By P. Vasco. Pratt Institute.
Briefly state your objectives order 120 mg sildalis otc erectile dysfunction hypothyroidism, design and methods along with your findings and conclusions purchase sildalis 120 mg free shipping impotence is a horrifying thing. In your introduction State the research hypotheses you are investigating. This will help set your work within the context of the current state of research in your chosen area. The reader will gain an idea of the questions or problems that other researchers are studying and the results of these investigations. A literature review is not just about regurgitating sequentially the facts and figures of various studies. You must show the examiner that you are able to draw information together and summarise the findings of studies that are in agreement, for instance ones that have similar findings or those using the same methodology. Show the examiner that you are able to critically appraise the evidence. What is the significance of their contribution to scientific knowledge or clinical practice? Remember to take a broad perspective that encompasses both those studies that are in accordance and those that op pose each other. Use the final part of this section to give more details of your planned research. You will need to: ° state your aims or objectives ° restate your hypotheses ° state the dependent and independent variables ° state your rationale for designing the research ° state the scope and depth of the project ° state definitions of terminology where appropriate. In your methods section The methods section tells the reader how you went about answering your question or investigating the problem. It must contain enough detail to en sure that another researcher is able to replicate your project. This informa tion will also help the reader to appraise the strengths and weaknesses of your research. Divide the information into subsections that cover the: RESEARCH PROJECTS 207 ° design ° subjects ° materials or equipment ° procedure. Your design State your design (for example, repeated measures, matched subjects) and your rationale for making this choice. Discuss any pilot studies you have carried out and how this has af fected your choice of design. Describe how your subjects were allocated to the experimental and control groups. Materials or equipment Be specific about your materials or apparatus (for example, any technical equipment you used or the content of a questionnaire). The procedure Describe exactly what was done (for example, how did you control for sit uational variables? State the statistical test and level of probability used in the experiment. Ethical issues Describe any ethical issues that arose out of your study and how you dealt with them. Include information about obtaining permission from the rele 208 WRITING SKILLS IN PRACTICE vant ethics committee. It would also be useful to briefly note how you have ensured client confidentiality. Provide a summary of the data within the text and place the full ver sion in the appendices. Visual displays like tables and graphs are invaluable for presenting numerical information. Remember there is no interpretation of the data in this section as this is reserved for the discussion section that follows. In your discussion This section is about making sense of and interpreting the significance of your findings. This helps focus the reader and reminds him or her of your original objectives as stated in the literature review. How do your results compare with the findings of the studies in your literature review? Have you attempted to explain any inconsistencies or unexpected findings? Make an objective evaluation of the strengths and weaknesses of your project. Describe how you might modify or extend your research project in the light of this evaluation. Describe what the implications of your project might be for develop ing theoretical knowledge or clinical practice. In your conclusion Draw your report to a close by reiterating the main points. Use your appendices for: ° the full version of your raw data ° copies of statistical calculations or computer analyses ° examples of materials used in data collection, for example copies of scoring sheets, instructions or questionnaires.
In their normal environments the bacteria The protoxin crystal is a hardy structure buy sildalis 120mg on-line discount erectile dysfunction pills, and does not are harmless and even can be beneficial generic 120 mg sildalis with amex impotence clinic. However, in the gut of insects, where the pH entry to other parts of the body, these so-called commensal is very basic, the protoxin can go into solution. The entry of these commen- happens an insect enzyme splits the molecule. One of the sal bacteria into the bloodstream is a normal occurrence for toxin fragments, the delta endotoxin, confers the lethal effect most people. If the The delta endotoxin binds to the epithelial cells lining immune system is not functioning efficiently then the invad- the gut wall of the insect. By creating holes in the cells, the ing bacteria may be able to multiply and establish an infection. Another consequence of are another illness (such as acquired immunodeficiency syn- the destruction is a modification of the pH to a more neutral drome and certain types of cancer), certain medical treatments level that is hospitable for the germination of the endospores. The resuscitation and growth of Bacillus thuringiensis within Examples of bacteria that are most commonly associ- the insect gut kills the larva. In the recent three or four The generalized location of bacteremia produces gener- decades, with the advent of techniques of molecular alized symptoms. These symptoms can include a fever, chills, rearrangement, the specificity of the bacterium for target pain in the abdomen, nausea with vomiting, and a general feel- insect pests has been refined. Not all these symptoms are present at the some one percent of the worldwide use of fungicides, herbi- same time. Septic shock produces more drastic See also Bacteriocidal, bacteriostatic symptoms, including elevated rates of breathing and heartbeat, loss of consciousness and failure of organs throughout the body. The onset of septic shock can be rapid, so prompt med- BBacteremicACTEREMIC ical attention is critical. The discovery of bacteria in the blood should be taken Bacteremic is a term that refers to the ability of a bacterium to as grounds to suspect bacteremia, because bacteria do not typ- multiply and cause an infection in the bloodstream. Antibiotic therapy is usually initiated sion of the bloodstream by the particular type of bacteria is immediately, even if other options, such as the transient entry also referred to as bacteremia. In addition, If the invading bacteria also release toxins into the antibiotic therapy is prudent because many bacteremic infec- bloodstream, the malady can also be called blood poisoning or tions arise because of an ongoing infection elsewhere in the septicemia. Along with the prompt start of treatment, the antibiotic associated with septicemia. Use of an ineffective antibi- 44 WORLD OF MICROBIOLOGY AND IMMUNOLOGY Bacteria and bacterial infection otic can provide the bacteria with enough time to undergo lacking fimbrae, showing that these structures can indeed pro- explosive increases in number, whereas the use of an antibiotic mote the capacity of bacteria to cause infection. At the As with many other infections, bacteremic infections point of entry, usually at small breaks or lesions in the skin or can be prevented by observance of proper hygienic procedures mucosal surfaces, growth is often established in the submu- including hand washing, cleaning of wounds, and cleaning cosa. Growth can also be established on intact mucosal sur- sites of injections to temporarily free the surface of living bac- faces, especially if the normal flora is altered or eliminated. The rate of bacteremic infections due to surgery is much Pathogen growth may also be established at sites distant from less now than in the past, due to the advent of sterile surgical the original point of entry. Access to distant, usually interior, procedures, but is still a serious concern. If a pathogen gains access to tissues by adhesion and See also Bacteria and bacterial infection; Infection and invasion, it must then multiply, a process called colonization. The initial inoculum is rarely sufficient to cause BACTERIA AND BACTERIAL INFECTION damage. A pathogen must grow within host tissues in order to Bacteria and bacterial infection produce disease. If a pathogen is to grow, it must find appro- Infectious diseases depend on the interplay between the abil- priate nutrients and environmental conditions in the host. If the ability of factors that affect pathogen growth, but the availability of a microorganism to invade, proliferate, and cause damage in microbial nutrients in host tissues is most important. Not all the body exceeds the body’s protective capacities, a disease nutrients may be plentiful in different regions. Infection refers to the growth of microorganisms ents such as sugars, amino acids and organic acids may often in the body of a host. Infection is not synonymous with disease be in short supply and organisms able to utilize complex nutri- because infection does not always lead to injury, even if the ent sources such as glycogen may be favored. Trace elements pathogen is potentially virulent (able to cause disease). In a may also be in short supply and can influence the establish- disease state, the host is harmed in some way, whereas infec- ment of a pathogen. For example, iron is thought to have a tion refers to any situation in which a microorganism is estab- strong influence on microbial growth.
Indeed purchase 120 mg sildalis visa erectile dysfunction and diabetes treatment, as medical historian Virginia Berridge has observed discount 120mg sildalis amex male erectile dysfunction icd 9, ‘the coalition advocating 40 THE REGULATION OF LIFESTYLE those restrictions pre-dated the evidence’ (Berridge 1998). Yet, as she acknowledged, ‘by the mid-1990s, there was widespread agreement that the epidemiological evidence on passive smoking was at least debatable’. It may have been regarded as debatable among medical experts at an elite symposium, but as far as public policy was concerned ETS was lethal. In a revealing exchange at the same symposium on the history of smoking and health, when Richard Doll was asked to compare the epidemiological evidence on passive smoking with his work in the 1950s, his response was ‘it’s utterly different’ (Doll 1998). Recalling that his study had shown a fifty-fold increase in risk for heavy smokers, he commented that ‘for passive smoking the evidence is qualitatively different’. While indicating that he did believe that passive smoking was harmful, he conceded that ‘the quantitative relationship is very weak’, suggesting that his belief was more grounded in loyalty to the anti- smoking cause than his confidence in the figures. The discovery of the link between smoking and lung cancer gave a great impetus to the quest for some similar causative agent of coronary heart disease (CHD), another condition which caused a rapidly increasing death toll from the 1920s onwards. Mortality from coronary heart disease grew at an even faster rate, reaching twice the rate of lung cancer in the early 1950s and three times the rate in the 1960s. Sudden death from a heart attack, particularly affecting men in middle age—a condition virtually unknown before the First World War—became familiar throughout the Western world. The coronary death rate in Britain reached a plateau in the late 1970s and then slowly declined (in the USA, this fall began a decade earlier). The cause of the rapid increase in CHD was (and largely remains) a mystery, as does the reason for its more recent decline (which began before any of the familiar preventive interventions had been implemented on a large scale). In the 1950s, studies of differences in coronary death rates in different countries led to the recognition of an association between diets high in saturated fats (in meat and dairy products) and heart disease. The factor linking dietary fat and the formation of fatty plaques on the lining of the coronary arteries, which in turn lead to the formation of blood clots causing heart attacks, appeared to be the level of cholesterol circulating in the blood stream. The resulting thesis that a diet low in fat could prevent 41 THE REGULATION OF LIFESTYLE or reverse these pathological processes and reduce the rates of resulting death and disease has subsequently become the conventional wisdom of Western society. The popular description of the traditional British fried breakfast as a ‘heart attack on a plate’ reflects the familiarity of the diet-heart disease thesis. It is indeed a plausible theory, yet, despite decades of intensive study, it still lacks scientific verification. Through the 1960s and 1970s controversy raged over the significance of dietary fat and the association between cholesterol and CHD and numerous researchers studied different aspects of the alleged link. A major joint US/ European study—the Multiple Risk Factor Intervention Trial (MR FIT)—investigated the effect of various diets and lifestyle changes on 60,000 men. Other investigators identified additional risk factors for coronary heart disease, notably smoking, lack of exercise, raised blood pressure, and many more. At the end of 1982, according to James LeFanu, a long-standing critic of the cholesterol-heart disease thesis, ‘the juggernaut crashed’ (LeFanu 1999:335). The MR FIT trial showed no benefit from intervention (and a WHO study a few months later came to the same conclusion). Furthermore, figures showed that the incidence of CHD was falling in different countries, in all ages, classes and ethnic minorities—apparently independently of dietary changes. Yet far from bringing to an end attempts to change diet justified by the cholesterol-heart disease thesis, campaigns promoting ‘healthy eating’ won ever greater official backing and became steadily more influential. This is the remarkable paradox underlying health promotion in relation to CHD, to which we will return in the next chapter. Here, we simply note the fundamental improbability of the diet-CHD thesis: human beings have lived throughout history, and continue to live, in the most diverse habitats on the most diverse diets, displaying phenomenal adaptability. It would therefore seem ‘improbable that for some reason right at the end of the twentieth century subtle changes in the pattern of food consumption should cause lethal diseases’ (LeFanu 1999:319–20). There can be no doubt however that, even though—in scientific terms—the cholesterol juggernaut had crashed, in the sphere of public health policy, it was surging ahead. In 1979 the British government published guidelines on Eating for Health which attempted to overcome the ‘ignorance and irresponsibility’ which it blamed for unhealthy lifestyle. The media responded to this initiative with ‘unbounded enthusiasm’, publicising the dangers of cholesterol to a receptive audience (Karpf 1988). The ‘Look After Yourself 42 THE REGULATION OF LIFESTYLE campaign was launched by the Health Education Council in 1977 and developed in the early 1980s in collaboration with the BBC through a series of popular radio and television programmes. This campaign took the healthy eating message to the people, providing special training for nurses and health visitors to run groups in GPs surgeries, community centres and workplaces. In the USA, the National Cholesterol Education Campaign was launched along similar lines in 1984. In 1992 a major trial on the prevention of CHD by reducing cholesterol levels and other risk factors revealed an increase in mortality among those who received medical intervention (Dunnigan 1993). Another report indicated an increase in non-cardiac deaths related to drug treatment for increased cholesterol levels. Two years later the pro-dietary intervention camp produced new epidemiological data confirming the association between circulating cholesterol levels and death from heart disease. It claimed ‘conclusive’ evidence from a number of large studies that a 10 per cent reduction in blood cholesterol level (over a five-year period) could produce a 25 per cent drop in heart attacks (or other coronary incidents) (Marmot 1994). Researchers also dismissed reports of the dangers of low cholesterol levels and the risks of cholesterol-lowering drugs (Law et al.
We’re up against some of the same subtleties as the civil rights struggle generic sildalis 120 mg overnight delivery erectile dysfunction treatment alprostadil. I’m not welcome in the bars anymore and many of the restaurants my brothers and sisters own and work in sildalis 120mg erectile dysfunction treatment high blood pressure. Their stories contrasted starkly with those of white interviewees, who sometimes complained about crowds gathering, anxious to help. Even without conclusive evidence of racism, dismissing these discrepancies is hard. One time I was on the train and when I was ready to get off, for some reason I just fell. If it wasn’t for one old white man who helped me up, I would have still been on that ground. I’m standing there waiting for this bus, and a little boy and his mother went by, and the little boy snatched my cane. My back’s hurting, my Society’s Views of Walking / 65 knee’s hurting, and I’m standing there about to pass out. Late in the focus group, Jackie Ford had a message: A neurologist told me that because of my gait being off, I should walk with my head down. Roughly one-third of the people I interviewed had never heard of the ADA. Another third merely knew of the law’s existence, without any sub- stantive understanding, and the ﬁnal third knew both the law and its pur- pose. Those who understood the ADA generally had professional or per- sonal reasons for awareness. Only one interviewee had actually read the ADA—Boris Petrov, the surgeon in his mid forties who had emigrated from the former Soviet Union. You know, when we’re all gone, this country will be changed by that act. For the ﬁrst time in history, this act was not dictated by—I don’t know the right word—pity. Not by pity, but to give people the chance to live who do it in a different way. Such meetings are often awk- ward, and after several forays, conversation ﬁnally focused on travel. The new boyfriend recounted well-researched ventures to distant, exotic desti- nations. In concluding, he asserted that he wanted to travel while he still could, before he got too old and slow. Such con- ﬁdent pronouncements tapped into my uncertainty as a relative newcomer to disability. Weakness, imbalance, and fatigue made getting around with the cane tough; I could only go so far. The minute-by-minute realities of my bodily sensations seemed leagues away from the empowering assertions of disability rights advocates—that “disabil- ity is something imposed on top of our impairments by the way we are un- necessarily isolated and excluded from full participation in society” (Oliver 1996, 22; cited in chapter 1). This chapter examines how people with progressive chronic conditions feel about their difficulty walking. No interviewees expressed happiness, joy, pleasure, or glee as their walking failed. But hope is complicated, as people with chronic illness “are im- pelled at once to defy limitations in order to realize greater life possibilities, and to accept limitations in order to avoid enervating struggles with im- mutable constraints” (Barnard 1995, 39). Disability rights activists might urge them to frame their experiences within the broader social context 66 How People Feel about Their Difficulty Walking / 67 (Oliver 1996; Charlton 1998; Linton 1998; Barnes, Mercer, and Shake- speare 1999; Albrecht, Seelman, and Bury 2001)—“it is not the inability to walk which disables someone but the steps into the building” (Morris 1996a, 10). And as Jenny Morris, who had a spinal cord injury, wrote, Insisting that our physical differences and restrictions are entirely so- cially created... Even if the physical environment in which I live posed no physical barriers, I would still rather walk than not be able to walk. Tobe able to walk would give me more choices and experiences than not being able to walk. This is, however, quite deﬁnitely, not to say that my life is not worth living, nor is it to deny that very positive things have happened in my life because I became disabled. We need courage to say that there are awful things about being disabled, as well as the positive things. Once in control, now constrained; once fear- less, now fearful; once mobile, now “stuck”; once working, now “on wel- fare”; once busily occupied, now at loose ends; once engaged, now isolated; once athletic, now on the sidelines; once stylish, “loving high heels,” now wearing “ﬂat, sensible shoes. It was June four years ago, and I was literally doing cartwheels in the yard teaching my daughter.
9 of 10 - Review by P. Vasco
Votes: 29 votes
Total customer reviews: 29