Health & Fitness Guide » Health

Placental abruption – Causes, Symptoms, Prevention and Treatment

admin — Mon, 11 Jul 2011 11:26:48 +0000

Placental abruption or abruptio placentae is a pregnancy complication wherein there is a complete or partial detachment of the placental lining from the uterine lining.

Placenta is an ephemeral (exists briefly) organ that develops in the uterus during pregnancy. Acting as the life support system for the growing baby, the placenta helps provides the baby with oxygen and maternal nutrients. It also helps the baby dispose his waste via the maternal kidneys.

Conversely, in case of a placental abruption, the baby is deprived of oxygen and nutrients, thus leaving both baby and mother in danger.

Causes:

Although the specific causes that lead to a placental abruption are unknown, certain risk factors are believed to raise the risk. These include preeclampsia (pregnancy induced hypertension), trauma or injury to the abdomen, maternal age less than 20 or greater than 35.

In addition, a shorter length of the umbilical cord, a history of uterine fibroids (benign tumors of the uterus) and UTI (urinary tract infections) during pregnancy also play a part.

Symptoms:

Placental abruption usually occurs in the third trimester. However, it can occur any time after the 20th week of pregnancy. Classic signs and symptoms of placental abruption include uterine tenderness, rapid uterine contractions, often without arrest, abdominal pain and vaginal bleeding (sometimes).

Prevention:

While one cannot prevent placental abruption, the risk can be decreased following certain precautions. Quit smoking and avoid alcohol. The risk of placental abruption can also be reduced by maintaining a good pre-conception health, right eating during pregnancy regular sleep patterns and correction of preeclampsia and diabetes.

Treatment:

There is no treatment available that can either fix a detached placenta or can stop it from detaching further. The most preferred treatment is often based on the severity of the separation, location of the separation and the duration of the pregnancy.

In cases of mild placental abruption, a complete bed rest and close monitoring are the most prescribed treatment options. However, in case of a complete separation, delivery (preferably C-section) is often sought as the safest option. Severe bleeding requires an immediate blood transfusion.

Unfortunately, 15 percent of the severe placental abruption cases end in fetal death.

Foods to boost sex drive

admin — Thu, 01 Jul 2010 18:23:30 +0000

While there are foods known to pump up your mood, sharpen your memory, fight your flab, boost your stamina, the aphrodisiac snacks serve a sexier purpose – they improve your sex life.

Hot Chilies

Capsaicin, an active component of chili peppers, increases blood circulation and stimulates nerve endings, thus making you feel more turned on.

Asparagus and Avocados

The flowering perennial plant species are abundantly high in vitamin E. These green plants help your body churn out sex hormones like testosterone, estrogen, and progesterone. The high levels of these hormones are known to circulate in the bloodstream, thereby stimulating sexual responses like clitoral swelling and vaginal lubrication.

Bananas

The phallus-shaped fruit is rich in potassium, a nutrient key to muscle strength.

Chocolate

Phenylethylamine, the key chemical in cocoa, refreshes the mind and invokes subtle feelings of well-being and excitement.

Oysters

Oysters are known to can spark readiness. The shellfish is high on zinc, a mineral that pumps up the production of testosterone, the hormone linked to a higher sex drive.

Pomegranates

Rich in antioxidants, the fruit protects the lining of blood vessels, allowing more blood to flow through them. As a result the genital feel an increased sensitivity.

Red Wine

It has always been popular for its relaxant properties. Red wine contains resveratrol, an antioxidant that helps boost blood flow and improves circulation before and during intercourse.

Salmon and Walnuts

Packed with omega-3 fatty acids, salmon and walnuts will keep sex-hormone production at its peak. Pumpkin seeds and flaxseeds also confer similar benefits.

Vanilla

The sweet bean mildly stimulates nerves, making sexual sensations feel even better.

Watermelon

The juicy fruit contains phytonutrient citrulline, the chemical which leads to an uptick in the amount of nitric oxide in the body. Higher levels cause blood vessels to relax and speeds up circulation, thus feeling more aroused in lesser time.

Boring household dangerous for moms-to-be

admin — Wed, 02 Jun 2010 11:29:40 +0000

Pregnant women have always been advised to go easy. Now there’s science to back it up.

According to the findings of a new study, pregnancy is not the time for household chores. The study, published in the current issue of the journal Pediatric Epidemiology, found that doing “boring and repetitive” household chores during pregnancy raises the odds of giving birth prematurely.

Doing mentally unstimulating work day-in day-out raises the risk of giving birth at least three weeks early by around 25 percent, researchers warn.

The findings of the study are backed by pregnancy records of nearly 12,000 new moms.

It data collected included details about the mom-to-be’s daily physical activities for both exercise and household chores, job profiles, overall pregnancy health, gestation of pregnancy and baby weight.

The results indicated that moms who indulged in mentally un-stimulating work were more likely to give birth prematurely. Their risk of giving birth at least three weeks before term were around 25 percent higher than moms who abstained doing such jobs.

Researchers believe that doing boring and repetitive tasks increase the levels of stress hormones that are involved in causing labor.

Conversely, switching to a completely sedentary lifestyle spells more trouble, researchers warn. Taking up a completely sedentary lifestyle increases the chances of having an underweight baby, researchers found.

“Pregnancy is not a disease. In fact, most women who are pregnant are healthy and most of them are being delivered of perfectly healthy babies. Women who are healthy and do not have pregnancy complications should not restrict their activities in order to achieve a better pregnancy outcome” lead researcher, Hajo Wildschut, of Erasmus University in Rotterdam stated.

Patrick O’Brien, a consultant obstetrician at the Royal College of Obstetricians and Gynaecologists added, “Exercise is good in pregnancy, it keeps you aerobically fit, it keeps your weight under control, it probably reduces the chances of difficulties and it makes it easier to deal with the birth and after wards.”

“Diet in a swimsuit” helps drop dress size without exercising!

admin — Mon, 31 May 2010 10:51:26 +0000

Want to shed those pounds without sweating it out at the gym? Here’s a novel way – the ‘diet in a swimsuit’.

The new 30-pound Bhs cozzie “diet in a swimsuit” helps women drop a dress size without them having to hit the gym. Adding more to it, it is made of a specially developed material that tucks in tummies and boosts the boobs.

Designed by the Bhs scientists, the swimsuit’s super-stretchy inner mesh is made of elastane and nylon, the materials that help squeeze and flatten bulges into shape.

The outer layer, also of elastane, smoothes the silhouette and the padded support lifts the boobs, giving the all perfect outline and the sexy cleavage.

“We realized ladies were fretting about showing their bodies. The collection was launched to create an immediate fix to their predicament” a Bhs spokesman said.

So now no more cutting down on favorite foods, no more early morning exercise regimes or tiresome gym sessions, just get into the “diet in a swimsuit” to get that dream figure.

Milk post exercise boost benefits of a workout in women

admin — Sat, 29 May 2010 17:21:58 +0000

Taking down two glasses of milk a day after workout regimen helps tone muscles and keep off fat, results of a new study claim.

Matching to the findings of a previous study that linked milk intake with increased muscle mass and fat loss in men, the findings of the new study claim to be equally established in women.

“The findings are more challenging because women not only steer clear of resistance training they also tend to steer away from dairy products based on the incorrect belief that dairy foods are fattening” Stu Phillips, professor in the Department of Kinesiology at McMaster University said.

During the 12-week study period, the researchers monitored young women who drank either milk or energy drinks post exercise.

Participants were asked not to drink or eat anything except water two hours prior to the training.

Participants then took to their exercise routine. The training consisted of three types of exercise: pushing like bench press and chest fly, pulling like seated lateral pull down and abdominal exercises without weights or the leg exercises which included leg press and seated two-leg hamstring curl. To ensure proper technique, the training was monitored one on one by personal trainers.

Immediately after the exercise routine, one group consumed half a liter of fat free white milk while the other group consumed a similar-looking but sugar-based energy drink. The drinks were consumed one hour post exercise.

“The women who drank milk gained barely any weight because what they gained in lean muscle they balanced out with a loss in fat” said Phillips. “Our data show that simple things like regular weightlifting exercise and milk consumption work to substantially improve women’s body composition and health.”

The findings of the study feature in the June issue of Medicine and Science in Sport and Exercise.

Migraine linked to lower breast cancer risk

admin — Tue, 14 Jul 2009 11:06:04 +0000

Who knew the disruptive and debilitating migraine headaches maybe actually bestow protective effects. According to the results of a latest trail conducted by researchers at the Fred Hutchinson Cancer Research Center in Seattle, migraine headaches actually lower the risk of developing breast cancer among women.

Making things brighter, the longer the history of migraine the lower is the risk of developing breast cancer, the researchers touted.

As both migraine and breast cancer are hormonally mediated diseases, therefore it’s “biologically plausible” that migraine sufferers stand a reduced risk of breast cancer, researchers highlighted.

While low levels of estrogen, the primary female sex hormone, are typically associated with severe and frequent migraine attacks in women, breast cancer is directly linked to increased levels of the hormones.

A study of nearly 9,000 American women aged between 34 to 64 years revealed that women with a history of migraine are 26 percent less likely to develop breast cancer as compared to non-migraine sufferers.

Moreover, use of nonsteroidal anti-inflammatory drugs (NSAIDs) such aspirin, ibuprofen and naproxen for alleviating migraine symptoms are also found to lower the breast cancer risk by 12 percent.

The study features in the July issue of Cancer Epidemiology, Biomarkers and Prevention, a journal of the American Association for Cancer Research.

Presbyopia and Types of Bifocal Lenses

admin — Sun, 12 Jul 2009 10:22:40 +0000

“To be, or not to be!” If you’ve answered Shakespeare’s pithy declaration in the affirmative and have made it past the age of forty, the next question yielded by life is, “To read, or not to read!” You see (no pun intended), after forty years of age, most people develop presbyopia. Essentially what this means is that the crystalline lens inside the eye, behind the pupil, loses its suppleness and thus its ability to focus for close activities such as reading, sewing, etc.

Everyone knows the remedy for “short arms”: reading glasses. But of course, these days it isn’t as simple as grabbing a pair of “specs,” though many people do this daily at drug store counters across the nation. To have your particular vision needs correctly addressed, it is necessary to have a complete eye exam by an optometrist or an ophthalmologist. Once you have the prescription, you will have to decide on what type of corrective lens is right for you.

Essentially there are four types of lenses to choose from.

The first are single vision lenses, meaning the entire lens is ground to your specific reading power. The advantage of getting them from an optical store as opposed to getting them from the drugstore is that each eye will be prescribed its required power. Though single vision lenses provides the absolute clearest reading field in terms of width and clarity, the drawback is not having distance vision, which means you have to continually take them on and off.

The second type is called a bifocal. It has a straight line, usually, with distance vision at the top and reading at the bottom. Its most glaring incarnation is the executive bifocal, which has something more like a ridge across the entire surface of the lens. Draftsman and people who have to unfurl large blue prints, while having to look up and down, prefer this design. Though there are some round designs, the straight top design, that varies in width from 25 to 45 millimeters, is the most common. This design addresses most general visual needs.

The third type is called a trifocal and, as its name suggests, it has three focal distances. The third focal distance is in the middle and is for intermediate distances not covered by the distant or near vision segments. This design would be more helpful for a typist, say, who has material spread on a desk at different distances.

The fourth type—and one that is gaining popularity, as sterling technology gets better, is the progressive lens. The progressive lens not only renders what is closest to natural vision; it doesn’t have visible lines, which make it cosmetically appealing, as well.

All of the aforementioned lenses can be had with a colorful yet utilitarian “tint.” Certain colors can be added to the lens to accommodate different work/office/lifestyle situations, even different colored computer screens! Some are even photochromatic, meaning they change in sunlight. All of them come in CR-39, a plastic, thus are lightweight.

If you absolutely hate “specs,” they actually make contact lens bifocals! They come in three types. Some of them are actually designed like the larger lenses, with clearly demarcated far and near visual zones. These are known as alternating vision designs. A second design is called simultaneous and has both distance and near vision zones centered on the cornea. Another is prescribed to be used monocularly, meaning that distance power is put in one eye and reading in the other. The brain somehow knows which one to shut on and off, given one’s activity at the time. It takes a bit of work and is not good for everyone, but those who can use them swear by them.

So, there you have it. Me thinks that in days of yore they could do aught but curse the darkness, even with candles lit. But, today, one can use one or a combination of the available technology to make sure that it is, indeed, poor Yorick.

Abuse And Its Effects

admin — Sun, 12 Jul 2009 10:11:25 +0000

Abuse is the misuse, excessive use or improper use of a person or object. It’s not uncommon to abuse television, a car or even a computer or video game system. When the object doesn’t work as we want it to it may be kicked, thrown, hit or smashed and the only person who suffers is the owner of the object. When the abuse is of a person, everyone involved suffers.

It is estimated that over 12 million cases of abuse occur in the United States each year. However, as abuse takes many forms – each with their own ramifications, secrets and shames – abuse is not always reported so the statistics regarding the number of abuse cases may actually be incorrect or incomplete.

Sexual, Emotional, Mental and Physical abuse are the four main types of abuse as listed in most medical journals, as they are the types most commonly reported when seeking medical attention, treatment or intervention. These four types of abuse are responsible for 98 percent of the total abuse cases reported in the United States.

According to Taber’s Cyclopedic Medical Dictionary, sexual abuse is “rape, sexual assault or sexual molestation wherein the active person forces themselves onto the abused which may be of the same or opposite sex and of any age.” In the event of sexual abuse, especially abuse that spans a period of time, the victim tends to experience feelings of loss of control over their own bodies and their own lives.

Although there may not be any physical signs of sexual abuse – with the exception of rape where bruises, abrasions and tears of the sexual organs may occur – there are behaviors which may indicate an occurrence of sexual abuse.

Victims may react by feeling that sex and acts of sex are “dirty, wrong and unhealthy” and will avoid all intimate contact with others or they may feel that they must use sex as a way to express emotions such as love, acceptance and caring and will become involved with various sexual acts, often times developing into deviate sexual behaviors.

Victims of sexual abuse should seek medical intervention to ensure they have not developed a sexually transmitted disease. In addition, victims of sexual abuse will need counseling with a licensed psychologist or psychiatrist who specializes in sexual abuse in order to learn coping mechanisms for the feelings of being out of control and the attitude regarding sex and intimacy.

Emotional abuse is defined as “the debasement of a person’s feeling so that he perceives himself as inept, uncared for and/or worthless.” Often times parents, caregivers or teachers will say things regarding a child’s behavior, performance or skills that will make a child feel that they are “no good,” “useless,” “stupid,” or “good for nothing.” These words, whether said to a child, an adolescent or even to an adult, can harm the ego, self-esteem and self-worth of a person.

Victims of emotional abuse develop feelings of shame, embarrassment and guilt as they feel they are a burden to those around them. These feelings often lead to depression, isolation and suicide. Although emotional abuse leaves no physical injuries, the damage done to the mind, heart and spirit can be extremely extensive. Those suffering from emotional abuse may need to seek medical intervention for antidepressant medications as well as therapy to deal with the feelings of worthlessness, loneliness and isolation. A psychiatrist or psychologist who specializes in emotional abuse would best be able to help those in these abuse situations.

Another common term for mental abuse is “mind games.” Mental abuse is when one person uses another person’s insecurities, phobias and fears to “force” another to do what they wish. Withholding various items, feelings, affection, or personal and physical needs such as food, sleep, water, comfort, warmth and elimination in order to make one person do another’s bidding is also a means of mental abuse. Examples of mental abuse include a husband withholding children in order to force a woman to have sex with him; not allowing someone to go to sleep in an attempt to get them to confess to something or share information; not allowing a person the use of bathroom facilities due to inappropriate behavior; or forcing someone to deal with a fear – such as one of spiders or snakes – as punishment.

The effects of mental abuse include depression, emotional withdraw, social isolation, self-mutilating behaviors, extremely low self esteem, addictions to drugs and alcohol, excessive anxiety, sleep disorders, or suicide. Treatment for mental abuse must begin immediately in order to lessen the after affects and possible complications – especially self-abusive behaviors and suicide.

Therapy sessions that include the individual and the family if involved should be done with a certified, licensed psychotherapist as well as a psychologist. If the mental abuse is prolonged and repeated, therapy may take a great deal of time and participation by all members of the family or parties involved.

Of all types of abuse, the most obvious and easily diagnosable is physical. Physical abuse is defined as “one or more episodes of aggressive behavior, usually resulting in physical injury with possible damage to internal organs, sense organs, the central nervous system or the muscle or bones of another person.” Common signs or indications of physical abuse include:

-Physical evidence of abuse and/or neglect including evidence of previous injuries

-Conflicting stories about the “accident” or injury from parents, guardian, husband or wife

-The cause of injury is blamed on siblings, children and/or pets

The evidence of an injury that is inconsistent with the person’s medical history

-In children, a history that is inconsistent with a child’s development such as hot water and a six-month old baby

-Coming to the hospital for a reason other then the one associated with signs of abuse such as complaining of a cough when there are bruises all over chest and back

-Caregiver, guardian, husband or wife reacts in an exaggerated or unemotional state

-Refusal of caregiver, guardian, husband or wife to authorize medical treatment

-Inappropriate response in abused person such as no response to pain or fear of being touched

-Repeated visits to emergency rooms for “accidents” or a history of visiting more then one hospital in an area repeatedly

The affects of physical abuse can be both physical and mental. Those who are abused for long periods of time or repeatedly will develop a sense of fear related to the abuser, will isolate themselves from family, friends and the community in an attempt to avoid confrontation regarding injuries, will make excuses for any and all injuries as well as fabricate stories as to how they occur, will defend any and all behaviors exhibited by abuser, must require abuser permission for even the most medial of tasks, especially those that must occur outside the home and will exhibit fearful or secretive behavior while in the presence of others.

Physical abuse can cause a person to live in fear, pain and sadness, which can affect their mental and emotional health as well. Depression, isolation, addiction and suicide are very common among those who have been physically abused. The first step in treatment for physical abuse is intervention. The abused person must be removed or leave from the abuser in order for any type of therapy, counseling or intervention to be affective. Once out of harm, the abused person will need medical treatment for any and all injuries as well as therapy with a licensed psychologist that specializes in abuse or post-traumatic stress disorder. Even with therapy and medical intervention, the wounds – those inside – will need time to heal.

Abuse of any kind is illegal. If you know of someone who may be abused, sexually, emotionally, mentally or physically, please notify your local authorities. Abuse hurts all those involved and although the bruises and cuts heal, the scars only fade.

Abruptio placenta

admin — Sat, 11 Jul 2009 15:05:44 +0000

Abruptio placenta is a very serious and rare condition in pregnancy when part or all of the placenta separates from the uterine wall. This occurs in 1 out of 100 pregnancies and is the leading cause of fetal death in the third trimester. The fetus depends solely on the placenta for oxygen and for food. One percent of fetuses die before birth, and 30-50% die during the birth process. Abruptio placenta can lead to maternal hemorrhage which can be dangerous. However, maternal death is rare.

The main symptom of abruptio placenta is bright red bleeding from the vagina. The bleeding does not always occur, though, because the blood can be trapped behind the placenta or the baby. Other symptoms include abdominal pain, tenderness around the belly, lower back pain, rigidity of the uterus, contractions, and decreased fetal movement.

RISK FACTORS

While the cause of abruptio placenta is generally not known, there are risk factors associated with it. The known risk factors are as follows:

1. High blood pressure, chronic or pregnancy induced (This is the most common risk factor.)

2. Trauma to the abdomen, such as in the case of domestic violence

3. Smoking

4. Cocaine use

5. Use of alcohol

6. Mother over 40 years of age

7. Previous abruptio placenta (increases the risk to 10%)

8. Premature rupture of the amniotic sac

TREATMENT

The diagnosis for abuptio placenta is made by ruling out any other possible causes of the symptoms. Sometimes an ultrasound is used to find the abruption, but it does not detect an abruption every time. If the baby is not in danger the mother will be hospitalized to allow the fetus to mature before delivery. A fetal monitor will be used to observe the baby’s heart rate. If the bleeding is severe or there is apparent danger to the baby, a cesarean will be performed immediately.

Overcoming Anxiety And Depression

admin — Thu, 09 Jul 2009 10:58:54 +0000

If you’ve ever been the victim of (or close to anyone who has experienced) anxiety and/or depression you know the suffering and confusion it can cause. It’s pretty much like wandering through a landmine, blindfolded, fingers crossed, hoping to avoid the explosions of thoughts and feelings that you’ve come to dread that signal the onset of an anxiety attack or a bout with depression. It’s not an effective method for avoiding pain and from time to time things just explode in your face.

When you’re walking that long and winding road that will return you to yourself (and it can be done), you need all of the help you can get. There are several tips below that many sufferers of anxiety and depression have tried and found to be effective as they make their way back to peaceful living. It does take courage to try, but please give the following methods a chance.

Relax and Let It Come

There is absolutely nothing to be gained in trying to avoid the fear and sadness that accompany anxiety/depression. The feelings come and go and in the early stages of your illness you are powerless to stop them. Just ride it out much as you would ride a wave in the ocean or a rollercoaster at the amusement park. Just float and bob along and take things as they come. However horrible the feelings are, they do pass if you just let them. Realize you are powerless at this point to stop them and just let them come and go.

Keep Busy

However awful the feelings of anxiety and depression are, eventually you recognize and become somewhat accustomed to the havoc they wreak in your life. One good thing to do is to keep busy. Immerse yourself in activities that occupy your mind. Chances are, your mind is playing some tricks on you right now and your objective is to keep your mind busy and lessen the amount of time you have to think about your problems.

Television and movies are not usually effective occupations. The mind can still wander and explore the murky depths of your problems while the show plays on in front your unseeing eyes. Books and newspapers also seem to be hard for an anxiety/depression sufferer to follow. What does seem to work are things that require you to think about anything other than what is going on in your own mind.

Some things that have been very effective for those who are recovering are crossword puzzles, word searches, jumbles and such. You must be actively seeking the answers in order to progress the puzzle and your mind cannot dwell on your problems at the same time.

Also effective are physical activities like housework, gardening, crafts and simple remodeling. I know it sounds absolutely overwhelming to think of accomplishing some of these things in your current condition; however, you absolutely must get up out of your chair (or bed or couch) and working on projects such as these will take your mind off of yourself. Just begin with small manageable steps and watch yourself slowly but surely come out of your shell.

Find a Friend

If at all possible, find one or two good friends that you can confide in. It is not good to broadcast your troubles to everyone you meet, no matter how great the temptation (and right now it is probably pretty great). However, it is a wonderful relief to have a couple of good and dear friends who understand you and will continue to tell you it will be okay (and it will).

The best scenario is to find someone who has been through anxiety/depression and recovered. When you talk to them, you know in your heart that they know your pain. They describe what they went through and it is your story. And you thought you were the only one. The incredible relief at knowing other people have suffered and recovered is indescribable.

If you don’t happen to know anyone personally who has experienced what you are going through, consult with a psychologist/psychiatrist to be put in touch with a group who specializes in these areas. At first it may seem a bit daunting to think of discussing your misery with others, especially strangers, however you have no idea how good it feels to know that others have experienced the horrible things you are experiencing and that you absolutely are not losing your mind.

Take Care of Yourself Physically

While facing the challenges of anxiety/depression, it is very easy to be so consumed that you forget to take care of yourself physically. No matter how hard it seems, you will be better off if you take care of your physical needs.

Get up every day and have a shower, shampoo your hair, brush and floss your teeth, shave and get dressed. You may not feel like doing anything other than curling up into a ball in your bed but you must keep living. The routine of getting cleaned up and taking care of yourself will eventually give you a feeling of security and well-being if you keep up with it.

Make sure you eat three meals a day. They don’t have to be large but just get some good, nourishing food into you at breakfast, lunch and dinner. Take a multi-vitamin. Take any prescribed medication. Get plenty of rest (as much as you can). Dress comfortably. Take care of yourself in the ways that you deserve. You’ll be surprised at the benefits and good feelings that come from being as physically comfortable as possible.

Get a Ritual

Now is a good time to find something that comforts you. A ritual. Something you do that makes you feel better and gives you a sense of safety and security. When you feel the dreaded sweaty palms and overwhelming fear that accompany anxiety or the awful sensation of dread and sadness that accompany depression, you need something that you can do reflexively to comfort yourself. It may not rid you of the overwhelming sensations you are experiencing, but it can give you an anchor to hold onto while the storm rages around you.

Some people knit or crochet. Some people have a worry stone that they rub. Others may prefer a rosary or repeating prayers they’ve known since childhood. Perhaps it’s a beloved pet that you hold on your lap and stroke when you’re feeling your worst. Only you can know what your port in the storm is but work on it until you find one.

Recovery from anxiety/depression is not easy nor is it fast. In fact, it’s probably one of the hardest fights you’ll ever have; however, the steps above can tip the scales in your favor and the battle can be won. You can recover from anxiety and depression and be stronger than you ever were before. You can persevere.