By B. Aldo. C. R. Drew University of Medicine and Science. 2018.

I used to get it before going out for nights out with friends purchase 100 mg zenegra fast delivery, and it kinda stopped me from doing it as I’d rather not go out and stress about the feeling purchase zenegra 100mg fast delivery, but now I have it [2] all the time so it doesn’t really make a difference anymore zenegra 100mg free shipping. The sufferer cannot deal with what is causing the anxiety cheap zenegra 100mg on-line, nor avoid it order zenegra 100 mg on line, because there is no clear cause for anxiety. In fact, the sufferer frequently knows, at least cognitively, that there is really nothing to worry about. Generalized anxiety disorder is most likely to develop between the ages of 7 and 40 years, but its influence may in some cases lessen with [4] age (Rubio & Lopez-Ibor, 2007). I was driving home, my three little girls were in their car seats in the back, and all of a sudden I couldn‘t breathe, I broke out into a sweat, and my heart began racing and literally beating against my ribs! Symptoms of a panic attack include shortness of breath, heart palpitations, trembling, dizziness, choking sensations, nausea, and an intense feeling of dread or impending doom. Panic attacks can often be mistaken for heart attacks or other serious physical illnesses, and they may lead the person experiencing them to go to a hospital emergency room. Panic attacks may last as little as one or as much as 20 minutes, but they often peak and subside within about 10 minutes. They focus their attention on the thoughts and images of their fears, becoming excessively sensitive to cues that signal the possibility of threat (MacLeod, Rutherford, Campbell, Ebsworthy, & Holker, [6] 2002). They may also become unsure of the source of their arousal, misattributing it to situations that are not actually the cause. As a result, they may begin to avoid places where attacks have occurred in the past, such as driving, using an elevator, or being in public places. Phobias A phobia (from the Greek word phobos, which means “fear‖) is a specific fear of a certain object, situation, or activity. The fear experience can range from a sense of unease to a full- blown panic attack. Most people learn to live with their phobias, but for others the fear can be so debilitating that they go to extremes to avoid the fearful situation. A sufferer of arachnophobia (fear of spiders), for example, may refuse to enter a room until it has been checked thoroughly for spiders, or may refuse to vacation in the countryside because spiders may be there. A common phobia is social phobia, extreme shyness around people or discomfort in social situations. Social phobia may be specific to a certain event, such as speaking in public or using a public restroom, or it can be a more generalized anxiety toward almost all people outside of close family and friends. People with social phobia will often experience physical symptoms in public, such as sweating profusely, blushing, stuttering, nausea, and dizziness. They are convinced that everybody around them notices these symptoms as they are occurring. The most incapacitating phobia is agoraphobia, defined as anxiety about being in places or situations from which escape might be difficult or embarrassing, or in which help may not be [7] available (American Psychiatric Association, 2000). Typical places that provoke the panic attacks are parking lots; crowded streets or shops; and bridges, tunnels, or expressways. People (mostly women) who suffer from agoraphobia may have great difficulty leaving their homes and interacting with other people. Phobias affect about 9% of American adults, and they are about twice as prevalent in women as in men (Fredrikson, Annas, Fischer, & Wik, 1996; Kessler, Meron-Ruscio, Shear, & Wittchen, [8] 2009). In most cases phobias first appear in childhood and adolescence, and usually persist into adulthood. As he describes it, I have got this obsessive-compulsive disorder where I have to have everything in a straight line or everything has to be in pairs. I’ll put my Pepsi cans in the fridge and if there’s one too many then I’ll put it in another cupboard somewhere. Before I can relax, I have to move all the leaflets and all the books and put them in a drawer. We may continuously replay a favorite song in our heads, worry about getting the right outfit for an upcoming party, or find ourselves analyzing a series of numbers that seem to have a certain pattern. Washing your hands once or even twice to make sure that they are clean is normal; washing them 20 times is not. The sufferers know that these rituals are senseless, but they cannot bring themselves to stop them, in part because the relief that they feel after they perform them acts as a reinforcer, making the behavior more likely to occur again. I decided to change the kitchen around one day, get all new stuff, so I threw everything Attributed to Charles Stangor Saylor. They may lose interest in things they used to enjoy; startle easily; have difficulty feeling affection; and may experience terror, rage, depression, or insomnia. The symptoms may be felt especially when approaching the area where the event took place or when the anniversary of that event is near.

With the increased use of digital radiography zenegra 100mg otc, the incidence of lost radiographs should decrease order 100mg zenegra free shipping. Digital dental sofware programs inter- nally record the date an image is entered into the fle buy generic zenegra 100 mg on line. Dentists are encouraged to keep complete and accurate dental records to facilitate dental identi- fcation and to protect the dentist in case of legal actions buy zenegra 100 mg cheap. When examining antemortem radiographs forensic dentists should remember that additional treatment may have been com- pleted on that patient in the interim period generic 100 mg zenegra with amex. Ignoring that possibility may lead to recording points of discrepancy that are, in fact, explain- able. Every practical attempt should be made to procure the latest available treatment record. Advances in dental material science have changed dental identifcation methodology. Te technological advances in dental resin materials coupled with the increased demand for esthetic restorations have further complicated some forensic comparisons. Te use of amalgam flling material is declining and is being replaced with the use of increasingly varied composite resin materials. Dental techniques, including microdentistry and the use of fowable resins, have made the postmortem examination process more complex. Forensic dentists must inspect restorations during postmortem examinations with a great deal more scrutiny than in the past, when “tooth colored” restorations were usually only seen in anterior teeth. Te restored surfaces of a tooth may appear more extensive in the postmortem exam than is recorded in an antemortem record for a specifc tooth. Te forensic dentist that assumes this to be a discrepancy may make the error of forgetting that additional dental treatment to that tooth may have occurred afer the latest antemortem record entry. Multisurface amalgam restorations may have been replaced with full crowns by a diferent dentist. Tese occurrences can Forensic dental identifcation 183 be labeled as “explainable discrepancies” or “logical progressions” and are not necessarily reasons to exclude a record in the compari- son process if other overwhelming information indicates that the two records are records of the same individual. When examining the antemortem radiographs, care must be taken to ensure that the x-rays are oriented correctly. If the antemortem x-rays are duplicates and not labeled as L or R and the flm dimple location is indeterminable, then the forensic dentist must request additional information from the submitting dentist, most ofen the original flms. Original flms should always be acquired and examined since duplicate flms are very ofen incorrectly oriented (see Chapter 10). Even if fve restorations are consistent among the ante- mortem and postmortem records, signifcant doubt must be raised if one unexplained exclusionary item is noted. For example, if the antemortem records show a full crown on a certain tooth and the postmortem record shows an occlusal amalgam on the same tooth, the comparison results in exclusion. Once a body is released, it may be buried or cremated before discovery that a record is inadequate or an image is substandard. Te accurate reconstruction of the antemortem record is an equally important phase of the identifcation process. With careful attention to detail, dental identifcations can be completed in a relatively short time period and at a reasonable cost when compared to other means of identifca- tion. In some instances, the forensic dentist may fnd it useful to consider the new technologies available to assist in the comparison process. With advances in this and other forensic identifcation sciences, new methods will become more commonplace. Trough the cooperative eforts of medical examiners, coroners, law enforcement ofcials, and forensic odontologists, dental com- parisons can be efciently and accurately completed to identify or exclude. Uses and disclosures for which consent, an authori- zation, or opportunity to agree or object is not required, uses and disclosures about decedents. Paper presented at American Academy of Forensic Sciences, Annual Meeting, F7, New Orleans. Paper presented at American Academy of Forensic Sciences, Annual Meeting, F6, Seattle. Te diversity of adult dental patterns in the United States and the implications for personal identifcation. Establishing personal identifcation based on specifc patterns of missing, flled, and unrestored teeth. Computer-aided dental identifcation: An objective method for assessment of radiographic image similarity.

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She subsequently The Humanistic Nursing Theory was originally earned her doctor of philosophy from Georgetown formulated as a way for nurses to define nursing order 100 mg zenegra with amex. That is purchase 100 mg zenegra free shipping, a way to illuminate the values and mean- Josephine Paterson and Loretta Zderad met in ings central to nursing experiences generic zenegra 100mg without prescription. Zderad were nursing visionaries who emphasized Their joint project was to create a new program synthesis and wholeness rather than reduction and that would encompass the community health com- logical/mathematical analysis zenegra 100mg on line. They challenged the ponent and the psychiatric component of the notion that the reductionistic approach is the graduate program effective zenegra 100 mg. This started a collaboration, di- touchstone of explanatory power, and they postu- alogue, and friendship that has lasted for over 45 lated an “all-at-once” character of existence in years. They shared and developed their concepts, nurses’ experiences of being in the world. They led approaches, and experiences of “existential phe- the way to many of the contemporary nursing the- nomenology,”which evolved into the formal Theory ories that emphasize the caring aspects of nursing of Humanistic Nursing. It speaks to the essences of nursing and embraces They were hired as “nursologists” by a forward- the dynamics of being, becoming, and change. It is also a theory that provides a three-pronged approach to the improvement of pa- methodological bridge between theory and practice tient care through clinical practice, education, and by providing a broad guide for nursing “dialogue” research. Nursing, as seen through Humanistic Nursing They worked with the nurses at Northport from Theory, is the ability to struggle with another 1971 until 1978 on this project, running workshops through “peak experiences related to health and suf- that incorporated their theory. In 1978 there was a fering in which the participants are and become in change in hospital administration that entailed a accordance with their human potential” (Paterson reorganization of services. According to Josephine Paterson and community, or from humanity for help Loretta Zderad, in nursing, the purpose of this dia- with some health-related issue. A nurse, a logue, or intersubjective relating, is, “nurturing the group of nurses, or the community of well-being and more-being of persons in need” nurses hearing and recognizing that call respond in a manner that is intended to In nursing, the purpose of this dialogue, or help the caller with the health-related intersubjective relating, is,“nurturing the need. What happens during this dialogue, well-being and more-being of persons in the “and” in the “call and response,” the need. Humanistic Nursing Theory is dialogue, the “and” in the “call and response,” the grounded in existentialism and emphasizes the “between,” is nursing. The method is phenomenological in- The new adventurer in Humanistic Nursing quiry (Paterson & Zderad, 1976 p. Engaging Theory may at first find some of these terms and in the phenomenological process sensitizes the in- phrases awkward. When I spoke to a colleague of quiring nurse to the excitement, anticipation, and the “moreness” and of “relating all at once,” she re- uncertainty of approaching the nursing situation marked, “Oh, oh, you’re beginning to sound just openly. Consider Josephine Paterson’s flective immersion in the lived phenomena” own description of humanistic nursing: “Our ‘here (Zderad, 1978, p. During this interchange, the nurse calls forth all If asked to conceptualize Humanistic Nursing that she is (education, skills, life experiences, intu- Theory succinctly, I would have to say, “call and ition, etc. Through this paradigm, Josephine Paterson the nurse must provide what it is that the patient is and Loretta Zderad have presented a vision of calling for. Remember the response of the nurse is nursing that is amenable to variation in practice guided by all that she is. This includes his or her settings and to the changing patterns of nursing professional role, ethics, and competencies. A nurse, a group of nurses, or the community Look at the conceptual framework of Human- of nurses hearing and recognizing that call respond istic Nursing Theory in Figure 11–1 to help explain in a manner that is intended to help the caller with and illustrate some of its basic concepts and as- the health-related need. It also Humanistic Nursing Theory, when we speak of includes past experiences with persons in the human beings, we mean patients (e. A person becomes a patient when he viduality as incarnate human beings who exist in or she sends a call for help with some health-related this particular space at this particular time, with problem. The person hearing and recognizing the circumscribed resources and in a physical body that call is a nurse. A nurse, by intentionally choosing to senses, filters, and processes our experiences to become a nurse, has made a commitment to help which we assign subjective meanings. In humanistic nursing we say to be a unique human being with his or her own that each person is perceived as existing “all at particular gestalt (see Figure 11–3). This task You can easily see that a nursing theory that is can be done with tenderness, dignity, and with based in the human context lends itself to phenom- masterful technical skills that make the procedure enological inquiry rather than reductionism, which almost unnoticeable. I once watched as a nurse po- attempts to remove subjective humanness and sitioned and suctioned a patient; as she performed strives to achieve detached objectivity. The early the task, she made sure that she also repositioned phenomenologists saw their goal as the examina- the little basket of flowers that she had placed by tion and description of all things, including the the patient’s bedside. The repositioning of the flow- human experience of those things, in the particular ers really had nothing to do with the technique of way that they reveal themselves.

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