterprise. They cost 160 euros, 640 euros and 1,920 euros per month. The basic version differs significantly from the other two versions in terms of functionality. However, the biggest differences are in the number of inclusive contacts and the additional costs for further contacts and the number of visits per month. Other differences can be found in the number of available subdomains and the limit for sending emails.
Importance for search engine optimization
Search engine optimization is part of the HubSpot software. In contrast to other full SEO suites, this area does not work independently but is interlinked with the other areas of online marketing. Inbound marketing is one of the most important buzzwords in the online marketing industry. In this context, software products such as HubSpot will gain in importance in the future.
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How to Build an eCars App on Heroku and Salesforce (Part 4)11x Certified Salesforce professional and developer with 10+ years experience and an MBA from UCLA Anderson School. This is the fourth article documenting what Iâve learned from a series of 10 Trailhead Live video sessions on Modern App Development on Salesforce and Heroku. In these articles, weâre focusing on how to combine Salesforce with Heroku to build an âeCarsâ appâa sales and service application for a fictitious electric car company (âPulsarâ) that allows users to customize and buy cars, service techs to view live diagnostic info from the car, and more. In case you missed my previous article, you can find it here. Just as a quick reminder: Iâve been following this Trailhead Live video series to brush up and stay current on the latest app development trends on these platforms that are key to my career and business. Iâll be sharing each step for building the app, what Iâve learned, and my thoughts from each session. These series reviews are both for my own edification as well as for others who might benefit from the content. The Trailhead Live sessions and schedule can be found here: Last timeâŚLast session, we did some data modeling in Salesforce using point-and-click methods and also went over some of the data modeling and scalability features of the Heroku platform. If you remember from the last article, I absolutely think that proper data modeling at the outset is critical to setting up an app for success. In this episode, weâre looking at a topic that is paradoxically both anathema to me and something that makes me love the Salesforce platform: creating front-end app experiences. I promise this will make sense as we get deeper into the article. Ever since I first got into app development, designing and building front-end experiences for an app or website has probably been my least enjoyable experience. With back-end development, things either worked the way they should, or you had clear bugs or errors: there was no middle ground. On the other hand, I found front-end to be far too subjective of a topic for my likingâeveryone had a different opinion about how something should flow, how it should look, whether to use rounded or square edges, which shade of blue would get more clicks, etc. Then, when you finally get to release the end product after much colorful debate, a group of users out in the wild invariably figures out a way to get confused by the front-end experience you worked so hard on. The fact that there is massive controversy over this meme is why I dislike working on both However, I think my early distaste for front-end related things is actually something that drew me deeper into the Salesforce ecosystem. I was naturally attracted to the platformâs meta-data driven architecture that allows me to quickly get an app concept up-and-running with a working and extensively customizable user interface without having to write a bunch of front-end HTML, CSS, and Javascript. Many of my clients are very visual in the way they process information, and oftentimes they need something in front of them they can play around with and âkick the tiresâ on before theyâre able to provide substantive feedback on ways we can improve their experience. Being able to prototype this way has saved me countless hours iterating on designs. As a result, this session really had me thinking about how much one can do with the front-end experience of a Salesforce app before having to do anything with code. Letâs look at some of those features in the context of our eCars app. Personalizing and Branding the Salesforce AppA nice feature thatâs been added to the Salesforce Lightning Experience interface is the Themes and Branding section of the User Interface area of app setup. Without needing code to customize the color palette, banners, logo, and images, we can completely personalize a Salesforce app to match the branding of the company. We can literally take theme customizations for a test-drive You can try out this feature yourself in the context of the Pulsar eCars app by uploading the app package to a developer edition or scratch org. You can get the GitHub repo for the eCars app at the following URL and if you need a review on how to deploy a Salesforce app to a scratch org from a GitHub repo, you can refer back to the very first article I wrote on this series. https://github.com/trailheadapps/ecars Creating Custom Record Pages Without CodeBeing able to customize the theme colors, logos, and images is certainly a nice appetizer, but the main course is really when we get into the user interface components of record pages without having to use any code. Lightning Experience has really taken this to the next level as wellâthose of you too new to have known Classic Experience might not fully appreciate all the new features Lightning offers. For the eCars app, we get to design, from scratch, a record page for the standard Lead object. Regardless of which object weâre working with, displaying relevant information to the user in both a logical and functional way is paramount. With the Lightning record pages, weâre presented with a plethora of variations on how we can optimize things for the user, all without code: Page Templates How should we organize information on the page? Do we need a header and two equal regions? A header, main section, and a sidebar? No header and three columns? Even if none of the many out-of-the-box layouts work, we can create a custom page template that can be achieved with some light coding. If none of these options work, you could be overthinking things Drag-and-Drop Components After the page regions are defined, we can simply start building out the record page using a number of drag-and-drop components such as tabs, record details, record highlights, related list items for the sidebar, etc. Basically, we can include anything that someone interacting with the record might need to access. Page Activations for Different Use Cases Once the page has been built and defined, we also have the option of activating it as a single org-wide default, or going a few levels deeper and then defining multiple versions of the same record page for different apps, user profiles, and record types. One user may need to see more, less, or different information for the same record. This reality makes defining multiple versions a handy tool to achieve that use case. The page activations can even be as granular as desktop vs. phone for added optimization for the different form factors.  Even More Granular UI Elements Without CodeIn addition to the customizations of the Lightning Record Pages, there are other, more specific ways to customize without code. Compact, Search, and Page Layouts If we need to customize which fields appear and in what orderâin places like the Record Highlights component, the Global Search results, or the Record Details componentâ we can use drag-and-drop methods on the Compact Layouts, Search Layouts, and Page Layouts sections of the Object Manager in Setup. I use these frequently as theyâre essential to organizing information for the users. Dynamic Actions with Conditional Visibility This is a relatively new feature at the time of this writing (only a few releases old), and itâs already helped me with those client requests that go something like, âCan we hide this button until so-and-so has filled out x,y,z or the record has gotten to this stage?â I used to hack this functionality together by creating a mess of record types and different page layouts, or Iâd just code a custom visualforce page. But now, hiding/rendering actions is as easy as defining the filters for them with a few clicks. The one consideration here is that this only works (currently) for desktop interfaces. Dynamic Forms Dynamic forms take the whole âconditional visibilityâ thing to a new level. This feature applies not just to buttons and actions, but to individual fields. Similar to the above use-case example for hiding buttons, sometimes a record just might present too many fields to the user at once. Dynamic forms solve this by allowing you to define under which conditions certain fields should be visible. As a result, users can go on about their business of filling things out and updating records. Then, as things progress, dynamic forms hide irrelevant fields and present new, relevant ones. This creates a nice, streamlined user experience. One âgotchaâ we have to keep in mind is that this is only available for custom objects, not standard ones like Leads, Accounts, Contacts, and Opportunities. That being said, Iâm betting this will change soon enough. Screen Flows â Multi-Step Wizards Without CodeScreen flows are probably one of the most powerful tools we can leverage when it comes to custom user experiences without crossing into the âcode zone.â If an app builder needs to hold a userâs hand during a complex and multi-step design process, then the screen flow is the likely tool of choice. Iâve found that there is a bit of a learning curve with screen flows. Although itâs hard to design them nicely from the outset, once someone gets the hang of it, theyâll need very little time to build out a totally bespoke data-entry wizard user experience during those times when even dynamic forms don't get the job done. And once Lightning Components get involved, flows can even launch and exchange information with Lightning Components in the middle of a flow. The possibilities really are endless. Concluding Thoughts and Other Helpful ResourcesAs I said earlier, designing front-end experiences is not one of my strong suits. Iâm pretty sure that if I had not found Salesforce on my app-building journey, I probably would have quit and found a different line of work, or I would have just become a purely back-end developer. The UI/UX tools and features on the Salesforce platform have instead helped me to deliver complete app experiences, front to back. For more information and specific practice on some of the topics covered, check out the links to the Trailhead modules and resources below: In the next article, weâre going to shift gears and dive into some actual coding for the eCars app with Lightning Web Components. If you havenât already joined the official Chatter group for this series, I certainly recommend you do so. That way, you can get the full value of the experience and also pose questions and start discussions with the group. Oftentimes, there are valuable discussions and additional references available there, such as the slides from the presentation and links to other resources and references. https://sforce.co/34Ld7xz About me: Iâm an 11x certified Salesforce professional whoâs been running my own Salesforce consultancy for several years. If youâre curious about my backstory on accidentally turning into a developer and even competing on stage on a quiz show at one of the Salesforce conventions, you can read this article I wrote for the Salesforce blog a few years ago. Also published at https://dev.to/jasonomnivo/building-front-end-app-experiences-with-clicks-not-code-2m6e Join Hacker Noon Create your free account to unlock your custom reading experience.
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Under the Depression Helmet
The last two weeks have been frenetic for Bre Hushaw, who is now known to millions of people as the girl in the depression helmet.
Hushaw has been hearing from people all around the world who want to try it, or at least to know how it works. Her life as a meme began when she agreed to an on-camera interview with the local-news site AZfamily.com for a story headlined âHelmet Approved by FDA to Treat Depression Available in Arizona.â The feel-good tale of Hushawâs miraculous recovery from severe depression was tossed into the decontextualizing maw of the internet and distilled down to a screenshot of a young woman looking like a listless stormtrooper.
Jokes poured in. Some of the most popular, each with more than 100,000 likes on Twitter, include: âIf u see me with this ugly ass helmet mind ur business.â âFriend: hey everything alright? Me, wearing depression helmet: yeah Iâm just tired.â âThe depression helmet STAYS ON during sex.â
Hushaw has been tracking the virality, sometimes cringing and sometimes laughing. She replies to as many serious inquiries as she can, while finishing up her senior year at the University of Northern Arizona before starting a job in marketing. A year ago, she didnât think she was going to live to graduation. Back when she was 10 years old, her mother died. Her depression symptoms waxed and waned from then on, and they waxed especially when she heard the gunshots on her campus during a shooting at the school in 2015. She tried many medications over the yearsâ14, by her count.
âFrom age 15 until I was 20, I was extremely suicidal, and I was self-harming,â she told me last week. She recounted multiple related hospitalizations, and a gradual loss of faith in the medical system.
So last year, when Hushaw learned of a helmet that promised to magnetically rewire her brain, she saw this as an obvious yes. The helmet contains magnets that exert energy on the electrical functioning of the brain, a process known as transcranial magnetic stimulation, or TMS. Hushaw went to a clinic and absorbed electrical impulses for 20 minutes every (business) day for six weeks.
[Read: Why a âlifesavingâ depression treatment didn't pass clinical trials]
Though Hushaw likens the feeling to being âtappedâ by a pencil, the chin strap makes it appear as if the helmet is going to blast her with energy. This didnât help with the jokes. I retweeted the news story with, âAfter wearing it you feel like a weight has been lifted off you.â That made me feel clever until I actually read the story and saw that Hushaw said almost exactly the same thingââI felt like there was a huge blanket that was lifted off my shoulders and I felt completely freeââreferring to suicidal depression.
Hushaw is okay with it. Despite the mockery, sheâs overall thrilled by the attention given to the helmet. The image above is a recreationâshe went back to the clinic to take the photo, and she sent it to me. I didnât ask her to do this. But she is passionate: âI just want to make sure that people are getting help,â she said. âI had a friend commit suicide on my campus and I just never want that to happen again.â
As she put it multiple times, âIt actually, really saved my life.â
The attention Hushawâs story received is testament to how few people know what to make of TMS. Even when I surveyed physician friends about it, several hadnât heard of it, and no one had seen it used in more than a rare case. It is certainly not woven into typical treatment plans.
Researchers at some academic institutions are taking the technology seriously. Yale has a Transcranial Magnetic Stimulation Research Clinic, and the service is offered at Johns Hopkins. There have been numerous studies suggesting promising clinical uses, including one this week in the journal Neurology. But the mechanisms proposed are vague. TMS may be beneficial in treating addiction, according to a 2017 paper in Nature Neuroscience Reviews, by âinfluencing neural activity ... throughout the brain.â According to the Mayo Clinic: âThough the biology of why TMS works isnât completely understood, the stimulation appears to impact how the brain is working, which in turn seems to ease depression symptoms and improve mood.â
Yes, TMS seems to impact how the brain is working. These statements are not abdications of explanatory burden, but come close to the extent of what is known. Serenity Mental Health Centers, the Arizona clinic that provided Hushaw with the electromagnetic treatment, claim that âpeople with depression often have areas of their brain with decreased activity, and people with [obsessive-compulsive disorder] often have overactive areas of their brain, so TMS stimulates and resets those regions of the brain.â
The notion that the device has dramatic effects on the structure or function of the brain is at odds, though, with the U.S. Food and Drug Administrationâs classification. In March, the regulatory agency issued a rule deeming them Class II medical devices, along with electric wheelchairs and pregnancy tests, which means that they are presumed to be safe. Most therapeutic devices that affect human physiology are Class III, which would certainly be the case with anything that âresets the brain.â The FDA argued that a Class II designation would âenhance patientsâ access to beneficial innovation, in part by reducing regulatory burdens by placing the device into a lower device class than the automatic Class III assignment.â
BRE HUSHAW
The first TMS helmet approved by the FDA, Neurostar, was for treatment of major depressive disorder, in 2008. Others have been since, as the market began to boom. On Tuesday, Brainsway, the company that made the helmet used by Hushaw, announced its initial public offering. Brainsway was also approved for obsessive-compulsive disorder in August of 2018, and the publicity efforts around this approval were what eventually led to Hushawâs news fame, according to the marketing director of the clinic that provides the helmet, Sunrise Mental Health Centers.
This marketing director, Candise Miller, has her own miraculous personal story of recovery via TMS. âMy life is forever changed. Iâm a completely different person,â she told me. She asked me to include a link to the clinicâs home page, which features her testimonial but does not mention that she is director of marketing.
Until the FDAâs new classification this year, the agency had reigned in marketing of such health claims by requiring pre-market approval for TMS devices. Manufacturers had to submit evidence that the devices had no immediately obvious adverse effects and at least a small amount effectiveness. For instance, the FDA said it based approval of Brainsway for OCD on a single study of 100 people, which showed improvements in some patients. A control group wore actual TMS helmets that secretly werenât turned on. Presumably due to placebo effect, this group also saw an 11 percent decrease in symptoms.
Like most treatments in psychiatry, there is value in showing up, and in believing you are being treated. These and other mechanisms are mysterious, and the effects are unreliableâattesting to the complexity of mental illness, and the many factors that go into causing and treating it.
The basic idea of shocking the system into compliance has deep roots. Since electroconvulsive therapy was introduced almost a century ago, the approach has been shown to unreliably but sometimes dramatically effective for treatment of severe depression. At least partly due to its barbaric connotations and the uncertainty of the outcomes, electroconvulsive therapy remains one of the most controversial treatments in medicine. It isnât practiced by most psychiatrists.
The electrical charges delivered by TMS are meant to be more focused, but still very powerful. Inside the helmet, a series of looped wires are connected to capacitors that pass electrical currents through them in bursts. Pulses generate a secondary electric current that alters the electric fields in the brain, depolarizing neurons and causing them to fire. The scalp and skull do not shield the electrical processes in the brain from such a force any more than a cubicle wall shields your ears from a colleague who is incapable of keeping their phone on silent.
Whether or how TMS would cause lasting change in brain function is not entirely clear. The concept was introduced in 1985 at the University of Sheffield, in England, as a diagnostic and mapping tool for the motor cortex. The technology can reliably be used to make a personâs legs jerk, but the ostensible aim of the current treatments is to reach beyond transient cortical activity and fundamentally alter the brainâs circuitry. And unlike the invasive neurological procedure of deep-brain stimulation, which has proven useful in treating OCD as well as Parkinsonâs disease and other conditions, the helmet doesnât require any holes in the skull and electrodes planted in the brain.
But TMSâs marketing claims raise questions about how the helmetâs electrical currents could reach the brainâs emotion-driving portions without causing any unwanted cortical activity or serious adverse effects. In electroconvulsive therapy, a person must be anesthetized and made to convulse, and this was always seen as an unfortunate byproduct of the attempt to reset deeper parts of the nervous system. TMS requires no sedation, and only rarely causes seizures. (The sessions are still supposed to be closely monitored by a licensed technicianâand the helmet is not supposed to be worn in public, as was implied in most of the jokes that hit the internet last week.)
The only people who claim to know precisely how these helmets treat such complex sociocultural-behavioral conditions as depression and anxiety are the ones selling treatment with the machine, or machines themselves. As TeeJay Tripp, the medical director of Arizonaâs Sunrise Mental Health Centers who treated Hushaw, understands it, TMS activates the prefrontal cortex, which can lead to downstream effects that ultimately impact the amygdala or other deep structures tied to emotion.
The lack of understanding about what might be happening in those deep structures is paired with uncertainty about what parts of the cortex should be stimulated in the first place. The common wisdom among TMS practitioners is that depression occurs in the right side of the brain and anxiety on the left. Depending on which you have, the energy needs to be focused on one side. But this two-sided model of the brain is not supported by any neuroscience text I can find.
In addition to treatments for depression and anxiety, Sunrise Mental Health Centers also offers to provide TMS for: âADD/ADHD, addiction, Alzheimerâs disease, anxiety, autism, bipolar disorder, chronic pain, eating disorders, multiple sclerosis, schizophrenia, stroke rehabilitation, and substance abuse.â The FDA has only approved TMS for depression and OCD, but the approach can still legally be used âoff-label.â When asked where in the brain electricity should be applied for these various conditions, Tripp says he bases his treatment on a mix of trial and error, along with whatever small studies have been done on any particular condition. Most notably among these uses, he and other practitioners have begun putting the helmets on children with autism.
I asked Tripp if he was concerned about potential long-term repercussions, or simply about rewiring the wrong area. He cited the fact that the FDA had approved the helmet 10 years ago (for use in depression), and there has been no research showing long-term harm yet. Miller, Sunriseâs marketing director, believes that TMSâs overhead so far has prevented it from being more widely known and used; she put the ballpark cost of a Brainsway at $200,000. She also contends that uptake has been slow because of âWestern medicineâs reliance on pharmaceuticals,â and the insurance companiesâ unwillingness to pay for it.
Insurance companies are increasingly covering the treatment, though. Direct-to-consumer marketing has increased demand in recent years, practitioners tell me, and many plans will cover the $10,000 to $12,000 treatment for people who havenât responded to trials of medications and therapy.
This is how LeeAnn Tucker afforded six weeks in the helmet. A 47-year-old former elementary school teacher in the Houston Area, she spent two decades âon and off of every antidepressant,â she says. She has been diagnosed with bipolar II, and she also has generalized anxiety disorder, PTSD, and panic attacks. The anxiety has led her to develop agoraphobia. âI donât leave my house unless I absolutely have to. Itâs just bad,â she says. âSometimes if Iâm in the grocery store I will have to leave my cart and just go home.â
Tucker has also been suicidal. âThe suicidal thoughts were so severe that I never told anyone,â she told me, ânot my doctor, not my husband. Because when you tell someone, then theyâll try to save you.â
A few years ago, she began seeing a new psychiatrist who had a video commercial for the Neurostar TMS helmet playing on a loop in his waiting room. (Neurostar provides all marketing material for patients. Clinicians buy the machine, and they also pay for each use of it.) She was convinced to try it. She was âtapped,â as they call it, âon the left side for depression, and on the right side for anxiety.â She sent me a video from her phone of her undergoing treatment. Her face is expressionless, and the piercing blasts sound like laser guns.
After six weeks of daily treatment, Tucker saw no improvement. âI would love to say it worked, but I felt no different when it was over,â she says. âIâm still depressed as fuck.â
One thing that did help, though, was that Tucker made friends with her technician, Allison Rose Zartier, over the course of weeks of treatment. âHaving someone like Allison administer TMS was actually the best part for me,â Tucker says. Zartier, who is now the TMS coordinator at a business called Elite Medical Wellness in Lake Charles, Louisiana, says she finds it unbelievable that some practitioners leave people alone during the 20-to-30-minute treatments. Some of the biggest benefits she has seen have come through talking to people while the magnets are firing. She says that a recently retired CEO needed to find a way to have purpose with all of his free time. Another extremely isolated person felt better after Zartier recommended a dog.
Advocates of the depression helmet consider the treatment great if it ends up actually helping even a small number (and harming fewer than it helps). For ECT and TMS, and anything that proposes to offer a hard restart to your central nervous system, the health risks cannot be zeroâand should be expected to be significant. TMS and other high-tech, high-cost treatments also have the potential to divert focus from social, structural, and preventive supportâthe basic elements of health that, when ignored, often manifest as depressive symptoms.
[Read: The diet that might cure depression]
The medical model of depression tends to offer treatments that imply they can fix emotions that may actually be related to a need to feel valued and secure. Addressing these and other basic imperativesâto sleep and eat well, and be physically active and socially connectedâis the first priority for treating and preventing most illnesses, mental and otherwise. This emphasis can be lost when an expensive magnetic helmet that promises to make the feelings somehow simply go away is seen as anything other than a last resort.
Zartier went through TMS herself, and told me she was able to stop taking antidepressants shortly after. She now runs a Facebook support group for TMS patients, in which Hushaw is also active. Zartier says the shared experience of having gone through this process fosters a sense of community. Itâs also a tool for recruiting prospective patients. Zartier says the $12,000 cost can be well worth it. She tells people itâs like âgoing to the gym, but for your brain.â
That community is growing. âIt keeps climbing faster, especially in the last four months. The word is finally getting out there,â Zartier says, which she believes is partly because Neurostar is now running television commercials. And sheâs seeing ever more parents in the concerned Facebook community bringing in children.
âI had a 10th grader who was suicidal, and I saw the pain in her eyes,â she says. âThe younger you are, the more the brain can be affectedâtheir brains seem to want to change.â
from Health News And Updates https://www.theatlantic.com/health/archive/2019/04/depression-helmet/587242/?utm_source=feed
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Under the Depression Helmet
The last two weeks have been frenetic for Bre Hushaw, who is now known to millions of people as the girl in the depression helmet.
Hushaw has been hearing from people all around the world who want to try it, or at least to know how it works. Her life as a meme began when she agreed to an on-camera interview with the local-news site AZfamily.com for a story headlined âHelmet Approved by FDA to Treat Depression Available in Arizona.â The feel-good tale of Hushawâs miraculous recovery from severe depression was tossed into the decontextualizing maw of the internet and distilled down to a screenshot of a young woman looking like a listless stormtrooper.
Jokes poured in. Some of the most popular, each with more than 100,000 likes on Twitter, include: âIf u see me with this ugly ass helmet mind ur business.â âFriend: hey everything alright? Me, wearing depression helmet: yeah Iâm just tired.â âThe depression helmet STAYS ON during sex.â
Hushaw has been tracking the virality, sometimes cringing and sometimes laughing. She replies to as many serious inquiries as she can, while finishing up her senior year at the University of Northern Arizona before starting a job in marketing. A year ago, she didnât think she was going to live to graduation. Back when she was 10 years old, her mother died. Her depression symptoms waxed and waned from then on, and they waxed especially when she heard the gunshots on her campus during a shooting at the school in 2015. She tried many medications over the yearsâ14, by her count.
âFrom age 15 until I was 20, I was extremely suicidal, and I was self-harming,â she told me last week. She recounted multiple related hospitalizations, and a gradual loss of faith in the medical system.
So last year, when Hushaw learned of a helmet that promised to magnetically rewire her brain, she saw this as an obvious yes. The helmet contains magnets that exert energy on the electrical functioning of the brain, a process known as transcranial magnetic stimulation, or TMS. Hushaw went to a clinic and absorbed electrical impulses for 20 minutes every (business) day for six weeks.
[Read: Why a âlifesavingâ depression treatment didn't pass clinical trials]
Though Hushaw likens the feeling to being âtappedâ by a pencil, the chin strap makes it appear as if the helmet is going to blast her with energy. This didnât help with the jokes. I retweeted the news story with, âAfter wearing it you feel like a weight has been lifted off you.â That made me feel clever until I actually read the story and saw that Hushaw said almost exactly the same thingââI felt like there was a huge blanket that was lifted off my shoulders and I felt completely freeââreferring to suicidal depression.
Hushaw is okay with it. Despite the mockery, sheâs overall thrilled by the attention given to the helmet. The image above is a recreationâshe went back to the clinic to take the photo, and she sent it to me. I didnât ask her to do this. But she is passionate: âI just want to make sure that people are getting help,â she said. âI had a friend commit suicide on my campus and I just never want that to happen again.â
As she put it multiple times, âIt actually, really saved my life.â
The attention Hushawâs story received is testament to how few people know what to make of TMS. Even when I surveyed physician friends about it, several hadnât heard of it, and no one had seen it used in more than a rare case. It is certainly not woven into typical treatment plans.
Researchers at some academic institutions are taking the technology seriously. Yale has a Transcranial Magnetic Stimulation Research Clinic, and the service is offered at Johns Hopkins. There have been numerous studies suggesting promising clinical uses, including one this week in the journal Neurology. But the mechanisms proposed are vague. TMS may be beneficial in treating addiction, according to a 2017 paper in Nature Neuroscience Reviews, by âinfluencing neural activity ... throughout the brain.â According to the Mayo Clinic: âThough the biology of why TMS works isnât completely understood, the stimulation appears to impact how the brain is working, which in turn seems to ease depression symptoms and improve mood.â
Yes, TMS seems to impact how the brain is working. These statements are not abdications of explanatory burden, but come close to the extent of what is known. Serenity Mental Health Centers, the Arizona clinic that provided Hushaw with the electromagnetic treatment, claim that âpeople with depression often have areas of their brain with decreased activity, and people with [obsessive-compulsive disorder] often have overactive areas of their brain, so TMS stimulates and resets those regions of the brain.â
The notion that the device has dramatic effects on the structure or function of the brain is at odds, though, with the U.S. Food and Drug Administrationâs classification. In March, the regulatory agency issued a rule deeming them Class II medical devices, along with electric wheelchairs and pregnancy tests, which means that they are presumed to be safe. Most therapeutic devices that affect human physiology are Class III, which would certainly be the case with anything that âresets the brain.â The FDA argued that a Class II designation would âenhance patientsâ access to beneficial innovation, in part by reducing regulatory burdens by placing the device into a lower device class than the automatic Class III assignment.â
BRE HUSHAW
The first TMS helmet approved by the FDA, Neurostar, was for treatment of major depressive disorder, in 2008. Others have been since, as the market began to boom. On Tuesday, Brainsway, the company that made the helmet used by Hushaw, announced its initial public offering. Brainsway was also approved for obsessive-compulsive disorder in August of 2018, and the publicity efforts around this approval were what eventually led to Hushawâs news fame, according to the marketing director of the clinic that provides the helmet, Sunrise Mental Health Centers.
This marketing director, Candise Miller, has her own miraculous personal story of recovery via TMS. âMy life is forever changed. Iâm a completely different person,â she told me. She asked me to include a link to the clinicâs home page, which features her testimonial but does not mention that she is director of marketing.
Until the FDAâs new classification this year, the agency had reigned in marketing of such health claims by requiring pre-market approval for TMS devices. Manufacturers had to submit evidence that the devices had no immediately obvious adverse effects and at least a small amount effectiveness. For instance, the FDA said it based approval of Brainsway for OCD on a single study of 100 people, which showed improvements in some patients. A control group wore actual TMS helmets that secretly werenât turned on. Presumably due to placebo effect, this group also saw an 11 percent decrease in symptoms.
Like most treatments in psychiatry, there is value in showing up, and in believing you are being treated. These and other mechanisms are mysterious, and the effects are unreliableâattesting to the complexity of mental illness, and the many factors that go into causing and treating it.
The basic idea of shocking the system into compliance has deep roots. Since electroconvulsive therapy was introduced almost a century ago, the approach has been shown to unreliably but sometimes dramatically effective for treatment of severe depression. At least partly due to its barbaric connotations and the uncertainty of the outcomes, electroconvulsive therapy remains one of the most controversial treatments in medicine. It isnât practiced by most psychiatrists.
The electrical charges delivered by TMS are meant to be more focused, but still very powerful. Inside the helmet, a series of looped wires are connected to capacitors that pass electrical currents through them in bursts. Pulses generate a secondary electric current that alters the electric fields in the brain, depolarizing neurons and causing them to fire. The scalp and skull do not shield the electrical processes in the brain from such a force any more than a cubicle wall shields your ears from a colleague who is incapable of keeping their phone on silent.
Whether or how TMS would cause lasting change in brain function is not entirely clear. The concept was introduced in 1985 at the University of Sheffield, in England, as a diagnostic and mapping tool for the motor cortex. The technology can reliably be used to make a personâs legs jerk, but the ostensible aim of the current treatments is to reach beyond transient cortical activity and fundamentally alter the brainâs circuitry. And unlike the invasive neurological procedure of deep-brain stimulation, which has proven useful in treating OCD as well as Parkinsonâs disease and other conditions, the helmet doesnât require any holes in the skull and electrodes planted in the brain.
But TMSâs marketing claims raise questions about how the helmetâs electrical currents could reach the brainâs emotion-driving portions without causing any unwanted cortical activity or serious adverse effects. In electroconvulsive therapy, a person must be anesthetized and made to convulse, and this was always seen as an unfortunate byproduct of the attempt to reset deeper parts of the nervous system. TMS requires no sedation, and only rarely causes seizures. (The sessions are still supposed to be closely monitored by a licensed technicianâand the helmet is not supposed to be worn in public, as was implied in most of the jokes that hit the internet last week.)
The only people who claim to know precisely how these helmets treat such complex sociocultural-behavioral conditions as depression and anxiety are the ones selling treatment with the machine, or machines themselves. As TeeJay Tripp, the medical director of Arizonaâs Sunrise Mental Health Centers who treated Hushaw, understands it, TMS activates the prefrontal cortex, which can lead to downstream effects that ultimately impact the amygdala or other deep structures tied to emotion.
The lack of understanding about what might be happening in those deep structures is paired with uncertainty about what parts of the cortex should be stimulated in the first place. The common wisdom among TMS practitioners is that depression occurs in the right side of the brain and anxiety on the left. Depending on which you have, the energy needs to be focused on one side. But this two-sided model of the brain is not supported by any neuroscience text I can find.
In addition to treatments for depression and anxiety, Sunrise Mental Health Centers also offers to provide TMS for: âADD/ADHD, addiction, Alzheimerâs disease, anxiety, autism, bipolar disorder, chronic pain, eating disorders, multiple sclerosis, schizophrenia, stroke rehabilitation, and substance abuse.â The FDA has only approved TMS for depression and OCD, but the approach can still legally be used âoff-label.â When asked where in the brain electricity should be applied for these various conditions, Tripp says he bases his treatment on a mix of trial and error, along with whatever small studies have been done on any particular condition. Most notably among these uses, he and other practitioners have begun putting the helmets on children with autism.
I asked Tripp if he was concerned about potential long-term repercussions, or simply about rewiring the wrong area. He cited the fact that the FDA had approved the helmet 10 years ago (for use in depression), and there has been no research showing long-term harm yet. Miller, Sunriseâs marketing director, believes that TMSâs overhead so far has prevented it from being more widely known and used; she put the ballpark cost of a Brainsway at $200,000. She also contends that uptake has been slow because of âWestern medicineâs reliance on pharmaceuticals,â and the insurance companiesâ unwillingness to pay for it.
Insurance companies are increasingly covering the treatment, though. Direct-to-consumer marketing has increased demand in recent years, practitioners tell me, and many plans will cover the $10,000 to $12,000 treatment for people who havenât responded to trials of medications and therapy.
This is how LeeAnn Tucker afforded six weeks in the helmet. A 47-year-old former elementary school teacher in the Houston Area, she spent two decades âon and off of every antidepressant,â she says. She has been diagnosed with bipolar II, and she also has generalized anxiety disorder, PTSD, and panic attacks. The anxiety has led her to develop agoraphobia. âI donât leave my house unless I absolutely have to. Itâs just bad,â she says. âSometimes if Iâm in the grocery store I will have to leave my cart and just go home.â
Tucker has also been suicidal. âThe suicidal thoughts were so severe that I never told anyone,â she told me, ânot my doctor, not my husband. Because when you tell someone, then theyâll try to save you.â
A few years ago, she began seeing a new psychiatrist who had a video commercial for the Neurostar TMS helmet playing on a loop in his waiting room. (Neurostar provides all marketing material for patients. Clinicians buy the machine, and they also pay for each use of it.) She was convinced to try it. She was âtapped,â as they call it, âon the left side for depression, and on the right side for anxiety.â She sent me a video from her phone of her undergoing treatment. Her face is expressionless, and the piercing blasts sound like laser guns.
After six weeks of daily treatment, Tucker saw no improvement. âI would love to say it worked, but I felt no different when it was over,â she says. âIâm still depressed as fuck.â
One thing that did help, though, was that Tucker made friends with her technician, Allison Rose Zartier, over the course of weeks of treatment. âHaving someone like Allison administer TMS was actually the best part for me,â Tucker says. Zartier, who is now the TMS coordinator at a business called Elite Medical Wellness in Lake Charles, Louisiana, says she finds it unbelievable that some practitioners leave people alone during the 20-to-30-minute treatments. Some of the biggest benefits she has seen have come through talking to people while the magnets are firing. She says that a recently retired CEO needed to find a way to have purpose with all of his free time. Another extremely isolated person felt better after Zartier recommended a dog.
Advocates of the depression helmet consider the treatment great if it ends up actually helping even a small number (and harming fewer than it helps). For ECT and TMS, and anything that proposes to offer a hard restart to your central nervous system, the health risks cannot be zeroâand should be expected to be significant. TMS and other high-tech, high-cost treatments also have the potential to divert focus from social, structural, and preventive supportâthe basic elements of health that, when ignored, often manifest as depressive symptoms.
[Read: The diet that might cure depression]
The medical model of depression tends to offer treatments that imply they can fix emotions that may actually be related to a need to feel valued and secure. Addressing these and other basic imperativesâto sleep and eat well, and be physically active and socially connectedâis the first priority for treating and preventing most illnesses, mental and otherwise. This emphasis can be lost when an expensive magnetic helmet that promises to make the feelings somehow simply go away is seen as anything other than a last resort.
Zartier went through TMS herself, and told me she was able to stop taking antidepressants shortly after. She now runs a Facebook support group for TMS patients, in which Hushaw is also active. Zartier says the shared experience of having gone through this process fosters a sense of community. Itâs also a tool for recruiting prospective patients. Zartier says the $12,000 cost can be well worth it. She tells people itâs like âgoing to the gym, but for your brain.â
That community is growing. âIt keeps climbing faster, especially in the last four months. The word is finally getting out there,â Zartier says, which she believes is partly because Neurostar is now running television commercials. And sheâs seeing ever more parents in the concerned Facebook community bringing in children.
âI had a 10th grader who was suicidal, and I saw the pain in her eyes,â she says. âThe younger you are, the more the brain can be affectedâtheir brains seem to want to change.â
Article source here:The Atlantic
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Why Doctors & Hospitals need Digital & Social Media Marketing
Digital marketing for doctors can be tricky. This is particularly because medical professionals need to go the extra mile to build a sense of trust and assurance with potential patients in the online space. Whether you are a practitioner or looking for ways to improve the visibility of your clinic, it is important to incorporate a digital-first marketing strategy to widen your clientele. Here are a few digital marketing tips for doctors to stay relevant and patient-centric.
Showcase your services through a website
The most important platform that serves as the first point of contact between you and a potential patient is your website or landing page. The user experience provided by your website will lay the foundation for the first impression created on visitors. To provide the best user experience, it is important to create a website or landing page that is extremely navigable and user-friendly. Furthermore, you must ensure it contains all the adequate information patients look for while searching for medical help. Important details such as doctors profile, consultation timings, health departments, courses of treatment and procedure to fix an appointment are extremely vital. Additionally, you can implement AMP-enabled pages for lightning-fast loading speed, to ensure visitors stay on your website and do not bounce off.
Featured below is a website developed for Dr Mohanâs Diabetes Centre â the nationâs leading diabetes clinic. From services to locations of clinics, the homepage covers all the aspects that patients are looking for, making it highly efficient and discoverable.
To add to that, featured below is a video on how AMP landing pages produced 33% lower CPL for India Home Health Care â a leading healthcare provider. When IHHC approached us to generate high-quality leads at lower cost-per-lead (CPL), we incorporated AMP-enabled landing pages that load faster, are mobile responsive and look great on both desktop and mobile. Within three months of launching, the total conversions increased by 20% with a 33% reduction in CPL.
Educate and enlighten with blogs
After creating a user-friendly website, the next area of focus is to build strong informational blogs that resonant with your medical practice. According to statistics, there are about 3.5 million medical searches on Google on a day-to-day basis. As a first step, you need to understand those subjects which are being constantly searched on the Internet. From informational content on symptoms and treatment options and FAQs to home remedies and simple tricks, you can use your blog as a platform to give simple advice to your customers. Additionally, there is no better place than blogs to feature the success stories of your patients. Customer testimonials can greatly influence your website traffic and readership. To stay relevant, it is important to plan an effective content strategy by identifying the important dates and months in the world of health.
Email marketing is yet another effective approach when it comes to digital marketing for doctors. Resourceful emailers help practitioners connect with their audience at a more personal level. Your patients will find it extremely useful as the information is right there in the inbox before even they plan to search for it.
Featured below is the blog page of Neuberg Diagnostics. Neuberg Diagnostics addresses a diverse range of healthcare concerns for its customers through an innovative content strategy. Their blogs are relevant, informative and highly engaging.
Leverage videos to invoke emotions
Recent statistics show that there are 5 million videos that are watched on YouTube every single day. Engaging videos generate 1200%  more shares than images and texts combined. Videos are a great digital marketing strategy for building credibility and authenticity for your brand. There is nothing more engaging than watching a medical professional provide deep insights on a particular disease or treatment. It helps your patients feel at ease and assures them that they are in the hands of an experienced practitioner. Videos are also an appropriate place to feature your customer testimonials. The greatest advantage of videos is its ability to invoke a wide range of emotions like hope, passion and courage which pushes them further down the marketing funnel.
For example, here is a video created by Dr. Mohanâs on the concept of âWhat is it about the 90âs?â. It is an inspirationa; video of how a 90-year-old person with diabetes defies all norms.
Optimise to get discovered
Imagine you have a great website, blogs, emailer and videos. But, your patients canât find you on Google. The best way to solve this problem is to adopt effective methods of search engine optimisation with a detailed on-page and off-page checklist. SEO is important when it comes to digital marketing for doctors since it helps in developing a content strategy based on specific keywords used by your patients for their searches. The first task that you need to implement before developing your content is to do a keyword research using tools like Google keyword research tool and LSI Keyword generator tool. It is always ideal to choose keywords that have a lower difficulty score and higher search volume. Although you need higher search volume for better ranking of your website, quality content is always the king.
Leverage local SEO for higher walk-ins
As per a recent survey, 39% of patients choose their practitioner from a Google search. These statistics prove that listing your clinic or medical practice on Google My Business Listings plays a huge role in increasing your visibility and footfalls. Ensure you provide ready information with updated phone numbers, complete address, services, working hours and a link to your website. GMB listings also offer reviews shared by older patients and visitors that add credibility to your practice. Additionally, you can also feature relevant blog posts in your listings, providing viewers with a detailed glance of what you have to offer.
For example, below is the GMB listing for Dr. Mohans with a link to their website, social media profiles and Wikipedia page.
Go Social for a strong connection
Digital marketing for doctors is incomplete without a strong social media marketing strategy. The most important factor that medical practitioners must keep in mind is the fact that every social media platform has a unique audience. The demographics and preferences of Facebook and Instagram are quite different than that of LinkedIn. So, it is always ideal to strategise your social media campaign based on the nature of the platform. There is no better tool than social media to address the complaints and concerns of your customers.
For instance, online communities and discussion forums are great tools to handle customer complaints. Hashtag campaigns, infographics, quizzes, memes, hangout interactions and live chats are other ways to effectively engage your audience through social media. Featured below is an innovative Facebook campaign done for Neuberg Diagnostics with the hashtag #Samjhoishare. The posts play around the concept of healthy living with a comic touch, covering all the aspects of a successful social media strategy.
Adopt a multilingual approach
Multilingual marketing is a great way to genuinely connect with your audience in a language they are comfortable in. By 2020, 9 out of every 10 Internet users will be consuming content in regional languages. Adopting a multilingual marketing strategy will give medical practitioners an early moverâs advantage to connect with their audience and stay ahead of their competitors. However, it is vital to take up an end-to-end multilingual strategy, from vernacular videos to regional ads, in order to create an impact and increase the credibility of your practice.
For example, featured below is a Facebook campaign on the Ten Commandments of Diabetes. While the English posts got an engagement of 8 likes, the same campaign in Tamil generated 6 shares and 2 comments, proving to be a much effective approach to reach your target audience.
 While implementing an effective digital marketing strategy for doctors, it is always important to ensure that all your digital tools are streamlined and are sync with each other. Doctors must also focus on building a content management platform to track the performance of your digital assets and identify key areas that require updation and improvement. You can also check out our blog on digital marketing tips for Pharma for more insights.
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Ad Blocking App Is âNuclear Weaponâ That Will Change Online Ads, Says Startup
www.inhandnetworks.com
The Mobile World Congress this week in Barcelona, Spain, was supposed to be a friendly celebration of technology. The photo-turned-meme of Facebook founder Mark Zuckerberg smiling and walking through a room of attendees hooked on virtual reality headsets successfully captured the vibe of the event.
But the cordiality of the conference was pushed aside during a talk between representatives from Google, Yahoo and an Israeli mobile ad-blocking startup called Shine. Shineâs chief marketing officer, Roi Carthy, compared its technology to a nuclear weapon that will reset the entire online advertising industry. Carthy accused tech companies of engaging in âmilitary gradeâ tracking, collecting consumer data with hidden cookies and trackers.
âLetâs be clear again that the reason that there are conversations now is...by virtue of Shine being able to put a nuclear weapon at the end of the pipe,â said Carthy. Yahoo Vice President Nick Hugh called the quote âa bit dramaticâ during the talk.
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Carthy also said Shine is the âsingle biggest threat in the history of advertising.â Google's managing director of media and platforms, Benjamin Faes, shot back at Carthy, saying Shine is a âbluntâ method to punish the good advertisers who donât spam online users. âI'm really concerned by this black-and-white think," Faes said.
Shine has been taking small steps to expand its technology around the world since launching in 2011. It just inked a deal with its first European mobile carrier early this month to add to its partnership with a separate Caribbean carrier, according to TechCrunch.
In the past few years, ad-blocking apps have been in the spotlight due to their ability to sever online revenue for media outlets that rely on the advertisements. Wired, The Washington Post and many other outlets have installed notifications alerting readers or even forcing them on both mobile and desktop to turn off their ad blockers before reading content on the sites.
Many have seen online advertising as a scourge on the Internet. In 2012, Adobe released a survey on online advertising, which found 68 percent of consumers found online advertisements to be âannoying.â
Despite all the bickering, Carthy and Faes found some common ground: They both agreed that online advertisements bloat the size of Web pages and slow down loading times. Taking matters into its own hands, Facebook created Instant Articles back in October, which allows articles from partnered publishers to quickly load on a userâs newsfeed. Last week, Facebook announced it will open up Instant Articles to any interested publishers.
At the Barcelona event, Faes announced that Google will be releasing open-source tools to help quicken the loading times on mobile. âStrange as it may sound, Iâm going to agree with Roi on one point,â Faes says. âI think the industry, advertisers and publishers have become very lenient on the speed.â
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