By: Edward T. F. Wei PhD
Vascular neurocognitive disorder is associated with a blockage of cerebral blood vessels that affects one part of the brain rather than a general loss of brain cells seen with Alzheimer’s disease medicine 93 948 generic 10 mg isordil with visa. Personality is not as affected in vascular neurocognitive disorder symptoms zoloft dosage too high discount isordil 10 mg without prescription, and more males are diagnosed than females (Erber and Szuchman symptoms vitamin b deficiency buy isordil 10mg on-line, 2015) symptoms colon cancer effective isordil 10mg. It also comes on more abruptly than Alzheimer’s disease and has a shorter course before death medications that cause hyponatremia purchase isordil visa. Risk factors include smoking, diabetes, heart disease, hypertension, or a history of strokes. Neurocognitive Disorder with Lewy bodies: According to the National Institute on Aging (2015a), Lewy bodies are microscopic protein deposits found in neurons seen postmortem. They affect chemicals in the brain that can lead to difficulties in thinking, movement, behavior and mood. Neurocognitive Disorder with Lewy bodies is the third most common form and affects more than 1 million Americans. It typically begins at age 50 or older and appears to affect slightly more men than women. The disease lasts approximately 5 to 7 years from the time of diagnosis to death but can range from 2 to 20 years depending on the individual’s age, health, and severity of symptoms. Lewy bodies can occur in both the cortex and brain stem which results in cognitive as well as motor symptoms (Erber & Szuchman, 2015). The movement symptoms are similar to those with Parkinson’s disease and include tremors and muscle rigidity. However, the motor disturbances occur at the same time as the cognitive symptoms, unlike with Parkinson’s disease when the cognitive symptoms occur well after the motor symptoms. Individuals diagnosed with Neurocognitive Disorder with Lewy bodies also experience sleep disturbances, recurrent visual hallucinations, and are at risk for falling. Looking more closely at the age ranges, more than 40% of Americans in their 60s are still working, while 14% of people in their 70s and just 4% of those 80 and older are currently employed (Livingston, 2019). Even though they make up a smaller number of workers overall, those 65 to 74-year-old and 75-and older age groups are projected to have Source the fastest rates of growth in the next 407 decade. Livingston (2019) reported that, similar to other age groups, those with higher levels of education are more likely to be employed. Approximately 37% of adults who are 60 and older and have a bachelor’s degree or more are working. In contrast, 31% with some college experience and 21% of those with a high school diploma or less are still working at age 60 and beyond. Not only are older persons working more, but they are also earning more than previously, and their growth in earnings is greater compared to workers of other ages (McEntarfer, 2019). In fact, jobs that require social skills, accumulated knowledge, and relevant experiences favor older adults (Erber & Szuchman, 2015). Older adults also demonstrate lower rates of absenteeism and greater investment in their work. Transitioning into Retirement: For most Americans, retirement is a process and not a one-time event (Quinn & Cahill, 2016). Sixty percent of workers transition straight to bridge jobs, which are often part-time, and occur between a career and full retirement. This may be due to not having adequate finances after retirement or not enjoying their retirement. Some of these jobs may be in encore careers, or work in a different field from the one in which they retired. Approximately 10% of workers begin phasing into retirement by reducing their hours. Retirement age changes: Looking at retirement data, the average age of retirement declined from more than 70 in 1910 to age 63 in the early 1980s. With individuals living longer, once retired the average amount of time a retired worker collects social security is approximately 17-18 years (James, Matz-Costa, & Smyer, 2016). Pilots, air traffic controllers, federal law enforcement, national park rangers, and fire fighters continue to have enforced retirement ages. Consequently, for most workers they can continue to work if they choose and are able. For those born before 1938, they can receive full social security benefits at age 65. For those born between 1943 and 1954, they must wait until age 66 for full benefits, and for those born after 1959 they must wait until age 67 (Social Security Administration, 2016). Medicare health insurance is another entitlement that is not available until one is aged 65. Financially, continuing to work provides not only added income, but also does not dip into retirement savings which may not be sufficient. Historically, there have been three parts to retirement income; that is, social security, a pension plan, and individual savings (Quinn & Cahill, 2016). Consequently, many older workers have had to work later in life to compensate for absent or minimal pension plans and personal savings. Social security was never intended to replace full income, and the benefits provided may not cover all the expenses, so elders continue to work. Unfortunately, many older individuals are unable to secure later employment, and those especially vulnerable include persons with disabilities, single women, the oldest Source old, and individuals with intermittent work histories. Some older adults delay retirement for psychological reasons, such as health benefits and social contacts. Recent research indicates that delaying retirement has been associated with helping one live longer. When looking at both healthy and unhealthy retirees, a one-year delay in retiring was associated with a decreased risk of death from all causes (Wu, Odden, Fisher, & Stawski, 2016). When individuals are forced to retire due to health concerns or downsizing, they are more likely to have negative physical and psychological consequences (Erber & Szuchman, 2015). Retirement Stages: Atchley (1994) identified several phases that individuals ago through when they retire: • Remote pre-retirement phase includes fantasizing about what one wants to do in retirement • Immediate pre-retirement phase when concrete plans are established • Actual retirement • Honeymoon phase when retirees travel and participate in activities they could not do while working • Disenchantment phase when retirees experience an emotional let-down • Reorientation phase when the retirees attempt to adjust to retirement by making less hectic plans and getting into a regular routine Not everyone goes through every stage, but this model demonstrates that retirement is a process. Post-retirement: Those who look most forward to retirement and have plans are those who anticipate adequate income (Erber & Szuchman, 2015). This is especially true for males who have worked consistently and have a pension and/or adequate savings. Many of these individuals chose to pursue additional training to improve skills to return to work in a second career. For some older students who no longer are focus on financial reasons, returning to school is intended to enable them to pursue work that is personally fulfilling. Attending college in late adulthood is also a great way for seniors to stay young and keep their minds sharp. Even if an elder chooses not to attend college for a degree, there are many continuing education programs on topics of Source interest available. In 1975, a nonprofit educational travel organization called Elderhostel began in New Hampshire with five programs for several hundred retired participants (DiGiacomo, 2015). This program combined college classroom time with travel tours and experiential learning experiences. In 2010 the organization changed its name to Road Scholar, and it now serves 100,000 people per year in the U. Academic courses, as well as practical skills such as computer classes, foreign languages, budgeting, and holistic medicines, are among the courses offered. Older adults who have higher levels of education are more likely to take continuing education. However, offering more educational experiences to a diverse group of older adults, including those who are institutionalized in nursing homes, can bring enhance the quality of life. Leisure: During the past 10 years, leisure time for Americans 60 and older has remained at about 7 hours a day. Those 60 and older now spend more than half of their daily leisure time (4 hours and 16 minutes) in front of screens. Screen time has increased for those in their 60s, 70s, 80s and beyond, and across genders and education levels. This rise in screen time coincides with significant growth in the use of digital technology by older Americans. In 2000, 14% of those aged 65 and older used the Internet, and now 73% are users and 53% own smartphones. Alternatively, the time spent on other recreational activities, such as reading or socializing, has gone down slightly. People with less education spend more of their Source leisure time on screens and less time reading compared with those with more education. Less educated adults also spend less time exercising: 12 minutes a day for those with a high school diploma or less, compared with 26 minutes for college graduates. These stereotypes are reflected in everyday conversations, the media, and even in greeting cards (Overstreet, 2006). Age is not revered in the United States, and so laughing about getting older in birthday cards is one way to get relief. The negative attitudes people have about those in late adulthood are examples of ageism, or prejudice based on age. The term ageism was first used in 1969, and according to Nelson (2016), ageism remains one of the most institutionalized forms of prejudice today. Nelson (2016) reviewed the research on ageism and concluded that when older individuals believed their culture’s negative stereotypes Source about those who are old, their memory and cognitive skills declined. In contrast, older individuals in cultures, such as China, that held more positive views on aging did not demonstrate cognitive deficits. It appears that when one agrees with the stereotype, it becomes a self-fulfilling prophecy, or the belief in one’s ability results in actions that make it come true. Being the target of stereotypes can adversely affect individuals’ performance on tasks because they worry they will confirm the cultural stereotypes. This is known as stereotype threat, and it was originally used to explain race and gender differences in academic achievement (Gatz et al. Stereotype threat research has demonstrated that older adults who internalize the aging 411 stereotypes will exhibit worse memory performance, worse physical performance, and reduced self-efficacy (Levy, 2009). In terms of physically taking care of themselves, those who believe in negative stereotypes are less likely to engage in preventative health behaviors, less likely to recover from illnesses, and more likely to feel stress and anxiety, which can adversely affect immune functioning and cardiovascular health (Nelson, 2016). Additionally, individuals who attribute their health problems to their age, had a higher death rate. Similarly, doctors who believe that illnesses are just natural consequence of aging are less likely to have older adults participate in clinical trials or receive life-sustaining treatment. In contrast, those older adults who possess positive and optimistic views of aging are less likely to have physical or mental health problems and are more likely to live longer. Removing societal stereotypes about aging and helping older adults reject those notions of aging is another way to promote health and life expectancy among the elderly. Unfortunately, racism is a further concern for minority elderly already suffering from ageism. Older adults who are African American, Mexican American, and Asian American experience psychological problems that are often associated with discrimination by the White majority (Youdin, 2016). Ethnic minorities are also more likely to become sick, but less likely to receive medical intervention. Older, minority women can face ageism, racism, and sexism, often referred to as triple jeopardy (Hinze, Lin, & Andersson, 2012), which can adversely affect their life in late adulthood.
Further medicine dropper order isordil 10 mg free shipping, the circuits of the middle prefrontal area and emotions of the Pthomegroup the Therapeutic Powers of Play 39 limbic system balance and eventually help the child to medicine zebra buy discount isordil line develop the capacity for self-regulation (Badenoch medicine 834 order 10 mg isordil fast delivery, 2008) treatment walking pneumonia purchase 10 mg isordil with visa. Among the reasons client self-expression is therapeutic are it promotes a deeper awareness of one’s disturbing thoughts treatment plantar fasciitis order isordil with a mastercard, feelings and conficts; it allows for the validation and normalization of one’s thoughts and feelings, as well as the correction of erroneous beliefs; and it strengthens one’s sense of self. The features of play that facilitate clients’ self-expression are: natural language, talking in the third person, an “as if” or not-real-life quality, indescribable, engrossment, and doing while talking. Natural Language Characteristically, young children do not have the vocabulary or abstract thinking abilities needed to verbally express their inner worlds. However, they can readily express their thoughts, feelings, and wishes through their natural medium of expression: play. Piaget (1951) stated, “Play provides the child with the live, dynamic, individual language indispensable for the expression of his subjective feelings for which collective language alone is inadequate” (p. He cited evidence from developmental studies on cognition indicating that for children in primary school (ages 5 to 11), the use of concrete play materials and activities is more suitable than verbal abstractions as a means of self-expression. According to Landreth (1993), toys are used like words by children, and play is the child’s language. He observed that play allows children to play out their problems, concerns, and feelings in a manner similar to the process of talk therapy with adults. Talking in the Third Person Pretend play allows children to talk in the third person, that is, to have dolls, puppets, and make-believe characters express or act out the thoughts, feelings, and behaviors that are too diffcult or threatening for children to express directly. This symbolic play allows for indirect expression and provides the necessary psychic distance from reality so the child does not become overwhelmed with negative affect or embarrassing thoughts. For example, it is common for child victims of physical abuse to have miniature child dolls being hit by parent dolls, and then to have them hitting the parents back. An “As If” or Not-Real-Life Quality Because make-believe play is apart from real life, children can express emotions, drives, and thoughts in play that they would not express in real life. Play presents clients with “plausible deniability concerning upsetting material, i. Indescribable At times, we cannot express inner states well in words, but we may be able to depict them better in one of the creative arts such as drawing, dance, or play creations. Isadora Duncan, a world-renowned dancer, once said, “If I could say it, I wouldn’t have to dance it (2015). Just as a picture can say more than a thousand words, a sand scene can express feelings and conficts for which the client previously had no verbal language. Hence, the sand scenes constructed in the playroom can offer a rich and highly individualized medium for preverbal and nonverbal expression. As a result, children are more likely to inadvertently express things they would ordinarily not express. In the safe, enjoyable environment of the playroom, children are likely to let their guard down and reveal their inner self, both in words and in play activities. Doing While Talking Often, doing something like playing allows a child a level of ease that facilitates talking. Access to the Unconscious Sigmund Freud (1913/1919) defned “dream work” as the mental processes that transform unac ceptable, unconscious wishes and impulses into acceptable, if often undecipherable, conscious dream images. This dream work is adaptive because it allows people to sleep undisturbed by thoughts and impulses that, if known, would awaken them and cause distress. Accordingto Elkind (1981), “play work” is a parallel mental process and serves as the royal road to the child’s uncon scious. Interpretation by the play therapist is often needed to decipher the hidden meaning and provide the client with insight into unconscious mental processes. In both play work and dream work, one primarily bypasses the censorship of the superego by fostering the use of the defense mechanisms of projection, displacement, symbolization, sublima tion, and fantasy compensation. Projection Projection is a process in which one attributes unacceptable parts of oneself, such as thoughts, feelings, or impulses, to individuals or play objects. It’s a way of believing certain characteristics belong to someone or some thing else rather than taking responsibility for them. Displacement Displacement in the playroom involves taking out one’s frustrations, feelings, and impulses on play objects because they are less threatening. Rather than verbalizing angry feelings toward the mother, a child may spank a doll in the playroom when the child really would like to hit mother for having been punished by her. Symbolization Symbolization means using a concrete thing to represent an abstract concept. The process of symbolization enables one to establish meaningful connections between different realms of experience based on proximity and likeness. For example, a school-age boy drew a series of images of parrots with powerful male bodies but weak wings. In real life, the boy was being given much adult responsibility but little freedom to make his own decisions or to pursue his own interests. Pthomegroup the Therapeutic Powers of Play 41 Sublimation Sublimation is a defense mechanism that allows one to channel libidinal drives, both aggressive and sexual impulses, into socially acceptable activities such as art and sports. Sand, water, paint, and clay play provide excellent ways to gratify unconscious anal and urethral drives. Cap guns, sparklers, and fashlights can help sublimate fre-setting impulses into socially acceptable play activities. A teenager experiencing diffculty controlling anger or hostile feelings might take up football or kickboxing as a means of fnding a useful outlet for such feelings. Fantasy Compensation the principle of compensatory activity is familiar to all of us. When one’s needs, impulses, and wishes are unfulflled, one tries to obtain satisfaction through fantasy gratifcation, such as pretend play, movies, and books. Fantasy compensation is a defense mechanism in which the weak can become strong, the neglected are nurtured, and the poor become rich (Robinson, 1920; Vygotsky, 1978). For example, a young boy whose father went bankrupt played as if his family lived in a 100-room mansion. Direct Teaching In direct teaching, the therapist imparts knowledge or skills through such strategies as instruc tion, modeling, guided practice, and positive reinforcement. Children learn and remember best when they are taught in an interesting and enjoyable manner, such as through play activities. When we make learning fun and enjoyable, we increase children’s motivation to spend time and effort learning. Studies of children’s television shows such as Sesame Street and Blue’s Clues have provided strong evidence of the value of combining learning and play. When this happens, changes in the chemical balance in the blood have been found to boost the production of the neurotransmitters needed for alertness and memory. John Locke, the eminent British philosopher, once said: I have always had a fancy that learning might bemade likeplayandrecreation tochildren; and that they might be brought to a desire to be taught, if only learning were proposed to them as a thing of delight and recreation, not a business or a task. Attention Is Captured Toys and play materials attract and hold a child’s attention through their colorful and novel appearance (Wood, 1986). Only after the play therapist has a child attending and listening can the play therapist teach the lesson. Sensory Input Young children think and learn primarily through their senses, not by abstract thought. The more senses used in the learning process, such as through three-dimensional play objects, the more the information is retained. Active Involvement Children tend to actively explore, become involved, and often get deeply engrossed in the play activities. Active, self-initiated learning experiences are more effective than just passively listen ing to instruction. Consolidation of Skills In addition to learning new things, play allows children to practice behaviors already known over and over again. Thus, play can consolidate skill development through repetitive practice (Piaget, 1951). The pleasure one gets from repeatedly shooting a basketball through a hoop can lead to solidifying that particular skill. In a similar manner, play helps children learn social skills, assertiveness, and anger control skills by frequently rehearsing them (Kelly, 1982). In play, one can practice a skill without fear of consequences for making a mistake. Learning by Example Toys such as stuffed animals, dolls, and puppets can be used to demonstrate and model the adaptive behavior the therapist wants the child to learn (Danger, 2003). Modeling to enhance problem-solving or social skills often involves a coping strategy. Thus, toy models initially display less-than-ideal coping skills and then gradually become more profcient (Bandura, 1977). Indirect Teaching Play therapists often provide guidance to their clients indirectly through the use of stories and metaphors. Storytelling is a universal and enduring way to teach children adaptive behaviors. Play therapists tell stories to indirectly teach children life lessons or solutions to their problems in a way that reduces defensiveness by bypassing the censorship of the ego and superego. The therapeutic use of stories allows children to distance themselves from painful themes and deal with them symbolically (Carlson & Arthur, 1999). The process of selecting appropriate therapeutic stories involves fnding those that refect the child’s identity and problem situations accurately and result in positive and achievable problem resolution. The use of stories in play therapy allows children to read or hear about others who have overcome problems similar to their own, giving them the opportunity to apply what they have learned from the stories to their own real-life situations. Published stories with therapeutic messages can be used (Pardeck, 1990), or play therapists can create their own individualized stories. The creative use of metaphors can also fuel learning, foster therapeutic insights, and pro vide new solutions to problems (Friedberg & Wilt, 2010; Linden, 1985). The metaphor is typ ically viewed as a verbal form of expression in traditional talk therapies and excludes nonver bal metaphors children use when they express themselves through play (Chesley, Gillett, & Wagner, 2008). Catharsis Catharsis involves the release of pent-up negative affect, such as anger or sadness. Throughout the history of humanity, catharsis has been considered to have a strong healing effect and has been applied in religion, literature, and drama. Catharsis is believed to produce therapeutic change by not only discharging deeply felt emo tions that have been stored up, but also by increasing one’s conscious awareness and control of those feelings. By deliberately expressing a strong emotion, one is likely to experience power over it. Also, catharsis allows one the satisfaction of completing some or all of a previously restrained or inter rupted sequence of self-expression. In the safety of the playroom, one can verbally or physically express that which would have occurred as a natural reaction to some upsetting experience had the expression not been thwarted at the moment (Nichols & Efran, 1985). TheRoleofPlay Play contributes to the effectiveness of catharsis in several ways: • the playroom provides a safe and supportive environment in which to vent negative affect. Physical play activities such as pounding clay allow the release of both physical tension and negative affect. Abreaction Abreaction, a psychoanalytic term, can be defned as a mental process in which repressedmemories of a traumatic event are brought to consciousness and are reexperienced with an appropriate release of negative emotions. The premise is that we have a basic need to assimilate emotionally signifcant experiences into a unifed, coherent conceptual system Unassimilated experiences will keep reemerging into consciousness so as to accomplish assimilation.
Those in the affected area should take necessary pre weatherman the preferred cautions immediately medicine world nashua nh cheap isordil uk. Adjectives such canes are ranked 1 to medicine used to treat chlamydia cheap 10mg isordil 5 according as severe or hard are used if a to medicine 7 day box buy isordil 10 mg cheap what is known as the Saffir cold spell exceeding two days is Simpson scale of strength: expected treatment 02 order isordil with visa. Category 1 — Hurricane has A freeze may or may not be ac central barometric pressure of companied by the formation of 28 symptoms rheumatoid arthritis purchase isordil without prescription. However, use of the term of 74 to 95 mph, is accompanied freeze usually is restricted for oc by a 4-5 foot storm surge and casions when wind or other con causes minimal damage. Florida Keys and killed 600 peo ple; Hurricane Camille, which gale Sustained winds within devastated the Mississippi coast the range of 39 to 54 mph (34 to in 1969, killing 256 and leaving 47 knots). A fall accumulating to 4 inches or more in depth in 12 hurricane eye the relatively hours, or calm area in the center of the 274 storm. In this area winds are light ice storm warning Reserved and the sky often is covered only for occasions when significant, partly by clouds. National Hurricane Center When a hurricane or typhoon the National Weather Service’s loses strength (wind speed), usu National Hurricane Center in ally after landfall, it is reduced to Miami has overall responsibility tropical storm status. In of Mexico, Caribbean Sea and the Atlantic, Caribbean and Gulf eastern Pacific Ocean. In the central Pacific, it is mation in the Pacific Ocean area June 1 through Nov. Sustained winds of 74 mph north along the East Coast, pro (64 knots) or higher, and/or ducing winds blowing from the b. Winds — Thunderstorm-re lated surface winds sustained or temperature-humidity index gusts 50 knots or greater. Hail — Surface hail three indicates the combined effect of quarters of an inch in diameter or heat and air moisture on human larger. A read aloft unless qualifying phrases ing of 75 would indicate discom such as hail aloft are used. Sleet, like tidal wave A term often used small hail, usually bounces when incorrectly for seismic sea wave. These waves are caused by un derwater earthquakes, landslides sleet (heavy) Heavy sleet is a or volcanoes and are sometimes fairly rare event in which the referred to as great sea waves. Forest Service usually from a cumulonimbus for avalanche-prone areas in the cloud, and touching the ground. It usually starts as a funnel cloud and is accompanied by a loud squall A sudden increase of roaring noise. On a local scale, it wind speed by at least 16 knots is the most destructive of all at and rising to 25 knots or more mospheric phenomena. If the public that difficult traveling or 276 hazardous road conditions are ex wind chill index Also known pected to be widespread. The wind chill index would be minus 22, for tropical storm A warm-core example, if the temperature was tropical cyclone in which the 15 degrees and the wind was maximum sustained surface blowing at 25 mph — in other winds range from 39 to 73 mph words, a temperature of 22 below (34 to 63 knots) inclusive. Heat Index Table Relative Humidity (Percentage) 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 Air Apparent Temperature Temp 110 123 130 137 143 150 105 113 118 123 129 135 142 149 100 104 107 110 115 120 126 132 138 144 95 96 98 101 104 107 110 114 119 124 130 136 90 90 91 93 95 96 98 100 102 106 109 113 117 122 85 84 85 80 78 79 75 73 73 70 67 67 Wind Chill Factor Table Air Temperature 35 30 25 20 15 10 5 0 -5 -10 -15 -20 -25 -30 -35 Wind Apparent Temperature mph 5 33 27 21 16 12 7 0 -5 -10 -15 -21 -26 -31 -36 -42 10 22 16 10 3 -3 -9 -15 -22 -27 -34 -40 -46 -52 -58 -64 15 16 9 2 -5 -11 -18 -25 -31 -38 -45 -51 -58 -65 -72 -78 20 12 4 -3 -10 -17 -24 -31 -39 -46 -53 -60 -67 -74 -81 -88 25 8 1 -7 -15 -22 -29 -36 -44 -51 -59 -66 -74 -81 -88 -96 30 6 -2 -10 -18 -25 -33 -41 -49 -56 -64 -71 -79 -86 -93 -101 35 4 -4 -12 -20 -27 -35 -43 -52 -58 -67 -74 -82 -89 -97 -105 40 3 -5 -13 -21 -29 -37 -45 -53 -60 -69 -76 -84 -92 -100 -107 45 2 -6 -14 -22 -30 -38 -46 -54 -62 -70 -78 -85 -93 -102 -109 Winds of more than 45 mph add little to the chilling. Wind shear itself is described as a sudden shift in well Hyphenate as part of a wind direction and speed. A plane compound modifier: She is a well flying through a microburst at dressed woman. Census Bureau, the 13-state re winter storm watch Alerts gion is broken into two divisions. The five Pacific division states Web See Internet; World are Alaska, California, Hawaii, Wide Web. See North Central region; Webster’s New World Northeast region; and South for College Dictionary See dictio the bureau’s other three regional naries. Webster’s Third New In Western Capitalize for the ternational Dictionary See film or book genre, but lowercase dictionaries. Western Hemisphere the continents of North and South weekend America, and the islands near them. Carribean the islands from weights Use figures: the the tip of Florida to the continent baby weighed 9 pounds, 7 of South America, plus French ounces. States and the northern shore of Major island elements are South America, separating the Cuba, Hispaniola (the island Caribbean Sea from the Atlantic shared by the Dominican Repub Ocean and including the Ba lic and Haiti), Jamaica, Puerto hamas, the Greater Antilles, and Rico, and the West Indies islands. Major island elements are the Central America the narrow nations of Barbados, Grenada, strip of land between Mexico and and Trinidad and Tobago, plus Colombia. Located there are Be smaller islands dependent in vari lize, Costa Rica, El Salvador, ous degrees on: Guatemala, Honduras, Nicaragua —Britain: British Virgin Is and Panama. It applies to most of posed of islands known as Basse the region south of the United Terre and Grande-Terre, plus five States except areas with a British other islands) and Martinique. Martin Island (the northern Guiana, is an additional excep half is held by France and is part tion. When the term is used in more West Indies See Western than its continental sense, it also Hemisphere. West Indies An island chain extending in an eastward arc be wheat It is measured in tween the southeastern United bushels domestically, in metric 279 tons for international trade. Whom is used when someone is the object of a verb or preposi whiskey, whiskeys Use the tion: the woman to whom the spelling whisky only in conjunc room was rented left the window tion with Scotch. Some ex white paper Two words, amples: lowercase, when used to refer to a citywide nationwide special report. Some examples: who’s, whose Who’s is a wide-angle wide-eyed contraction for who is, not a pos wide-awake wide-open sessive: Who’s there The same for street-wise in the street will See the shall, will entry wise youth (an exception to Web and subjunctive mood. Physical for a brand of wind-resistant descriptions, sexist references, sports jacket. To cite some examples, this means that: window dressing the —Copy should not assume noun. See —Use the same standards for 281 men and women in deciding below the normal standards for whether to include specific men literate writing. This does not mean ary notes, comparisons and that valid and acceptable words usage guidelines to help a writer such as mankind or humanity choose the correct word for a par cannot be used. See courtesy titles; divorcee; Any word listed in Webster’s the man, mankind entry; and New World may be used for the persons. If the dictionary cautions that a particular usage is objected to word-of-mouth (n. The dictionary provides guid ance on many idiomatic expres words as words the mean sions under the principal word in ing of this phrase, which appears the expression. The definition and occasionally in this book and spelling of under way, for exam similar manuals that deal with ple, are found in the way entry. When a news story must use a word as a word, workday place quotation marks around it. World Bank Acceptable in all references for International wrack See the rack, wrack Bank for Reconstruction and De entry. The Roman Catholic church is not a member but cooperates with the council in various pro grams. World Court this was an al ternate name for the Permanent Court of International Justice set up by the League of Nations. The term comes from the “Yellow Kid,” yam Botanically, yams and a comic strip in the New York sweet potatoes are not related, al World in 1895. It is based on the promise of God in the Book of Genesis that Israel would forever belong to Abraham and his de scendants as a nation. The Bible also frequently uses Zion in a general sense to denote the place where God is especially present with his people. Perhaps it is also an indication of how the coverage of sports continues to grow and how important it is to the overall news re port. Writing about sports requires a broad understanding of law and economics and psychology and sociology and mores. As the appetite grows, so too does the need for writing with style and consistency. Good sports writing depends on the same writing and reporting tools as any other story. See the volleyball entry for can the Associated Press recog an example of such a summary. In football, only Walter singular athletic unless otherwise Camp’s selections through 1924, in a formal title. The first All Follow the forms below for all America basketball team was major auto races: chosen in 1948. On second reference: the go to the first winner of two league, the pennant in the West, games. The spellings for some fre Figures in parentheses are the quently used words and phrases, player’s total in that category for some of which are exceptions to the season. Webster’s New World: backstop outfielder Use the First Game line shown ballclub passed ball here only if the game was the first ballpark pinch hit (v. It is in Tuesday’s Games cluded to show its placement Cincinnati (Gullett 14-2 and Nolan 4-4) at New York when needed. Louis, night ab r h bi ab r hbi Stone lf 4 0 0 0 Flannry 2 3 010 Only games scheduled. The figure showing the Philadelphia 010 200 000 3 place finish is followed by an ath San Diego 000 200 000 2 None out when winning run scored. Johnson 6-14 1-1 13, Ainge 9-15 0-0 19, Buckner 3-5, ed as performances, mention the 0-0 6, Williams 3-5 0-0 6, Wedman 11-11 0-2 26, Maxwell 1 word points on the first usage 1 1-2 3, Kite 3-5 1-2 7, Carr 1-3 0-0 3, Clark 1-2 0-0 2. He is 6 Hatcher 3-8 0-0 6, Immel 2-2 1-1 5, Haley 1-1 4-4 6, Miller 0 2 0-0 0, J. Berry 10-14 3-5 23, Glass 4-5 3-6 11, Wennington 5-9 For subdivisions: the Atlantic 4-4 14, Moses 5-6 0-0 10, Mullin 6-11 4-6 16, Jackson 1-3 5-5 Division of the Eastern Confer 7, Stewart 0-3 2-2 2, S. Jones 1-2 2-2 4, Bross 0-1 0-0 0, ence, the Pacific Division of the Rowan 0-2 0-0 0, Shurina 0-0 1-2 1, Coregy 0-0 0-0 0. Figures after each player’s last betting odds Use figures name denote field goals, free and a hyphen: the odds were 5-4, throws, free throws attempted he won despite 3-2 odds against and total points. Johnson 8-14 3-4 19, Scott 5-14 0-0 10, Cooper 1-5 2-2 4, McAdoo 6-13 0-0 12, McGee 4-7 4-5 14, Spriggs 4 structions: 3-to-2 odds, odds of 3 7 0-2 8, Kupchak 3-3 1-2 7. Note that a 154 pounds — Super Welter comma is used in giving pinfalls of more than 999. Some other terms: boxing the three major kidney punch A punch to an sanctioning bodies for profession opponent’s kidney when the al boxing are the World Boxing puncher has only one hand free. If the puncher Council and the International has both hands free, a punch to Boxing Federation. F 10 9 9 9 9 9 9 10 10 9 10 10 10 10 10 If a match ends early because Total — Ali 146, Frazier 143. In most boxing jurisdictions F 9 10 10 9 9 9 9 9 10 10 9 10 10 10 10 there is no such thing as a tech Total — Ali 145, Frazier 143. Example: Height 6-0 6-3 Canoeing, Men Reach 75 80 Kayak Singles, 500 meters Chest Normal 43 44 Heat 1 — Rudiger Helm, Germany, 1:56. Forearm 13 13 1/2 First Repechage — 1, Ladislay Soucek, Czech Republic, Waist 34 1/2 34 1:53.
Very simply stated medications adhd purchase isordil 10 mg online, psychiatry medicine number lookup cheap 10 mg isordil overnight delivery, as an academic discipline medications voltaren generic isordil 10 mg line, is at risk of quick disappearance medicine uses buy isordil now, if the tendency will continue to treatment for ringworm purchase genuine isordil reduce psychopath ology to a list of commonsensically derived and crudely simplified oper ational features, and if any reflection on the relations between phenomenal aspects of mental disorders is systematically discouraged by a combination of editorial, teaching and funding policies. There is an urgent need to re potentiate and re-emphasize clinical skills and sophistication. Continental phenomenology with its detailed descriptions of the structures of conscious ness (and its ongoing integration with analytic philosophy of mind and cognitive science [10, 12, 57]) is ideally suited as a conceptual framework for such a psychopathological reappraisal. It enables a precise description and classification of single anomalous experience in relation to its more encompassing intentional structures. The problem of reliability, often raised against the phenomenological approach, is not un solvable; it is a matter of intense relearning and a profound transformation of psychiatric culture. High reliability of the current operational criteria is seldom achieved; if so, then only at the precious cost of validity. Even if we continue with the polythetic operational diagnostic systems, we will still need a prototypical, phenomenologically informed hierarchy of disorders in order to improve our diagnostic practices and taxonomic research. Conventional approaches have aimed at identifying the main disorder of the patient (the single label model). This model has been considered insuffi cient in many circles [1, 2], which have pointed out its limitations in ad dressing the complexity of clinical conditions. The comprehensive diagnostic model that has received most attention over the past few decades has been the multiaxial diagnostic approach. In contrast to general narrative statements of comprehensive content, the multiaxial model ensures that all key domains are covered and that they are assessed and formulated in a structured manner . While the development of multiaxial systems continues, more encompassing comprehensive diagnostic models are emerging. They in clude multiaxial schemas supplemented by narrative statements focused on cultural framework or the uniqueness of the person of the patient. This chapter presents an examination of the development of the multi axial model, of experience obtained with established multiaxial diagnostic schemas, as well as of some of the newest comprehensive approaches. These pioneering biaxial schemas were shortly followed by triaxial ones (psychiatric syndromes, personality conditions, and biopsychosocial aetio pathogenic constellations) published by Bilikiewicz in Poland  and Leme Lopes in Brazil . The above-mentioned early proposals stimulated two decades later con siderable creative interest in multiaxial diagnosis and assessment in psych iatry, including the development of several multiaxial systems for use in adult psychiatry, child and adolescent psychiatry, and old age psychiatry. Most of these systems were composed of either four or five axes and represented an elaboration of the two main aspects of mental disorders, i. A comparative tabular presentation of early multiaxial systems in psychiatry is available elsewhere . Axis I of the system is used to record diagnoses of both mental (including personality) and physical disorders . The design of this simple system was intended to accommodate the considerable variation in the availability and quality of primary care in various parts of the world, a wide range in the professional background, training and experience of primary care workers, and socially engendered variation in the nature and extent of psychosocial problems presented. In spite of these difficulties, the international field test of this multiaxial system, carried out as a case vignette rating exercise in seven countries, demonstrated its usefulness for compiling lists and glossaries of psycho logical and social problems frequently seen in primary care settings in different parts of the world. It has been used extensively throughout China, and this experience revealed a number of problems with it . Its main objective is to improve psychiatric care, with training, research and administration as additional objectives. It has been reported [29, 30] that the preparations of these adaptations have included the participation, through extensive consultations, of most of the psychiatrists and a large number of representatives of other mental health professionals and general practitioners in the island. Attempts are under way to evaluate the usefulness of this schema for clinical care. This concern is particularly pertinent in non-industrialized areas, where professionals frequently work in primary care settings under constraints of both limited personnel and resources. To ensure its successful application, we are faced with the problem of having to strike the right balance between the wish for richness of information, comprehensiveness of disease description, simplicity and a manageable system . Despite international surveys reporting that the multiaxial approach is helpful as well as useful, the use of such systems has not been without problems. Actual use in daily clinical practice can be seen as a good test for its value as a professional instrument and here it has to be recognized that daily use by clinicians of the ``non-nosological' axes has been limited, despite an expressed interest in them by the very same clinicians. The particular value in clinical settings has primarily been linked to the elucida tion of complex clinical cases, and experiences have paid particular atten tion to the perceived use in daily clinical practice of the various multiaxial schemas [12, 31, 32]. With an increasing focus on the management of clinical care, cost reduction and efficiency of services, a multivariate approach  that provides a sys tematic scrutiny of clinical information may become increasingly demanded as a means to understand and predict service utilization and cost. For such purposes, the utility of a measurement of adaptive functioning is evident in estimating the need for services and in providing a tool for a better allocation of the available mental health services. Yet, the level of functioning and the decision whether to hospitalize or not are found to be clearly correlated , and psychiatric patients who are chronically ill are reported to have the lowest premorbid level of functioning . Similarly, it has been demonstrated that recovery from a moderate depression is more closely related to psychosocial circumstances than to the effects of psychopharmacological treatment . The routine use of a multiaxial formulation in daily practice could conse quently improve outcome assessment and be a useful tool in daily clinical evaluation. Despite that, we are still seeing that limited research has focused on the interaction between the utilization of services, the severity of the condition, and ratings of adaptive functioning or psychosocial stressors/ contextual factors. Also, the predictive value of a multiaxial rating for treatment outcome needs further elucidation. Moving from the psychiatric field to that of chronic pain, certain similar ities are found. It has been emphasized that only by applying a multidimen sional or multiaxial (dimensional and categorical domains) approach can the complexity of the pain condition be fully captured, and a unidimen sional approach is found to be inadequate in evaluating pain patients . Consequently, a multidimensional perspective is necessary to ensure that adequate treatment is instituted. It involved the participation of 147 respondents: for the Americas (27), Europe (83), Africa and the Middle East (9), and Asia and the South Pacific (28). Among the most highly rated recommendations for future diagnostic systems, was ``to promote the use and training in multiaxial diagnostic formulations', i. It provides descriptions of various situations related to human functioning and disability as well as a framework for their recording and coding in a meaningful, interrelated and easily accessible way. These dimensions are reflective of various aspects of body functions and structure, perform ance of activities, and involvement in life situations. Con textual factors include both personal and environmental factors and are seen as an essential component of the classification. A number of journal papers and books are now emerging on the applica tion of the Cultural Formulation to culturally diverse cases in a variety of clinical settings [42±46]. In addition to its specific cultural value, the Cul tural Formulation represents a methodological contribution towards a more comprehensive diagnostic model based on the combination of standardized and narrative components . A fundamental feature of this approach is to consider the patient in his/her totality and not just as a carrier of a disease. Its comprehensive diagnostic model is composed of a Standardized Multiaxial Diagnostic Formulation and a Personalized Idiographic For mulation. The fourth axis rates quality of life, which is emerging as a major descriptor of health status as well as an outcome measure of clinical care. The Personalized Idiographic Formulation involves a narrative state ment reflecting the joint perspective of the clinician, the patient, and the family with regard to clinical problems and their contextualization, positive factors of the patient, and expectations on restoration and promotion of health. Its roots are truly international, with growing trends for creative interaction among uni versal, continental and national levels. Well-designed validation studies at both inter national and local levels are needed to appraise empirically the effectiveness of these proposals and guide their further development. World Health Organization (1996) Multiaxial Classification of Child and Adolescent Psychiatric Disorders. World Health Organization (1992) International Statistical Classification of Dis eases and Related Health Problems. Paper presented at the Sympo sium ``Towards Integration in the International Classification', Annual Meet ing of the American Psychiatric Association, Chicago, 17 May. Paper presented at the Presidential Symposium ``To wards Integration in International Psychiatric Classification', Annual Meeting of the American Psychiatric Association, Chicago, 17 May. In current psychiatric classifications, disorders are arranged in groups according to major common themes or descriptive likeness. To help the clinician to make a diagnosis, mental disorders have been defined using explicit diagnostic criteria and algorithms. For most disorders, the definitions in volve exclusion as well as inclusion criteria. To assess the signs and symp toms required for making a diagnosis, a number of clinical assessment instruments have been developed for a variety of purposes and for use by clinicians or interviewers, in different settings. As a consequence, they share many of the advantages and limits that are inherent in the classification systems of today. The classifications of mental disorders are based on two types of criteria: pathogenetic criteria and descriptive criteria. The adoption of one or the other type of criteria defines two fundamentally different psychopatho logical models. The first is grounded in the concept of disease and presumes the existence of natural disease entities that are defined mainly by their aetiology and their pathogenesis. All of the disorders without known aetiology or pathophysiological process are grouped together on the basis of shared clinical features. Until recently, mental disorders were briefly defined in glossaries and described more extensively in textbooks. However, neither glossaries nor textbooks provided any rules for combining signs and symptoms into diag noses. In the early 1970s, a group of clinicians associated with the Washington University in St. Louis  developed explicit diagnostic criteria for a limited number of disorders and proposed specific algorithms for making psychiatric diagnoses. The procedure consists in defining mental disorders using explicit inclu sion and exclusion criteria. The definition of mental disorders involves monothetic as well as poly thetic criteria sets. In monothetic criteria sets all of the items must be present for the diagnosis to be made, whereas with polythetic criteria sets the diagnosis may be made even if the presentation includes only a proportion of the items that are proposed to define a disorder. They do however exclude items that may be clinically useful but which are not always present and they carry the implication that diagnostic features are more pathognomonic than is usually the case. Polythetic criteria allow for greater variation, but they also allow for more heterogeneity. On the whole, the procedure implies a strict adherence to a ``diagnostic grammar' , according to which any imprecision is considered a ``mistake' or ``error'. Formulations such as ``often', ``persistent', ``most of the time', ``acute', or ``several' are not exact statements, and need to be corrected. Explicit diagnostic criteria become operational diagnostic criteria when every single operation involved in their assessment has been explicitly and comprehensively defined . Individual criteria are translated into one or more questions that should allow a rigorous assessment of the various components that are included in the criterion. The questions are intended to highlight the presence or absence of a given sign or symptom, to deter mine whether they are clinically significant, to determine their duration and onset, to verify whether they represent a significant deviation from a previ ous premorbid state or whether they had always been present, and to establish that they are part of a specific mental disorder and cannot be attributed to a physical illness or the use of a psychoactive substance.
Arteritis has been diagnosed main manifestations of cavernous angiomas; such head C medicine 44175 purchase 10 mg isordil fast delivery. Evidence of causation demonstrated by either or ache should be coded to treatment myasthenia gravis order line isordil either of these accordingly medications zithromax cheap isordil uk. The variability in the fea constriction syndrome have been excluded by tures of 6 medications causing dry mouth buy cheap isordil 10mg. The major risk is of little diagnostic value until other signs are present 5 medications for hypertension cheap isordil 10mg online, of blindness due to anterior ischaemic optic neur such as focal decits, seizures, altered cognition or dis opathy, which can be prevented by immediate steroid orders of consciousness. Any new headache and/or facial or neck pain ful lling criterion C Diagnostic criteria: B. A cervical artery lesion has been demonstrated, or a surgical or radiological intervention has been A. Evidence of causation demonstrated by either or tion to other local signs of a cervical artery both of the following: disorder, or has led to the diagnosis of a cer 1. Severaloftheseinvestigations with other signs of the cervical artery are commonly needed since any of them can be normal. Either of the following: tebral artery dissection and persisting for more than 1 1. The dissection has stabilized, spontaneously or tion, spontaneously or through treatment, rather through treatment than onset of the cervical artery dissection. Headache has persisted for >3 months after sta bilization of the dissection Comments: Headache with or without neck pain can be D. Research is needed to iden usually unilateral (ipsilateral to the dissected artery), tify risk factors for such persistent headache; a previous severe and prolonged (for a mean of four days). Migraine may play a role, as may anxiety/ However, it has no constant specic pattern and it depression. Associated signs (of cerebral or retinal ischaemia and local signs) are Description: Headache caused by the surgical procedure common: a painful Horner’s syndrome, painful tinnitus of carotid endarterectomy. International Headache Society 2018 84 Cephalalgia 38(1) Diagnostic criteria: Pain can also involve the neck and face. In particular, arterial dissection has been excluded Notes: by appropriate investigations. In particular, arterial dissection has been excluded plasty or stenting remain scarce. The third subform is disorder part of the rare hyperperfusion syndrome, often preced ing a rise in blood pressure and the onset of seizures or 6. Description: Headache caused by the endovascular pro cedures of cervical angioplasty and/or stenting. Inoneseriesof21patientsstented diuse, progressive and severe, and associated with for idiopathic intracranial hypertension, 10 patients other signs of intracranial hypertension. It can also be exhibited ‘stent-headaches’ diering from those experi unilateral and sudden, and sometimes very misleading, enced before treatment, located at the site of the stent, in mimicking 1. Treatment should be started as early as possible three of the following: and includes symptomatic treatment, heparin followed by 1. International Headache Society 2018 86 Cephalalgia 38(1) a) severe, occurring abruptly within seconds 3. Migraine and triggered by angiography following the procedure and lasting a few days (in these cases, the patient should have both c) a migraine attack, occurring in a person who diagnoses: the appropriate type or subtype of has 1. Intra-arterial carotid or vertebral angiography has been performed Diagnostic criteria: C. Evidence of causation demonstrated by either or the angiography both of the following:! The disease is self and/or showering limiting in one to three months, with disappearance of c) present or recurrent during 1 month the arterial abnormalities (hence ‘reversible’) and, after onset, with no new signicant head almost always, resolution of the headache. Any new headache fullling criterion C acterized clinically by severe diuse headaches that B. Probability of causation demonstrated by all of ache recurring over a few days or weeks. International Headache Society 2018 88 Cephalalgia 38(1) Note: Diagnostic criteria: 1. Any new headache fullling criterion C has been excluded by appropriate investigations. Acute headache is often the presenting symptom and Diagnostic criteria: can be the sole symptom of this disorder. Recurrent attacks of migraine with typical, hemi plegic or prolonged aura, fullling criterion C Description: Headache caused by dissection of an intra B. Either or both of the following: ing symptom preceding subarachnoid haemorrhage or 1. Recurrent headache fullling criterion C ally the rst symptom of the disease, appearing at a B. These episodes are associated cluster headache-like attacks have been rarely reported. Headache attributed to syndrome of retinal vasculopa onset headache in another subset. New attacks of migraine-like aura, with or with aura, fullling criterion C out mild headache, fullling criterion C B. Migraine-like attacks are secondary to and part of more of the following: the clinical manifestations of the syndrome 1. Note: Comment: the syndrome of retinal vasculopathy with cerebral leukoencephalopathy and systemic manifest 1. Other clinical manifestations are visual impair a small-vessel disorder associated with progressive ment from vascular retinopathy, and neurological amyloid deposition in the walls of cortical and lepto decline and premature death due to progressive enhan meningeal vessels. The diagnosis in such cases may be diagnosis of pituitary apoplexy suspected from family history. Recurrent migraine-like attacks, with or without aura, fullling criterion C Comments: the rare clinical syndrome of pituitary B. A genetic or non-genetic chronic intracranial vas apoplexy is an acute, life-threatening condition. It is culopathy has been demonstrated one of the causes of non-aneurysmal subarachnoid C. Acute haemorrhagic pituitary infarction has been embolic cerebellar infarcts presenting as thunder diagnosed clap headache. Late-life migraine accompaniments as a sionals from a special writing group of the Stroke cause of unexplained transient ischemic attacks. Transient ischemic attacks in young patients: a Predictors of intracranial pathologic ndings in thromboembolic or migrainous manifestation A patients who seek emergency care because of head ten-year follow-up of 46 patients. Headache as a crucial symptom in the etiology of convexal subar achnoid hemorrhage. Response of matic intracerebral haemorrhage headaches to non-narcotic analgesics resulting in Abadie V, Jacquin A, Daubail B, et al. Am J Emerg Med prognostic value of headache on early mortality in 1995; 13: 43–45. Headaches in needed when the computed tomography scan is intracerebral hemorrhage survivors. Warning signs in hematoma of arterial origin: a report of four cases and subarachnoid hemorrhage: a cooperative tudy. Avoiding pitfalls in the Subdural haematoma: a potentially serious conse diagnosis of subarachnoid hemorrhage. N Engl J Med bifurcation aneurysm: case report and review of lit 1997; 336: 28–40. Spontaneous follow-up of 71 patients with thunderclap headache acute subdural hematomas. Arteriovenous malformations and migraine: ing as headache and acute subdural hematoma. Resolution of of persistent headache following stroke: a 3-year classic migraine after removal of an occipital lobe follow-up. Images from headache: a ‘‘noisy’’ headache: Thunderclap headache without subarachnoid dural arteriovenous stula resembling new daily hemorrhage associated with regrowth of previously persistent headache. Clinical fea vascular malformations and subarachnoid tures of cerebral cavernous malformations patients! Giant cell angioma presenting as atypical facial and head (temporal) arteritis: involvement of the vertebral pain. Intraventricular cerebral cavernomas: a series of 12 patients and review of the literature. Primary inal or leptomeningeal angiomatosis angiitis of the central nervous system: diagnostic (Sturge Weber syndrome) criteria and clinical approach. Primary (granulomatous) angiitis of the central Planche V, Chassin O, Leduc L, et al. Sturge–Weber nervous system: a clinicopathologic analysis of 15 syndrome with late onset hemiplegic migraine-like new cases and a review of the literature. N Engl J Med 2013; 368: central nervous system vasculitis: analysis of 101 1971–1979. Rheum Dis Clin North Am to cervical carotid or vertebral artery 1993; 19: 941–953. Cervical-artery dissections: pre recommendations for the management of large disposing factors, diagnosis, and outcome. J Neurol Neurosurg endarterectomy headache and the role of the Psychiatry 2005; 76: 1084–1087. Long-term results of stenting versus sinus stenting endarterectomy for carotid-artery stenosis. Headache in lateral sinus in idiopathic intracranial hypertension carotid artery stenting and angiography. Non aneur ysmal thunderclap headache with diuse, multifocal endarterial procedure segmental and reversible vasospasm. The clinical of postoperative headache after endovascular coil and radiological spectrum of reversible cerebral embolization of unruptured intracranial aneurysms. Headaches during angiography and endovascular Hemorrhagic manifestations of reversible cerebral procedures. Characteristics of Epidemiology, pathophysiology, diagnosis, and headache during and after digital substraction management of intracranial artery dissection. Post-angio Intracranial dissection mimicking transient cerebral graphy headaches. Eect of intracranial vasculopathy revascularization on headache associated with Moyamoya disease in pediatric patients. Caucasian patients with Moyamoya angiopathy – a Vahedi K, Boukobza M, Massin P, et al.
Order 10mg isordil with visa. Does Drinking Coffee Dehydrate You?.