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Free listing can be used as a rapid scanning technique in groups buy discount vytorin 20mg on line cholesterol q score, or can be used as an interview exercise vytorin 20mg with visa lowering cholesterol with diet and exercise, one-on-one buy generic vytorin 20mg line cholesterol ratio risk factor. Free lists are important because they provide natural language information that can be used in questionnaire construction or in educational materials which are culturally appropriate for a specific group. It is useful to record unexpected responses in free listing exercises, words and phrases that we subsequently need to be described and discussed in greater ethnographic detail, since these labels provide a window into unknown behaviours or into previously unexplored elements of the culture. For this reason, information on demographic characteristics of the informants is collected, in conjunction with the free listing. This creates the opportunity to use the data to analyse relationships between drug use domains and other variables such as: cultural orientation; intra cultural variation; gender differences in knowledge; or economic and educational differences, since it would be expected that the answers to free listing questions might differ based on the sex, age, income, educational level and other culturally significant factors. Free listings can also be used to generate ethnographic questions and to suggest the wording for questions in quantitative survey instruments. Free listing was used in the qualitative field assessment of the cross culturally applicable “model” core questionnaire that is included in this guide. Chapter 10 includes the free listing protocol and questions used in the field assessment. Free listing was extremely useful in identifying the different drugs used (and their local street names) at each of the six sites. Some of the more sophisticated uses of free listing data treat these nominal or categorical data as variables which can be used in statistical procedures, to provide more extensive explorations of the relationships among informants or among the elements in a cultural domain. The advanced techniques for analysing free listings are described in Systematic Data Collection (Weller and Romney 1988). They start with the elements of a well defined cultural domain, and they allow the researcher to explore the relationships of elements within that domain. Data collection is accomplished by asking informants to make judgements about the similarities and differences of the domain elements to one another using one of these techniques, such as a pile sort. A pile sort is a qualitative technique that uses visual aides to allow informants to create unconstrained classifications of items within a cultural domain. The most common method is to place pictures, real objects, written labels, or combinations of these on cards. The informant is asked to classify all of the elements by placing the cards into piles. The respondents are allowed to form as many or as few piles as they want, based on any similarities or differences they perceive among the elements. This information can then be stored as a simple computer data base and analysed by one of several ethnographic programmes which create a numerical comparison of the variables called a distance matrix. Distance matrices can be analysed using statistical techniques which transform the numbers into a visual representation of the relationships of informants to other informants, or of variables to other variables. The two most common statistical techniques associated with the use of these methods are cluster analysis and multidimensional scaling (Kruskal and Wish 1978). The cluster analysis technique can be used to create and explore cultural typologies of the domain. It allows a researcher to identify hierarchical structural relationships in a complex data set. Both of these techniques are complimentary to the qualitative and descriptive approaches common in ethnography. The results of the project demonstrated that the students were linking risks within bounded risk areas. Two works (Weller and Romney 1988; Bernard 1988) provide detailed descriptions on how these techniques can be integrated into other types of ethnographic research. These assumptions about the nature of "cultural truth" and informant accuracy are derived from a model of culture that is probabilistic in nature. Consensus theory models of culture are developed through a formalised set of questions about similarities and differences in shared experience and knowledge on the part of informants. Consensus theory melds ethnographic survey questions with a formal mathematical model based on approaches used by psychometricians in test construction, and influenced by signal detection theory and latent structural analysis procedures (Romney, Weller, and Batchelder 1986). One important attribute of consensus theory is that it is designed to work with a common condition in ethnography, the situation where we know the correct questions to ask, but do not know which are the correct, or the most nearly correct cultural answers to those questions. At the present time, consensus modelling can be accomplished through the use of true-false, fill-in-the-blank, and multiple choice question formats, and is being tested for use with rank order formats. Cultural knowledge that cannot be assessed through these formats cannot be tested using this process, at this time. Some recent uses of consensus theory include measuring intra cultural variation in diseases judged on concepts of contagion, severity, hot/cold treatments, consensus about the existence of a subculture of corporeal punishment (Weller, Romney, and Orr 1986), and a study of hypertension among Ojibwa Indians in Canada (Garro 1987).

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Syncope 80 Instruments for tooth extraction Main instruments of extraction are: 1 order vytorin 30 mg amex serum cholesterol ratio uk. Forceps for upper teeth with crown and they are also classified according to the class of tooth to be extracted and their beaks are with cleft cheap vytorin 30 mg elevated cholesterol definition. Forceps for extraction of lower teeth without crown 30mg vytorin for sale cholesterol test chemist, their beaks are without cleft. Special forceps for roots in the upper jaw Bayonet-forceps is a specially designed for extraction of retained roots of upper wisdom tooth and roots of all classes of the upper teeth. Wisdom teeth forceps for the upper jaw 83 Figure 13: wisdom forceps for the upper jaw 84 Special beaks of the forceps They are designed in such a way that, they are suitable for extraction of - Misplaced or partly erupted teeth, - Where mouth is small, - For bicuspids to be able to extract standing in front of the patient, - To remove retained roots, etc. As wheel and axel Position of the patient Position of the patient may be sitting, semi sitting or lying according to the condition of the patient. Position of Operator For extraction upper teeth the doctor stands in front of the patient, the arm of the dental chair raised for the upper left side. Apply traction the pressure which should be applied to dislocate should depend on the thickness of the jaw i. Therefore the pressure should be applied to the buccal aspect of the maxilla for extraction of premolars and molars of upper teeth. The various spaces cellulitis will be difficult to be discussed here but the only ones which are more serious and which should be given attention as they may cause air way distress will be discussed as follows: General 1. Infection in a facial plane that threatens the air way, chest, orbit, or intracranial- extension. Only the shortest and most direct and dependent route to the abscess cavity or cellulitis, with preservation of anatomical structures and placement of the incision in esthetically acceptable area. Use blunt dissection with hemostats advancing into all areas of involved space to ensure that all loculi of pus have been allowed to drain. Clean drains in a sterile fashion daily, advance them gradually, and remove them when the drainage stops or becomes minimal. Medical supportive care the patients who need hospitalization are with all the following conditions: 1. Significant clinical presentations, high fever 0 (>101 F), dehydration, malaise, inability to take fluids, trismus, neurological changes, or lower cervical and deep space involvement. Compliance- a patient who is unreliable or incapable of properly caring for him or herself. Need for parentral antibiotics: based on presentation of the patient, previous culture and sensitivity testing or acute illness. Other considerations need for other medical or surgical consultation for patient management; organisms resistant to oral antibiotics, bone involvement, or need for surgical debridement. During the initial examination, ligation of obvious bleeding vessels and application of occlusive pressure dressings may be necessary to control the bleeding. The pressure dressings also provide temporary immobilization of the hard and soft tissues. The lip should be examined bimnually and bidigitally inorder to avoid missing penetrating wound of the lip. The wound should be inspected for: • Foreign bodies and • Cleaned thoroughly 103 Wound healing depends on the following: • Minimal tissue damage • Debridement of necrotic tissue • Maximal tissue perfusion and oxygenation • Proper nutrition and moist environment Rx:- • Careful cleansing of the skin and wounds is an essential preliminary step in the care of all facial injuries. Soft tissue wounds heal in three general ways:- • Primary intention refers to the reapproximated tissues. This type of healing is seen with surgical incisions that are closed with sutures or well approximated by adhesive plasters. Fracture of teeth a) Fracture of crown (only enamel) b) Fracture of crown (enamel and dentine) c) Fracture of crown (with exposure of the pulp) d) Fracture of roots, (oblique horizontal, apical and vertical) 105 Cause Car accident Fall accident Homicidal injury Common sites of trauma of teeth: Upper frontal teeth Lower frontal teeth in order of priority. Diagnosis: History Physical examination Dental X-ray Treatment If patient comes to the hospital with in 6-12 hours inter-dental fixation and administration of antibiotics (for intrusion and extrusion) If Fracture of crown, Restoration If Fracture of crown with exposed pulp, root canal therapy or extraction depending on the availability of the dental facilities. Fracture of the oro-facial region Signs of fracture A) Certain • deformity, • dislocation, • abnormal movement • Creptation • Post X-ray pictures B) Uncertain • Pain, • heamatoma, • loss of function 107 Systematic examination 1. Manual investigation, pain on pressure or push o Palpation of deformities, o creptation, o Sensitivity of the trigeminal nerve. Intra-oral examination, • Ability to open the mouth, • Disturbance of the occlusion, • Deviation of the jaw (upper/lower) • Inspect for the posterior displacement or swelling of the tongue • Inspect for the presence of broken tooth or denture 108 General management and treatment 1.

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This may Try to choose someone who knows for Work and Pensions be harder to cope with if you are you very well cheap vytorin 20mg fast delivery cholesterol levels chart ireland. Financially buy cheap vytorin 20 mg on line cholesterol and saturated fat in shrimp, you may need urgent • What to do after a death in Family and friends can help you advice and support best vytorin 30 mg cholesterol mayo clinic. It is always worth talking to your undertaker or religious adviser to see if they can help. Knowing all about the stages of labour and what to expect can help you to feel more in control when the time comes. If you plan to give birth in hospital • Your wash bag with toothbrush, • Dressing gown and slippers. You may want to • A loose, comfortable outfit to include the following: wear after you have given birth and to come home in. It should not • Clothes (including a hat) and restrict you from moving around or nappies for the baby. If more than rest and care for you cannot use your mobile, make your baby, so do as much sure that you have a phone card or planning as you can in change for the phone. Work out how you will get to If labour starts early • Buy tinned and dried food hospital or the midwifery unit, as it Labour can start as early as like beans, pasta and rice. If a neighbour has said that they will take you, make an alternative arrangement just in case they are not in. Home births If you are planning to give birth at home, discuss your plans and what you need to prepare with your midwife. You are likely to need the following: • clothes (including a hat) and nappies for the baby • about 24 super-absorbent sanitary towels. Important numbers Keep a list of important numbers in your handbag or near your phone. This small amount of signs of labour when the time sticky pink mucus is called the really comes, but if you are in any ‘show’. If you are During a contraction, your uterus losing more blood, it may be a gets tight and then relaxes. You may sign that something is wrong, so have had these throughout your phone your hospital or midwife pregnancy – particularly towards the straight away. When of water surrounding your baby you are having regular contractions may break before labour starts. Your contractions handy if you are going out, and will become longer, stronger and put a plastic sheet on your bed. If your waters break before labour starts, you will notice either a Labour is painful, so it is important Other signs of labour to learn about all the ways you can slow trickle from your vagina • Backache or the aching, heavy or a sudden gush of water that relieve pain. Write down what you want in your birth plan, but remember that you should keep an open mind. You may find that you want more pain relief than you had planned, or your doctor or midwife may suggest more effective pain relief to help the delivery. The following techniques can help • Ask your partner to massage you you to be more relaxed in labour, (although you may find that you and this can help you to cope don’t want to be touched). This can make you feel more in control and less frightened about what is going to happen. Read books like this one, talk to your ‘Gas and air’ (Entonox) midwife or doctor and attend antenatal classes if they are This is a mixture of oxygen and available in your area. Try kneeling, walking around Water can help you to relax How it works or rocking back and forwards. The water will be chance to practise using the mask kept at a temperature that is or mouthpiece if you attend an comfortable for you but antenatal class. Side effects There are no harmful side effects for you or the baby, but it can make you feel lightheaded. Some women also find that it makes them feel sick or sleepy or unable to concentrate on what is happening. It is probably most effective You are given an intramuscular during the early stages, when many injection. You might prefer How it works anaesthetic and opioid) are then to ask for half a dose initially, to Electrodes are taped onto your back administered through this tube. For most heart will need to be continuously women, an epidural gives complete monitored by a machine.

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There are different ways give you a definite answer about statistical chance of having a of carrying out screening cheap vytorin online american express xenical cholesterol. All women should have dating and Screening results More information nuchal translucency scans between Some maternity services give the • www buy 30 mg vytorin cholesterol ratio definition. As with • an ultrasound scan detects an amniocentesis cheapest generic vytorin uk cholesterol medication without side effects, a rapid result can be These tests will give you a definite abnormality that is associated obtained, but if all the chromosomes diagnosis of Down’s syndrome and with a genetic disorder are going to be checked the results sometimes other abnormalities. Within are faced with a painful decision the fluid are cells that contain What happens? A small sample of sure you see the appropriate health and may be a little uncomfortable. Usually, the fluid will be tested Help and support for Down’s syndrome and other serious syndromes. They can give you more information or put you in touch with parents If all the chromosomes have to who decided to continue with a pregnancy in which an abnormality be looked at, it can take up to had been detected or those who decided to have a termination. When deciding whether or not to go ahead with this test, try to balance the risk of miscarriage against the value of the result to you. Waiting times in clinics can vary, and this can be particularly difficult if you have young children with you. Make sure you get answers to your questions or the opportunity to discuss any worries. You should be asked to keep your maternity notes at home with you 1 2 3 4 5 and to bring them along to all your antenatal appointments. This refers to the length of your pregnancy in weeks from the date of your last menstrual period. These are the results of your urine tests for half of your pregnancy, it may be a sign of pre-eclampsia protein and sugar. Early in pregnancy the top of the uterus, or ‘fundus’, can be felt low down, below your 12 navel. If there is a big difference (more than two weeks), ask your midwife what action is appropriate. Up to about 30 weeks, your baby moves head (or bottom, or feet if they are in the breech position) about a lot. If your baby stays with its bottom downwards, They may say that the head is ‘engaged’ – this is when this is a breech (‘Br’) presentation. If all of your baby’s head can be felt above the means your baby is lying across your abdomen. Usually it is nothing to worry about, but tell your midwife or doctor if it suddenly gets worse as this may be a sign of pre-eclampsia (see page 67). They want to make you feel provide care for the majority of happy with all aspects of the care women at home or in hospital. The professionals during labour and, if everything is as previous complications in you see should introduce themselves straightforward, will deliver your pregnancy or chronic illness. If any complications develop You can request to see an but if they forget, during your pregnancy or delivery, obstetrician if you have any don’t hesitate to you will also see a doctor. It may help may also meet student midwives to make a note • An anaesthetist is a and student doctors. After the of who you doctor who specialises in providing birth, you and your baby will have seen and pain relief and anaesthesia. If you be cared for by midwives and what they have said decide to have an epidural, it will maternity support workers. In many hospitals your midwife can arrange for you to talk to an anaesthetist about analgesia or anaesthesia if you have medical or obstetric problems. Some provide antenatal education and teach antenatal exercises, Research relaxation and breathing, active You may be asked to positions and other ways you • A paediatrician is a participate in a research project can keep yourself fit and healthy doctor specialising in the during your antenatal care or during pregnancy and labour. This may be to test a postnatal exercises to tone up your your baby after the birth to new treatment or to find out muscles.

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