By X. Finley. Rockford College. 2018.

Last generic kamagra polo 100mg visa causes of erectile dysfunction in 50s, but never least order kamagra polo 100 mg overnight delivery erectile dysfunction treatment philippines, my heartfelt thanks to Geoffrey Hudson for his love and his encouragement of my scholarly endeavours— especially this book. Other friends and colleagues who must be thanked are Jane Abson and Robert McCoy, for their friendship and exemplary research assistance; Justin Busch and Tracey Lee, for reading portions of the manuscript and still remaining my friends; Mary Milliken, for her generous editorial assistance and staunch friendship; Gary Bowden, Sharon Cody, Susan Doherty, Barbara Fisher-Townsend, Deborah Johnston, Lanette Ruff, Vanda Rideout, and Carolyn Williston-Aubie, for their eleventh-hour assistance; Lynn Cameron, for her help in finding participant observation venues and for her enduring friendship; Joey Moore, Catherine Gloor, Scott Anthony Thompson, Rhona Shaw, Elizabeth Graham, Sandy Kitchen, Sally Landon, Jim Mulvale, Heather Young Leslie, Paul Roberts, and Pum van Veldhoven, for their collegiality and camaraderie; Mary Quenville, Rachel Derry, and Rick Miles, for always listening, as well as Nicky Kieffer, for always shining. Most importantly, I offer my deepest gratitude to the people who participated in this research. In taking part in the interviews they graciously allowed me into their lives. This page intentionally left blank Introduction Alternative and complementary therapies are a popular form of health care in the Western world (Eisenberg et al. There are numerous therapies available and a variety of commercial outlets stock a plethora of vitamins, herbal remedies, and other types of alternative health care products. A range of venues pro- vides information on healing groups and, in some cases, holistic health associations have centralized access to alternative therapies. Popular media, including television, radio, magazines, and newspapers increasingly feature these approaches to health and healing (Anyinam 1990). For example, in a search of selected popular print media in Canada I found almost four hundred entries for alternative health care between January 1995 and 1997 alone. In addition, there are hundreds of web sites devoted to discussion of alternative and complementary health care on the Internet (Achilles et al. This book concerns the experiences of Canadians who use alternative therapies. The first large-scale survey of the use of alternative approaches among Canadians was carried out by the Canada Health Monitor (1993), who found that 20 percent of Canadians reported participation in alternative forms of healing. Subsequently, in their survey of fifteen thousand Canadians for the Fraser Institute, Ramsay et al. Further, it is likely that the use of alternative health care in Canada is under-reported simply because a significant number of people remain reluctant to disclose their use of these therapies to others, especially their doctors (Eisenberg et al. For example, a 1997 Angus Reid poll showed that Canadians invested almost $1. Additional evidence for the popularity of alternative health care in Canada includes the number of courses in alternative therapies available. For instance, in September of 1998 one Canadian community college held weekend workshops and courses on a variety of therapies, including ear candling, mystical healing gems, herbalism, homeopathy, Chinese medicine, and shiatsu massage (Mohawk College 1998:156–59). By 2003, the same college not only offered several workshops or courses in complementary therapies, but also provided a certificate programme in aromatherapy, and was in the process of developing a diploma programme in herbal medicine (Mohawk College 2003a, 2003b). There is also evidence that participation in alternative therapies in Canada is on the rise (Achilles et al. For example, Northcott and Bachynsky (1993:432) found that “annual usage of alternative health care therapies (other than chiropractic)... Likewise, the number of alternative and complementary therapists in Canada has increased, and it is estimated that there are approximately twelve thousand licensed alternative practitioners in Canada (Achilles et al. The number of actual alternative and complementary practitioners in Canada is impossible to determine, as many practitioners—such as aromatherapists or reiki practitioners— remain unregulated and undocumented. Clearly, alternative therapies are an important part of Canadians’ health care regimes and their use of these approaches to health care is deserving of deeper analysis. Introduction | 3 Despite the number of people participating in alternative approaches to health and health care, very few sociologists have examined individuals’ experiences in using these therapies. Rather than focussing on alternative practitioners or the therapies themselves, this book provides the reader with a detailed understanding of the subjective experiences of the Canadian user of alternative approaches to health and healing. I explore how and why the people who took part in this research come to use alternative therapies, the ideology that informs the alternative models of health and healing they espouse, and the impact on them of the ideology underpinning these models. The people who spoke with me sought out alternative health care in order to solve problems for which they found little or no redress in other quarters. They began using alternative therapies through a variety of different points of entrée, including encounters with friends, family members, and the media, among others. Once involved in using these therapies, they developed ever-expanding networks of alternative health care composed of alternative practitioners and lay users of alternative therapies. In participating in alternative health care, and in interaction with others who use it, these people began to take on alternative ideologies of health and healing. For some, these ideologies became a mechanism through which they transformed their subjective perceptions of health status for the better. Quite simply, despite experiencing what is serious physical disability or disease, these people are able to see themselves as healthy because they are engaged in the process of healing.

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Those three survivors were introduction of that device on a widespread scale into discharged from hospital with moderate to severe cerebral anaesthetic practice has cheap 100mg kamagra polo fast delivery erectile dysfunction age 29, in itself order kamagra polo 100 mg visa young erectile dysfunction treatment, reduced the opportunities for disability. These findings support the proposal that death may training in the anaesthetic room. Manikin training offers an alternative, but most would agree that training on patients is be recognised in normothermic patients who have had a period required to amplify manikin experience. Informed collapse to the arrival of ambulance personnel exceeds consent is difficult to obtain at the sensitive and emotional time 15 minutes, provided that no attempt at CPR has been made in of bereavement, and approaches to relatives may be construed as coercion. Proceeding without consent may be considered as that time interval and the ECG has shown an unshockable assault. This recommendation is supported by a review of 414 The dilemma does not stop with tracheal intubation, and other patients who had not received any CPR in the 15 or more techniques, such as fibre optic intubation, central venous access, minutes to ambulance arrival. No patient survived who had a surgical cut-down venous access, chest drain insertion, and non-shockable rhythm when the first ECG was recorded. This resulted in an algorithm for ambulance personnel 105 ABC of Resuscitation encountering death in these conditions, which has been The involvement of relatives and close friends accepted by the Professional Advisory Group of the Scottish Ambulance Service and the Central Legal Office to the Bystanders should be encouraged to undertake immediate basic life support in the event of cardiorespiratory arrest. Traditionally, The validity of the proposed guidelines depends on the relatives have been escorted away from the victim when the accurate diagnosis being cardiac arrest within the first 15 or so healthcare professionals arrive. The Resuscitation unsupported arrest could be less—perhaps much less—than Council (UK) has confirmed the need to identify and respect 15 minutes. In these circumstances, resuscitation could possibly relatives’ wishes to remain with the victim. Clearly, care and consideration of the relative in these stressful situations become still be successful. When the 15 minute asystole guideline has of increasing concern as the invasive nature of the resuscitation been used in the United States, however, this concern has attempt escalates from basic life support, to defibrillation and proved to be unfounded. These must be disseminated throughout the service and to all other concerned groups. Legal aspects Doctors, nurses, and paramedical staff functioning in their official capacity have an obligation to perform CPR when medically indicated and in the absence of a “Do Not Further reading Resuscitate” decision. The emergency services must avoid such 1 complications in unconscious patients by being aware of the 2 3 possibility of spinal cord injury from the nature of the accident, 4 and in conscious patients by suspecting the diagnosis from the 5 6 history and basic examination. If such an injury is suspected the 7 40% patient must be handled correctly from the outset. Spinal injuries most commonly result from road trauma involving vehicles that overturn, unrestrained or ejected occupants, and motorcyclists. Falls from a height, high velocity crashes, and certain types of sports injury (e. Particular care must be taken moving unconscious patients, those who complain (a) Coma position—note that the spine is rotated. Impaired consciousness (from injury or alcohol) and distracting injuries in multiple trauma are amongst the commonest causes of a failure to diagnose spinal injury. All casualties in the above risk categories should be assumed to have unstable spinal injuries until proven otherwise by a thorough examination and adequate x rays. It must also be remembered that spinal cord injury without radiological abnormality (SCIWORA) can occur, and may be due to ligamentous damage with instability, or other (b) Lateral position—two hands from a rescuer stabilise the soft tissue injuries such as traumatic central disc prolapse. The unconscious patient It must be assumed that the force that rendered the patient unconscious has injured the cervical spine until radiography of its entire length proves otherwise. Until then the head and neck must be carefully placed and held in the neutral (anatomical) position and stabilised. A rescuer can be delegated to perform (c) Prone position—compromises respiration. However, splintage is best achieved with a rigid collar of appropriate size supplemented with sandbags or bolsters on each side of the head. The sandbags are held in position by tapes placed across the forehead and collar. If gross spinal deformity is left uncorrected and splinted, the cervical cord may sustain further injury from unrelieved angulation or compression. Alignment must be corrected unless attempts to do this increase pain or exacerbate neurological symptoms, or the head is locked in a position of torticollis (as in atlanto-axial rotatory subluxation). In these situations, the head must be (d) Supine position—if patient is supine the airway must splinted in the position found. During turning or lifting, it is vital that the whole spine is maintained in the neutral position.

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The risk of 82 Vanderver and Gaillard rash discount 100 mg kamagra polo otc erectile dysfunction ginseng, especially in interaction with valproic acid buy generic kamagra polo 100mg online impotence 16 year old, a frequently used anticonvulsant in this population, warrants careful titration as doses are increased. Early reports on the use of felbamate in LGS suggested a response with seizure reduction of >50% in 50% of children with LGS. Also, more recent studies in which a subgroup of patients had the diagnosis of LGS, suggest that felbamate continues to be efficacious in 41% of children with refractory epilepsy after 3 years of follow-up. There is also some suggestion that add-on felbamate therapy may decrease the seizure frequency by increasing levels of valproic acid. Although felbamate and lamotrigine are both efficacious, especially for injury causing drop attacks, both are associated with serious idiosyncratic or hypersensitivity reactions leading to interest in newer anticonvulsants. Topiramate has a broad spectrum of action and few therapy-limiting adverse events. An initial double-blind randomized study revealed a decrease in seizure frequency of >50% in 33% of children with target doses of approximately 6mg=kg=day vs. A follow-up open label study after adjustment of mean anticonvulsant doses to 10 mg=kg=day demonstrated a reduction in seizures of! Another multicenter study found seizure reduction of >50% in 40% of patients with a mean dose of 4. A more recent open, multicen- ter study, however, recorded a response rate as defined above of only 25%, although this is discrepant with other reports of topiramate efficacy as add-on therapy in LGS. These three anticonvulsant agents have been shown to decrease seizure fre- quency including drop attacks by about half in as much as one-half of children when used as adjunctive agents. Because seizures remain intractable, other options are often considered. A small sub- group of patients with LGS in a study of zonisamide as an adjunctive agent in pedia- tric epilepsy had a ‘‘response’’ of 25–50%, although effectiveness is not clearly defined. Levetiracetam is also used, although there is limited data regarding efficacy. Benzodiazepines, especially clobazam and nitrazepam, are used with some suc- cess. A small study recently suggested that nitrazepam may be at least as efficacious as other anticonvulsant drugs, decreasing seizure frequency by $50% in more than 60% of patients. Use of these drugs is limited by the development of tolerance and physiologic dependence. The ketogenic diet has also been used with some success in many centers although there are no well-documented studies of this therapy specifically for LGS. Prospective studies show a modest reduc- tion in seizure frequency after vagal nerve stimulator implantation. This therapy may be helpful in limiting drop attacks and therefore may lead to improvement in quality of life. Corpus callosotomy has also been used to reduce tonic seizures that result in injury secondary to falling, with some moderate success. The recognition of episodes of nonconvulsive status, which may occur fre- quently in these patients, is important. The use of steroids in this situation has been occasionally used when more conventional therapies have failed. Very few patients have complete seizure control and none of these therapies appears to have altered the progress of intellectual decline. Anticonvulsant manage- ment should aim to minimize polypharmacotherapy and accumulated toxicity. When possible, AEDs should be limited to one or two agents (unless switching medications where the child would be on three AEDs during transition). Treatment of LGS has therefore remained inherently frustrating for both physicians and families. Lennox–Gastaut Syndrome 83 PROGNOSIS Prognosis in children with LGS is defined mainly by neurodevelopmental outcome and refractory seizures. Other important considerations, such as the mortality due to status epi- lepticus, are not particular to this seizure syndrome. Seizure types evolve as the child matures, most typically into more complex partial, and generalized tonic–clonic sei- zures, although the nocturnal seizures persist into adolescence. Mental retardation and behavior disorders persist in a static fashion, although greater demands on an older child or changes in polypharmacotherapy may occasionally make the encepha- lopathy appear progressive.

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The most common package used by social scientists at this present time is SPSS for windows purchase 100 mg kamagra polo fast delivery impotence yahoo, which 122 / PRACTICAL RESEARCH METHODS TABLE 10: USING COMPUTERS FOR QUALITATIVE DATA ANALYSIS: ADVANTAGES AND DISADVANTAGES ADVANTAGES DISADVANTAGES Using computers helps to In focus groups the group moves alleviate time-consuming and through a different sequence of monotonous tasks of cutting purchase kamagra polo 100mg line erectile dysfunction va benefits, events which is important in the pasting and retrieval of field analysis but which cannot be notes and/or interview recognised by a computer. Computers are a useful aid to Programs cannot understand those who have to work to tight the meaning of text. Programs can cope with both Software can only support the multiple codes and over-lapping intellectual processes of the codes which would be very researcher – they cannot be a difficult for the researcher to substitute for these processes. Some software can conduct Participants can change their multiple searches in which more opinions and contradict than one code is searched much themselves during an interview. Programs can combine codes in The software might be beyond complex searches. Programs can pick out instances User-error can lead to of pre-defined categories which undetected mistakes or have been missed by the misleading results. Computers can be used to help Using computers can lead to an the researcher overcome over-emphasis on mechanical ‘analysis block’. HOW TO ANALYSE YOUR DATA/ 123 has become increasingly user-friendly over the last few years. However, data input can be a long and laborious process, especially for those who are slow on the key- board, and, if any data is entered incorrectly, it will influ- ence your results. Large scale surveys conducted by research companies tend to use questionnaires which can be scanned, saving much time and money, but this op- tion might not be open to you. If you are a student, how- ever, spend some time getting to know what equipment is available for your use as you could save yourself a lot of time and energy by adopting this approach. Also, many software packages at the push of a key produce profes- sional graphs, tables and pie charts which can be used in your final report, again saving a lot of time and effort. Most colleges and universities provide some sort of statis- tics course and data analysis course. Or the computing de- partment will provide information leaflets and training sessions on data analysis software. If you have chosen this route, try to get onto one of these courses, especially those which have a ‘hands-on’ approach as you might be able to analyse your data as part of your course work. This will enable you to acquire new skills and complete your re- search at the same time. Statisticl techniques For those who do not have access to data analysis soft- ware, a basic knowledge of statistical techniques is needed to analyse your data. If your goal is to describe what you have found, all you need to do is count your responses and reproduce them. This type of frequency count is usually the first step in any analysis of a large scale survey, and forms the base for many other statistical techniques that you might decide to conduct on your data (see Example 12). For example, someone might be unwilling to let a researcher know their age, or someone else could have accidentally missed out a question. If there are any missing answers, a separate ‘no answer’ category needs to be included in any frequency count table. In the final re- port, some researchers overcome this problem by convert- ing frequency counts to percentages which are calculated after excluding missing data. However, percentages can be misleading if the total number of respondents is fewer than 40. HOW TO ANALYSE YOUR DATA/ 125 EXAMPLE 12: TOM Tom works part-time for a charity which provides infor- mation and services for blind and partially sighted peo- ple in the town. He was asked to find out how many people use the service and provide a few details about who these people are and what they do in life. Tom de- signed a short questionnaire which could be adminis- tered face-to-face and over the telephone by the receptionist. Anyone who called in person or telephoned the centre over a period of a month was asked these ques- tions. If they had already completed a questionnaire they did not have to do so again. Tom did not have access to any computing facilities, so he decided to analyse the questionnaires by hand. He conducted a count of gender, age, occupation, postcode area of residence and reason for attending or telephon- ing the centre. From this information, members of staff at the centre were able to find out that their main custo- mers were women over the age of retirement.

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The predilection of asomatognosia for the left side of the body may simply be a reflection of the aphasic problems asso- ciated with left-sided lesions that might be expected to produce aso- matognosia for the right side buy cheap kamagra polo 100 mg on-line erectile dysfunction drug companies. Asomatognosia is related to anosognosia (unawareness or denial of illness) but the two are dissociable on clini- cal and experimental grounds cheap kamagra polo 100 mg amex erectile dysfunction drugs that cause. Neurology 1990; 40: 1391-1394 Cross References Anosognosia; Confabulation; Neglect; Somatoparaphrenia Astasia - see CATAPLEXY Astasia-Abasia Astasia-abasia is the name that has sometimes been given to a dis- order of gait characterized by impaired balance (disequilibrium), - 39 - A Astereognosis wide base, shortened stride, start/turn hesitation, and freezing. The term has no standardized definition and hence may mean different things to different observers. It has also been used to describe a disorder characterized by inability to stand or walk despite normal leg strength when lying or sitting, believed to be psychogenic (although gait apraxia may have similar features). Modern clinical classifications of gait disorders subsume astasia-abasia under the categories of subcortical disequilibrium and frontal disequilibrium (i. A transient inability to sit or stand despite normal limb strength may be seen after an acute thalamic lesion (thalamic astasia). Human walking and higher- level gait disorders, particularly in the elderly. Neurology 1993; 43: 268-279 Cross References Gait apraxia Astereognosis Astereognosis is the failure to recognize a familiar object, such as a key or a coin, palpated in the hand with the eyes closed, despite intact pri- mary sensory modalities. Description of qualities, such as the size, shape and texture of the object may be possible. There may be associated impairments of two-point discrimination and graphesthesia (cortical sensory syndrome). Astereognosis was said to be invariably present in the original description of the thalamic syn- drome by Dejerine and Roussy. Some authorities recommend the terms stereoanesthesia or stereo- hypesthesia as more appropriate terms for this phenomenon, to empha- size that this may be a disorder of perception rather than a true agnosia (for a similar debate in the visual domain, see Dysmorphopsia). Cross References Agnosia; Dysmorphopsia; Graphesthesia; Two-point discrimination Asterixis Asterixis is a sudden, brief, arrhythmic lapse of sustained posture due to involuntary interruption in muscle contraction. It is most eas- ily demonstrated by observing the dorsiflexed hands with arms out- stretched (i. Movement is associated with EMG silence in antigravity muscles for 35-200 ms. These features distinguish asterixis from tremor and myoclonus; the phenomenon has previously been described as negative myoclonus or negative tremor. Recognized causes of asterixis include: - 40 - Ataxia A Hepatic encephalopathy Hypercapnia Uremia Drug-induced, for example, anticonvulsants, levodopa Structural brain lesions: thalamic lesions (hemorrhage, thalamo- tomy) Unilateral asterixis has been described in the context of stroke, contralateral to lesions of the midbrain (involving corticospinal fibers, medial lemniscus), thalamus (ventroposterolateral nucleus), primary motor cortex and parietal lobe; and ipsilateral to lesions of the pons or medulla. Unilateral asterixis and stroke in 13 patients: localization of the lesions matching the CT scan images to an atlas. European Journal of Neurology 2004; 11(suppl2):56 (abstract P1071) Cross References Encephalopathy; Myoclonus; Tremor Asynergia Asynergia or dyssynergia is lack or impairment of synergy of sequen- tial muscular contraction in the performance of complex movements, such that they seem to become broken up into their constituent parts, so called decomposition of movement. Dyssynergy of speech may also occur, a phenomenon sometimes termed scanning speech (q. This is typically seen in cerebellar syndromes, most often those affecting the cerebellar hemispheres, and may coexist with other signs of cerebellar disease, such as ataxia, dysmetria, and dysdiadochokinesia. Cross References Ataxia; Cerebellar syndromes; Dysarthria; Dysdiadochokinesia; Dysmetria; Scanning speech Ataxia Ataxia or dystaxia refers to a lack of coordination of voluntary motor acts, impairing their smooth performance. The rate, range, timing, direction, and force of movement may be affected. Ataxia is used most frequently to refer to a cerebellar problem, but sensory ataxia, optic ataxia, and frontal ataxia are also described, so it is probably best to qualify ataxia rather than to use the word in isolation. Cerebellar hemisphere lesions cause ipsilateral limb ataxia (hemiataxia; ataxia on finger-nose and/or heel-shin testing) whereas midline cere- bellar lesions involving the vermis produce selective truncal and gait ataxia. These fibers run in the corticopontocerebellar tract, synapsing in the pons before passing through the middle cerebellar peduncle to the con- tralateral cerebellar hemisphere. Triple ataxia, the rare concurrence of cerebellar, sensory and optic types of ataxia, may be associated with an alien limb phenomenon (sensory type). There are many causes of cerebellar ataxia, including: ● Inherited: Autosomal recessive: Friedreich’s ataxia Autosomal dominant: clinically ADCA types I, II, and III, now reclassified genetically as spinocerebellar ataxias, types 1-25 now described Episodic ataxias: channelopathies involving potassium (type 1) and calcium (type 2) channels Mitochondrial disorders Huntington’s disease Dentatorubropallidoluysian atrophy (DRPLA) Inherited prion diseases, especially Gerstmann-Straussler- Scheinker (GSS) syndrome ● Acquired: Cerebrovascular events (infarct, hemorrhage): usually cause hemiataxia; postanoxic cerebellar ataxia Inflammatory: demyelination: multiple sclerosis, Miller Fisher variant of Guillain-Barré syndrome, central pontine myelinolysis - 42 - Ataxic Hemiparesis A Inflammatory: infection: cerebellitis with Epstein-Barr virus; encephalitis with Mycoplasma; HIV Neoplasia: tumors, paraneoplastic syndromes Neurodegeneration: one variant of multiple system atrophy (MSA-C); prion diseases (Brownell-Oppenheimer variant of sporadic Creutzfeldt-Jakob disease, kuru); idiopathic late- onset cerebellar ataxia Drugs/toxins: for example, alcohol, phenytoin Metabolic: vitamin E deficiency, thiamine deficiency (Wernicke’s encephalopathy), gluten ataxia, hypothyroidism (debatable) References Klockgether T (ed. Neurology in clinical practice: principles of diagnosis and management (3rd edition).

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