The mechanics of these effects evolved over the years and now we have multiple mechanics being used in the game depending on the spell or effect. This post explains all the different mechanics and defines the terminology that is used in our theorycraft wiki, which defines how effects work in the AMR simulator.
Spell Dmg Vs Global Spell Dmg
30% Rule refresh is how most actively cast periodic effects work now. You may also see this called Pandemic. This is because warlocks were given a passive spell called Pandemic which allowed them to refresh DoTs in this way. The mechanic was eventually extended to the whole game. When a periodic effect is cast on a target that already has the effect, the lesser of: the remaining duration of the effect or 30% of the base duration of the effect is retained and added to the base duration of the effect. That is the new duration of the effect on the target. The currently scheduled tick will still occur as scheduled.
Hasted Interval (Ticks) is the most common haste scaling for active spells. The interval is calculated as Base Interval / (1 + Haste). In this example: 3 / (1 + 0.25), or 2.4 seconds. The updated tick schedule for this spell would be:
Hasted Duration is another way to scale periodic effects with Haste. Not very many effects use this method. This effectively Snapshots your haste at the time you cast/apply the effect. You will sometimes see the term snapshot or snapshotting when talking about periodic effects. In this case, it means that full duration and tick schedule of the DoT is determined at the time it is applied. No change in Haste will affect that schedule. Here is the schedule for our example spell with 25% Haste:
Hasted Cooldown is yet another way to allow a periodic effect to scale with Haste. This is only used on effects that are not meant to be maintained with 100% uptime. Haste is allowed to affect the actual cooldown of the spell, letting you cast it more often.
Some periodic effects will tick immediately when they are applied. This tick does not interact in any way with the refresh mechanics of the effect. Refreshing one of these effects will maintain the tick schedule per the refresh rules, but add the immediate tick at the time of the refresh. Many spells have this type of behavior, but the immediate tick is actually a separate spell effect (and spell id) in the game.
Spell Power is the caster equivalent of Attack Power, however Spell Power is not directly granted by Intellect or Spirit without talent conversions. Spell Power increases the damage of most spells, and some proc effects, however not everything that deals elemental damage scales with Spell Power.
Generic Haste Rating provides melee and ranged haste reducing the attack time of your auto attacks, as well as spell haste which reduces the cast time of spells, as well as the global cooldown. But the global cooldown cannot be reduced below 1 second.
Breath holding spells might be a frightening experience for children and consequently for their parents. Breath holding spells may occur in children who have a normal neurological exam and in children who meet age-appropriate developmental milestones, but normally breath-holding spells do not affect the subsequent neurological development of a child. Breath holding episodes usually follow an inciting event in which the patient is being disciplined, is angry, or is being irritated, etc. Then an episode of crying and breath holding episode may occur which may proceed to loss of consciousness. These episodes may be prevented by distracting the child and by avoiding the triggers. This activity reviews the evaluation of breath holding spells and the role of the interprofessional team in managing this condition and educating the parents.
Objectives:Describe the cause of breath holding spells.Discuss the impact of breath holding spells on neurologic development.Outline management options for breath holding spells.Summarize the interprofessional team response to evaluating a patient with breath holding spells and the management options.Access free multiple choice questions on this topic.
Breath holding spells might be a frightening experience for children and consequently for their parents. Breath holding spells may occur in children who have a normal neurological exam and in children who meet age-appropriate developmental milestones, but normally breath-holding spells do not affect the subsequent neurological development of a child.[1] Breath holding episodes usually follow an inciting event in which the patient is being disciplined, is angry, or is being irritated, etc. Then an episode of crying and breath holding episode may occur which may proceed to loss of consciousness.[2] These episodes may be prevented by distracting the child and by avoiding the triggers.
Breath holding spells were once considered to be attention-seeking behavior, but studies showed that these episodes are not intentional and are a result of an involuntary reflex.[3] Children who voluntarily hold their breath do not lose consciousness and return to normal breathing after they get what they want.
There are two types of breath holding spells. The most common ones are the cyanotic breath-holding spells, which are 85% of breath holding spells and are most commonly a result of temper tantrums. The trigger for these episodes is anger or frustration of the child, who will typically cry for a brief period, becomes silent, stop breathing, and then becomes cyanotic. The patient usually recovers in less than a minute, regains consciousness and after the episode gasping for air may occur, and the child may seem tired. Even though the incident appears frightening, children do not have any long-term effects after these episodes. Rarely, another event may be triggered if the child continues crying.
Sometimes there are features of both cyanosis and pallor, which are termed mixed episodes. Even though the frequency of breath-holding spells may vary, it could happen many times in a day or just once a year.
Breath holding spells are a common problem in the pediatric population especially between ages from 6 months to 6 years. Most of the cases of breath holding spells occur before the child turns 18 months old and may occur in 5% of otherwise healthy children.[5]
Some studies suggest that a dysfunctional autonomic nervous system may play a role in the cause of the spells. Also, iron deficiency anemia has been identified very commonly in these children. Genetics may play a role since parents of the children with the condition may have a history of breath holding spells during childhood.[6]
There is no specific diagnostic testing for breath-holding spells. The diagnosis is usually made by the description of the episode. A history of any inciting event should be elicited especially to distinguish any seizure disorder, as history is very typical for breath holding spells. The color of the patient during the episode may help to differentiate the type of the episode. If an incident can be recorded on video for the doctor to review, this often can be helpful in making the diagnosis. Since it may be confusing to distinguish seizure disorders from breath holding spells, an electroencephalogram (EEG) is frequently being done but shows no seizure activity. However, if breath-holding spells persist for more than 2 minutes, EEG may be done to rule out seizure disorders. Neuroimaging studies are unnecessary since these patients have normal anatomy. Other causes of syncope and seizure should be ruled out such as epileptic disorders and cardiac arrhythmias. Since iron deficiency is prevalent among this children complete blood count should be drawn.[7]
There is no intervention needed for these episodes. Anti-epileptic drugs are not helpful for these children and treating with seizure medication does not prevent a child from having breath-holding spells.[7]
Several studies suggest that there may be an association between iron deficiency anemia and breath holding spells and iron supplementation can decrease the frequency of breath holding spells frequency, with a starting dose of 4 to 6 mg/kg/day.[8][9] Iron treatment can be given even if the child does not have iron deficiency since it may decrease the frequency of spells.
Breath holding spells are not harmful, do not result in brain damage and neurologic development outcome if normal will be normal. By four years of age, most children will no longer have the episodes. Even though these children do not have behavioral disorders, behavioral problems may develop if the family starts to alter the discipline techniques.
Parents should be educated on how to handle the events and receive reassurance that breath-holding spells have no long-term effects. The parents may also benefit from a counselor if these episodes are creating stress and affecting family dynamics. Parents may get help to cope with the stress and may get educated about discipline techniques.
Breath holding spells might be benign, but they can be extremely stressing for caretakers; therefore reassurance and proper explanation is the mainstay of the treatment. If there is an underlying cause such as iron deficiency anemia, it should be addressed, and treatment options considered if these spells interfere with patients' or parents' regular daily activities. Individual therapies, online support groups, and education by the mental health nurse and clinician may be offered to the families.
Spell power is an attribute that increases the effect of spells. Spell power increases the damage amount of damaging spells and the healing amount of healing spells. Prior to Patch 3.0.2, the attribute known as spell damage would only increase the effects of damaging spells. Healing spells were only increased by the healing attribute. As of Patch 3.0.2, spell power now affects both types of spells. Nevertheless, there are items which can increase your bonus healing independently of damage spells. Similarly, there are items which grant bonuses only to certain magic schools such as fire or nature. 2ff7e9595c
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