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![]() ![]() Depression and Heart Disease - Depression and Bipolar Support Alliance. Introduction. Depression can strike anyone. However, research over the past two decades has shown that people with heart disease are more likely to suffer from depression than otherwise healthy people, and conversely, that people with depression are at greater risk for developing heart disease. Furthermore, people with heart disease who are depressed have an increased risk of death after a heart attack compared to those who are not depressed. Depression may make it harder to take the medications needed and to carry out the treatment for heart disease. Treatment for depression helps people manage both diseases, thus enhancing survival and quality of life. Heart disease affects an estimated 1. Depression is about twice as likely to occur in people with heart disease compared with the general population. Both conditions have been linked to inflammation. Researchers looked. American women and men and is the leading cause of death in the U. S. 3 While about 1 in 2. American adults experiences major depression in a given year, the number goes to about 1 in 3 for people who have survived a heart attack. Depression and anxiety disorders may affect heart rhythms, increase blood pressure, and alter blood clotting. They can also lead to elevated insulin and cholesterol levels. These risk factors, with obesity, form a group of signs and symptoms that often serve as both a predictor of and a response to heart disease. Furthermore, depression or anxiety may result in chronically elevated levels of stress hormones, such as cortisol and adrenaline. As high levels of stress hormones are signaling a . Persons with heart disease, their families and friends, and even their physicians and cardiologists (physicians specializing in heart disease treatment) may misinterpret depression's warning signs, mistaking them for inevitable accompaniments to heart disease. Symptoms of depression may overlap with those of heart disease and other physical illnesses. However, skilled health professionals will recognize the symptoms of depression and inquire about their duration and severity, diagnose the disorder, and suggest appropriate treatment. Depression Facts. Depression is a serious medical condition that affects thoughts, feelings, and the ability to function in everyday life. Depression can occur at any age. NIMH- sponsored studies estimate that almost 1. American adults, or about 1.
Heart Failure And DepressionDepression is both a risk factor for heart disease and is often experienced by people who have had a major heart event. Depression is two or three times more common. Although available therapies alleviate symptoms in over 8. Depression results from abnormal functioning of the brain. The causes of depression are currently a matter of intense research. An interaction between genetic predisposition and life history appear to determine a person's level of risk. Episodes of depression may then be triggered by stress, difficult life events, side effects of medications, or other environmental factors. Whatever its origins, depression can limit the energy needed to keep focused on treatment for other disorders, such as heart disease. Heart Disease Facts. Heart disease includes two conditions called angina pectoris and acute myocardial infarction (. Like any muscle, the heart needs a constant supply of oxygen and nutrients that are carried to it by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged and cannot supply enough blood to the heart, the result is coronary heart disease. If not enough oxygen- carrying blood reaches the heart, the heart may respond with pain called angina. The pain is usually felt in the chest or sometimes in the left arm and shoulder. The part of the heart that does not receive oxygen begins to die, and some of the heart muscle may be permanently damaged. Chest pain (angina) or shortness of breath may be the earliest signs of heart disease. A person may feel heaviness, tightness, pain, burning, pressure, or squeezing, usually behind the breastbone but sometimes also in the arms, neck, or jaws. These signs usually bring the person to a doctor for the first time. Nevertheless, some people have heart attacks without ever having any of these symptoms. Risk factors for heart disease other than depression include high levels of cholesterol (a fat- like substance) in the blood, high blood pressure, and smoking. On the average, each of these doubles the chance of developing heart disease. Obesity and physical inactivity are other factors that can lead to heart disease. Regular exercise, good nutrition, and smoking cessation are key to controlling the risk factors for heart disease. Heart disease is treated in a number of ways, depending on how serious it is. For many people, heart disease is managed with lifestyle changes and medications, including beta- blockers, calcium- channel blockers, nitrates, and other classes of drugs. Others with severe heart disease may need surgery. In any case, once heart disease develops, it requires lifelong management. Click here for more heart disease facts. Get Treatment for Depression. Effective treatment for depression is extremely important, as the combination of depression and heart disease is associated with increased sickness and death. Prescription antidepressant medications, particularly the selective serotonin reuptake inhibitors, are generally well- tolerated and safe for people with heart disease. There are, however, possible interactions among certain medications and side effects that require careful monitoring. Therefore, people being treated for heart disease who develop depression, as well as people in treatment for depression who subsequently develop heart disease, should make sure to tell any physician they visit about the full range of medications they are taking. Specific types of psychotherapy, or . Ongoing research is investigating whether these treatments also reduce the associated risk of a second heart attack. Preventive interventions based on cognitive- behavior theories of depression also merit attention as approaches for avoiding adverse outcomes associated with both disorders. These interventions may help promote adherence and behavior change that may increase the impact of available pharmacological and behavioral approaches to both diseases. Exercise is another potential pathway to reducing both depression and risk of heart disease. A recent study found that participation in an exercise training program was comparable to treatment with an antidepressant medication (a selective serotonin reuptake inhibitor) for improving depressive symptoms in older adults diagnosed with major depression. Exercise, of course, is a major protective factor against heart disease as well. Use of herbal supplements of any kind should be discussed with a physician before they are tried. Recently, scientists have discovered that St. John's wort, an herbal remedy sold over- the- counter and promoted as a treatment for mild depression, can have harmful interactions with some other medications. Treatment for depression in the context of heart disease should be managed by a mental health professional—for example, a psychiatrist, psychologist, or clinical social worker—who is in close communication with the physician providing the heart disease treatment. This is especially important when antidepressant medication is needed or prescribed, so that potentially harmful drug interactions can be avoided. In some cases, a mental health professional that specializes in treating individuals with depression and co- occurring physical illnesses such as heart disease may be available. While there are many different treatments for depression, they must be carefully chosen by a trained professional based on the circumstances of the person and family. Recovery from depression takes time. Medications for depression can take several weeks to work and may need to be combined with ongoing psychotherapy. Not everyone responds to treatment in the same way. Prescriptions and dosing may need to be adjusted. No matter how advanced the heart disease, however, the person does not have to suffer from depression. Treatment can be effective. Other mental disorders, such as bipolar disorder (manic- depressive illness) and anxiety disorders, may occur in people with heart disease, and they too can be effectively treated. For more information about these and other mental illnesses, contact NIMH. Remember, depression is a treatable disorder of the brain. Depression can be treated in addition to whatever other illnesses a person might have, including heart disease. If you think you may be depressed or know someone who is, don't lose hope. Seek help for depression. References. 1Nemeroff CB, Musselman DL, Evans DL. Depression and cardiac disease. Depression and Anxiety, 1. Suppl 1): 7. 1- 9. Frasure- Smith N, Lesperance F, Talajic M. Depression and 1. Circulation, 1. 99. Morbidity and mortality: 2. National Heart, Lung, and Blood Institute, 2. The de facto mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1- year prevalence rates of disorders and services. Archives of General Psychiatry, 1. Lesperance F, Frasure- Smith N, Talajic M. Major depression before and after myocardial infarction: its nature and consequences. Psychosomatic Medicine, 1. National Advisory Mental Health Council. Health care reform for Americans with severe mental illnesses. American Journal of Psychiatry, 1. Blumenthal JA, Babyak MA, Moore KA, et al. Effects of exercise training on older patients with major depression. Archives of Internal Medicine, 1. Source: National Institute of Mental Health. NIH Publication No. Depression and Heart Disease : Mind and mood affect the heart. Published: February, 2. 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SQM found that centers that achieved “world class” customer satisfaction ratings had a FCR average of 8. While no single performance metric, or combination thereof, fits all contact centers, ICMI has identified seven key call center metrics that are most critical in. Let’s be clear: if you’re not measuring any part of your service delivery, you are missing a huge opportunity to improve, grow or even save your business during. This article provides an overview of how to configure service level management in Service Manager. This section also contains procedures that cover service level. IT Outsourcing & ITIL. April 28, 2016. The outsourcing of IT and other services is now a common and established phenomenon. It can be viewed in many different ways. FCR average of only 6. Increased customer satisfaction isn't the only big benefit realized by contact centers that achieve high FCR. These centers typically also enjoy: Lower operating costs. 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Aiming for calls that require neither transfers nor follow- up work is a sound approach to high quality service, but it is incomplete from an FCR measurement standpoint, say experts, because it fails to take into account something essential - - the customer's perspective. It’s important to let the customer tell you if their issue has been resolved, whether through real- time or near- real- time customer feedback channels, such as post- call IVR surveys, online surveys, live surveys or immediate email- based surveys. SERVICE LEVEL/RESPONSE TIMEService level and response time are classic metrics, and they’re fundamental to effective management of the contact center and the customer experience. These metrics tell you how accessible the center is to customers, how many agents are needed to provide efficient service or how your center's service compares to others in your industry. Service level is defined as: . ![]() Response time (which is the equivalent of service level for transactions that don't have to be handled the moment they arrive) is defined as: . These metrics measure how well you are getting customer contacts in the door and into the hands of agents (and thus are essential for planning and budgeting). They are the clearest indication of what customers experience when they attempt to reach your contact center. When establishing and assessing service level and response time objectives, the important thing isn't merely how high your overall stated objectives are, but how consistently the center hits those objectives throughout the day. Don’t be lulled into thinking solid performance here is the only thing to watch. A center can achieve its objectives, yet still be wasting resources, creating extra work and providing poor quality. Accessibility is an enabler, not a guarantee of quality or of customer delight. Accessibility means that contacts are getting in and being handled efficiently so that the contact center has the opportunity to accomplish its mission of ensuring long- lasting customer satisfaction and loyalty. If quality is poor, things such as repeat contacts, unnecessary contacts and escalations and complaints will eventually drive service level down and frustrate your customers. ADHERENCE TO SCHEDULEAdherence to schedule is a measurement of how much time during an agent's shift he or she is logged in and handling contacts or at least available to do so. Most centers choose an adherence objective around the 8. Adherence is comprised of time spent in interacting with customers, as well as time spent in after- call work, making necessary outbound calls and waiting for calls to arrive. Time taken for lunch, breaks, training, etc., is not counted as time assigned to handle contacts, and thus is not factored into adherence to schedule measurements. While always an important metric in contact centers, adherence to schedule has taken on an even more significant role of late as centers have learned to focus more on what really matters, and on what agents can control. Where average handle time and calls per hour used to rule the metric roost, centers have discovered that agents are merely slaves to such measurements and that these metrics aren't indicative of whether staff is in the right place at the right times, doing what they are supposed to be doing. Agents can't control how many calls are coming in or how long a transaction might take on the customer side, but they can be held accountable for where they are and what they are doing. This is not to say that contact centers should completely do away with more traditional productivity metrics. After all, the center needs to have an idea about how many calls a typical agent is handling and how long those calls are lasting to help pinpoint any scheduling adjustments that may have to be made. The good news is that when placing a stronger emphasis on adherence to schedule by having agents in the right places at the right times, things like average handle time and calls per hour tend to take care of themselves. That is assuming the center has taken time to provide agents with adequate training and a quality mindset, and that the center has done a decent job of forecasting and scheduling. That said, there is the danger of focusing too stringently on adherence to schedule - - watching agents' every move with the help of workforce management technology and inevitably eliciting cries of micro- management from them. Here are several recommendations from ICMI for ensuring solid adherence stats that agents won’t find intrusive: Train each agent on how much of an impact he or she has on the queue, and on customer accessibility and satisfaction. Establish concrete service level and response time objectives that everybody knows, understands and accepts. Educate agents on the essential steps involved in resource planning to ensure that they understand how schedules are produced. Develop appropriate priorities for the wide range of tasks your agents perform on the job. Provide real- time information to agents and back it up with training on how to interpret that data. Track and manage schedule adherence at the supervisory level, as conditions dictate. Track schedule adherence for the entire group for planning purposes and to assess how well management has created a process that enables appropriate schedule adherence. FORECASTING ACCURACYForecasting accuracy – better described as forecasted contact load vs. It is a critical, high- level objective in all contact center environments. Underestimating demand leads to understaffing. This, in turn, leads to long wait times in queues, frustrated customers, burned- out agents and high toll- free costs (due not only to the long hold times, but also to the longer call times that might result from dedicating a portion of the call to caller complaints about hold times). However, overestimating demand results in waste, overstaffing and increased idle time. Forecasted call load is available from the system used for forecasting (e. ACD, workforce management system, email response management system, Web servers - - wherever data is available. Forecasting accuracy should not be reported as a summary of forecasted versus actual contacts across a day, week or month, but rather as an illustration of accuracy for each reporting interval, typically half- hours. SELF- SERVICE ACCESSIBILITYIt has become the quest of most contact centers to deflect from the agent queue as many basic transaction types as possible. These calls are shunted to self- service systems - - mainly IVR and interactive Web applications. This can help enhance service efficiencies and cut costs; it also frees up agents to use their valuable skills to assist customers with more complex issues, thus keeping staff engaged and motivated. But some centers get so caught up trying to lure customers off the phones and into self- service that they forget to track something essential: how well the self- service systems actually . Self- service accessibility has emerged as a critical metric in this age of automation and customer- centricity. Leading contact centers gauge not only how many customers begin self- service transactions via IVR and the Web, but also how many complete those transactions without live- agent assistance. Centers with a serious focus on effective self- service have invested in tools that record customer interactions with IVR apps and Web sites. Such tools help to pinpoint any system glitches or snags that hinder the customer experience and that cause customers to . Service Metrics Group - Customer Experience Measurement. The Games Workshop Battle Mat Stencil
![]() Warhammer – a beginner's guide to the legendary battle game . In its 3. 2- year history the tabletop game of fantasy battles has provided a gateway into gaming for generations of players, and it remains one of the most recognisable franchises in the industry. But creator Games Workshop recently brought the game’s three decades of bloodshed and battle to a close, destroying the Warhammer world in a cataclysmic in- game event known as the End Times. Now the company has unveiled the game’s new incarnation. Warhammer: Age of Sigmar is a complete overhaul of the game’s rules and fictional background. So what has changed, and why did Games Workshop bring the curtain down on their iconic world of fantasy warfare? What is Warhammer? Shop games workshop scenery grass battlemat. Free delivery and returns on eligible orders of £20 or more. File about games workshop battle mat,download an entire games workshop battle mat document onto your computer. Games Workshop Range. Age Of Sigmar Battle Mat: Khorne Dominion. Find great deals on eBay for games workshop battle mat and battle mat. Shop with confidence. ![]() Warhammer is a tabletop battle game which puts players in command of armies of valiant humans, noble elves, savage orcs or a variety of twisted and monstrous creatures. Players collect forces of miniature plastic models, all with different stats and abilities, and use them to play out clashes on a tabletop battlefield. Unlike a board game, where players’ moves are restricted to defined areas, Warhammer commanders freely manoeuvre their units set distances using rulers and resolve shooting and hand- to- hand combat by rolling dice. In its lifetime the game has gone through several editions, tweaking rules and adding new units and creatures for players to deploy in their armies. Its science fiction spin- off, Warhammer 4. Space Marines, war machines and vicious alien hordes. If you go into a Games Workshop store, you’re very likely to see large Warhammer battlegrounds set up in the shop, usually beautifully modelled to resemble real landscapes. Buy 6' x 4' Open Field Neoprene Tabletop Battlemat with Carrying. Field Neoprene Tabletop Battlemat with Carrying Case. GAMES WORKSHOP Warhammer Age of Sigmar: Battle Mat - Soulblight Necropolis. Rating * Name Email * Review Subject *. Buy Warhammer Age of Sigmar Battle Mat: Khorne Dominion ( 64-22) Games Workshop: Mini Table Games - Amazon.com FREE DELIVERY possible on eligible purchases. So it’s toy soldiers? Is it just for kids? Plenty of children and young teens play Warhammer, but the game has always involved a heavy dose of strategy that appeals to adults as well. Building an effective army, utilising your force’s strengths and exploiting your opponent’s weaknesses are the keys to victory. But the Warhammer hobby extends beyond the game itself. ![]() Players spend hours building and painting their miniatures, a process that requires patience, dedication and, sometimes, considerable artistic skill. Warhammer players collect, paint and fight battles with armies of miniature troops. Photograph: Games Workshop. The Games Workshop Battle Matrix![]() What’s changed in the new edition? Age of Sigmar rewrites the Warhammer setting from the ground up. Where previous editions of the game pitted rival empires against one another in a world reminiscent of the works of JRR Tolkien, Michael Moorcock and Robert E Howard, the new version seeks to establish a more distinct universe. The most notable change is the addition of the Stormcast Eternals faction – an elite force of human warriors elevated to the service of the god Sigmar. These replace the multiple human armies of previous editions and bear a striking resemblance to Warhammer 4. Space Marines - Games Workshop’s best- selling line of miniatures. Other races, including the rat- like Skaven and the shambling hordes of the undead, have returned, but the names of some forces have been changed, presumably so that they can be registered as trademarks. The generic orcs, goblins and ogres have become orroks, grots and ogors respectively. What about the game mechanics? Mechanically, the game is dramatically different from its previous editions, which revolved around regiments manoeuvring across the battlefield in rank- and- file formations. Troops in Age of Sigmar fight as loose units, much more akin to Warhammer 4. The new edition also hugely simplifies the army- building process. Where previously each unit came with a points value to ensure even contests between players, the game now does away with the arithmetic of constructing a force, instead giving outnumbered players in- game bonuses to level the playing field. Units themselves have also been made much simpler, represented by just four numerical stats. Unlike past editions, which required players to buy supplemental army books to play with their chosen faction, each box of miniatures now ships with a Warscroll, a printed sheet containing all the information needed to field a unit in battle. It’s a similar approach to that of Fantasy Flight Games’ popular Star Wars space battle titles. Why has the game changed so dramatically? Just as video games spawn numerous sequels, it’s common for tabletop games of all sorts to evolve over time. As players fine- tune their armies and find the optimum strategies, designers introduce new elements to provide a fresh challenge and new storyline elements. A customer plays a game of Warhammer in a Games Workshop store in London. Photograph: Alamy. But Warhammer’s publisher Games Workshop particularly needed to rejuvenate the game. After a long period of success, the firm’s sales and profits slumped in 2. The company had also suffered from falling interest in its Lord of the Rings games series, which had initially generated healthy revenues, but hadn’t retained their popularity following the end of Peter Jackson’s film trilogy. Is the game going to expand over time? Definitely. At the time of publishing, two armies have been revealed: the heroic Stormcast Eternals and the bloodthirsty warriors of the Chaos god Khorne. You can expect an ever- growing range of troops for both of these forces, as well as entirely new factions in the months and years to come. Can I still use my old miniatures? If you’ve collected armies for prior editions of Warhammer, there’s nothing stopping you and your friends from continuing to play with the models and rule sets you’re already familiar with. Games Workshop has also published conversion rules for their existing range of miniatures, allowing you to use your armies under the new system. Several of the conversion guides take quite a tongue- in- cheek tone, however. The rules include bonuses for players who sport impressive moustaches or who pretend to ride on horseback during play, and this suggests that they aren’t taking the whole thing entirely seriously. Don’t expect Games Workshop to provide continued support for older editions of the game, either. If you’re looking to expand your existing armies, you’ll have to look at picking up second- hand miniatures. Warhammer 4. 0,0. Forbidden Stars review: an absorbing evening of combat. So how do I get started, and what does it cost? The Age of Sigmar starter set comes with everything you need to fight small two- player battles between the Stormcast Eternals and the forces of Chaos. If this all seems a bit intimidating, there are plenty of online tutorials covering army painting techniques. You don’t need to be Michaelangelo, but most opponents will expect you to give your troops at least a basic paint job. Speaking of opponents, you’ll also need people to play against. Games Workshop runs events in its stores, of which there are over 4. Alternatively, you may want to find a local games club to play at. Several organise informal games or more serious tournament play. Are there any alternative battle games? Yes. If the Warhammer universe doesn’t interest you, there are lots of other fantasy and science fiction wargames that you might find more appealing. US studio Fantasy Flight Games has released two space battle games set in the Star Wars universe. The X- Wing Miniatures Game focuses on lightning- fast dogfights between squadrons of Rebel and Imperial pilots, while Star Wars: Armada offers a more drawn- out, strategic experience featuring some of the biggest and most powerful ships from the film franchise. How the boundary between board and video games is blurring. Nottingham- based Mantic Games has produced a number of games by former Games Workshop designer Alessio Cavatore. Kings of War pits armies of humans, dwarves, elves and orcs against one another in a fantasy setting while the upcoming Warpath – with work- in- progress rules available to download now free of charge – lets players fight futuristic battles with high- tech troops and weaponry. If you’re a fan of previous editions of Warhammer and 4. K, they might be the closest thing you’ll find nowadays. Warmachine, from Privateer Press, features battles between forces of heavily armoured steampunk war- walkers, while the company’s other game, Hordes, puts players in command of armies of monstrous creatures. And Beyond the Gates of Antares is a science fiction game designed by Rick Priestley, Warhammer’s co- creator and long- time creative director. It ditches many of Warhammer’s gothic trappings, taking its cues from “harder” military sci fi. The Games Workshop battle mat. I'm serious, at last, about building my gaming table. I need one to playtest my game. And, ultimately, if I want to play a game of warhammer it would be easier to have a battle- table instead of a too- small diningroom table. So, I was reading about the Games Workshop battle mat (2. I couldn't find it on their website though. And thus, I found myself phoning the local GW store in my vicinity. We now sell a modular board set made from plastic. It's slightly more expensive though? How much does that cost? A unit of 4. 0 mantic dwarves costs 3. A unit of 1. 0 orc boar riders from mantic costs 2. Anybody buying GW stuff must be mad or rich. |
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