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Some oversight bodies include: United States: National Futures Association (NFA) and Commodity Futures Trading Commission (cftc) United Kingdom: Financial Conduct Authority (FCA) Australia: Australian Securities and Investment Commission (asic) cara withdraw xm forex Switzerland: Swiss Federal Banking Commission (sfbc) Germany: Bundesanstalt f?r Finanzdienstleistungsaufsicht (BaFIN). It is possible to lose all your capital. In effect, it is an exchange rate set and controlled by the PBoC. The bid is the best price at which you are willing to sell your" currency on the market. You need good customer support, easy transactions and transparency. Foreign currencies become more valuable when the demand becomes greater than available supplies. For an inexperienced trader, yes, it's gambling. Report, and whether countries manipulate the rate of exchange.
Forex, trading in, iran, how, to, get Started Online
You can place different kinds of orders: Market orders: With a market order, you instruct your broker to execute your buy/sell at the current market rate. The exchange rate tells you how much you have to spend in" currency to purchase base currency. For example, if you want to trade 100,000 units at a margin of one percent, your broker will require you to put 1,000 cash in an account as security. This single system continued until 1967 when countries began to increasingly use floating exchange rates in their transactions, where the currency market controls exchange rate activities. The forex market is volatile, and you will see a lot of ups and downs. Visit the broker's website. The currency that you are purchasing is called" currency. Future Group News Economic Times Forex. If your broker voluntarily submits to government oversight, then you can feel reassured about your broker's honesty and transparency. TradeOpus is your authority for Binary Options Trading. We use cookies to make wikiHow great.
If a country has many goods that are in demand, then the country will likely export many goods to make money. A long position means that you want to buy the base currency and sell the" currency. The Central Bank was manipulating the exchange rate, was contra. 2 Determine your margin. If the website says something like "Coming Soon!" or otherwise looks unprofessional, then steer clear of that broker. Usually, one pip equals.0001 of a change in value. The brokers are the ones with the pricing, and execute the trades. If you want to learn common pitfalls which will cause you to make bad trades, consult a trusted money manager.
Forex trading in, iran and a list of best brokers in Farsi in 2019
3 Fill out the appropriate paperwork. With the yuan being strengthened, and wages in China rising, China today. Economy will continue to weaken, which is bad for the.S. Begin trading, buying and selling stocks, shares, bonds, futures, commodities, currencies, forex, options, mutual funds, gold, oil, silver, ETF's and CFD's online, from your desktop or mobile. Sometimes unscrupulous brokers will go into review sites and write reviews to boost their own reputations. 3, decide what currency you want to buy and sell.
Million Dollar Forex Early. In forex trading, you sell one currency to purchase another. The bid price is the price at which your broker is willing to buy base currency in exchange for" currency. Here you can find a list of global reliable Forex brokers online offering service in Farsi for iranian traders living abroad. Reports on a country's GDP, for instance, or reports about other economic factors like employment and inflation, will how to trading forex in iran have an effect on the value of the country's currency.
Trading forex and CFD how to, learn, trading, iFCM
Did this summary help you? A pip measures the change in value between two currencies. Its how to trading forex in iran high-risk, 24-hour-availability, and short-term trades have become popular with day-traders as well. Reviews can give you a flavor for a broker, but you should always take them with a grain of salt. You can ask for the paperwork by mail or download it, usually in the form of a PDF file. Japan experienced a long deflationary period between. In accordance with FTC guidelines, m has financial relationships with some of the products and services mention on this website, and m may be compensated if consumers choose to click these links in our content and ultimately sign up for them. Make sure to check the costs of transferring cash from your bank account into your brokerage account. Also, if the government of a country loosens regulations for economic growth, the currency is likely to increase in value.
Manipulations With, exchange, rate On, forex
Check to see that the brokerage is regulated by a major oversight body. If your position is still open, your losses will only count if you choose to close the order and take the losses. The broker will tell you the minimum amount with which you can open an account. Your gains and losses will either add to the account or deduct from its value. Forex trading seems to be not allowed in Iran and there are not local iranian Forex brokers in this country. Show more answers Unanswered Questions Show more unanswered questions Ask a Question 200 characters left Include your email address to get a message when this question is answered. Dollar, then you probably want to sell dollars in exchange for a currency from a country where the economy is strong. Warnings Check to make sure that your broker has a physical address. Its primary purpose is to establish currency values (currency exchange rate) and convert foreign currencies for the convenience of global traders and investors. Select a Broker helps you find, review, compare and select an online trading and investment broker in Iran. You can usually obtain charts from your broker or use a popular platform like Metatrader. By using our site, you agree to our cookie policy. If you don't want to do the work to educate yourself, hire a full-service broker to do the thinking for you.
Start trading forex with a demo account before you invest real capital. Click the link and follow the instructions to get started with trading. Risk Warning: Your capital is at risk. Iranian Rial,.00 IRR, inv. Even experienced traders sometimes have to rely on luck, because there are so many variables at play. Exchange rates are directly related to trade and a country's economic health. Look at a country's trading position. Usually the broker will send you an email containing a link to activate your account. Privacy Policy here, risk Disclosure: Trading in the financial markets comes with varying levels of risk.
Iran, today Training, how
1 2, read a forex". In other words, you would sell British pounds and purchase.S. How To Win In Binary Options Risk On Cboe. Question Is trading Forex the same as gambling? If a country is having an election, then the country's currency will appreciate if the winner of the election has a fiscally responsible agenda. Countries have manipulated their currency-value as a means to stabilize their economies and boost their global trade advantage.
This trading advantage will boost the how to trading forex in iran country's economy, thus boosting the value of its currency. Make sure you don't make this mistake. Not unless you really know what you're doing. Eventually you will see profits. In our example above, you would want to sell.S. It is important to use only about 2 of your funds per trade, combining the stop-loss order with that. The ask price is the best available price at which you are willing to buy from the market.
Trade, forex : 12 Steps (with Pictures) - wikiHow
You should also check to see how much your bank will charge to wire money into your forex account. Question Is Forex trading safe? Let's say that you invested 20 in EUR/USD, and today your total losses are. Stop orders: A stop order is a choice to buy currency above the current market price (in anticipation that its value will increase) or to sell currency below the current market price to cut your losses. 6 4 Watch your profit and loss. Easy Way To Trade Binary Options Uk Broker. Submit Tips Try to focus on using only about 2 of your total cash. The prices in Forex are extremely volatile, and you want to make sure you have enough money to cover the down side.
Increased demand may be a result of a country's level of business activity, GDP, employment levels, or interest rate increase. Successful traders are simply good at recognizing economic and political conditions that lead to increasing or decreasing currency values. The fees will cut into your profits. He is trying to stabilize the exchange rate with little foreign exchange in his coffers. References Article Summary X To trade forex, choose a brokerage that is regulated by a major oversight body like National Futures Association (NFA) or Financial Conduct Authority (FCA) and open an account. Templates Of The Sites For Forex. Question How much capital does one needs to have to start trading? Sentiment analysis: This kind of analysis is largely subjective. If a broker doesn't offer an address, then you should look for someone else to avoid being scammed.
5 Part 3 Starting Trading 1 Analyze the how to trading forex in iran market. It is the responsibility of the trader to recognize the risks involved. Take these factors into consideration when choosing your brokerage: Look for someone who has been in the industry for ten years or more. With a personal account, you can execute your own trades. A reserve currency is one that global governments choose to maintain in significant quantities due to its low-fluctuation rate. Your trading account will be at a brokerage, but you can link it to whatever bank account you choose. In forex there are no guarantees. Trade deficit with China.


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Green People is a forward-thinking brand specialising in organic skin care products. With an extensive range of natural products – shampoos, soaps, face creams & body washes to name just a few – it is one of the biggest names in organic beauty in the UK.
Incepted in 1994 by Charlotte Vøhtz, Green People was created with a mother's desire to find natural and gentle products for her daughter's sensitive skin.
Charlotte searched the high street high and low for natural products, only to discover that many so-called natural skincare brands used almost entirely synthetic ingredients. That's when the journey began to become the UK's most-loved natural and organic skincare brand. Charlotte says:
"From that moment, I realised that we all are children of the chemical age and that man-made chemicals found everywhere, combined with changing dietary habits, profoundly affect us all".
Green People Blemish Banish Concealer£10.50
Hide your blemishes AND get rid of them with this highly effective concealer for medium-light complexions.
Green People Day Solution Facial Cream SPF15 (50ml)£20.99
Balancing organic skin defence cream with UV protection.
Green People Facial Oil Anti Ageing (30ml)£22.99
Organic anti-ageing oil to boost collagen and improve skin elasticity without blocking pores.
Green People Firming Eye Serum (day) (10ml)£15.49
Instantly firming and refreshing anti-ageing organic eye serum.
Green People Fruit Scrub Facial Exfoliator£14.49
A highly effective yet gentle natural exfoliator for instant radiance.
Green People Fruitful Nights (Night Cream) (50ml)£19.49
Organic night cream with key natural actives to tone, nourish and reduce wrinkles
Green People Gentle Cleanse & Make Up RemoverFrom: £13.49
An ultra-gentle, fragrance-free 2-in-1 cleanser & make-up remover
Green People Gradual Tan Moisturiser£17.59
Achieve a natural sun-kissed look all year
Green People Help At Hand (Hand Cream) (50ml)£11.99
A soothing and protective natural hand cream
Green People Hydrating After Sun Lotion (200ml)£16.49
A natural after sun lotion for all skin types
Green People Hydrating Firming Serum (50ml)£19.99
A remarkable organic serum which hydrates, reduces wrinkles and doubles collagen production
Green People Irritated Scalp Shampoo (200ml)£13.49
A natural shampoo for normal/oily hair with an itchy, irritated scalp.
Green People Moisturising Shower Gel£13.49
Luxurious, gentle body wash for daily use in the bath or shower
Green People Natural Toothpaste (50ml)£4.49
A 100% natural toothpaste: 4 flavours
Green People Neutral Scent Free Cleanser and Make Up Remover (50ml)£13.49
An ultra-gentle, fragrance-free 2-in-1 cleanser & make-up remover.
Green People Neutral Scent Free Rejuvenating Eye Cream (10ml)£14.49
Soothing, scent-free eye cream for sensitive eyes
Green People Neutral Scent Free Shower Gel (200ml)£12.49
Fragrance-free body wash for extra sensitive skin
Green People No.1 Exfoliating Face Scrub (100ml)£13.49
A certified organic and natural exfoliator and face wash for men.
Green People No.2 Soothing Shaving Gel (100ml)£13.49
2-in-1 certified organic face wash and natural shaving gel
Green People No.3 Cooling Moisturiser (100ml)£14.49
A certified organic, non-greasy after shave moisturiser.
Green People No.8 Thyme & Prebiotics Deodorant (75ml)£10.49
A naturally effective certified organic roll-on deodorant for men.
Green People No.9 Mint & Prebiotics Deodorant (75ml)£10.49
Green People Organic Daily Aloe Conditioner (200ml)£12.49
A natural conditioner for normal or dry hair.
Green People Organic Daily Aloe Shampoo (200ml)£12.49
A soothing natural shampoo for all hair types.
Green People Organic Daily Aloe Shower Gel (200ml)£12.49
Natural body wash for use in bath or shower.
Green People Organic Day Solution Anti blemish (50ml)£19.49
Organic, alcohol-free day cream to balance and prevent blemishes.
Green People Organic Foaming Anti Blemish Facewash (100ml)£13.49
A natural anti-blemish face wash for daily use.
Green People Organic Homme (Mens) 7 Active Fix Repair Serum (50ml)£18.49
Certified organic facial repair serum for men, with proven anti-ageing benefits.
Green People Organic Irritated Scalp Conditioner (200ml)£13.49
A natural conditioner for normal/oily hair with an itchy scalp.
Green People Organic Rejuvenating Eye Cream (night) (10ml)£14.49
Antioxidant rich nourishing anti-wrinkle eye cream.
Home > SUPPLEMENT BRANDS > Green People


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I am a
Woman who likes Men 60 years old Cancer
I live in
Milano, Italy
I look for
Long term relationship, Friendship
Physical appearance
My height is 170 cm, average build, european ethnicity, brown eyes, brown hair.
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Education and job
I am, I'm a employee, I deal with public services and admin, in the job sector personal and household services, in particular: contabile.
I don't smoke, I don't drink.


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We are a church on a mission with God to bring hope and health to Southeast San Diego.
Daily Word and Prayer
Our Elder, Steve Peters, posts a daily text and message daily via facebook and his text ministry. We encourage prayer requests to be sent to the office for prayer and share...prayer by staff and share with the congregation for prayer each Sunday. Friday afternoons at 1:00 the doors of the church are open for prayer with the pastor.
Bible Study
There is a weekly Bible study on Wednesdays at 3PM until 4:30PM. We will be following "The Story" for the next 30 weeks.
Sunday school
We meet each Sunday Morning at 9 AM as a small group before our traditional (spritual) worship service starts at 10AM. We have a second Bible study group, part of Urban Life (the younger crowd), that meets at noon.
Our new youth group welcomes the neighborhood youth from Gompers, Lincoln, Morse High Schools. We plan in the spring of 2015 to plant an urban farm, have a new basketball courts in our parking lot, start movie nights on Fridays. Stay tuned here or send our leaders an email to learn more.
Our FABULOUS choir rehearses each Wednesday night at 6PM.
Community service
We have become a beacon of light and life in the Southeast. Among other ministries and missions, we support Presbyterian Urban Ministries, Southeast Relay for Life, Samuel Nehemiah's Champsheart ministry in Nigeria.


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Last week, Amazon confirmed to CNBC that it would no longer accept new gives for face masks, hand sanitizer, and other products related to the coronavirus outbreak. "Face masks and hand sanitizers are the quantity a single and quantity two most searched terms on Amazon.
Our pricing technique aim to bridge the gap between reliability and affordability. We are focused to accomplish lengthy term company relationships
Bad fat is less than perfect. Saturated fats from animal products elevate the levels of blood cholesterol in entire body needs. They are good for suburban nearby Arachadonic acid and when over-consumed hinder or affect the body's immune system. This can been responsible
on aristotle\'s poetics" style="max-width:400px;float:left;padding:10px 10px 10px 0px;border:0px;">University could be good for pupils which can be willing to learn, but it could also be expensive. From tuition service fees to cost of living, one may end up experiencing financial issues when in school. You'll learn to reduce costs when in university and steer
Besides Google, how to get a book review here are a couple of other hotel review sites. Make sure you check out a number of them use their search boxes discover if the accommodation you will be looking at is listed with them.
South of the CBD Oils could be the suburb of
Karine Le Roch, a professor of cell biology at the University of California, Riverside, explained that both HCQ and CQ are weak bases that elevate the pH of parts of human cells called organelles - which are analogous to organs in animals - and which are normally acidic.


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21 Fun Cupcakes for the 4th of July
Fourth of July fun gets even sweeter when whimsical cupcakes turn up at the party.
Rainbow Cupcakes
I've been making these colorful cupcakes with my mom since I was in high school. The cheery sweets are as fun to make as they are to eat. —Tammy Quinn, Lynden, Ontario
Patriotic Ice Cream Cupcakes
These frosty cupcakes are practically a fireworks display on their own. The little treats feature red velvet cake, blue moon ice cream, a creamy white topping and star-spangled sprinkles. —Taste of Home Test Kitchen
Arnold Palmer Cupcakes
These fun cupcakes take a favorite Arnold Palmer recipe and turn it into dessert. Add a slice of lemon on top for a puckery finish. —Jessee Arriaga, Reno, Nevada
Lemon Cream Cupcakes
Instead of a layer cake, serve guests these delicate cupcakes tinged with a tangy lemon flavor. —Ruth Ann Stelfox, Raymond, Alberta
Tres Leches Cupcakes
This cupcake version of tres leches cake actually uses four types of milk, plus cream, but quatro leches cake just doesn't have the same delicious ring to it. If you love dairy, you won't be disappointed with this special take on the classic.
Root Beer Cupcakes
Root beer barrel candies and a spice cake-like batter give these cupcakes an old-fashioned flavor. Kids will especially love them! —Dot Kraemer, Cape May Court House, New Jersey
Patriotic Cookie & Cream Cupcakes
Bring on the red, white and blue with these creative cupcakes, perfect for the Fourth of July, Memorial Day or any favorite occasion. With some delicious and colorful frosting and a careful arrangement, your sweet display will be a patriotic nod to our great American flag. —Rebecca Wetherbee, Marion, Ohio
Aloha Cupcakes
A friend asked me to make a coconut and pineapple cupcake for a gathering she was hosting. Everyone agreed that this beauty took them to the tropics. The macadamia nuts are completely optional (the friend happens to be allergic), and the cupcakes are still fantastic without them. —Shannon Dobos, Calgary, Alberta
Key Lime Pie Cupcakes
I bake over 200 of these cupcakes for our church suppers, and we always run out. If you can't find Key lime juice, use lime juice. Just add a tad more sugar. —Julie Herrera-Lemler, Rochester, Minnesota
Chocolate Macaroon Cupcakes
A delightful coconut and ricotta cheese filling is hidden inside these chocolate cupcakes. —Dolores Skrout, Summerhill, Pennsylvania
Zucchini Cupcakes
I asked my grandmother for this recipe after trying these irresistible spice cupcakes at her home. I love their creamy caramel frosting. They're such a scrumptious dessert, you actually forget you're eating your vegetables, too! —Virginia Lapierre, Greensboro Bend, Vermont
Chocolate-Dipped Ice Cream Cone Cupcakes
I created this recipe based on our family's love of chocolate-dipped ice cream cones. Red heart-shaped sprinkles make them fun for Valentine's Day. Vary the color to match the occasion. —Jennifer Gilbert, Brighton, Michigan
Coconut Tres Leches Cupcakes
Three types of milk wonderfully moisten these cupcakes. Toasted coconut on top adds an elegant touch. —Taste of Home Test Kitchen
Key Lime Cupcakes
I made these light, tangy cupcakes on a chilly day to remind me of our vacation in southern Florida, where Key lime pies are star attractions. —Jennifer Gilbert, Brighton, Michigan
Buttermilk Chocolate Cupcakes
Good any time of the year, a chocolate cupcake recipe make a great get-up-and-go treat on busy summer days. These buttermilk chocolate cupcakes have been a frosted favorite with family and friends for at least 35 years. They're really popular at bake sales. —Ellen Moore, Springfield, New Hampshire
Berry-Topped White Cupcakes
Guests just love these yummy white cupcakes that are topped with a cream cheese frosting. The strawberry-blueberry garnish makes them the perfect treat for a patriotic-themed party on Memorial Day or Fourth of July. —Judy Kenninger, Brownsburg, Indiana
Pineapple Upside-Down Cupcakes
I have baked cupcakes for years. These easy to make treats make an attractive dessert for special occasions. —Barbara Hahn, Park Hills, Missouri
Firecracker Cupcakes
These no-fuss treats are so much fun to make with kids, and they put a spark in Fourth of July parties. You can tint the whipped topping red and blue to make the frosting festive, too. —Erin Glass, White Hall, Maryland
Orange Dream Mini Cupcakes
The bright taste of these cute cupcakes reminds me and my friends of orange-and-vanilla frozen treats. —Jen Shepherd, St. Peters, Missouri
Yellow Cupcakes
Nothing is better than homemade cupcakes. They are so delicious and fluffy. Choose whatever frosting you want to top these treats. —Taste of Home Test Kitchen
Red Wine and Chocolate Cupcakes
Red wine and chocolate make an amazing pairing, especially in these rich, elegant cupcakes made for my mother's birthday. She adores them! —Candace Cheney, Fort McMurray, Alberta


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BWI Business District is a stop on the Baltimore Light Rail system. There are currently 36 free public parking spaces and connections can be made to MTA Maryland's Route 17 and 99 buses, WMATA's B30 express bus, and Howard Transit's Silver Route from this station.[1] Additionally, portions of the BWI Trail can be found across the street from the parking lot.
Howard County, Maryland, Columbia, Maryland, Maryland, Baltimore, Ellicott City, Maryland
Route 27 (MTA Maryland), Route 9 (MTA Maryland), Howard Street (Baltimore), Route 120 (MTA Maryland), Route 410 (MTA Maryland)
Glen Burnie, Maryland, Anne Arundel County, Maryland, Severn, Maryland, Linthicum, Maryland, Maryland
Linthicum, Maryland, Washington, D.C., Maryland Route 170, Anne Arundel County, Maryland, Hanover, Maryland


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Q 6. Find the perimeter of each of the following shapes :
(a) A triangle of sides 3 cm, 4 cm and 5 cm.
(b) An equilateral triangle of side 9 cm.
(c) An isosceles triangle with equal sides 8 cm each and third side 6 cm.
(a) The perimeter of a triangle = Sum of all the three sides
= 3cm + 4cm + 5cm
= 12 cm
(b) The perimeter of a eqilateral triangle
= Sum of all the sides of the triangle
= (9cm +9cm +9cm)
= 27cm
(c) Perimeter of a given isosceles triangle
= Sum of all sides
= 8cm + 8cm +6cm
= 22 cm


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Genetics of Glaucoma
Genetics of Glaucoma Study
Glaucoma is an eye disease where vision is lost due to damage to the optic nerve. It affects approximately 300 000 Australians and is the leading cause of irreversible blindness worldwide.
Glaucoma is an age related disease; a person's chance of developing glaucoma significantly increases after the age of 50. Alarmingly, 1 in 2 sufferers do not know they have the disease. Loss of sight is usually gradual, with a considerable amount of peripheral vision being lost before the person is aware of any problem.
But there is hope: glaucoma blindness is preventable in most cases if diagnosed in the early stages.
About this Study
This research project's purpose is to identify specific genetic risk factors associated with risk of glaucoma. Glaucoma is one of the most strongly genetic human diseases. Whilst we already know some of the key genes involved in glaucoma risk, there are many more to be found. Identifying more genes will help us learn more about the disease as well as enabling us to more accurately predict who will and will not develop glaucoma. Prediction of who is at high risk of early onset disease is key so that sight-saving treatments can be applied in time. For more information about the study click Frequently Asked Questions.
For this study we need to recruit both men and women who have been diagnosed with glaucoma by an ophthalmologist or optometrist, have been prescribed a glaucoma medication, or have family history of glaucoma.
If you would like to contact us about this study you can email us at: firstname.lastname@example.com


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Auditions open at Osceola Arts
Auditions open at Osceola Arts – Sign up for auditions for Disney's The Little Mermaid at Osceola Arts will be held on Monday, May 21st at 2411 E Irlo Bronson Memorial Hwy, Kissimmee.
Auditions open at Osceola Arts has opened auditions for Disney's The Little Mermaid.
The musical will run July 13-29 at 2411 E. Irlo Bronson Memorial Hwy in Kissimmee and auditions signup can be found by clicking here.
Actors should come prepared with a headshot, resume, and 32 bars of a song in the style of the show. No CDs or background tracks will be allowed, please bring sheet music. An accompanist will be provided.
Actors will also be required to participate in a short dance audition and should bring appropriate clothing. Dance audition will be done in groups and all actors must complete the dance audition.
PLEASE NOTE: Minimum Age Requirement for actors is incoming Sophomore High School Students with the exception of the role of Flounder. Seeking a student 4th grade or older for the role of Flounder.
Callbacks will be held Wednesday, May 23rd.
Walk-ins are welcome. If you do not see a time slot that works for you, you may show up on either night between 6-9pm and will be seen as time permits or cancellations occur.
Please select one audition time. You will receive an email confirmation with your approved audition time 24 hours before your audition! If you have any questions or need to cancel/reschedule please email firstname.lastname@example.com
In the meantime, enjoy some upcoming presentations at Osceola Arts:
Love, Loss & What I Wore on Fridays/Saturdays at 7:30pm; Sundays at 2pm, May 11-May 20. For more information, click here.
Hairspray, Jr. on June 1st at 7pm, June 2nd at 2pm and 7pm, and June 3rd at 7pm.
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text: RESEARCH REPORTAn Intervention Enhances Resilience in Entry-Level Physical Therapy Students A Preliminary Randomized Controlled TrialMejia-Downs, Anne PT, MPH, PhDAuthor Information Anne Mejia-Downs is an associate professor in the Krannert School of Physical Therapy at the University of Indianapolis, Indianapolis, IN 46227 (firstname.lastname@example.com). Please address all correspondence to Anne Mejia-Downs. This research was funded in part by an Adopt-A-Doc Scholarship in 2016, presented by the Education Section of the American Physical Therapy Association. The author declares no conflicts of interest. This study was registered with ClinicalTrials.gov (ID#D05500). Received August 13, 2018 Received in revised form April 17, 2019 Accepted April 24, 2019 Journal of Physical Therapy Education: March 2020 - Volume 34 - Issue 1 - p 2-11 doi: 10.1097/JTE.0000000000000114 Free Metrics Abstract Introduction: The purpose of this study was to assess the impact of a resilience curriculum on stress levels, resilience, and protective factors, among physical therapist (PT) students during academic stress. Physical therapist students experience high levels of psychological stress during their education. Individuals with greater resilience are better equipped to handle stress. There is a lack of research examining the effect of resilience interventions in PT students. All students enrolled in an entry-level Doctor of Physical Therapy (DPT) program in Indianapolis, IN were eligible. Forty-three students volunteered to participate and all contributed preintervention and postintervention data for the study. Methods: Participants were randomly assigned to receive a resilience curriculum (n = 22) or to a wait-list control group (n = 21), with the researcher blinded to the assignment. An 8-hour resilience curriculum was delivered in 4 consecutive, 2-hour weekly sessions to the intervention group. Both the intervention and the control groups completed baseline and follow-up assessments. The control group was offered a 2-hour condensed version of the curriculum after postintervention assessments. Outcomes measured included stress, resilience, coping flexibility, optimism, emotions, social support, and illness. Results: There were significantly greater increases in resilience (P = .03) and positive emotions (P = .02) in the intervention group compared to the control group. There were no significant differences in stress, coping flexibility, negative emotions, optimism, social support, or illness symptoms. Less perceived stress, greater coping flexibility, and higher positive mood scores predicted greater baseline resilience, accounting for 56% of the variance. Discussion and Conclusion: This preliminary study demonstrates that a resilience curriculum delivered to DPT students increases resilience and positive emotions. Providing DPT students with tools to improve psychological resilience may better prepare them to meet the demands inherent in entry-level DPT educational programs. INTRODUCTION Given that high stress levels and negative consequences associated with stress are experienced by physical therapist (PT) students,1-7 it is important to explore methods to reduce these stressors. College students have been shown to benefit from programs to learn strategies to manage stress and enhance resilience.8,9 Providing PT students with tools to improve psychological resilience is an important consideration in managing the stress inherent in physical therapy education programs. The purpose of this exploratory randomized controlled trial was to assess changes in stress levels, resilience, protective factors, and illness after an 8-hour resilience curriculum presented to Doctor of Physical Therapy (DPT) students during a period of academic stress compared to a wait-list control group. Hypotheses: an evidence-based resilience curriculum will 1) increase resilience and protective factors against stress and 2) decrease stress, negative affect, and symptoms of illness, among DPT students who receive the intervention compared to those in a wait-list control group. A secondary aim was to explore student characteristics that were associated with baseline resilience. REVIEW OF LITERATURE Stress is defined as the physiological and psychological response to a perceived inability to meet the demands placed upon oneself.10 College students have higher stress levels than the general population,1,2,11,12 perhaps owing to the unique circumstances in this life stage of emerging adulthood.13 Similar to other health professional students,11,14-29 PT students experience stress and anxiety at greater levels than college students or adults in the same age range.1,2,7 Several studies of college students have reported differences in stress levels between the sexes. In a national study of college students, far more female than male students reported feeling "overwhelmed" (90.2% vs 75.1%) and "tremendous" stress (12.6% vs 8.7%)12 in the previous year.12(p16) Among students in 3 PT education programs in the United States, there were significantly greater levels of stress and anxiety in the female compared to male students.2 As the literature on this topic in the United States is limited, it may also be helpful to consider PT education programs abroad. Female gender was associated with greater levels of perceived stress in undergraduate PT education programs in Australia and Sweden, but there were no differences in a program in Israel.4 Among PT students in 2 undergraduate programs and a Masters level program in the United Kingdom and Australia; only the undergraduate programs demonstrated increased stress in female compared to male students.6 In these studies of PT students, male students were older than female students, pointing to increased age as a possible confounder of the relationship between gender and stress level. Thus, there appears to be a lack of consensus on the differences in stress levels between the sexes. There are also mixed results with regards to differences in stress by year of study in PT education programs. Stress levels were greater in later years of study in undergraduate PT students in Sweden, and Masters level PT students in Australia reported more stress than Bachelors students,4,6 while another study found that stress levels were lowest in the final year of study for Israeli undergraduate students.5 Other studies have found no differences in stress by year of study in PT students.1,2,4,7 In a study in the United States by Frank and Cassady,2 there was no difference in levels of perceived stress by year of study; however, second-year DPT students reported more anxiety than did first-year DPT students. Further studies are needed to determine if there is a real association between the year of study in PT programs and the level of stress, or if the difference is due to variation in curricula or cultural differences among the countries studied. A certain amount of stress may be perceived as positive, enhancing an individual's ability to focus or increase the motivation to learn, but for college students much of the stress causes illness and psychological distress, including for health professional students.7,17,22,30-33 Rawson et al30 found a significant association between stress and illness in undergraduate students, while O'Meara et al7 and Frazer et al3 also identified this association in Masters level physical therapy students. For student PTs, similar to other health care students,28 academic stress is a greater source of stress than personal or financial issues.1,3-7 Even the academic environment can be a source of stress—classrooms that were crowded, too hot, or too cold were named as significant sources of stress.3 One might expect that PT students who were employed in addition to attending classes would experience greater levels of stress due to time constraints; however, Walsh et al1 found low levels of stress in undergraduate PT students who worked part-time (10.8 hours on average), and studies of Bachelor and Masters PT students4,6 found no association between employment and levels of stress. Stress can be managed if an individual possesses and uses appropriate resources to respond effectively. Individuals with greater resilience are better equipped to handle stress.34-36 "Resilience is a dynamic process wherein individuals display positive adaptation despite experiences of significant adversity or trauma."37(p858) This description captures 2 basic components of resilience—adversity or hardship, and an affirmative, positive reaction to it. Not surprisingly, many believe that resilience cannot be demonstrated in the absence of adversity.36-39 Resilience resources, described as protective factors against stress, may mitigate the negative effects of stress. Examples of an individual's resilience resources include positive affect, dispositional optimism, perceived social support, and coping flexibility, among others.15,28,34,36,40-45 Fewer studies have demonstrated that college students have benefited from programs designed to increase levels of resilience. In a randomized controlled trial (RCT),8 undergraduate and graduate students participated in a 4-week resilience intervention during the final weeks of classes, a time of increased stress due to examinations. Participants demonstrated higher levels of resilience and protective factors against stress, and fewer psychological symptoms.8 In another RCT, graduate students who received an individualized resilience training program by computer demonstrated increased control over and recovery from stress compared to an attention-control student group who reviewed published information about stress.9 There are no published reports of resilience programs benefiting physical therapy students specifically, but it stands to reason that these types of curricula would also be an enhancement in physical therapy graduate education. PARTICIPANTS Student participants were recruited from 2 DPT educational programs in Indianapolis, IN—the University of Indianapolis and Indiana University. The author met with the DPT Program Director at each University to review the components and timeline of the intervention, and arranged for an email that described the study, to be delivered to all DPT students currently enrolled in any of the 3 years of the respective programs. There were no exclusion criteria. Personal visits were made to each of the 3 cohorts at each University to further explain the study and entertain questions from potential participants. Forty-three DPT student participants signed up for and completed the study and provided both baseline and follow-up survey data. No participants dropped out of the study. METHODS Research Design and Procedures This randomized, controlled trial was conducted at 2 universities to evaluate the effects of a resilience curriculum delivered to DPT students. Institutional Review Board approval was obtained by Rocky Mountain University of Health Professions, the University of Indianapolis, and Indiana University. Informed consent was obtained from all participants prior to data collection. The study process is demonstrated in Figure 1. This study was registered with ClinicalTrials.gov (ID D05500).Flow Diagram of Study ProcessParticipants who agreed to participate sent an email to a research assistant who assigned them a study code to use in place of their names for the duration of the study. The researcher was blinded to the identity of the participants for data collection. The random assignment function of Excel was used to randomly assign participants to the intervention group (n = 22) to receive the resilience curriculum or to a wait-list control group (n = 21). Participants were notified of this status by an email from the research assistant. Demographic and baseline assessment surveys were completed by both groups. The resilience curriculum, "Stop Running on Empty!" was developed by the author using evidence of previously published resilience and stress management interventions and is described in detail elsewhere.46 The learning objectives of the curriculum are included in Table 1. The curriculum incorporated topics and techniques used in previous mental health prevention programs for college students.8,9,47-51 The face-to-face curriculum, presented by the researcher, involved education about components of resilience, skills building exercises, group and paired discussion, and homework exercises to practice the application of learned skills. Beginning in week 3 of the fall semester, the resilience curriculum was delivered in 4 consecutive 2-hour weekly sessions. Instead of delivering the curriculum in one 8-hour session, this schedule allowed participants time to reflect on each session's content and practice skills. This schedule also allowed the researcher the opportunity to review content from each of the previous sessions and address questions. Due to conflicting course schedules for different years of the program, the curriculum was presented to each cohort separately at the University of Indianapolis, and in the evening for all cohorts combined at Indiana University. The group sizes ranged from 4 to 7 students, and participants signed in using their code so attendance could be monitored for each session.Table 1: Resilience Curriculum: Learning ObjectivesData Collection Instruments Online surveys were used to collect baseline demographic information, including sex, age, race, marital status, year of study, average number of hours worked outside of school (0–5 hours, 6–14 hours, or 15 hours or greater), institution, undergraduate major (exercise-related vs not exercise-related), history of psychological disorder, and Grade Point Average. The following survey tools were assessed for both groups at baseline, up to 2 weeks prior to the intervention, and again within 2 weeks after the intervention. All surveys were administered using Qualtrics Software Version 2016 (Qualtrics LLC, Provo, UT). Cronbach's alpha was measured for each instrument in this population. The total time to complete the surveys at baseline or postintervention was 25–45 minutes. Connor-Davidson Resilience Scale This 25-item tool52 measures characteristics of resilience, including hardiness, personal competence, social bonds, patience, and spiritual influences. Participants replied to items about psychological resilience in the past month, using a 5-point Likert scale. Scores for each item were summed, with the highest possible score of 100. Discriminant and convergent validity for this scale have been demonstrated; test–retest reliability has been reported at .87, and the reliability coefficient for the Connor-Davidson Resilience Scale (CD-RISC) ranges from .89 to .93.52,53 The CD-RISC has been studied in numerous populations including young adults and health professionals, in addition to college students.8,52-56 Perceived Stress Scale The Perceived Stress Scale (PSS) was developed to assess "the degree to which situations in one's life are appraised as stressful,"57(p387) with higher scores indicating increased stress. Using a 5-point Likert scale, participants indicated the frequency, in the previous month, they experienced the feelings described. The scores of the 4 positively stated items were reverse coded and the scores for each of the 10 items were then summed, with the highest possible score equaling 40. The 10-item version of this tool was used as it had better psychometric properties than the other versions.58,59 In college students, internal reliability for this tool ranged from .74 to .91, and test–retest reliability was .77 when reflection involved the last 2 weeks.58,59 The PSS has been validated for ages 18–29 years and has been used extensively in studies of students.2,4,5,8,18,60,61 Coping Flexibility Scale The Coping Flexibility Scale (CFS) is a 10-item tool used to measure the ability of an individual to effectively modify coping behavior.61 Kato61(p263) defines coping flexibility as "the ability to discontinue an ineffective coping strategy and produce and implement an alternative coping strategy." Participants responded to the 10-item CFS scale using a 3-point Likert scale to reflect how a situation applied to them. Two items were reverse coded, and the scores for each of the 10 items of the CFS were then summed. The highest possible score was 30, with a higher score representing greater coping flexibility. The CFS contains 2 subscales: the Evaluation Coping subscale assesses the ability to consider the effectiveness of a coping strategy for a given situation, and the Adaptive Coping subscale measures the ability to change to a more effective strategy when needed. The CFS has demonstrated good to excellent overall reliability in college students (.73–.90); evaluation coping ranged from .71 to .91, while adaptive coping ranged from .83 to .90.61,62 In college students, the CFS had acceptable test–retest reliability (.71–.73), and both convergent and discriminant validity have been demonstrated.61 The Revised Life Orientation Test The Revised Life Orientation Test (LOT-R) is a 10-item scale designed to measure dispositional optimism, with higher scores indicating higher optimism.63,64 Participants replied to items using a 5-point Likert scale. Four of 10 items in this survey were filler items and not scored, and 3 items were reverse coded, with the highest possible score of 30 for this tool. For a sample of undergraduate, masters, and doctoral students,8,65,66 internal reliability has been reported at .72. Modified Differential Emotion Scale The Modified Differential Emotion Scale (mDES) was used to measure positive and negative emotions of various states.66 Using a 5-point Likert scale and reflecting over the last 2 weeks, participants indicated the frequency they experienced the emotions described. For the average of the 9 items in the positive emotions subscale, a higher mean represented more positive moods, and for the average of the 8 items in the negative emotions subscale, a higher mean represented more negative moods. In a sample of college students and recent graduates, the internal reliability for this measure was .79 for the subscale of positive emotions and .69 for the negative emotions subscale, with discriminant validity demonstrated between the positive and negative scales.66,67 Social Provisions Scale The Social Provisions Scale (SPS) is a 24-item assessment of perceived support from relationships with family, friends, and others.68,69 This scale assesses areas of social relationships with 6 subscales of 4 items each (Guidance Support, Reassurance of Worth, Social Integration, Attachment, Nurturance, and Reliable Alliance).68,69 Participants responded using a 4-point Likert scale, to items about perceived social support. After 12 of the items were reverse scored, the scores for each item were summed. For this scale, there was a possible high score of 96, with a higher score representing greater perceived social support. The SPS had excellent overall internal reliability of .92, with subscale reliability ranging from .65 to .76.68 This tool has been validated in a variety of populations, including college students.68 Symptoms of Illness Checklist The Symptoms of Illness Checklist (SIC) is a 33-item tool designed to measure the number, frequency, and severity of physical symptoms in the previous 2 months, but has also been demonstrated to show sensitivity to discern changes within a 2-week period.70 Participants used a 4-point Likert scale to report symptom frequency, and a 5-point Likert scale to report symptom impact, of 32 separate symptoms during the previous 2 weeks. The item about blood pressure was not scored due to the lack of reliability that has been found for this item.70 The frequency score (1–4) was multiplied by the impact score (1–5) of each symptom, and these values were summed to compute the total SIC score. Each symptom could have contributed up to 20 points to the total score. Internal reliability of this instrument ranged from .75 to .86 for a sample of undergraduate students and a mixed group of community members and graduate students. There was also a high correlation between the SIC and an objective measure of physician interviews (.94).70 Follow-up assessments were collected anonymously from all participants using their assigned codes. These assessments were completed within 2 weeks after the intervention during the period of midterm examinations, a presumably stressful time for the students. The wait-list control group was offered a 2-hour condensed version of the curriculum 2 weeks after postintervention assessments. Data Analysis Data analysis was completed using SPSS Version 23 (IBM Corporation, Armonk, NY). Missing values were replaced by the median values for the measure instead of the mean, since the data were not normally distributed.71 Cronbach's alpha was used to assess the internal reliability of the survey instruments. Demographic differences between the intervention and wait-list control groups were analyzed using t tests to compare differences in mean values in data that were normally distributed, and a Mann–Whitney U nonparametric test was used for data that were not normally distributed. Fisher's exact test was used to compare differences in nominal data with small frequencies. Chi-square tests were used to compare differences in other nominal data. To test the effectiveness of the curriculum, a 2 by 2 (group by time) mixed model analysis of variance (ANOVA) was used to analyze the survey outcomes that were normally distributed. For the survey outcomes that were not normally distributed, nonparametric Mann–Whitney U tests, to compare outcomes preintervention and postintervention, and Wilcoxon signed ranks tests, to compare intervention and control groups, were used. To identify baseline predictors of stress or resilience measures in the intervention and control groups combined, Pearson's correlations were used to find bivariate associations between normally distributed continuous variables and the PSS and CD-RISC scores. Spearman's correlation was used for continuous variables that were not normally distributed. The association of binary nominal variables to PSS and CD-RISC was tested with a t-statistic. For nominal variables with greater than 2 levels, ANOVA was used. Baseline variables that demonstrated a significant association with PSS or CD-RISC in bivariate analyses were entered into a multiple linear regression model predicting resilience. Variables that were not statistically significant in the regression were dropped from the model. RESULTS Forty-three DPT students completed baseline and follow-up surveys. Attendance at the curriculum sessions ranged from 86% to 100%, with 15 participants attending all 4 sessions. Ten students from the wait-list control group attended the 2-hour condensed curriculum that was offered 2 weeks postintervention. Table 2 describes the baseline demographic characteristics of the intervention and control groups. Both groups consisted of predominantly White, female, single students, in their mid-20s. Fewer participants did not allow for meaningful analysis of the results by year in the program, race, or marital status. There were no statistically significant differences between the control and intervention groups on demographic characteristics.Table 2: Participant DemographicsA total of 14 individual item values were missing among the survey measures and replaced with median values. One participant did not include values for items 6–33 in the SIC. That participant's score for that measure was not included in the analysis. Reliability of the survey instruments, as measured by Cronbach's alpha, is shown in Table 3. Total scales and most subscales showed good to excellent internal reliability.Table 3: Internal Reliability of OutcomesTable 4 depicts the mean and standard deviation, or the median and interquartile range (for nonnormally distributed variables), for all survey variables, and shows the results of the ANOVA group by time effect for each. There was a significant group by time interaction for the CD-RISC (F = 4.893, df = 1, P = .03), meaning the curriculum significantly improved resilience over time. This occurred despite the fact that the groups did not differ significantly at baseline. The mean difference in CD-RISC scores from baseline to postintervention for the intervention group (14.5% increase) was statistically significant (F = 7.015, df = 1, P = .01), and the mean difference in CD-RISC score for the control group (6.5% increase) was also statistically significant (F = 7.015, df = 1, P = .01).Table 4: Results of Survey MeasuresThere was also a significant group by time interaction for the positive emotions of the mDES (F = 5.730, df = 1, P = .02) even though the groups did not differ significantly at baseline. The mean difference in positive emotion scores of the mDES from baseline to postintervention for the intervention group was statistically significant (F = 19.507, df = 1, P < .001), but the mean difference for the control group was not statistically significant. There were no significant group by time interactions for measures of perceived stress, coping flexibility, negative emotions, optimism, social support, or illness symptoms. However, there was a significant increase in social support in both the intervention group (Z = 4.109, P < .01) and the control group (Z = 4.016, P < .01), from baseline to postintervention. There were no statistically significant associations between baseline PSS scores and participant characteristics. The only statistically significant association between baseline participant characteristics and baseline CD-RISC scores was in hours worked (F = 4.076, df = 2, P = .02). Because there was a statistically significant association between hours worked and baseline resilience, this variable was entered into the regression equation. Table 5 demonstrates the association between CD-RISC scores and the other survey measures. The 5 variables that were significantly associated with baseline resilience (baseline PSS, CFS, LOT-R, positive items of the mDES, and hours worked) were entered as predictor variables into a stepwise multiple linear regression model, predicting baseline resilience. Criterion to enter a variable into the model was P < .05, and the criterion to remove a variable was P < .10.71 Three predictor variables, i.e., PSS (t = −3.046, P = .004, B = −.370), CFS (t = 2.778, P = .008, B = .318), and positive items of the mDES (t = 2.387, P = .022, B = .296), remained significant and were retained in the model. The stepwise regression, ANOVA, F = 16.878, df = 3, P < .001, indicated a significant linear predictive model. The linear regression model accounted for 56.5% (R2 = .565) of the variation in the CD-RISC measure of resilience.Table 5: Correlation With CD-RISCDISCUSSION AND CONCLUSION This study demonstrated the effectiveness of a resilience intervention for students in 2 DPT educational programs. Doctor of Physical Therapy students who attended an 8-hour resilience curriculum had significantly greater increases in resilience, as measured by the CD-RISC, and positive emotions, as measured by the mDES, compared to students in the wait-list control group. Both groups experienced a significant increase over time in perceived social support. In addition, lower levels of perceived stress, higher positive emotions, and greater coping flexibility were found to be significant independent predictors of resilience at baseline. The literature describing associations of perceived stress level by gender, year of study, or hours of employment is mixed. The current study, likely due to the small sample size, found no significant associations with perceived stress in any of these areas. Although it has been shown that resilience programs can improve levels of resilience in college students,8,9 this is the first, albeit small, RCT to demonstrate the effectiveness of a resilience program for DPT students in particular. Evidence of this curriculum's effectiveness is supported by the study design (RCT) where baseline differences in outcomes were controlled. Similar to the resilience curriculum studied by Steinhardt and Dolbier8 with undergraduates and graduate students, the current study also found significantly increased resilience and positive emotions and increased social support. However, unlike that study, the current study did not find decreased perceived stress, negative emotion, or symptoms of illness. Previous studies have reported a 4% increase in CD-RISC scores in a study of college freshman, an 11% increase in a sample of undergraduate and graduate students, and a 4% increase in a study of nursing students.72 The increase of 14.5% in CD-RISC scores by the intervention group in the current study compared to previous research was quite high, and even the wait-list control group's increase of 6.5% is greater than changes reported in previous literature.72 The finding that the wait-list control group also demonstrated increases in resilience and social support is interesting. Grouping DPT students in cohorts allows them to interact and become increasingly comfortable with each other, using one another for support. Since social support has been shown to decrease the stress response68,73-75 and is associated with resilience,52,54-56,74,76,77 instinctively relying on each other for instrumental and appraisal social support may serve to improve resilience of student PTs. The current study found that lower stress levels, more positive emotions, and greater coping flexibility predicted greater resilience in DPT students. This is consistent with previous literature demonstrating the association of positive emotions and adaptive coping skills with resilience in other populations.28,36,54,78,79 Based on the findings of this study, the measures that appear to be most appropriate to predict resilience in the DPT student population are the PSS, CFS, and the mDES. Previous literature cites the following norms for the PSS for samples of students: 4-year college (12.0 ± 5.6), graduate school (12.2 ± 5.4), and advanced degree (11.4 ± 5.2). The mean PSS scores for the current study (intervention pre [13.9 ± 5.0] and post [11.68 ± 5.1], control pre [13.9 ± 4.6] and post [13.60 ± 5.5]) demonstrate the sample of DPT students to be within the established norms for undergraduate and graduate students. A variety of factors have been shown to influence resilience and stress management in student populations that are beyond the scope of this study. Mindfulness and other meditation techniques studied in health professional students and practitioners have been shown to be associated with lower levels of stress and increased resilience.50,51,78,80-82 Self-esteem and hardiness are characteristics that have been associated with higher levels of resilience in students.8,50,83-85 Many studies have also shown that physical activity may decrease stress, which may affect resilience.11,51,60,77,86-88 Since physical therapy students have been shown to exercise at higher levels than the average American,89,90 it is reasonable to assume that participants in both the intervention and the control groups engaged in physical activity in comparable amounts at baseline. However, since the resilience curriculum included information about the role of physical activity as part of a coping strategy, it is possible that the intervention group performed physical activity at higher levels compared to the wait-list control group. Additionally, psychological disorders such as depression and anxiety have been associated with higher levels of stress in students.21,29,30,52,91,92 In the current study, the psychological disorders of depression, anxiety, and eating disorder did not show statistically significant association with any outcomes, likely due to fewer participants. Even though the percentage of participants who reported a psychological condition (23%) appears excessive, it is in line with the presence of psychological distress and disorders in other studies of college students (up to 29%) in the United States and other countries.29,93-95 None of the other factors mentioned above were assessed for this study of resilience, and participants were not asked to alter any behaviors such as meditation or physical activity during the study period. These factors certainly could have affected the assessment of resilience and other outcome measures. The time frame of the curriculum, based on that of a previous resilience program for college students,8 could be seen as a strength of the program. It allowed time for the researcher to review content at each subsequent session and also allowed time for participants to practice skills and complete the assigned homework in between sessions. The main limitation of the study was the small sample size, limiting the extent to which true effects could be detected. Great efforts were taken to recruit more participants; all potential DPT students from the 2 programs were recruited by email and in person. Although several additional students inquired about the study, fewer than expected consented to participate. Even though the current program was shorter in duration than other stress management programs offered to college and health professional students,23,26,49,78,82 the 8-hour commitment may have appeared excessive for busy DPT students. Therefore, the study sample size was underpowered to detect some effects and predictors of stress and resilience. Another limitation is the lack of outcomes to measure learning. Students offered anecdotal remarks during curriculum sessions, but no objective measures were used for assessment. At the beginning of each session when content from the previous session was reviewed, students presented examples of how they used the material during the previous week, suggesting that learning did occur. However, an objective assessment of learning should be included in future studies, along with a longitudinal component to demonstrate retention of information and application of resilience techniques. An additional factor that may have affected the outcomes is that the resilience curriculum was not delivered to the entire intervention group at once, due to differing course schedules. This may have affected how components of the curriculum were perceived since not all participants heard the same discussion from peers. However, the smaller groups may have fostered more meaningful discussions. Generalization of these findings to other entry-level PT education programs should be made with caution. The study sample was small and not diverse, consisting of mostly single, White, female students, in their mid-20s, from the Midwest. The age and gender differences in the study sample contrast those of recent student applicants according to American Physical Therapy Association data.96 The median age of recent applicants is younger (22–23 years of age) than the study participants, and the proportion of male participants (39.2%) to female participants (60.7%) is greater.96 Research with larger samples of diverse DPT students is needed to confirm these study results and to allow the data to be compared with other health disciplines. Given the high risk for depression and anxiety in health profession students, Mazurek et al11 recommend early identification of mental health issues and the provision of support for mental health early in health professional graduate programs. Other researchers have recommended offering stress management programs to health professions students, including DPT students, to assist in managing high levels of stress.3,4,7,28,79,80,97-99 The current study supports addressing high levels of stress with a resilience program to increase positive emotions and improved resilience. Adding a resilience program to current DPT curricula may be an important way to manage the stress inherent in DPT education programs. Physical therapists are called upon to address the physical and mental health needs of patients. This task may be better suited to health care providers who have experience with practicing effective resilience mechanisms themselves. This may allow practitioners to promote resilience to their patients and model it for their peers. Future research should focus on the outcomes of DPT students who have had resilience training compared to those who have not. Differences in resilience with respect to performance on written and practical examinations, clinical experiences, and performance on the National Physical Therapy Examination could be explored. In addition, the impact of resilience training on daily stress and burnout of PTs practicing in the clinical environment could be addressed. ACKNOWLEDGMENTS The author would like to acknowledge the members of her Dissertation Committee who supported and advised her throughout the study process: Dr. Christyn Dolbier, Dr. Frederick May, and especially Dr. Janelle O'Connell, Dissertation Chair. The author would also like to thank the Directors of the Doctor of Physical Therapy Programs who supported this research, Dr. Peter Altenburger at Indiana University, and Dr. Stacie Fruth, formerly at the University of Indianapolis. Thanks also to Kathy deJong, research assistant at the University of Indianapolis. Finally, the author expresses appreciation for the students who participated in the study.REFERENCES 1. Walsh JM, Feeney C, Hussey J, Donnellan C. Sources of stress and psychological morbidity among undergraduate physiotherapy students. Physiotherapy. 2010;96:206–212. Cited Here | PubMed | CrossRef 2. Frank LM, Cassady SL. Health and wellness in entry-level physical therapy students: Are measures of stress, anxiety and academic performance related? Cardiopulm Phys Ther J. 2005;16:5–13. Cited Here | View Full Text | CrossRef 3. Frazer GH, Echternach JI. Response of physical therapy students to stress indicators. J Phys Ther Educ. 1991;5:72–77. Cited Here | CrossRef 4. 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At a press briefing today, executives from Twitter outlined policy changes that'll affect the social network's over 330 million users in the months to come. Twitter product lead Kayvon Beykpour focused on three core tenets in his presentation: Health, conversations, and interest. From a report: "Public conversation is only valuable if it's healthy enough that people would want to participate in the first place," he said. "[We need to] ensure the integrity of the information that people are consuming on the platform is high." On the conversations side of the equation, Twitter plans to take different parts of conversations and stick them in a sleeker, slicker global view. It'll pull out pieces like users' names, their verified statuses, and more within tweet details in a Reddit-style tree layout, making it easier to follow threads. Perhaps more significantly, Twitter intends to roll out controls over conversation dynamics, which in the coming year will allow users to choose who's able to reply to a given tweet: (1) Anyone on Twitter, (2) a group of people you follow and mention, (3) people you know, or (3) no one. Twitter calls this last option a "statement," and they'll be denoted by an icon in the lower right corner indicating that the tweet can't be replied to.
Read more of this story at Slashdot.


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