what is theta burst stimulation

Theta burst stimulation (TBS) is a form of repetitive transcranial magnetic stimulation (TMS). When applied to motor cortex it leads to after-effects on corticospinal and corticocortical excitability that may reflect LTP/LTD-like synaptic effects.

The physiological basis of the effects of intermittent theta burst stimulation of the human motor cortex Authors V. Di Lazzaro,Close author notes Institute of Neurology, Università Cattolica, L. go A. Gemelli 8, 00168 Rome, Italy Fondazione Don C. Gnocchi, Rome, Italy Search for more papers by this author F. Pilato,Close author notes Institute of Neurology, Università Cattolica, L. go A. Gemelli 8, 00168 Rome, Italy Search for more papers by this author M. Dileone,Close author notes Institute of Neurology, Università Cattolica, L. go A. Gemelli 8, 00168 Rome, Italy Search for more papers by this author P. Profice,Close author notes Institute of Neurology, Università Cattolica, L. go A. Gemelli 8, 00168 Rome, Italy Search for more papers by this author A. Oliviero,Close author notes Institute of Neurology, Università Cattolica, L. go A. Gemelli 8, 00168 Rome, Italy FENNSI Group, Hospital Nacional de Paraplejicos, SESCAM, Finca la Peraleda, 45071 Toledo, Spain Search for more papers by this author P. Mazzone,Close author notes Neurochirurgia CTO, Via S. Nemesio 21, 00145 Rome, Italy Search for more papers by this author A. Insola,Close author notes Neurofisiologia CTO, Via S. Nemesio 21, 00145 Rome, Italy Search for more papers by this author F. Ranieri,Close author notes Institute of Neurology, Università Cattolica, L. go A. Gemelli 8, 00168 Rome, Italy Search for more papers by this author M. Meglio,Close author notes Institute of Neurosurgery, Università Cattolica, L. go A. Gemelli 8, 00168 Rome, Italy Search for more papers by this author P. A. Tonali,Close author notes Institute of Neurology, Università Cattolica, L. go A. Gemelli 8, 00168 Rome, Italy Fondazione Don C. Gnocchi, Rome, Italy Search for more papers by this author J. C. Rothwell Close author notes Sobell Department of Neurophysiology, Institute of Neurology and The National Hospital for Neurology & Neurosurgery, Queen Square, London WC1N 3BG, UKSearch for more papers by this author First published: 15 August 2008 Full publication history DOI: 10.1113/jphysiol.2008.152736 View/save citation Cited by (Cross Ref): 119 articles Check for updates Citation tools Corresponding author V. Di Lazzaro: Istituto di Neurologia, Università Cattolica, L. go A. Gemelli 8, 00168 Rome, Italy. Email: vdilazzaro@rm.unicatt.it Abstract

An inhibitory form of TBS (continuous, c TBS) suppresses MEPs, and spinal epidural recordings show this is due to suppression of the I1 volley evoked by TMS. Here we investigate whether the excitatory form of TBS (intermittent, i TBS) affects the same I-wave circuitry. We recorded corticospinal volleys evoked by single pulse TMS of the motor cortex before and after i TBS in three conscious patients who had an electrode implanted in the cervical epidural space for the control of pain. As in healthy subjects, i TBS increased MEPs, and this was accompanied by a significant increase in the amplitude of later I-waves, but not the I1 wave. In two of the patients we tested the excitability of the contralateral cortex and found a significant suppression of the late I-waves. The extent of the changes varied between the three patients, as did their age. To investigate whether age might be a significant contributor to the variability we examined the effect of i TBS on MEPs in 18 healthy subjects. i TBS facilitated MEPs evoked by TMS of the conditioned hemisphere and suppressed MEPs evoked by stimulation of the contralateral hemisphere. There was a slight but non-significant decline in MEP facilitation with age, suggesting that interindividual variability was more important than age in explaining our data. In a subgroup of 10 subjects we found that i TBS had no effect on the duration of the ipsilateral silent period suggesting that the reduction in contralateral MEPs was not due to an increase in ongoing transcallosal inhibition. In conclusion, i TBS affects the excitability of excitatory synaptic inputs to pyramidal tract neurones that are recruited by a TMS pulse, both in the stimulated hemisphere and in the contralateral hemisphere. However the circuits affected differ from those influenced by the inhibitory, c TBS, protocol. The implication is that c TBS and i TBS may have different therapeutic targets. The phenomenon of activity-dependent strengthening of synaptic transmission, known as long-term potentiation (LTP) is an important mechanism of learning and memory as well as many other forms of experience-dependent plasticity in the mammalian brain ( Malenka & Bear, 2004 ). LTP has been investigated extensively in animal studies but recently the introduction of transcranial magnetic stimulation (TMS) has provided the opportunity to investigate similar mechanisms in the intact human brain with protocols of repetitive TMS (r TMS) that resemble those used in experimental preparations ( Cooke & Bliss, 2006 ). Thus, repetitive TMS of the motor cortex leads to after-effects on the excitability of corticospinal and corticocortical pathways that remain for periods of an hour or so. Pharmacological studies show that at least some of the protocols are influenced by drugs that act at the NMDA receptor, suggesting that the effects may be due to a change in the effectiveness of synaptic connections ( Hallett, 2007 ). The fact that it may be possible to induce LTP/LTD-like changes in the human brain has important implications for therapeutic applications. The hope is that r TMS-induced changes of synaptic connections will promote recovery of function in parts of the brain damaged by an acute or a chronic lesion ( Ridding & Rothwell, 2007 ). One approach for producing lasting effects in the brain using r TMS, is the recently introduced theta burst stimulation (TBS) protocol. TBS uses bursts of high frequency stimulation (3 pulses at 50 Hz) repeated at intervals of 200 ms (i.e. 5 Hz, the theta rhythm in EEG nomenclature). Interestingly, different patterns of delivery of TBS have opposite effects on synaptic efficiency of the stimulated motor cortex ( Huang et al. 2005 ). The paradigm termed intermittent theta-burst stimulation (i TBS) produces a persisting increase in the amplitude of motor responses evoked by TMS whereas continuous theta-burst stimulation (c TBS) leads to suppression of TMS evoked responses ( Huang et al. 2005 ). It is assumed that these after-effects are due to changes in neural circuits in the cortex involving processes similar to LTP or to long-term depression (LTD) of cortical synapses ( Huang et al. 2007 ). In a recent study we provided direct evidence for the cortical origin of the inhibitory effects of c TBS by recording the corticospinal volleys evoked by single pulse TMS in conscious human subjects who had received an implanted epidural stimulator for the control of pain ( Di Lazzaro et al. 2005 ). We found that c TBS selectively decreased the amplitude of the earliest I-wave. We also tested the effects of i TBS, the facilitatory TBS protocol in a chronic stroke patient who had a dorsal epidural electrode, and we found that i TBS enhanced the corticospinal descending activity evoked by lower limb area stimulation ( Di Lazzaro et al. 2006 ). The ability to record descending corticospinal activity in conscious humans provides a very useful insight into the after-effects of r TMS since the synchronous neural volleys are a direct measure of the effectiveness of synaptic input to corticospinal neurones evoked by TMS. Effectively, they can provide information about postsynaptic activity that is reasonably comparable to that recorded in experimental studies of LTP and LTD performed in hippocampal slice preparations. In this study we have used this method to examine the action of i TBS over the hand area motor cortex in three conscious subjects with no structural abnormality of the central nervous system who had a cervical epidural electrode implanted chronically for control of pain. We also took the opportunity to compare the variability of the effects with those in a separate large group of control subjects without the implanted electrodes who were given the same form of i TBS. Methods Epidural recordings As described in previous publications ( Di Lazzaro et al. 2004 ), we recorded descending corticospinal activity evoked by TMS of the motor cortex directly from the high cervical epidural space of three conscious subject (aged 49, 72 and 88 years) with no abnormality of central nervous system who had electrodes inserted for control of intractable dorso-lumbar pain. Because pain was resistant to medical therapy, the implantation of epidural electrodes for spinal cord stimulation, a minimally invasive and effective option for treatment of chronic pain ( Lanner & Spendel, 2007 ), was performed in these patients. The patients gave their written informed consent. The study was performed according to the Declaration of Helsinki and approved by the ethics committee of the Medical Faculty of the Catholic University of Rome. The patients were taking no centrally acting medication at the time of the experiments. This is because the trial screening period of epidural stimulation, before permanent implantation, is arranged to occur after a period of wash out of any drugs used for pain relief as well as any other central nervous system acting drug. This is well tolerated by the patients because epidural stimulation is considered only in patients resistant to medical treatment and the interruption of medical treatment for a few days does not usually produce any discomfort. It is necessary to do this so that the efficacy of the epidural stimulation on the symptoms of pain can be evaluated before permanent implantation. Magnetic stimulation was performed with a high power Magstim 200 (Magstim Co., Whitland, Dyfed, UK) producing magnetic stimuli with a monophasic waveform. A figure-of-eight coil with external loop diameters of 9 cm was held over the right motor cortex at the optimum scalp position to elicit motor evoked potentials (MEPs) in the contralateral first dorsal interosseous (FDI) muscle. In subjects 1 and 3, we evaluated the remote effect of right motor cortex i TBS by recording also the epidural activity and MEPs evoked by the contralateral, left, motor cortex stimulation. Active motor threshold (AMT) was defined as the minimum stimulus intensity that produced a liminal MEP (about 200 μV in 50% of 10 trials) during isometric contraction of the tested muscle. Resting motor threshold (RMT) was defined according to the recommendations of the IFCN Committee ( Rossini et al. 1994) as the minimum stimulus intensity that produced a liminal MEP (> 50 μV in 50% of 10 trials) with the tested muscle at rest. Two different orientations of the stimulating coil over the motor strip were used, with the induced current flowing either in a latero-medial (LM) or in a posterior–anterior (PA) direction. RMT was determined separately for LM and PA stimulation. LM magnetic stimulation was used to identify the latency of the earliest (D-wave) descending volley ( Di Lazzaro et al. 2004 ). The responses to 20 stimuli at an intensity of 150% RMT were averaged at rest, both for LM and PAEpidural recordings were made between the most proximal and distal of the four electrode contacts on the epidural electrode. These had a surface area of 2.54 mm 2 and were 30 mm apart. The distal contact was connected to the reference input of the amplifier. MEPs and epidural activity were band-pass filtered (bandwidth 3 Hz to 3 k Hz) (D360 amplifiers, Digitimer, Welwyn Garden City, UK) and each single trial was recorded on computer for later analysis using a CED 1401 A/D converter (Cambridge Electronic Design, Cambridge, UK) and associated software with a sampling rate of 10 k Hz per channel. Amplitude of the volleys was measured from onset to peak, where onset was defined either as the immediately preceding trough, or as the initial deflection from baseline. To improve the identification and the measurement of the individual volleys we averaged the single trials in blocks of two consecutive trials TBS was delivered over the right motor cortex ‘hot spot’ for MEPs in the contralateral FDI muscle using a Mag Pro stimulator (Medtronic A/S, Copenhagen, Denmark) connected to a figure-of-eight coil (MCF B65). The initial direction of the current induced in the brain was anterior to posterior. The magnetic stimulus had a biphasic waveform with a pulse width of about 280 μs and maximum magnetic field strength of 1.5 T. The stimulation intensity was defined in relation to AMT evaluated using the Mag Pro stimulator. An intensity of 80% AMT was used. We used the i TBS protocol in which 10 bursts of high frequency stimulation (3 pulses at 50 Hz) are applied at 5 Hz every 10 s for a total of 600 pulses ( Huang et al. 2005 ). We compared the corticospinal volleys, evoked by single pulse TMS immediately before and starting from 6 min after the end of i TBS, because at this interval there is the maximum of facilitation ( Huang et al. 2005 ). In subjects 1 and 3, the right, stimulated, hemisphere was studied first. Because the mechanism of the I1 wave is different from that of the later I-waves, as suggested by the differential behaviour of the I1 and later I-waves in several TMS protocols and in inhibitory protocols in particular ( Di Lazzaro et al. 2004 ), the effects of i TBS on the amplitude of the I1 and of the later I-waves (the sum of the amplitude of all the individual waves after the I1 wave) were analysed separately. MEP recordings Effects of age on i TBS The three patients were of very different ages. Since several previous reports noted changes in neurophysiological parameters with age ( Peinemann et al. 2001; Sawaki et al. 2003; Pitcher et al. 2003; Hortobágyi et al. 2006; Oliviero et al. 2006; Talelli et al. 2008) we tested whether this could also be an important contributor to the individual differences we described by examining the effect of i TBS on MEPs in 18 healthy subjects of varying ages (mean age 51.2 ± 17.9 ( s.d.) years; range 25–74 years) who did not have epidural electrodes implanted. Single pulse TMS and i TBS were performed as described above. We evaluated RMT, AMT and MEP amplitude bilaterally before and after TBS. In order to evaluate any age related effect, we divided the subjects into three groups: six subjects between 20 and 40 years (mean age was 27.3 ± 1.7 years), six subjects between 41 and 60 years (mean age was 58.5 ± 1.5 years) and six older subjects who were more than 60 years old (mean age was 67.8 ± 2.7 years). None of the subjects had been treated with neuroactive drugs in the 60 days prior to participating in this electrophysiological study. Effects of i TBS on transcallosal inhibition We evaluated the effects of i TBS on transcallosal inhibition in 10 of the subjects (mean age 26.6 ± 4.1 ( s.d.) years; range 20–34 years) with no epidural electrode. Single pulse TMS and i TBS were performed as described above. The effect of i TBS on callosal function was evaluated by measuring the ipsilateral silent period (i SP) of the stimulated hemisphere before and after i TBS since this has been proposed as a simple electrophysiological test of callosal function ( Meyer et al. 1999; Chen et al. 2008 ). Ipsilateral SPs were elicited whilst subjects held a tonic voluntary contraction of approximately 50% of MVC of the FDI ipsilateral to the stimulated hemisphere. Five stimuli at 200% AMT were given. The ipsilateral cortical silent period was measured according to the objective graphical method described by Garvey et al. (2001). This method allows an automated and objective estimation of onset and offset points, based on statistical analysis of variation of the baseline EMG activity ( Garvey et al. 2001 ). EMG signal was sampled at 5 k Hz. One hundred millisonds of rectified averaged prestimulus EMG signal (that is 500 data points) was analysed to calculate the mean EMG level and the mean consecutive difference of the data points. Ipsilateral SP onset was the first point to fall below the lower variation limit if 50% or more of the data points in the following 5 ms window were also below the lower variation limit. Ipsilateral SP offset was the first point to fall above the lower variation limit if 50% or more of the data points in the following 5 ms window were also above the lower variation limit. In order to automate the procedure, we used a self-made function for the Matlab software (The Math Works, Inc., Natick, MA, USA). Ipsilateral SPs were measured before and after i TBS using the same stimulus intensity. Statistics Epidural recording To improve the identification and the measurement of the individual volleys, we averaged the single trials in blocks of two consecutive trials. Because only three subjects were studied, we compared the subaverages (of two individual trials) before and after i TBS separately for each subject. To analyse the effect of i TBS on corticospinal volleys and MEPs, the corticospinal volleys (I1 wave and later I-waves) and MEP amplitudes were entered into three separate (one for each subject) one-way ANOVAs (analyses of variance) with the factor stimulation condition (pre and post) and parameters of I1, later I-waves and MEP amplitudes. Epidural recordings (contralateral – not stimulated – hemisphere) To improve the identification and the measurement of the individual volleys we averaged the single trials in blocks of two consecutive trials. Because only two subjects were studied, we compared the subaverages (of two individual trials) before and after i TBS separately for each subject. For the analysis of the effect of i TBS on corticospinal volleys and MEPs, the corticospinal volleys (I1 wave and later I-waves) and MEP amplitudes were entered into two separate (one for each subject) one-way ANOVAs with the factor stimulation condition (pre and post) and parameters of I1, later I-waves and MEP amplitudes. MEP recordings Effects of i TBS on RMT, AMT and MEP amplitude. The effect of i TBS on RMT, AMT and MEP amplitudes in both hemispheres was assessed by analyses of variance with the factors stimulation condition (pre and post) and parameters of RMT, AMT and MEP amplitudes. We evaluated stimulated and not stimulated (contralateral) hemispheres separately. Effects of ageing on i TBS effects For each subject we calculated the percentage of facilitation (in the stimulated hemisphere) and inhibition (in the contralateral hemisphere). The percentage facilitation (in stimulated hemisphere) and inhibition (in contralateral hemisphere) of the three groups were compared by ANOVA using Bonferroni correction for multiple post hoc comparisons. Effects of i TBS on transcallosal inhibition In control subjects, the i SPs evoked before i TBS were compared with the corresponding i SPs evoked after i TBS using Wilcoxon tests. Results Epidural recordings LM magnetic stimulation evoked the earliest negative potential. It had a latency of 3.1 ms in subject 1, 2.6 ms in subject 2 and 2.9 ms in subject 3. The short latency of this wave is consistent with direct activation of corticospinal axons. We have therefore termed this volley D-wave ( Di Lazzaro et al. 2004 ). PA magnetic stimulation evoked three descending waves in all subjects ( Figs 1, 2 and 3 ); the earliest of these waves had a latency which was 1.1–1.4 ms longer than the volley recruited by LM magnetic stimulation. Since the earliest volley elicited by LM magnetic stimulation is probably a D-wave we have termed the later volleys recruited by PA magnetic stimulation I-waves, numbered in order of their appearance ( Di Lazzaro et al. 2004 ). Figure 1. Open in figure viewer Download Powerpoint slide Corticospinal volleys and motor evoked potentials evoked by single pulse magnetic stimulation in baseline conditions and after right motor cortex intermittent theta burst stimulation (i TBS) in subjects 1 after stimulation of the ipsilateral (left panel) and contralateral (right panel) hemisphere Each trace is the average of 20 sweeps. A, magnetic stimulation evokes three descending waves. The latency of the earliest (I1) wave is indicated by the vertical line. After i TBS, a further I-wave is recruited (I4), the size of the I2 and I3 waves is increased ( F 1,18 = 26.53, P < 0.000), and the amplitude of the I1 wave is unchanged ( F 1,18 = 0.606, P = 0.446). The amplitude of MEP is significantly increased after i TBS ( F 1,18 = 30.1, P < 0.0001). B, magnetic stimulation evokes three descending waves. After i TBS, the size of the latest (I3) wave is decreased ( F 1,18 = 7.116, P = 0.016), the amplitude of the I1 wave is unchanged ( F 1,18 = 4.08, P = 0.058), and the amplitude of MEP is decreased ( F 1,18 = 14.254, P = 0.001). Figure 2. Open in figure viewer Download Powerpoint slide Corticospinal volleys and motor evoked potentials evoked by single pulse magnetic stimulation in baseline conditions and after right motor cortex intermittent theta burst stimulation (i TBS) in subject 2 Each trace is the average of 20 sweeps. Magnetic stimulation evokes three descending waves. After i TBS, the size of the I2 and I3 waves is increased ( F 1,18 = 5.9, P = 0.026), and the amplitude of the I1 wave is unchanged ( F 1,18 = 2.4, P = 0.138). The amplitude of MEP is slightly increased after i TBS, but the change is not significant ( F 1,18 = 0.57, P = 0.459). Figure 3. Open in figure viewer Download Powerpoint slide Corticospinal volleys and motor evoked potentials evoked by single pulse magnetic stimulation in baseline conditions and after right motor cortex intermittent theta burst stimulation (i TBS) in subjects 3 after stimulation of the ipsilateral (left panel) and contralateral (right panel) hemisphere Each trace is the average of 20 sweeps. A, magnetic stimulation evokes three descending waves. The latency of the earliest (I1) wave is indicated by the vertical line. After i TBS, the size of the I2 and I3 waves is increased ( F 1,18 = 9.04, P = 0.008), the amplitude of the I1 wave is unchanged ( F 1,18 = 0.137, P = 0.716). The amplitude of MEP is significantly increased after i TBS ( F 1,18 = 6.35, P = 0.021). B, magnetic stimulation evokes several descending waves. After i TBS, the size of the later waves is significantly decreased ( F 1,18 = 10.74, P = 0.004), and the amplitude of the I1 wave is unchanged ( F 1,18 = 1.3, P = 0.268). The amplitude of MEP is decreased after i TBS, but the change is not significant ( F 1,18 = 0.59, P = 0.453). Figure 1 shows the effect of i TBS on the amplitudes of the I-waves and of MEPs in subject 1. The I1 wave was not significantly modified by i TBS (4.5 μV baseline and 5.3 μV after i TBS; F 1,18 = 0.606, P = 0.446), but the mean amplitude of later waves increased significantly ( F 1,18 = 26.53, P < 0.000) by 64% (14.3 μV baseline and 23.5 μV after i TBS). After i TBS a further I-wave (I4) appeared with a mean amplitude of 5.3 μV. The consequence of these changes can be observed in MEPs we recorded in the FDI muscle. These increased after i TBS by 144% of their pre-r TMS size (1.12 m V baseline and 2.74 m V after i TBS; F 1,18 = 30.1, P < 0.0001; Fig. 1 ). Figure 2 shows the effect of i TBS on the amplitudes of the I-waves and MEP in subject 2. The I1 wave was not significantly modified (8.9 μV baseline and 10.1 μV after i TBS; F 1,18 = 2.4, P = 0.138). The mean amplitude of later waves increased significantly after i TBS ( F 1,18 = 5.9, P = 0.026) by 45% (7.9 μV baseline and 11.6 μV after i TBS). The consequence of these changes can be observed in MEPs we recorded in the FDI muscle. These increased by 16% of their pre-r TMS size after i TBS ( Fig. 2 ). However, the increase in MEP was not significant (0.59 m V baseline and 0.685 m V after i TBS; F 1,18 = 0.57, P = 0.459). Figure 3 shows the effect of i TBS on the amplitudes of the I-waves and MEP in subject 3. The I1 wave was not significantly modified (6 μV baseline and 6.3 μV after i TBS; F 1,18 = 0.137, P = 0.716). The mean amplitude of later waves increased significantly ( F 1,18 = 9.04, P = 0.008) after i TBS by 22% (11.6 μV baseline and 14.2 μV after i TBS). The consequence of these changes can be observed in MEPs we recorded in the FDI muscle. These increased by 46% of their pre-r TMS size after i TBS (0.39 m V baseline and 0.56 m V after i TBS; F 1,18 = 6.35, P = 0.021). The mean results obtained in the three subjects are shown in Fig. 4. Figure 4. Open in figure viewer Download Powerpoint slide Bar graphs showing grand mean amplitudes of the I1 wave, of the later I-waves (the sum of the amplitudes of waves following I1) and of motor evoked potentials in baseline conditions and after i TBS in the three subjects studied The amplitude of later I-waves is increased by about 46% after i TBS, and the amplitude of MEPs is increased by about 90% after i TBS. In subjects 1 and 3, we evaluated the effects of i TBS on responses evoked by stimulation of the opposite hemisphere ( Figs 1 and 3 ). The increase of corticospinal volleys and MEPs evoked by stimulation of the right hemisphere was associated with a decrease in the amplitude of later volleys and of MEPs recorded after stimulation of the left hemisphere. In subject 1, the I1 wave was not significantly modified by i TBS ( F 1,18 = 4.08, P = 0.058; mean amplitude of the I1: 6.2 μV baseline and 4.6 μV after i TBS). The mean amplitude of later waves decreased significantly ( F 1,18 = 7.116, P = 0.016) by 28% (14.7 μV baseline and 10.5 μV after i TBS). The consequence of these changes can be observed in MEPs we recorded in the right FDI muscle. These decreased by 42% of their pre-r TMS size after i TBS (0.82 m V baseline and 0.47 m V after i TBS; F 1,18 = 14.254, P = 0.001). Similar findings were obtained in subject 3; the I1 wave was not significantly modified by i TBS ( F 1,18 = 1.3, P = 0.268; mean amplitude of the I1: 5.9 μV baseline and 5.4 μV after i TBS). The mean amplitude of later waves decreased significantly ( F 1,18 = 10.74, P = 0.004) by 37% (20.4 μV baseline and 16.6 μV after i TBS). The consequence of these changes can be observed in MEPs we recorded in the right FDI muscle. These decreased by 12% of their pre-r TMS size after i TBS (1 m V baseline and 0.88 m V after i TBS), but this change was not statistically significant ( F 1,18 = 0.59, P = 0.453). Effect of age on RMT, AMT and MEP following i TBS in healthy subjects In the control group of 18 subjects, the mean RMT and AMT of the hemisphere stimulated with i TBS did not change significantly (RMT baseline 51.6 ± 9.7% ( s.d.) and after i TBS 50.7 ± 10.36%, F 1,34 = 0.062, P = 0.805; AMT baseline 39.5 ± 7.4% ( s.d.) and after i TBS 38 ± 7.3%, F 1,34 = 0.375, P = 0.545). Overall, the mean amplitude of MEPs of the hemisphere stimulated with i TBS increased by 70.9 ± 91.2% ( s.d.) after i TBS ( F 1,34 = 7.729, P = 0.009; 0.8 ± 0.3 m V ( s.d.) baseline and 1.28 ± 0.65 m V after i TBS). However, the analysis of data showed a high interindividual variability with changes after i TBS ranging from –21% to +302%. Similarly in the hemisphere contralateral to the i TBS, there was no significant change in the mean RMT and AMT (RMT baseline 52.5 ± 10.3% ( s.d.) and after i TBS 51.9 ± 10.1%, F 1,34 = 0.017, P = 0.896; AMT baseline 40.2 ± 7.3% ( s.d.) and after i TBS 40.5 ± 7.3%, F 1,34 = 0.019, P = 0.892). However, the mean amplitude of MEPs evoked from the contralateral hemisphere decreased by 19.5 ± 30.6% ( s.d.) after i TBS ( F 1,34 = 4.6, P = 0.039; 0.80 ± 0.35 m V ( s.d.) baseline and 0.59 ± 0.26 m V after i TBS). Again, there was a high interindividual variability with changes after i TBS ranging from –85% to +37%. MEP facilitation in the stimulated hemisphere was larger in younger control subjects (group I aged 20–40 and II aged 41–60 years) than in older subjects (group III aged 61–80 years) (facilitation of MEPs: group I 96.4 ± 112% ( s.d. ), group II 80 ± 105%, and group III 36.3%± 46.9%; Fig. 5 ), but the difference was not significant ( F 2,15 = 0.67, P = 0.528). Inhibition of MEPs from the contralateral hemisphere was similar in younger and older subjects ( Fig. 5; inhibition of MEPs: group I –9.8 ± 37% ( s.d. ), group II –35.3 ± 30%, and group III –13.6 ± 21.3%; F 2,15 = 1.246, P = 0.316). Figure 5. Open in figure viewer Download Powerpoint slide Mean increase in MEP amplitude of the stimulated and contralateral hemisphere after i TBS in groups of control subjects of different ages The facilitation of MEPs (in stimulated hemisphere) is larger in younger control subjects (groups I aged 20–40 and II aged 41–60 years) than in older subjects (group III aged 61–80 years) (facilitation of MEPs: group I 96.4 ± 112% ( s.d. ), group II 80 ± 105%, and group III 36.3 ± 46.9%), but the difference is not significant ( F 2,15 = 0.67, P = 0.528). Inhibition of MEPs (in contralateral hemisphere) is similar in younger and older subjects ( F 2,15 = 1.246, P = 0.316). Effects of i TBS on transcallosal inhibition In the control group of 10 subjects, the mean i SP was not significantly modified by i TBS (37.1 ± 13.6 ms ( s.d.) baseline and 30.9 ± 14.9 ms ( s.d.) after i TBS; P = 0.83, Wilcoxon test). Discussion Recording of corticospinal activity evoked by motor cortex TMS is a valuable method of investigating the after-effects of r TMS protocols on synaptic excitability. This is because the amplitude of the synchronized corticospinal volleys is a direct reflection of the effectiveness of excitatory synaptic input to pyramidal neurones evoked by single pulses of TMS. As such these measures are a good substitute for the population synaptic activity recorded in experimental models of LTP. The present results demonstrate that r TMS given as i TBS leads to a pronounced increase in the excitability of cortical circuits generating the later I-waves, whilst the earliest I-wave is unaffected. I-waves represent synchronous activity of corticospinal axons originating from trans-synaptic activation of corticospinal cells. Although their origin is still unclear, there is a good deal of evidence to suggest that the early and late I-waves are generated by independent cortical mechanisms ( Ziemann & Rothwell, 2000; Di Lazzaro et al. 2004 ). Thus, our results suggest that i TBS produces its effect by influencing the intrinsic circuitry of the motor cortex that generates later I-waves. The increase in synaptic cortical activity revealed by the increase in corticospinal activity in our patients is consistent with the idea that i TBS may induce LTP-like changes at synaptic connections in motor cortex ( Huang et al. 2007 ). A careful examination of the recordings of subject 2, shows that the most evident change after i TBS is a more pronounced trough between the I2 and I3 wave. This change might be explained by a more synchronous discharge of the axons of cortical circuits generating the later I-waves. In this subject, the effect of i TBS on MEP amplitude was limited when compared with that observed for epidural activity. One possible explanation is that volleys recorded from the epidural space may be destined for other muscles in addition to FDI so that the increase in epidural volley amplitude may be more pronounced than the effect on the MEP. The effect of the i TBS on the later I-waves is similar to that observed using other TMS protocols. For example, the suppression seen in short latency intracortical inhibition and the suppression produced via transcallosal inhibition both preferentially affect the later I-waves and leave the I1 wave virtually unchanged ( Di Lazzaro et al. 2004 ). However, the effect of the i TBS contrasts with that of inhibitory c TBS since that protocol preferentially affects the I1 wave and leaves the later I-waves virtually unchanged ( Di Lazzaro et al. 2006 ). This specificity suggests that the two protocols produce their effects by modulating different circuits of the motor cortex. The effect of i TBS on corticospinal volleys was variable among subjects; it was very pronounced in subject 1 (later waves were increased by about 64% and, after i TBS, a previously absent I4 appeared) while a pronounced smaller effect was observed in subject 3 (later waves were increased by about 20%). Subject 2 showed an intermediate change. Interestingly subject 1 was the youngest and subject 3 the oldest, and it can be hypothesized that there is an age related decline in cortical excitability changes induced by r TMS in agreement with experimental studies that show an age related decline of LTP ( Barnes, 1979; Sawaki et al. 2003 ). Another possibility is that the different degree of facilitation is related to the high interindividual variability of the effects of r TMS ( Maeda et al. 2000 ). In order to investigate the effect of age we measured the effects of i TBS on MEP amplitude in a large population of control subjects. We observed a high variability in the magnitude of i TBS effects. Although there was greater facilitation in younger subjects than in older subjects the difference was not significant. Thus, the data suggest that the different behaviour of corticospinal activity of younger and older patient with the epidural electrode is due mainly to the interindividual variability of the effects of i TBS and only to a minor extent to an age related decline of the response to i TBS. Interestingly, in subjects 1 and 3 the increase in corticospinal activity and MEPs that was observed after i TBS of the ipsilateral hemisphere was associated with reduced excitability of the contralateral hemisphere. Such interhemispheric effects of standard r TMS protocols have been observed by a number of authors ( Gilio et al. 2003; Schambra et al. 2003; Plewnia et al. 2003; Pal et al. 2005; Heide et al. 2006) with variable results. Two more recent studies with c TBS have also reported effects, but again the data are conflicting ( Ishikawa et al. 2007; Stefan et al. 2008 ). Since there have been no published studies of the interhemispheric effects of i TBS we decided to investigate them in a group of 10 healthy subjects. As in the patients, MEPs evoked from the contralateral hemisphere were reduced after i TBS. The mechanism of this effect is not clear. As noted by others, it could be due to persisting changes in the tonic activity of transcallosal connections from the hemisphere receiving i TBS. Alternatively there could have been a lasting change in the intrinsic excitability of the contralateral hemisphere secondary to changed transcallosal input during the i TBS. We hypothesized that if the former were the case then we might be able to detect it as an increase in the excitability of transcallosal inhibitory connections assessed by means of the i SP. However, there was no change in this following i TBS, so that it seems likely that i TBS caused locally persisting changes in contralateral corticospinal excitability and that these were responsible for the reduction in MEPs. Finally, it should be noted that the epidural recording was performed in patients with chronic pain. Because noxious stimuli affect motor cortex excitability ( Valeriani et al. 1999 ), we cannot exclude the possibility that the presence of pain influenced the response of the motor cortex to i TBS in our patients. However, the facilitation of MEPs after i TBS was similar to that described in normal subjects by Huang et al. (2005), suggesting that this effect is not sensitive to painful inputs. Indeed the changes observed in MEP amplitude were consistent with those observed in corticospinal activity. We conclude that the epidural recordings obtained in our patients provided valuable information about the origin of the facilitation independently from any possible pain-related change in cortical excitability. In conclusion, we found that i TBS at an intensity of 80% AMT leads to a rapid increase in the excitability of cortical mechanisms that generate later I-waves in response to single TMS pulses. This differs from the results seen after c TBS, which preferentially affects the amplitude of the I1 wave and not later I-waves. The implication is that populations of excitatory cortical circuits are differentially sensitive to the effects of i TBS and c TBS. This may be of importance when testing the therapeutic potential of these methods in rehabilitation of patients with neurological disorders. Ancillary References Related content Citing Literature


what do soapstone sits cost

s). Cut-to-Size The most time consuming part of the fabrication is cutting the slabs to size. For your convenience we offer cut-to-size services at the cost of $14.00 per square foot (prices may vary per location, does not include cost of material). When you soapstone arrives you will need to do the edge treatments, cut outs and installation.

Get Natural Soapstone Countertops at a Fraction of the Cost with Our DIY Kit Our Kitchen-to-Go Kit is ideal for the handy homeowner who would like a beautiful soapstone kitchen countertop at a considerable saving. Unlike granite, soapstone is soft enough that it doesn’t require special tools for fabrication. All you need is a circular saw, a jigsaw, a drill/driver, a grinder, and a sander, making your kitchen soapstone countertop an inexpensive DIY project. How To Save Soapstone is a soft stone that can be cut and shaped without any special stone working tools. Did you know that more than half the cost of natural stone counters comes from labor? With soapstone you can eliminate that expense and have natural stone countertops for a fraction of the cost!Are you interested in a custom DIY soapstone project? Looking to build the perfect soapstone kitchen countertop or soapstone bathroom sink? We will even give you a “practice piece” for you to test before you commit to doing it. Can’t decide which soapstone slab to buy? M Teixeira Sospstone offers a Complete Soapstone Sample Package. Order yours today!Complete DIYFor the most savings you would do everything yourself. Simply order pre-cut slabs you need for your project. We stock pre-cut DIY slabs in 30″ widths by 6′ and 7′ long and full size slabs up to 10′ in lenght (all sizes may not be available at all time

This option is good for those who need to use larger/heavier non DIY slabs , and need to get the larger slabs to a more manageable size. Cut-to-Size and Finished Edge Another time saver option, we’ll deliver the slabs to you cut to size and with a finished edge of your choice. Full Pre-Fabricated This option is ideal those who choose not to do any fabrication and just want to install the countertops. Once we obtain accurate measurements and/or templates we will fabricate your countertops to your specification. When your countertops arrive all you have to do is the installation.1616DIY Soapstone Countertop Support Help is always available, to answer technical questions, before, during and after the DIY project. We have our own branches in three different US time zones that ensure,no matter where you are calling from during business hours, we are open!Check out this step-by-step tutorial for installing a soapstone countertop from This Old House featuring M. Teixeira Soapstone. Learn More Not Sure What Stone to Order? Order Soapstone Samples We offer a complete soapstone sample package to help you select the right stone for your project. You will receive 6 to 8 pieces of stone, depending on our current soapstone selection. Each soapstone sample is labeled with its stone variety name. Order Samples DIY Soapstone Products Make sure you visit our online store for our DIY Slabs and Kitchen-to-Go kit. View DIY Products Soapstone on Sale For more savings be sure to check out our Soapstone on Sale page. These sales change monthly. We offers sales on sales that may include the cut to size option for free. View Sales


what is granicrete

Granicrete is very durable, and, unlike granite, remains impermeable to water, food bacteria, harsh chemicals and stains. Granite, on the other hand, stains with certain fruits, oils, and retains bacteria. Granicrete is also seamless and uses a USDA approved epoxy coating, unlike granite.

Custom Granicrete Surfaces: Countertops, Floors, Patios, Walls

FAQ• What is Granicrete?• What colors are available?• How does this compare to granite or marble?• How long does it take to install my countertops?• Can I resurface my existing countertops?• Can I place hot pans/dishes on my Granicrete countertop?• What maintenance is needed?• Does the product come with a warranty? What is Granicrete? Granicrete is a durable polymer modified concrete mix used as a thin overlay for new or existing surfaces that can be colored to look like granite, marble stone or concrete. What colors are available? The Granicrete colors can be used as-is or mixed to produce virtually any color you desire. The colors are blended to create a unique look that only you will have. How does this compare to granite or marble?

How long does it take to install my countertops? Granicrete countertops typically are done in 2-3 days, but additional time is required for the epoxy system to cure. After 3-5 days, counters should be ready for gentle use. Ideally, once the countertops are done we recommend 72 hours before placing heavy objects on them. If downtime is an issue, the countertops can be built offsite and left to cure, and then brought in and installed to be used immediately. Can I resurface my existing countertops? Typically, yes. We will come out for the initial consultation and inspect the existing countertops to make a final determination. Normally if the countertops are solid and the existing laminate is not lifting or rotting, we will be able to use them. Other things to consider at this time would be an under-mount sink, changes in size or different edges. If needed, we can fabricate and install the new countertop for you. Can I place hot pans and dishes on my Granicrete countertop? No. Granicrete resists temperatures up to 500 degrees but as with any countertop (granite, laminate or man-made stone), you would want to use some type of heat pad to protect your surface. What maintenance is needed? After installation the only maintenance required is keeping it clean. It’s just a matter of easy care and maintenance with just mild soap and water, or a dilution of a bleach and water. Does the product come with a warranty? Yes. Custom Surfaces carry a 3-year limited warranty against manufacturer defects.


northampton county tax department pa phone number

es. When contacting Northampton County about your property taxes, make sure that you are contacting the correct office. You can call the Northampton County Tax Assessor's Office for assistance at 610-559-3141. Remember to have your property's Tax ID Number or Parcel Number available when you call!Please call the assessor's office in Easton before you send documents or if you need to schedule a meeting.

[Pennsylvania Assessors]Property Taxes By State > Pennsylvania > Northampton County Property Tax > Northampton County Tax Assessor Northampton County, Pennsylvania - Assessor's Office The Northampton County Assessor is responsible for appraising real estate and assessing a property tax on properties located in Northampton County, Pennsylvania. You can contact the Northampton County Assessor for: Information on your property's tax assessment Reporting upgrades or improvements Checking the Northampton County property tax due date Paying your property tax Your property tax bill Appealing your property tax appraisal669 Washington St The Northampton County Assessor's Office is located in Easton, Pennsylvania. Easton is the county seat of Northampton County, where most local government offices are located. The assessor's office is located in the same building as the Northampton County Courthouse, at 669 Washington Street. Northampton County Assessor Contact Information Northampton County Assessor Address Northampton County Assessor Northampton County Government Center, Room 305 669 Washington Street Easton, PA 18042Northampton County Assessor Phone Number (610) 559-3141Northampton County Assessor's Websitehttp://www.northamptoncounty.org/northampton/cwp/view.asp?a=1525&q=620434Additional Northampton County Information Delinquent Property Taxes & Pay Property Taxes How to pay property taxeshttp://www.northamptoncounty.org/northampton/cwp/view.asp?a=1525&q=620455Property Tax Search Tool Find Northampton County property tax recordshttp://www.ncpub.org/Search/Disclaimer2.aspx? From Url=../Search/Generic Search.aspx?mode=address Northampton County Assessor's Office Services There are three major roles involved in administering property taxes - Tax Assessor, Property Appraiser, and Tax Collector. Note that in some counties, one or more of these roles may be held by the same individual or office. For example, the Northampton County Tax Assessor may also serve as the Northampton County Tax Appraiser. The Northampton County Tax Assessor is responsible for setting property tax rates and collecting owed property tax on real estate located in Northampton County. The Northampton County Property Appraiser is responsible for determining the taxable value of each piece of real estate, which the Tax Assessor will use to determine the owed property tax. The Northampton County Tax Collector is responsible for collecting property tax from property owners. They issue yearly tax bills to all property owners in Northampton County, and work with the sheriff's office to foreclose on properties with delinquent tax

If you have general questions, you can call the Northampton County Courthouse at 610-559-3000. Learn More Find the tax assessor for a different Pennsylvania county Find property records for Northampton County The median property tax in Northampton County, Pennsylvania is $3,319.00All of the Northampton County information on this page has been verified and checked for accuracy. If any of the links or phone numbers provided no longer work, please let us know and we will update this page.


types of eyebrow shapes

pe. Oval Face Shape This is considered to be the one best face shapes to have. This shape doesn’t need much attention. Any shape suits well on the person with oval face cut but curved eyebrows look exceptional. A soft angled eyebrow is what suits this face best. Usually most of the hair styles also look good on such people.

Select Eyebrow Shape According to Face Shape December 17, 2010 Eyes by Naina A good beauty routine and awesome make up skills will show on your face. But there is one thing that can spoil all your efforts – a badly/wrongly shaped eyebrow. I say through experience that no matter how much your skin glows or how professionally you apply your make up , the ‘something’s -wrong’ feeling stays if your eyebrows aren’t done correctly.. I can safely bet at one point or the other we have faced the horror of having our brows spoilt, that too by professionals. HORRID isn’t it?? The whole pain of waiting for it grow back again, rubbing in litres of castor oil so that they grow faster and what not. I had mine totally messed before my cousin’s wedding and it was a nightmare, living through those 2-3 weeks. Anyway we save that cribbing for later on . So the point of saying so much is that a well defined eyebrow adds the ‘chaar chand’ to your looks, it is something that makes you look better, instantly. It is important that we our eyebrow shape is in accordance with our face shape. There is nothing called as a perfect face shape, it is all about how you make it look perfect. And eyebrows have a major role to play here. It is possible to balance out face shapes by shaping the eyebrow correctly. For instance, a long face looks shorter with flat brows and longer with arched brows. Just see what difference eyebrows, make to the face, makeup and hairstyle remaining constant. So let’s get started. READ THESE FOR WEIGHT LOSS: Diet Chart for Weight Loss | How to Lose Weight With PCOS | 10 Best Herbal Pills for Weight Loss | 10 Best Tricks for Lazy People to Lose Weight | Best Diet for PCOS to Lose Weight Eyebrow Shapes Basic Face Shapes We have an article on determining your face shape. Read HERE. READ THESE FOR GLOWING SKIN: 9 Best Face Packs For Glowing Skin | 10 Tips by Shahnaz Husain for Glowing Skin | Home Remedies For Glowing Skin | 7 Besan Face Packs for Glowing Skin | Beauty Products For Glowing Skin The shape of one’s eyebrow is totally a personal choice, but there are some basics which will help if kept in mind. Let’s find the correct eyebrow shape according to face sha

Also a soft angled eyebrow is the most common eyebrow shape. Think – Jennifer Aniston Round Face Shape The goal is to make a round face appear less round by making the face look longer. A high arched eyebrow gives an up down look and elongates the face. People with a round face should stay away from rounded eyebrows, this face the face look more round. If one is not comfortable with highly arched brows, one can also opt for a soft angled eyebrow (similar to oval face). That will also serve the purpose to some extent. Think – Drew Barrymore BEST OF IMBB: How To Make Vitamin C Serum At Home | 7 Best Pigmentation Creams in India | 8 Natural Products to Add Volume to Thin, Fine Hair | 8 Ways to Tighten Sagging Breasts | How to Remove Pimple Marks from Face | Top 10 Shampoos for Dry and Rough Hair | 8 Best Drugstore Foundations That Do Not Oxidize Long Face Shape The aim is to make long face appear shorter . This is done by a flat eyebrow, as opposed to an arched brow. Flat eyebrow will draw attention away from the length of your face and add a bit of width to it instead. It stops the gaze going up and down thus making the face shorter in comparison. An arched brow is a no-no for a long face; it just makes the face look abysmally long. Keep the arch low as it helps in giving an illusion of more width to the face. The style is similar to one used in the low forehead case. Think – Sarah Jessica Parker Square Face Shape The most striking feature of this type of face is the strong jaw line. Forehead, cheeks and jawline will both be equal in width and the jawline will be squared. You will want to stick with a brow shape that balances out your jawline. The aim is to soften the jaw line. An angled eyebrow with sharp peak balances the face. Curved brows also work but an angled eyebrow evens out the face. Make sure that the arch of your brow is directly above the square of the jaw. Brows should be on the thinner side to soften the appearance of the face. Think – Marilyn Monroe Best of IMBB: Best Hair Serums for Dry Frizzy Hair | Homemade Hair Regrowth Oil to Prevent Hair Loss | How To Lose Fat From Face in 30 Days | Homemade Face Pack for Instantly Bright and Glowing Skin | 10 Products To Get Rid of Skin Pigmentation | 7 Ways To Make Black Lips Pink!Heart Face Shape The aim is to soften the striking curves of the face with rounded eyebrows. So that the face looks like a typical heart, with rounded tops and pointy bottom. Rounded brows give a soft feminine look where as sharp curves further angle the face. Best choice for heart shape is a rounded eyebrow with very soft arches. The arch may be high or low depending on whether it is a short heart shaped face or a long heart shaped face. Try to keep brow width natural but not too bushy or too thin. Think – Scarlett Johansson. Diamond Face Shape This kind of face is widest at around the cheek bones. The aim is to soften and balance out the face. A curved eyebrow solves this purpose, it makes the widest part subtle and the arch elongates the face so that it looks balanced and not strikingly angular. Choose a curved brow to soften your angular face or keep emphasis on the center arch of the brow to draw away from the width of your face. Think – Rihanna. BEST OF FAIRNESS: 10 Best Skin Whitening Creams in India | 7 Homemade Face Packs for Instant Glow and Fairness | 6 Best Herbal Fairness Creams | 10 Best Fairness Packs in the Market | 7 Best Pigmentation Creams in India As this article is on eyebrows, I would like to share certain other tips about eyebrows-Dry eyebrows cause eyebrow hair fall . It is good to always keep them moisturized. Massaging in castor oil to the eyebrows helps in thicker growth and darker brows. Ginger juice if applied on eyebrows daily helps in arresting eyebrow hair fall. It is good the brush eyebrow daily with an eyebrow brush, this increases blood circulation round the area. If you don’t have a brush, lightly massage with finger tips. Avoid tweezing at home; it is best left to professionals. If you have to shape it yourself, stand far away from the mirror. Looking in too closely will cause you to lose symmetry. All images collected from the internet. SOLUTIONS FOR ACNE: 5 Remedies to Treat Acne at Home | Top 10 Creams for Fading Acne Scars | 10 Home Remedies to Treat Scalp Acne | 8 Home Remedies to Reduce Acne Scars | 10 Tea Tree Oil Products for Acne-Prone and Sensitive Skin | Home Remedies to Treat Hormonal Acne Also Read: How to Determine Your Face Shape How to Select Hairstyles According to Face Shape Short Hairstyle for Face Shapes How to Select Sunglasses According to Face Shape HAIR: 8 Natural Products to Add Volume to Thin, Fine Hair | 8 Ways to Regrow Hair on Bald Spots | 6 Hair Growth Secrets from Around the World | 7 Best Hair Oils For Faster Hair Growth | How to Make Rough Hair Silky | 30 Killer Hair Care Tips Overall rating: 0 out of 5 based on 0 reviews. Name Email Review Title Rating Review Content Related Posts Street Wear Eyeliner Kajal Royal Blue Review Sugar Cosmetics Blend the Rules Eyeshadow Quad 02 Believe Review Catrice Cosmetics Brow Hero 2in1 Brow Pomade and Camouflage Waterproof 20 So Bella Review


what age does a horse get their permanent teeth

es. Incisors and Canines Horses will start to get their permanent incisors when they are about 2-1/2 years old. The middle set of incisors is the first to grow in. The second set of incisors should come in around 3-1/2 years old, and the outside set of incisors should come in around 4-1/2 years old. The adult canine teeth come in between 4-5 years of age. All horses can, but not all horses do have canine teeth. Mares are less likely to have canine teeth, but it is possible.

How to Age a Horse By Its Teeth

How to Age a Horse By Its Teeth Dental care, Horses Horses often have many different owners through their lives. During those transitions, it can be easy to “forget” a horse’s birthday. Your veterinarian can estimate your horse’s age by looking at his teeth! Horses have baby and adult teeth, so knowing when these teeth come in is very helpful. Once the adult teeth are in, they tend to wear in a similar pattern, and this can also help your veterinarian estimate your horse’s age. How to Age a Horse By Its Teeth Baby Teeth A horse’s baby teeth are also called deciduous teeth, or caps. This simply means that they will fall out as the adult teeth grow in, just like in people. You can roughly tell a horse’s age by which baby teeth they have, and by the growth and wear on their adult teeth. Most horses will be born with their first set of incisors (the center teeth). Their middle incisors will come in between 4-6 weeks of age, and the outside set of incisors will come in between 6-9 months of age. Horses do have canine teeth, and their baby canines should come in between 6-9 months of age (not all horses have baby canines). Horses have three sets of baby premolars (3 on each side, top and bottom). They are often born with all of these teeth. Otherwise, they should come in within the first 2 weeks of life. Adult Teeth As horses get older, their baby teeth (caps) start to fall out and their adult (permanent) teeth start to come in. You may find a lost cap, but most of the time horses swallow their baby teeth (or lose them out in the pasture somewhere). Swallowing caps does not cause any problems for hors

Premolars and Molars Premolars and molars are the large teeth in the back of your horse’s mouth. Your veterinarian can examine your horse’s mouth and teeth to see how they are coming in, and if they need to be floated. Horses have 4 sets of premolars on each side, top and bottom. The first premolar is very small, and not all horses have this tooth. The first premolar is also called the “wolf tooth.” If present, the wolf teeth usually come in between 5-6 months old. Some veterinarians will pull the wolf teeth at the same time a male foal is castrated. The rest of the premolars don’t come in until a bit later. The second premolar (the first large, flat tooth) comes in around 2-1/2 years; the third premolar comes in around 3 years; and the fourth premolar comes in around 4 years old. (The lower premolars may come in earlier than this. )Horses have three sets of molars on each side, top and bottom. Some horses may have a very small fourth molar, but this is not very common. Your horse’s molars will be coming in around the same time as his premolars. The first molar comes in between 9-12 months old; the second molar comes in around 2 years old; and the third molar comes in between 3-1/2 to 4 years old. Older Horses It is very difficult to tell how old dogs and cats are after all their permanent teeth have come in. Horses’ teeth continue to grow for their entire lives, so there are a few additional signs that can help estimate a horse’s age, even after all his permanent teeth have come in. One way to estimate the age of a horse is by the angle of the incisors. When you look at a young horse’s teeth from the side, the top and bottom incisors will meet in almost a straight up and down line. As horses get older, this angle changes and becomes more steep. This is an inexact way to estimate the age of a horse, but an older horse will have a much steeper angle than a young horse. The outside upper incisor has a mark called Galvayne’s groove. This is a dark groove in the center of the outside upper incisor. It first appears near the gumline around the time a horse is 9-10 years old. As the tooth continues to grow, Galvayne’s groove progresses further down the tooth. Around the time a horse is 18-20 years of age, this mark will extend from the gum to the bottom of the tooth. After 20 years old, the mark will no longer be seen near the gum, but will still be present lower down on the tooth. Not all horses have Galvayne’s groove, and the timing of the appearance of the groove is not exactly the same in all horses. Do you know how old your horse is? Every horse will get their teeth at a slightly different time, and will wear their teeth in a slightly different way. Your veterinarian can examine your horse’s teeth and estimate how old they are. Call us or come in to talk to our veterinarians or veterinary technicians about the routine vaccinations we recommend for horses and regular dental care that horses should receive.age, dental, foal, horse, teeth. Bookmark.


carbon reactivation facilities california

With three spent carbon reactivation facilities (Darlington, PA, Parker, AZ and Red Bluff, CA), Evoqua Water Technologies is a leader in spent carbon reactivation. The Darlington and Parker facilities are both permitted to process RCRA hazardous spent carbon, making Evoqua the only supplier with permitted capacity serving both the East and West Coasts. The Red Bluff facility is the largest non-hazardous carbon reactivation facility in the western United States.

Spent Carbon Reactivation And Recycling

"Product/Service Spent Carbon Reactivation And Recycling Evoqua Water Technologies operates three regional state-of-the-art reactivation and recycling facilities to handle RCRA hazardous and non-hazardous liquid and vapor phase spent carbon. In recent years, a variety of market dynamics have driven the cost of virgin activated carbon upward. These cost increases, coupled with a greater desire for ""green"" processes that minimize waste and recycle raw materials, have driven many activated carbon users to reconsider a tried and true process: carbon reactivation. Carbon reactivation is the process of utilizing elevated temperatures followed by steam in a rotating kiln or multiple hearth furnace to remove organic compounds adsorbed onto the carbon during normal service use. Furthermore, reactivation destroys 99.99% of the removed organic contaminants through a combination of chemical reactions and oxidation in the reactivation plant’s afterburner. The reactivation process thus ends the liability associated with disposing and handling of the adsorbed contaminants, while restoring the surface area and pore volume of the spent carbon to near virgin-grade levels. The reactivation process recycles spent carbons into new activated carbon materials that continue to provide excellent performance in many treatment applications. Reactivation can be applied to carbons used in both liquid phase and vapor phase applications. Spent carbons can be segregated from other spent carbons and returned to the same customer for reuse, or pooled with other spent carbons and sold into other applications as a cost-effective alternative to virgin carbon. Evoqua has extensive experience with all of these types of reactivation services.

Both the Darlington and Red Bluff facilities are capable of supplying custom reactivated carbon for potable applications that meet ANSI / NSF Standard 61. Our reactivation facilities can process RCRA hazardous and non-hazardous liquid and vapor phase spent carbons. After inspection and acceptance, the spent carbon is heated to 1600° F to ensure proper reactivation. The cooled reactivated carbon is identified by lot numbers, sampled and analyzed in accordance with our QA/QC program. This process assures the highest quality reactivated carbon. The entire state-of-the-art process is computer controlled and monitored, ensuring that the facilities meet or exceed federal and state regulatory requirements for air and water discharges. A “Certificate of Reactivation” can be issued for each shipment of recycled carbon. This certifies that the spent carbon has been recycled in a manner that meets or exceeds all applicable RCRA and Benzene NESHAP and Subpart CC regulations. Features and Benefits Facilities meet and comply with all RCRA, Benzene NESHAP and Subpart CC requirements Limit liabilities - Certificate of Reactivation certifies processing meets or exceeds appropriate regulations Cost effective – easy procedures for carbon profiling and acceptance QA/QC procedures ensure highest quality of all reactivated carbon Spent carbon receiving options include by slurry trailers, rail, drums, totes, etc. All facilities certified to ISO14001, ensuring the highest levels of environmental compliance ANSI / NSF61 certified potable reactivated carbons available from Darlington and Red Bluff facilities Spent Carbon Reactivation Programs Evoqua reactivated carbon programs utilize our network of service technicians that are trained in performing carbon exchanges from both larger hard piped adsorber vessels by vacuum and slurry exchange and smaller adsorber vessels by direct vessel exchange. React and Return is a highly controlled program where the customer’s spent activated carbon is removed, reactivated, and returned for reuse to the same customer. The carbon is segregated from other carbons during reactivation and storage. Virgin carbon is used to offset normal losses that occur during handling and reactivation to ensure that 100% of the original carbon volume is returned to the customer. For react and return services provided for drinking water applications at our Darlington, PA and Red bluff, CA facilities, the reactivated carbon is certified to ANSI / NSF Standard 61 for potable water treatment. Pool reactivation is where spent carbons are removed and the resulting reactivated carbons are then pooled according to application type (vapor phase/liquid phase) and mesh size. These pooled carbons can then be sold into many applications as a substitute for virgin carbons to lower operating costs. Our pool reactivated carbons provided under this program are as follows: Aqua Carb® S Series – for non-potable, liquid phase applications Vo Carb® S Series – for vapor phase applications Click here to learn more or connect with a product specialist "


requirements to become a drill sergeant

ff)To become a drill sergeant or AIT platoon sergeant, soldiers must meet these requirements.• Obtain a commander’s evaluation by a lieutenant colonel or higher.• Demonstrate leadership ability and potential, character, and ability to perform in stressful situations.

What are the requirements to become a drill sergeant in the U.S. Army?

"Drill Instructors and Drill Sergeants U. S. Army United States Armed Forces Military What are the requirements to become a drill sergeant in the U. S. Army?5 Answers Alan Waters, Retired Army Infantry (mortars) 1SG : Computer tech large Middle School Texas Answered Jan 29, 2017 · Upvoted by Christopher Aeneadas, former Soldier 98C at U. S. Army (1999-2003) · Author has 283 answers and 602.5k answer views Regular Army is normally a two year tour and you can volunteer for a third year. A lot of times the third year can be done as an instructor at the Drill Sgt. School. Two ways to become a drill Sgt., is to be DA selected or volunteer. I was selected for both recruiting duty and drill Sgt. duty one week apart. Since I was selected for recruiting duty first, that is where I went. Rather than write an answer, this is straight out of the Army Times from April of last year!The last bullet from below• Undergo a thorough background screening also includes your financial records. Do you make the cut? Army's drill sergeant, AIT platoon sergeant requirements By: Michelle Tan, April 25, 2016 (Photo Credit: Mike Morones/Sta

• Be physically fit and meet Army weight and body fat standards.• Be able to pass the Army Physical Fitness Test.• Have no incidents of abuse.• Have no record of emotional instability as determined by a screening of health records and a clinical evaluation by a competent mental health officer.• Have no speech impediment.• Be a high school graduate or have a GED.• Display good military bearing. Army Times The Army is looking for hundreds of NCOs for drill sergeant duty• Have no court-martial convictions.• Have no record of disciplinary action, to include letters of reprimand, in the last five years.• Have a GT score of 100• Qualify on an M16A2 or M4 within the last six month.• Drill sergeant candidates must hold the rank of E-5 through E-7. Sergeants must have at least one year time in grade, have at least four years of active federal service and be a Basic Leader Course graduate.• AIT platoon sergeant candidates must be an E-6 or E-7. Staff sergeants must have at least two years’ time in grade, four years of active federal service and be an Advanced Leader Course graduate.• Undergo a thorough background screening.3.2k Views · View Upvoterspromoted by MSW@USCBecome a military social work leader. GRE not required. Complete USC's Master of Social Work in as little as 1 year with a BSW. Request information!Learn More at msw.usc.edu Related Questions More Answers Below What are the requirements to become a drill sergeant? What are the requirements to become a sergeant major of the US army? What is involved in U. S. Army Drill Sergeant School? How does one become a drill sergeant in the Australian army? How does one become a Drill Sergeant in the US Army? How many years would it take to become a US Army Drill Sergeant? Ask New Question John Mortimer, former Sergeant First Class (E-7) Infantryman at U. S. Army (2004-2015)Answered Feb 13, 2018 · Upvoted by Joseph A. Merrill III, former SFC USAR (Ret) at U. S. Army (1971-1998) and Chris Henrikson, former Sergeant at U. S. Army (2002-2008)I was a Drill Sergeant for three years, and I remember back in Drill Sergeant School the cadre always pushed the idea that we were supposed to be the “Top 10%” of the Army. They said it more to motivate us than anything, but there are a lot of requirements that make it difficult to be selected and accepted. Much of what I have to say is more from memory than anything, so I would encourage you to check out http://www.tradoc.army.mil/tpubs... That regulation covers a lot of the details on Drill Sergeant School and the Drill Sergeant program. First of all, the rank requirement is SGT/E-5 through SFC/E-7. A candidate must be able to pass on the basic standards of being a Soldier, of course. This means passing the APFT, passing height and weight requirements, qualifying with your weapon, and so forth. After that, one needs recommendations from the first O-5/LTC in your Chain of Command. The LTC is going to verify the candidate would be an effective Drill Sergeant, maintains impeccable military bearing/appearance, has not committed any serious offenses, has no record of any type of abuse, and is a trustworthy individual. These are the easiest and most basic standards. Candidates have to pass a background check. All soldiers go through some type of background check when they join the military, but obviously over time the validity of that check fades, so TRADOC requires basic checks to ensure the candidate does not have a criminal record. Something that has been emphasized lately is ensuring candidates have not committed any infractions related to the rules and regulations governing Equal Opportunity (EO) or Sexual Harassment/Assault Response and Prevention (SHARP) programs. While unfounded allegations may require extra scrutiny, any proven allegations would disqualify an individual. As far as education goes, I believe the GT score requirement is 100. The candidate is also supposed to be an ALC graduate. I phrase it this way because the Army does change over time depending on personnel requirements, so the GT score and school requirements may fluctuate. The last area I can remember would be the psychological requirements. A candidate cannot have any serious emotional instabilities or conditions that would result in speech impediments. Honestly, this whole area is subjective. The screening is done by doctors, who may be either military or civilian. When I went through the process I had to speak with a counselor, take a personality test, and then go talk to other counselors who deal primarily in domestic issues. The screening is basically left up to the medical professionals, but in the end they just have to sign off saying the candidate is fit for duty and does not have any propensity for abuse. I hope this clears some things up for you. If you have questions about what it actually takes to be a Drill Sergeant or pass Drill Sergeant School, I can talk about that too. Take care,John5.8k Views · View Upvoterspromoted by Lending Tree Amazing VA benefits not enough vets claim. Veterans could receive up to $42,000 with these VA benefits. Learn More at lendingtree.com Christopher Aeneadas, former Soldier 98C at U. S. Army (1999-2003)Answered Feb 13, 2018 · Upvoted by Quora User, Hobby Farmer, Amateur Brewer, Retired US Army Cavalry Scout and Quora User, former Supervisor S2 at Armies · Author has 1.5k answers and 839.7k answer views I will give you an ethics test at the end of this post. It will tell whether you should be a Drill Sergeant or a Recruiter. There is no MOS you can enlist into to be a Drill Sergeant or a Recruiter. You must have another job. You are pulled out of that job to do a more important one. No job is more important than spawning new soldiers. Failure to recruit, train, and retain will destroy the Army in a way no enemy ever could. There must be many people involved in this process. How big do you want your basic training classes to be? If your average soldier doesn't spend at least 10% of their career, on average, involved in one of those three tasks your Army will shrink. Few want to do those jobs forever. They suuuuuck. I don't think I made that clear enough. Recruiting and Drill Sergeant jobs suuuuuuuuuuuuuuuuuuuuck. I DON’T CARE ABOUT YOUR GIG LINE PRIVATE! MISSOURI IS COLD! I WANT A PCS BACK TO HAWAII!Most people want desperately to get back to the job they enlisted to do. To deal with soldiers rather than civilians or soldiers-in-the-making. So if your job is not so severely understaffed that the Army can never fill all the billets, you will eventually be a Recruiter, a Drill Sergeant, or a retention officer. Volunteer or be voluntold. Your call, Sarge. People who work next to you today may be your branch manager tommorow. Someone at Army HQ knows who you are. They know what kind of person you are. So here is the ethics test to sort out who does which (suck) job: You are the land-navigator for your company. You read the map and discuss the matter only with your Captain. Today you are taking everyone home from a ruck march. Last night you slept in the field. Training. A higher level of command issued an order/guidance that due to 112 degree heat and extreme humidity you may only march your boys and girls 19 kilometers per day. You, being a squared away NCO, look at your topographic map. You take the GPS coordinates of where you camped based on the map and plug them into your planning document. You take the GPS coordinates off the map for where your barracks is. You double check these electronically.19.12 kilometers. Crap. You aren't going to divide this up into 2 days and make everyone sleep in tents, are you? Roughly 1 football field separates this from your warm, snug bed. Your wife is waiting. So you bring the problem to your Captain.“Well Sergeant, we can't get any trucks to pick us up on short notice. We can't stay in the field. We have shit to do tomorrow. Are you sure your instruments were calibrated properly? Remeasure and make it happen, Sergeant.”Now which instrument should you “re-calibrate""? The map? The tape measure? The GPS unit you were forbidden to fiddle with the innards of? Didn’t we all decide that tape was a half-inch short during our last height/weight check? You just can’t rely on those things. If you call your Captain back and argue with him/her, you do things by the book. You are a Drill Sergeant. Enjoy your hat. If you realize your error after looking closely at your tape measure, you are a Recruiter. Doesn't it look a little long to you? It looks long to me. Your Captain clearly thought it needed adjustment. Now you are marching 18.9 kilometers. Stop asking questions and make it happen, Sergeant. So are you a Drill Sergeant or a Recruiter? You already know the answer. By the time you are elligible for either job, your branch manager does too.5.4k Views · View Upvoters Joseph Damore, Future Soldier at Rancho Cordova recruiting station,love everything military. Answered Apr 24, 2016 · Upvoted by Jatavius Williams, Been an United States Army Drill Sergeant For 13yrs Now. and Christopher Aeneadas, former Soldier 98C at U. S. Army (1999-2003) · Author has 108 answers and 241.8k answer views There are two ways to become a Drill Instructor (DI) (Army calls them Drill Sergeants). A lot of E-6's (Staff Sergeant in the Army) will become a DI, recruiter, or some sort of inspector, to get there E-7 (Sergeant First Class in the Army) promotion. It's usually a three year term. Then there are a couple of people who choose to become a DI, they have to be an NCO (non commissioned officer), and pass the DI instruction course. Being a DI is a very honorable job, you train the next generation of warriors, the people who protect our freedom.1.7k Views · View Upvoters Quora User, former Staff Sergeant (Ret.) - Radio/Radio Teletype Oper. at U. S. Army (1965-1994)Answered Jan 8, 2018 · Upvoted by Christopher Aeneadas, former Soldier 98C at U. S. Army (1999-2003) · Author has 866 answers and 259.1k answer views First, you must be the rank for Sergeant (E-5). Secondly, you must meet the basic requirements to become a Drill Instructor/Sergeant. This is based on what the Drill Instructor School is looking for. The standards to meet these requirements are higher than the ‘basic’ standards required by the Army for NCOs, but not by much. And you must pass the training received during the courses given at the Drill Instructor School/Course. Once you graduated/pass that training, you receive our certificate/diploma of training, Drill Instructor/Sergeant hat and are then assigned to a Basic and/or AIT (Advanced Individual Training) base to being your career as a Drill Instructor/Sergeant. As with any school like this, they are looking for the ‘best of the best’ to train the ‘best’. It’s not for everyone, but for those that make it through the course, it’s a very good boost to their career in the Army and in getting promoted faster than would otherwise occur.1.4k Views · View Upvoters Related Questions Is becoming an Army drill sergeant har? How can I rank higher to Staff sergeant in the U. S. Army? How can you become an Army sniper in the U. S. Army? How do I become an Army drill sergeant? Can a drill sergeant become a war sergeant, or can they do both of them? Do drill sergeants really yell that much? Should I be a U. S Marine or in the U. S Army? Are there any soft-spoken drill sergeants? What are the requirements to become an army doctor? Why doesn't the U. S. Army use RPGs? Ask New Question Related Questions What are the requirements to become a drill sergeant? What are the requirements to become a sergeant major of the US army? What is involved in U. S. Army Drill Sergeant School? How does one become a drill sergeant in the Australian army? How does one become a Drill Sergeant in the US Army? How many years would it take to become a US Army Drill Sergeant? Is becoming an Army drill sergeant har? How can I rank higher to Staff sergeant in the U. S. Army? How can you become an Army sniper in the U. S. Army? How do I become an Army drill sergeant? Can a drill sergeant become a war sergeant, or can they do both of them? Ask New Question "


what is pataday drops used for

ps? + Side Effects Pataday eye drops are a type of antihistamine that is used to treat redness and itching in the eyes caused by allergies. It is available on prescription and it is not recommended for those who have irritations as a result of wearing contact lenses.

What are Pataday Eye Drops? + Side Effects

What are Pataday Eye Dro

How to Use Pataday Eye Drops The eye drops should be applied to the affected eye, usually one or two times per day, as directed. The exact dosage will vary depending on the brand. Before you use the drops, you must wash your hands. You must also make sure that the dropper tip does not touch your eye or any other surface, as this could lead to cross-contamination. Pataday eye drops contain preservatives and contact lenses could absorb this. Hence, if you wear contacts, you should take them out before you use the medication. You should also wait at least 10 minutes after using the medication before you put back your contacts. Tilt your head back, look to the ceiling, and pull your lower eyelid down, creating a pouch. Hold the dropper over the eye, applying the number of drops you have been prescribed. Then look down and gently close your eyes, leaving them closed for about two minutes. Place a finger in your eye’s inside corner and gently apply some pressure. This will stop it from draining. Do not rub your eyes, do not squeeze them shut, and do not blink. The dropper should not be rinsed and it has to be replaced after you have used it. To really benefit from the medication, you must use it regularly in order to notice its effects. Make sure you use it for as long as your physician has instructed. If you have any other eye conditions that are being treated with medication, you should wait at least five minutes between medications. If you have both drops and ointment, you should always use the drops first. This ensures they can actually enter the eye because the ointment could block it. If your condition does not improve or even gets worse, you must speak to your physician. Conditions that Pataday Eye Drops Can Treat Pataday eye drops are usually used for the treatment of allergic conjunctivitis. In some cases, it is used to treat people who have allergic rhinitis that affects the eye. Pataday Eye Drops Side Effects The most common side effects of these eye drops include: Feeling a foreign object in the eye Swelling of the eyelid Dryness, redness, stinging, and/or burning of the eye Blurred vision Headaches While these side effects can be uncomfortable, your physician is aware of them and has determined that the benefits of the eye drops outweigh the disadvantages. Furthermore, while uncomfortable, the side effects are not generally dangerous. It is unlikely that you will suffer a serious side effect from this drug, including allergic reactions. However, if you notice trouble breathing, dizziness, swelling of the throat, tongue, or face, extreme itching, or a rash, you need to speak to a physician as those are signs of a serious allergic reaction. The table below highlights the known side effects of Pataday ophthalmic eye drops. Commonality Side Effect Severity Common Headaches Less severe Infrequent Fluid buildup in the eyelid tissue Less severe Blurred vision Dry eyes Eye irritation Nausea Weakness Bloodshot eyes Cornea inflammation Nose inflammation Eye pain Runny nose Congestion Sinus irritation Uncommon Back pain Body pain or aches Change in taste Chills Diarrhea Cough. Tenderness in the area around the eye Swollen glands, particularly in the neck Insomnia Tiredness Rare Drug hypersensitivity Severe Irritation of the throat Pain on the throat.\Less severe Precautions to Take with Pataday Before you use Pataday, which has olopatadine hydrochloride as the active ingredient, you must tell your physician and pharmacist about any allergies you currently have. Chloride and benzalkonium allergies, for instance, are quite common and both ingredients are included in this medicine. You must also tell your doctor if you currently wear contact lenses, and you have to be open and honest about your medical history and any drugs (over the counter, prescription, herbal, or supplemental) you currently take. Additionally, you may not drive or use machinery while using these drops. During pregnancy, only if there is a clear need for Pataday drops should it be used. A doctor should discuss the different risks and benefits with you. No tests have been performed to determine whether the drug can be passed on to breastmilk in nursing mothers. Hence, do consult with your physician first. There are a number of possible drug interactions with Pataday eye drops. If you are currently on any medication that has interactions, your physician will determine whether or not you should discontinue to take them, not use the eye drops, or whether the interactions are manageable. It is also for this reason that you must tell your physician about any medication you currently take. If swallowed, these eye drops may be harmful. If the drops have been swallowed, you suspect an overdose, or an allergic reaction is occurring, you must phone an ambulance or your nearest poison control center. The medication should not be shared with other people. Any missed dose should be taken as soon as possible, unless it is already near to the time of your next dosage. You should not double dose, in other words, as this could lead to overdose and harm your eye and your overall health. Resources and References: Pataday – Information on Pataday Eye Drops (Pataday.com)Pataday Ophthalmic – How to Use Pataday Ophthalmic Drops (Web MD.com)David Mc Mahon, MBAMy name is David Mc Mahon, MBA, Masters in Nutrition (Candidate) and I created this site to educate consumers like you about dry eye syndrome and related eye disorders. I welcome any and all questions related to your condition. You can discover the secret to how I cured my own dry eye syndrome.


what is codonopsis

The plant species called the codonopsis can reach five feet in length. This herb is a twining perennial characterized by possessing oval shaped leaves and green colored flowers with distinct purple colored veins. The long and sweet taproot of the codonopsis is used in herbal medicine around the world.

Codonopsis

"Codonopsis Codonopsis pilosula Common names Codonopsis Poor Man's Ginseng

Codonopsis is cultivated around the world, but it is originally native to Asia and was traditionally used in the herbal medical system of many ancient Asian cultures. Parts used Root. Uses Herbal remedies made from the codonopsis can help prevent problems such as stomach pain and chronic headache. Codonopsis remedies have been used in the treatment of asthma and even cancer - herbalists recommend using the remedy to treat such conditions. Remedies made from the codonopsis help lower stress and boost the ability of the body to tolerate stress when used regularly. Codonopsis remedies also increase stamina and endurance. Specific disorders can be treated using codonopsis. A person suffering from any of the health conditions given below can benefit from remedies made from the codonopsis. Codonopsis remedies have been used in the treatment of cancer and tumors. One beneficial effect of the codonopsis on the body is that it increases the red and white blood cell count. This results in a reduction of the side effects induced by the use of toxic compounds - normally used as a part of the chemotherapy for the treatment of cancer and tumors. Codonopsis aids the body by boosting the healing process following radiation therapy; patients who have been irradiated can recover faster when given codonopsis. Codonopsis can be used in the treatment of chronic headaches. Remedies made from the codonopsis are extensively used in the traditional Chinese medicine - TCM. In this Asian system of herbal medication, codonopsis is used to alleviate headaches that come along with high blood pressure problems. TCM practitioners also recommend codonopsis remedies to relieved tension in the muscles, as well as an aid in treating indigestion and related abdominal disorders. Codonopsis remedies have also been used in the treatment of the auto-immune disorder known as lupus. The dysfunctional immune system in a body affected by lupus is restrained by the remedy. Lupus is a dangerous auto-immune disease, where the immune system goes haywire and starts destroying the DNA found in the cells of the skin - in other words, the body is bent on destroying itself. Codonopsis remedies have also been employed to treat peptic ulcer and other ulcerations in the body. The effect of codonopsis on peptic ulcers was researched during animal studies, the remedy was found to be capable of preventing the formation of peptic ulcers induced in the body by excessive long term stress. Remedies made from the codonopsis are particularly beneficial for the treatment of ulcers that have been compounded by the loss of appetite, chronic diarrhea, or bouts of vomiting over an extended period of time. Codonopsis is also useful in alleviating a chronic tendency to vomit or retch. Traditionally, in some Asian cultures, a remedy made from the codonopsis plants was used to treat people affected by loss of appetite, chronic diarrhea, or vomiting - this remedy is in fact centuries old. Extracts of the codonopsis were analyzed in the laboratory; these studies suggest that a substance in the extract acts on the body by reducing the secretion of pepsin - an enzyme found in the stomach. The extract also reduces the rate at which food is passed from the stomach to the large intestine - these findings show that codonopsis is indeed capable of treating problems in the stomach. Several herbalists have employed codonopsis in the form of an astringent to heal profuse uterine bleeding and also to treat rheumatic as well as other types of aching joints. This herb is known to possess general tonic, aphrodisiac and styptic (binding) properties. In addition, pharmacological studies have also corroborated that codonopsis facilitates digestion as well as metabolism, which, in turn, aids in fortifying the immune system, widening the secondary blood vessels, invigorating the nervous system and, at the same time, works to slow down the actions of adrenal cortex that helps in lowering the blood pressure. It is worth mentioning here that codonopsis is one herb that is employed to cure an assortment of health condition, such as digestive problems, asthma, exhaustion, high blood pressure (hypertension) and anxiety. The taproot of this herb encloses nearly all the therapeutic agents of this herb. Precisely speaking, the codonopsis taproot encloses alkaloids, saponins, polysaccharides, steroids and several different natural amalgamations that make this herb useful for the entire body. The use of Codonopsis pilosula helps to rejuvenate the spleen and, hence, it is often used in the form of a stimulant or tonic. This herb also helps to augment the amount of red and white blood cells and is, therefore, employed to cure anemia. The aptitude of codonopsis to fortify the immune system is considered to be among the greatest benefits offered by this herb. The polysaccharides present in the taproot of codonopsis encourage the manufacture of interferon within the body and, at the same time, perk up the immune building attributes of this herb even more. Codonopsis taproot also contains adaptogenic substances that reinforce the capability of the body to endure stress or anxiety. This, in fact, aids in providing relief from several symptoms related to stress, including exhaustion, persistent headache as well as high blood pressure. In addition, these adaptogenic constituents of codonopsis taproot also work in the form of a tonic for the stomach as well as the entire digestive tract, thereby easing a number of disorders related to the gastrointestinal system, including indigestion, nausea, and diarrhea as well as vomiting. Diaper Rash Ointment100.00g / 3.53oz$ 19.99Hair & Scalp Revitalizer100.00ml / 3.38floz$ 38.99Rosacea/ Acne/ Psoriasis Oil50.00ml / 1.69floz$ 30.99Cold Sore Oil10.00ml / 0.034floz$ 14.99Nutrient Rich Face Cream60.00ml / 2.03floz$ 31.99It may be noted here that contemporary medicine has found a number of novel utilities for the herb Codonopsis pilosula. The curative attributes of this herb ease the adverse effects that are often endured by cancer patients who are undergoing chemotherapy or radiation therapy as a part of their total therapeutic program. The side effects generally experienced by such cancer patients include indigestion, lassitude, nausea and shortness of breath, while the energy-augmenting and immune-enhancing properties of codonopsis assist in reinstating their vivacity. Codonopsis is a good substitute for the Chinese herb ginseng and has often been employed for treating human immunodeficiency virus (HIV). Codonopsis is thought to possess therapeutic attributes comparable to those of ginseng, but in a much weaker variety. In fact, occasionally the herb Codonopsis pilosula is referred to as the ginseng for the poor man as it is comparatively inexpensive and is employed as an alternate for the more costly ginseng to prepare several natural curative medications. In general, codonopsis is employed to cure the conditions for which ginseng is used. In China, people take this herb internally in the form of a tonic prepared using both herbs with a view to reinstate the abating energy as well as to prevail over lassitude. Occasionally, codonopsis is also blended with another Chinese herb, gingko biloba, because the Codonopsis pilosula possesses antioxidant properties which augment the aptitude of gingko biloba in enhancing memory. Remedies made from the codonopsis are available in herbal stores in different forms. Herbal stores usually sell tablets, herbal teas, and tinctures made from the codonopsis. Since, the codonopsis is a relatively inexpensive compared to ginseng, this herb that is often substituted for real ginseng in many herbal tonics that are sold as ""ginseng"" based remedies. The addition of codonopsis instead of ginseng in such herbal formulas reduces the cost for herbal product makers. There is another side to the story as in many such cases of false marketing, the addition of codonopsis in the remedy often makes the tonic more effective in treating the problem - in fact, it can sometimes be much more effective than the expensive ginseng herb. The professional supervision of an experienced herbalist is recommended for all individuals interested in the use of codonopsis to the treat the ulcers affecting them. Habitat and cultivation Codonopsis (botanical name Codonopsis pilosula) is a flowering herb that grows perennially. Belonging to the Lobelia family, this herb is indigenous to China and Korea, where people have used the herb for therapeutic purposes for many thousand years. Codonopsis is currently grown across the globe, especially for its therapeutic attributes as well as its attractiveness as an ornamental plant. Codonopsis pilosula has a preference for properly drained, rich, light soil and conditions that are completely sunlit or places having partial shade. Precisely speaking, codonopsis likes a somewhat acidic soil. This herb only thrives well when grown in complete sunlight provided the soil is damp for the major period of its growing season. While the herb has the aptitude to endure cold when it is in a dormant stage, the new growths during spring time as well as the mature codonopsis are susceptible to frosts and, therefore, it is advisable to cultivate this herb in a sheltered location to avoid the early morning sun. Codonopsis is basically a climbing plant that has the ability to support itself by jostling over and coiling around other plants in the vicinity. As this plant loathes its roots being disturbed, it is best to plant them in their permanent positions outdoors at the earliest. In addition, it is advisable that you grow codonopsis on an elevated bank to allow people to have an excellent view of the ornamental flowers of the herb. It is worth mentioning here that codonopsis plants are vulnerable to destructions caused by slugs, especially the young shoots that appear in spring are at great risk. In fact, even the mature plants are also consumed by the slugs. Codonopsis pilosula is generally propagated by its seeds that are ideally sown just below the soil surface either in spring or during the beginning of summer in a greenhouse in ericaceous manure. It is important to ensure that the compost always remains damp. Normally, it takes about one to six weeks for the seeds to germinate when kept at a temperature of 20°C. When the plantlets have grown sufficiently large to be handled, prick them out individually, plant them in separate containers and continue to grow them in the greenhouse at least for the duration of their first winter of existence. The young plants may be transplanted into their permanent positions outdoors during the later part of spring or the beginning of summer. Ensure that you provide the plants with adequate protection from slugs invasion at least till they are established properly. Alternately, you may also propagate codonopsis by means of root division undertaken carefully during spring, as this herb does not like its roots to be disturbed. Ideally, you should make small root divisions that are separated slowly from the sides of the primary clump keeping in view that this does not result in much disturbance to the plants. In addition, this should be done in such a manner that you need not dig out the clump, which may kill the plant. These small root divisions should be planted in separate pots and put in a place having light shade within the greenhouse till the time they have rooted properly. The young plants emerging from the root divisions may be transplanted into their permanent positions outdoors during summer provided they have grown sufficiently large. In case their growth is sluggish, you should transplant them outdoors in the next spring. Constituents Although it has been reported that the herb Codonopsis pilosula has shown that this herb encloses alkaloids, saponins (for instance, codonoposides), and polysaccharides, chemical analysis of this herb is yet to identify some of these elements. Therefore, for instance, perlolyrine is the only alkaloid that has been verified as contained by the herb. However, scientists are yet to ascertain the functions, if any, of perlolyrine. In such a situation, it is believed that the saponins are the most active principal constituents of codonopsis. This herb also encloses polysaccharides in the ratio of approximately 1 per cent of the weight of the plant's dehydrated root. Side effects and cautions People using therapeutic formulations prepared from Codonopsis pilosula ought to be aware of the side effects of using this herb and also initiate necessary precautions. For instance, people enduring allergy or hypersensitivity to using Codonopsis pilosula, any of the elements contained by the herb or any associated plant species belonging to the Campanulaceae family should keep away from this herb. In addition, there is not enough clinical evidence about the safety of using codonopsis. Moreover, it has been reported that the use of this herb by humans has resulted in some adverse effects. Therefore, it is advisable that this herb needs to be used with great caution, especially by patients having bleeding disorders or those who are already taking any type of blood-thinning or antiplatelet medications. In addition, patients who are taking purgatives or medicines to soften the stool or have bowel inflammation or even appendicitis should also use codonopsis very cautiously. Usually, this herb has been used to encourage digestion as well as cleanse the intestinal tract. It is also suggested that patients who are taking antacids or medications for gastric reflux should also use Codonopsis pilosula with great cautions, since this herb has the potential to diminish the secretion of gastric acid-pepsin. Also people who are using any type of oral medication should take care while using therapeutic formulations prepared from Codonopsis pilosula, since the extract of this herb may possibly slow down the gastrointestinal movement. This herb should also be avoided by pregnant women as well as those who are planning pregnancy. In fact, even nursing mothers should keep away from codonopsis, as there is an absence of sufficient evidence regarding its safety for use during these conditions. Hair & Scalp Revitalizer Outstanding, 100% natural formula for all your scalp and hair problems including baldness. Skin Ointment This is a very powerful, 100% natural, herbal ointment with calendula stem cells. It is extremely effective on all skin problems. Skin Revitalizer An advanced, 100% natural revitalizer that will keep your skin glowing and looking young - all without harmful chemicals. Comments Post your comments, tips, and suggestions. "