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By G. Hamil. New York Law School.

The second generally arrives later cheap viagra super active 25 mg visa whey protein causes erectile dysfunction, with concerns about whether and how children should help out purchase 100mg viagra super active erectile dysfunction treatment non prescription. Studies have examined families with dis- abled young children (Curry 1995; Olkin 1999, 92–111), but few have At Home—with Family and Friends / 99 looked at how chronic diseases and disability affect adult filial relation- ships. Society seemingly views fully functioning legs as essential prerequisites to meaningful parent- ing, despite scant evidence that children of disabled parents suffer (Olkin 1999). Public consternation reflects two erroneous expectations: unless fully ambulatory, parents cannot care effectively for children; and when parents fail (as seems inevitable), responsibility will devolve to the state. Given these concerns, mothers with mobility problems attract the greatest hostility; fathers presumably have wives who do what’s needed. Many women cannot even find physicians willing to counsel them on birth control, pregnancy, or childbirth (Fine and Asch 1988, 21). Six obstetricians turned away one woman wheelchair user before a seventh agreed to de- liver her baby. Most hurtful was the censure of her now-former best friend, who asserted that her pregnancy was selfish and she would “ruin” her child’s life. Her baby is now one year old, and she acknowledges the usual ups and downs of new parenthood. Certain progressive chronic diseases affecting mobility, like diabetes, do heighten pregnancy risks, for mother and child. Candy Stoops worried about how her newly diagnosed neurologic disease would affect her pregnancy. I said that I didn’t want to abort unless I absolutely had to—if it meant danger to the baby as well as me, we might consider it. My neurologist called a specialist in New York to talk it over, and he said, “Go for it! But my neurologist felt that we could keep things under control enough for 100 / At Home—with Family and Friends me to at least have this baby. Candy said she had “a natural delivery because they had no idea how I was going to react under anesthesia,” but then for seven years she took medications with significant side effects. She and her husband decided not to have other children, worried that it might worsen her disease. I wasn’t able to go bike riding with him or skating—my husband did that. Instead of working as she would have done, she stayed home with her boy. Admittedly, she couldn’t carry him, so when he was fourteen months old,“he could climb up and down the stairs because he had to. One woman feels badly that she cannot pick up and carry a child tugging at her sleeve. Another woman spends hours playing cards and board games with her children in lieu of trips to the playground. Bonnie Winfield was six when her thirty-year-old father, a third-generation dairy farmer, developed polio from a rare vaccine reaction. My parents didn’t really sit my brothers and me down—we were all under eight—and try to explain what is going on with Dad. We just knew, all of sudden, we had this stuff in the house, from the portable commode to shower curtains on bathroom doors because Dad’s wheelchair couldn’t get through with the door there. We had a long hallway that connected our bedrooms, and my dad used to take his walker and practice walking going up and down. You knew Dad’s legs didn’t work, and you knew he was trying to get them to work again. Us kids had to go out and round up the cows, and we learned to milk, and my mom and my grandmother milked. When people would hold open doors for Dad, we kids would just walk through. But that was what he wanted because he didn’t want to be treated any differently than anybody else. In contrast to Bonnie, many children have grown and left home by the time their parents develop mobility problems. So the long-standing rela- tionships between parents and children shape the impact of mobility diffi- culties.

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Disc swelling may be due to raised intracranial pressure (papilledema viagra super active 25 mg without prescription erectile dysfunction diabetes medication, q viagra super active 50 mg without prescription erectile dysfunction doctor omaha. The clinical history, visual acuity and visual fields may help determine the cause of disc swelling. Recognized causes of disc swelling include: ● Unilateral: Optic neuritis Acute ischemic optic neuropathy (arteritic, nonarteritic) Orbital compressive lesions, for example, optic nerve sheath meningioma (Foster Kennedy syndrome) Graves ophthalmopathy (through compression of retinal veins by myositis) Central retinal vein occlusion Infiltration: carcinoma, lymphoma, granuloma Raised intracranial pressure (papilledema; more usually bilateral) ● Bilateral: Raised intracranial pressure (papilledema) Malignant hypertension - 95 - D Disinhibition Hypercapnia High CSF protein, as in Guillain-Barré syndrome Any of the unilateral causes Cross References Foster kennedy syndrome; Papilledema; Pseudopapilledema; Retinal venous pulsation; Visual field defects Disinhibition Disinhibited behavior is impulsive, showing poor judgment and insight; it may transgress normal cultural or social bounds. The disinhibited patient may be inappropriately jocular (witzelsucht), short-tempered (verbally abusive, physically aggressive), distractible (impaired atten- tional mechanisms), and show emotional lability. A Disinhibition Scale encompassing various domains (motor, intellectual, instinctive, affective, sensitive) has been described. Disinhibition is a feature of frontal lobe, particularly orbitofrontal, dysfunction. This may be due to neurodegenerative disorders (frontotemporal dementia, Alzheimer’s disease), mass lesions, or be a feature of epileptic seizures. Cross References Attention; Emotionalism, Emotional lability; Frontal lobe syndromes; Witzelsucht Dissociated Sensory Loss Dissociated sensory loss refers to impairment of selected sensory modalities with preservation, or sparing, of others. The anterior spinal artery syndrome also leaves the dorsal columns intact. Conversely, pathologies confined, largely or exclusively, to the dorsal columns (classically tabes dorsalis and suba- cute combined degeneration of the cord from vitamin B12 deficiency, but probably most commonly seen with compressive cervical myelopa- thy) impair proprioception, sometimes sufficient to produce pseudoa- thetosis or sensory ataxia, while pain and temperature sensation is preserved. A double dissociation of sensory modalities on opposite sides of the trunk is seen in the Brown-Séquard syndrome. Small fibre peripheral neuropathies may selective affect the fibers which transmit pain and temperature sensation, leading to a glove- and-stocking impairment to these modalities. Neuropathic (Charcot) joints and skin ulceration may occur in this situation; tendon reflexes may be preserved. Cross References Analgesia; Ataxia; Brown-séquard syndrome; Charcot joint; Main suc- culente; Myelopathy; Proprioception; Pseudoathetosis; Sacral sparing - 96 - Dorsal Guttering D Divisional Palsy The oculomotor (III) nerve divides into superior and inferior divi- sions, usually at the superior orbital fissure. The superior division or ramus supplies the superior rectus and levator palpebrae superioris muscles; the inferior division or ramus supplies medial rectus, infe- rior rectus and inferior oblique muscles. Isolated dysfunction of these muscular groups allows diagnosis of a divisional palsy and sug- gests pathology at the superior orbital fissure or anterior cavernous sinus. However, occasionally this division may occur more proxi- mally, at the fascicular level (i. This may reflect the topographic arrangement of axons within the oculomotor nerve. Proximal superior division oculomotor nerve palsy from metastatic subarachnoid infiltration Journal of Neurology 2002; 249: 343-344 Cross References “False-localizing signs”; Oculomotor (iii) nerve palsy Dix-Hallpike Positioning Test - see HALLPIKE MANEUVER, HALLPIKE TEST Doll’s Eye Maneuver, Doll’s Head Maneuver This test of the vestibulo-ocular reflex (VOR) is demonstrated by rotating the patient’s head and looking for a conjugate eye movement in the opposite direction. Although this can be done in a conscious patient focusing on a visual target, smooth pursuit eye movements may compensate for head turning; hence the head impulse test (q. The maneuver is easier to do in the unconscious patient, when testing for the integrity of brainstem reflexes. While directly observing the eyes, “catch up” saccades may be seen in the absence of VOR. Measuring visual acuity (dynamic visual acuity, or illegible E test) two to three lines may be dropped on visual acuity with head movement compared to visual acuity with the head still if VOR is impaired. Cross References Bell’s phenomenon, Bell’s sign; Caloric testing; Coma; Head impulse Test; Oculocephalic response; Supranuclear gaze palsy; Vestibulo- ocular reflexes “Dorsal Guttering” Dorsal guttering refers to the marked prominence of the extensor tendons on the dorsal surface of the hand when intrinsic hand mus- cles (especially interossei) are wasted, as may occur in an ulnar nerve lesion, a lower brachial plexus lesion, or a T1 root lesion. Benign - 97 - D Double Elevator Palsy extramedullary tumors at the foramen magnum may also produce this picture (remote atrophy, a “false-localizing sign”). In many elderly people the extensor tendons are prominent in the absence of significant muscle wasting. Cross References Wasting “Double Elevator Palsy” This name has been given to monocular elevation paresis. It may occur in association with pretectal supranuclear lesions either contralateral or ipsilateral to the paretic eye interrupting efferents from the rostral interstitial nucleus of the medial longitudinal fasciculus to the superior rectus and inferior oblique subnuclei. Brain 1992; 115: 1901-1910 Cross References Bell’s phenomenon, Bell’s sign Downbeat Nystagmus - see NYSTAGMUS Dressing Apraxia - see APRAXIA Drooling - see SIALORRHEA Dropped Head Syndrome Dropped head syndrome (head droop or head drop) refers to forward flexion of the head on the neck, such that the chin falls on to the chest (cf. This syn- drome has a broad differential diagnosis, encompassing disorders which may cause axial truncal muscle weakness, especially of upper thoracic and paraspinous muscles.

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X Field notes may record practical details order 50mg viagra super active with mastercard causes of erectile dysfunction in your 20s, methodologi- cal issues purchase viagra super active 25mg with mastercard erectile dysfunction doctor called, personal thoughts, preliminary analyses and working hypotheses. X Data analysis takes place in the field so that hypotheses can be discussed with key informants. X The community should be left on good terms and any written reports should be given back to the people for their interest and personal comments. It could be influenced also by the methodo- logical standpoint of the person who teaches on your re- search methods course. DECIDING WHICH APPROACH TO USE For quantitative data analysis, issues of validity and relia- bility are important. Quantitative researchers endeavour to show that their chosen methods succeed in measuring what they purport to measure. They want to make sure that their measurements are stable and consistent and that there are no errors or bias present, either from the respon- dents or from the researcher. Qualitative researchers, on the other hand, might ac- knowledge that participants are influenced by taking part in the research process. They might also acknowledge that researchers bring their own preferences and experience to the project. Ask two researchers to analyse a transcript and they will probably come up with very different results. This may be because they have studied different subjects, 110 HOW TO ANALYSE YOUR DATA/ 111 or because they come from different political or methodo- logical standpoints. It is for this reason that some re- searchers criticise qualitative methods as ‘unscientific’ or ‘unreliable’. This is often because people who come from quantitative backgrounds try to ascribe their methods and processes to qualitative research. For qualitative data, the researcher might analyse as the re- search progresses, continually refining and reorganising in light of the emerging results. For quantitative data, the analysis can be left until the end of the data collection process, and if it is a large survey, statistical software is the easiest and most efficient method to use. For this type of analysis time has to be put aside for the data input process which can be long and laborious. However, once this has been done the analysis is quick and efficient, with most software packages producing well presented graphs, pie charts and tables which can be used for the final report. QUALITATIVE DATA ANALYSIS To help you with the analysis of qualitative data, it is use- ful to produce an interview summary form or a focus group summary form which you complete as soon as possible after each interview or focus group has taken place. This includes practical details about the time and place, the participants, the duration of the interview or focus group, and details about the content and emerging themes (see Figures 2 and 3). It is useful to complete these forms as 112 / PRACTICAL RESEARCH METHODS soon as possible after the interview and attach them to your transcripts. The forms help to remind you about the contact and are useful when you come to analyse the data. The method you use will depend on your research topic, your personal preferences and the time, equipment and fi- nances available to you. Also, qualitative data analysis is a very personal process, with few rigid rules and procedures. It is for this reason that each type of analysis is best illu- strated through examples (see Examples 8–11 below). Formats for analysis However, to be able to analyse your data you must first of all produce it in a format that can be easily analysed. This might be a transcript from an interview or focus group, a series of written answers on an open-ended questionnaire, or field notes or memos written by the researcher. It is useful to write memos and notes as soon as you begin to collect data as these help to focus your mind and alert you to significant points which may be coming from the data. These memos and notes can be analysed along with your transcripts or questionnaires. You can think of the different types of qualitative data analysis as positioned on a continuum (see Fig. HOW TO ANALYSE YOUR DATA/ 113 Interviewee: ________________ D at e o f I n t erview:________________ P l ac e : ________________________ Time of Interview:________________ Duration of Interview: __________ Where did the interview take place? Did any issues arise which need to be added to the interview schedule for next time? Have I promised to send any information or supply them with the results or a copy of the transcript?

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