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  • Section Chief of Urology, Jesse Brown Veterans Administration Hospital, Chicago, Illinois

Cascara sagrada (sacred bark) * Introduced as a palliative for constipation (non-homoeopathic) arrhythmia word breakdown 20 mg telmisartan visa, fifteen drops of fluid extract here it restores normal function by its tonic effects pulse pressure 84 generic 80 mg telmisartan mastercard, but it has a wider sphere of action hypertension young adults purchase 80mg telmisartan free shipping, as careful provings will show. Carcinosinum (a nosode from carcinoma) * It is claimed the Carcinosin acts favorably and modifies all cases in which either a history of carcinoma can be elicited, or symptoms of the disease itself exist. Indigestion, accumulation of gas in stomach and bowels; rheumatism - Cancerous cachexia. Castanea vesca (chestnut leaves) * A useful remedy in whooping-cough, especially in the early stage, with dry, ringing, violent, spasmodic cough. Relationship - Compare: Pertussin - Whooping-cough (when symptoms return again after being allayed). Castor equi (rudimentary thumb-nail of the horse) * General action on thickening of the skin and epithelium. Nervous women who do not recover fully, but are continually irritable, and suffer from debilitating sweats. Extremities - Severe drawing, erratic pain and stiffness in small joints, fingers, toes, ankles, etc. Ears - Ringing, roaring, pulsating, with deafness; words and steps re-echo; chronic middle-ear catarrh; accumulation of ear-wax. Modalities - Worse, dry, cold winds, in clear fine weather, cold air; from motion of carriage. Ceanothus americanus (new jersey tea) * this remedy seems to possess a specific relation to the spleen. Relationship - Compare: Tinospora cordifolia (a Hindoo medicine for chronic cases of fever with enlarged spleen). Cedron (rattlesnake bean) * Periodicity is the most marked characteristic of this drug. Fever - Chilliness towards evening; then frontal headache extending into parietal region. Cenchris contortrix (copperhead snake) * Like the other snake poisons, it affects the system profoundly. Heart - Feels distended, fills whole chest, as if it fell down in abdomen; sharp stitches, fluttering under left scapula. Cereus bonplandii (a night-blooming cereus) Mind - Great desire to work and to be doing something useful. Cerium oxalicum (oxalate of cerium) * Spasmodic reflex vomiting and spasmodic cough are within the sphere of this remedy. Chamomilla Anthemis nobilis (german chamomile) * the chief guiding symptoms belong to the mental and emotion group, which lead to this remedy in many forms of disease. Irritable, dry, tickling cough; suffocative tightness of chest, with bitter expectoration in daytime. Extremities - Violent rheumatic pains drive him out of bed at night; compelled to walk about. Sleep - Drowsiness with moaning, weeping and wailing during sleep; anxious, frightened dreams, with half-open eyes. Respiration - Coryza with much lachrymation, sneezing, and discharge of clear water from the nose. Chelidonium majus (celandine) * A prominent liver remedy, covering many of the direct reflex symptoms of diseased conditions of that organ. Modalities - Worse, right side, motion, touch, change of weather, very early in morning. Bitter taste, no appetite; constipation, hypochondriasis languor, congestion of liver; burning weight in liver and stomach. Chenopodium anthelminticum (jerusalem oak) * Characteristic pain in scapula very marked. Back - Intense pain between angle of right shoulder-blade near spine, and through the chest. Aphis chenopodii glauci (plant-lice from chenopodium) * Partakes largely of the properties of the plant upon which the insect lives. Back - Severe pains in region of lower inner angle of left shoulder-blade, running into chest.

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Smoke-Free Policies: Cost-Effectiveness Numerous studies have examined the effectiveness of smoke-free policies in relation to pulse pressure 22 generic 80 mg telmisartan with mastercard health outcomes blood pressure pulse buy discount telmisartan 20mg on-line, but relatively little research has explored the cost-effectiveness of smoke-free policies hypertension vasoconstriction buy discount telmisartan 40 mg line. Two recent reviews of tobacco control programs identified only two studies that addressed the cost-effectiveness of smoke-free policies. Using a simulation model, Mudarri147 examined the potential benefits and 218 Monograph 21: the Economics of Tobacco and Tobacco Control costs of a proposed U. Two studies have examined the cost-effectiveness of smoke-free policies in low-income countries. Higashi and colleagues156 examined the cost-effectiveness of four tobacco control interventions, including smoking bans in public places and worksites, in Viet Nam, a low-income country with very high smoking rates among men. The modeling of the costs of the smoke-free intervention included initial investment in passing legislation, mass media advocacy in the first year, production of nonsmoking signs in different forms in the first and sixth years, 5 years of ongoing management, and 10 years of law enforcement activities. The implementation of effective smoking bans in both public places and worksites, relative to the status quo, was found to avert the loss of approximately 3. Donaldson and colleagues157 investigated the cost-effectiveness of implementing a complete ban on smoking in public places in the Indian state of Gujarat relative to the existing partial ban. Costs of implementation as well as direct medical costs associated with smoking were included. The authors concluded that a complete ban is a cost-saving alternative to the existing partial ban. The guidelines for Article 8 provide practical guidance for countries to enact and implement smoke-free policies, and stress that smoke-free legislation should be simple, clear, and enforceable and should involve civil society as an active partner. Additionally, in many countries smoking is still permitted in hospitals and other health care settings, a situation that is particularly important to address because health care professionals and health care workplaces often serve as examples for other professions and settings. Around the world, the tobacco industry has been a key factor impeding the enactment of comprehensive smoke-free laws, 219 Chapter 6: the Impact of Smoke-Free Policies because these laws work to reduce tobacco use prevalence and consumption and decrease its social acceptability, and thus pose a serious threat to the tobacco industry. Hospitality industry workers, because of the intensity and duration of their exposure, often experience the most immediate benefits of smoking restrictions, including rapidly improved respiratory and cardiac health. Positive health outcomes associated with smoke-free policies are observable immediately and are sustained over time. A consensus across much of the literature, particularly among those studies that adhere to rigorous methodological criteria, is that implementation of smoke-free policies does not cause negative economic effects for businesses, including hospitality venues such as bars and restaurants. Rather, benefits may accrue to businesses, including improved productivity, reduced absenteeism, and lower employee health care costs. Studies should also assess the economic impact of these laws, both on health care costs and business revenues, particularly for hospitality sector businesses. Research is needed to enhance understanding of how best to encourage individuals, landlords, and governments to ban smoking in these private indoor settings, and to assess the health and economic consequences of these bans. The question of how comprehensive smoke-free policies affect overall government revenues remains an area for further study. Finally, as smoking bans in outdoor locations such as beaches, parks, and other settings become more common, it will be important to understand the health and economic implications of these measures. Comprehensive smoke-free policies in workplaces reduce active smoking behaviors including cigarette consumption and smoking prevalence. Overall, rigorous empirical studies (largely from high-income countries) using objective economic indicators find that smoke-free policies do not have negative economic consequences for businesses, including restaurants and bars, with a small positive effect being observed in some cases. Around the world, the tobacco industry is the greatest obstacle to enacting comprehensive smoke-free policies, often by arguing, despite strong evidence to the contrary, that smoke-free policies harm businesses. Other economic benefits of smoke-free policies for businesses include increased worker productivity, health care savings, reduced cleaning and maintenance costs, and reduced insurance costs. Profits over people: tobacco industry activities to market cigarettes and undermine public health in Latin America and the Carribbean. Deaths from secondhand smoke exposure in the United States: economic implications. The economic burden of smoking and secondhand smoke exposure in rural South-West China. Burden of household environmental tobacco smoke on medical expenditure for Japanese women: a population-based study.

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Simply put fetal arrhythmia 38 weeks telmisartan 40 mg on line, it defines a person whose biological birth sex conflicts with his or her psychological gender arrhythmia reference guide buy telmisartan 40mg online. Transvestite A person and especially a male who adopts the dress and often the behaviour associated culturally with the opposite sex especially for purposes of emotional or sexual gratification heart attack karaoke demi lovato generic 20mg telmisartan. More recently, it has been reclaimed by nonheterosexuals as a word used to describe themselves. Practices that are not heterosexual, hetero normative or gender binary are part of queer practices. Queer theory challenges either/or, essentialist notions of homosexuality and heterosexuality within the mainstream discourse, and instead posits an understanding of sexuality that emphasizes shifting boundaries, ambivalences, and cultural constructions that change depending on historical and cultural context. This emphasis on non-straightness lends queer theory its assimilationist, anti-essentialist cast, for when one considers the realms of fantasy, the unconscious, repression, and denial, much that is ostensibly considered "heterosexual" easily falls within the realm of queer. Ideology Ideology as a term is rooted in the writings of German philosophers Karl Marx and Friedrich Engels. They defined Ideology as "The ideas of the ruling class are in every epoch the ruling ideas. The class which has the means of material production at its disposal, has control at the same time over the means of mental production. The function of ideology would be the continual reproduction of the means of production and thereby to ensure the continuous dominance of the ruling class. It makes the subordinate classes accept a state of alienation against they would otherwise revolt. This definition has since been critiqued and gone through many changes the Italian Marxist philosopher Antonio Gramsci has contributed significantly to expand our understanding of the term. Secondly, Gramsci argued to expand ideology from a set or formal ideas to include "common sense. The French critic Louis Althusser built on this concept to articulate two types of "apparatuses" for maintaining dominance: "repressive state apparatuses", for instance, the army, police, etc. Ideology, along with discourse, are the two central concepts in understanding the cultural transmission of ideas, values, and assumptions. Discourse Discourse is generally used to designate the forms of representation, codes, conventions and habits of language that produce specific fields of culturally and historically located meanings. For example, two notably distinct discourses can be used about various jihadi movements describing them either as "freedom fighters" or "terrorists". In other words, the chosen discourse provides the vocabulary, expressions and perhaps also the style needed to communicate. Discourse is closely linked to different theories of power and state, at least as long as defining discourses is seen to mean defining reality itself. This conception of discourse is largely derived from the work of French philosopher Michel Foucault. Introduction While masculinities are produced and structured through specific practises of everyday life in every society, conflict, violence and war may be seen as the swift horses on which they ride like the horsemen of the Apocalypse to spread and reinforce themselves. The central concern of this module is to develop a mode of understanding how specific practices of masculinities and femininities are produced by violent conflict and in turn contribute to producing violence. In the light of contemporary neo liberal economic surge, marked by massive shifts in the nature of agricultural societies and their produce, privatisation of public services and resources, destruction of labour protection and the under employment of male workers along with exploitation of female labour, it becomes imperative to examine the intersections between gender, violent conflict and development. It has been suggested by many researchers that contemporary globalisation buttressed by an unprecedented militarisation at the global and local level is neither temporary nor an incidental aspect of capitalism but its very nature and that conflict and war are its organising principles. An important aspect of this globalisation of conflict and militarisation of economies is its sustenance through the production of specific kinds of gendered ideologies and practices, not so much because of but as centrally embedded ideas of this mode of organising nations and their relationships with each other. Within this module we will examine this aspect in the context of 19th century histories of the relationship between the colonisers and the colonised in south Asia. They were obliquely reinforced by the writings on war of authors like Ernst Junger. Comparing modern war with elemental eruptions like volcanic outbursts, Junger saw war as the supreme force essential for the survival and good health of nations. If one of these youths had been asked his motives for taking the field, the answer, certainly would have been less clear. The meaning an importance given to a military weapon and to the sexual weapon are equal. This module will be taught through the following three sub themes: a) the evolution of modern warfare: the emergence of levee en masse and total mobilisation transformed warfare from an exploit of the elite to a totalising activity that now dominates the world system and its ruling ideologies. The democratisation of war and its consequences on families, society and nation states.

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The artery xopenex arrhythmia purchase telmisartan 80 mg on-line, in company with the nerve and vein blood pressure chart daily buy 20mg telmisartan with amex, re-enters the pelvis by the small sciatic foramen blood pressure readings by age buy telmisartan 40 mg free shipping, and gets under cover of a dense fibrous membrane (obturator fascia), between which and the obturator muscle, it courses obliquely downwards and forwards to the forepart of the perinaeum. At the place where the vessel re-enters the pelvis, it lies removed at an interval of an inch and a half from the perinaeum, but becomes more superficial as it approaches the subpubic space, N. The levator ani muscle separates the pudic vessels and nerves from the sides of the rectum and bladder. The principal branches given off from the pudic artery of either side, are (1st), the inferior hemorrhoidal, to supply the lower end of the rectum; (2nd), the transverse and superficial perinaeal; (3rd), the artery of the bulb; (4th), that which enters the corpus cavernosum of the penis, N; and (5th), the dorsal artery of the penis. Having now considered the relations of the pelvic organs in a lateral view, we are better prepared to understand these relations when seen at their perinaeal aspect. In another figure is seen a vessel ("accessory pudic"), which, passing between the base of the bladder and the levator ani muscle, crosses in contact with the left lobe of the prostate. The summit of the bladder covered by the peritonaeum; G *, its side, not covered by the membrane. The median line of the body is marked as the situation where the opposite halves unite and constitute a perfect symmetrical figure. Every structure-superficial as well as deep-which occupies the median line is either single, by the union of halves, or dual, by the cleavage and partition of halves. The two sides of the body being absolutely similar, the median line at which they unite is therefore common to both. Union along the median line is an occlusion taking place by the junction of sides; and every hiatus or opening, whether normal or abnormal, which happens at this line, signifies an omission in the process of central union. The sexual peculiarities are the results of the operation of this law, and all forms which are anomalous to either sex, may be interpreted as gradations in the same process of development; a few of these latter occasionally come under the notice of the surgeon. The region which extends from the umbilicus to the point of the coccyx is marked upon the cutaneous surface by a central raphe dividing the hypogastrium, the penis, the scrotum, and the perinaeum respectively into equal and similar sides. The umbilicus is a cicatrix formed after the metamorphosis of a median foetal structure-the placental cord, &c. In the normal form, the meatus urinarius and the anus coincide with the line of the median raphe, and signify omissions at stated intervals along the line of central union. When between these intervals the process of union happens likewise to be arrested, malformations are the result; and of these the following are examples:-Extrusion of the bladder at the hypogastrium is caused by a congenital hiatus at the lower part of the linea alba, which is in the median line; Epispadias, which is an urethral opening on the dorsum of the penis; and Hypospadias, which is a similar opening on its under surface, are of the same nature-namely, omissions in median union. Hermaphrodism may be interpreted simply as a structural defect, compared to the normal form of the male, and as a structural excess compared to that of the female. Spina bifida is a congenital malformation or hiatus in union along the median line of the sacrum or loins. As the process of union along the median line may err by a defect or omission, so may it, on the other hand, err by an excess of fulfilment, as, for example, when the urethra, the vagina, or the anus are found to be imperforate. As the median line of union thus seems to influence the form of the hypogastrium, the genitals, and the perinaeum, the dissection of these parts has been conducted accordingly. By removing the skin and subjacent adipose membrane from the hypogastrium, we expose the superficial fascia. The adipose tissue, which in some subjects accumulates on either side of the linea alba, renders this depression more marked in them. From the central linea alba to which the fascia adheres, outwards on either side to the folds of both groins, the membrane forms two distinct sacs, which droop down in front, so as to invest the testicles, E**, and penis in a manner similar to that of the skin covering these parts. As the two sacs of the superficial fascia join each other at the line B, coinciding with the linea alba, they form by that union the suspensory ligament of the penis, which is a structure precisely median. The superficial fascia having invested the testicles each in a distinct sac, the adjacent sides of both these sacs, by joining together, form the median septum scroti, E. In this region the membrane is found to adhere laterally to the rami of the ischium and pubes; whilst along the median perinaeal line the two sacs of which the membrane is composed unite, as in the scrotum, and form an imperfect septum. In front of the anus, beneath the sphincter ani, the fascia degenerates into cellular membrane, one layer of which is spread over the adipose tissue in the ischiorectal space, whilst its deeper and stronger layer unites with the deep perinaeal fascia, and by this connexion separates the urethral from the anal spaces. The superficial fascia of the hypogastrium, the scrotum, and the perinaeum forming a continuous membrane, and being adherent to the several parts above noticed, may be regarded as a general double sac, which isolates the inguino-perinaeal region from the femoral and anal regions, and hence it happens that when the urethra becomes ruptured, the urine which is extravasated in the perinaeum, is allowed to pass over the scrotum and the abdomen, involving these parts in consequent inflammation, whilst the thighs and anal space are exempt.

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References:

  • https://academic.oup.com/bmb/article-pdf/52/1/58/799919/52-1-58.pdf
  • https://www.ohsu.edu/sites/default/files/2019-10/OPAL-K%20Sleep%20Disorders%20Care%20Guide%20v.10.2019F_1.pdf
  • http://www.dcf.ks.gov/services/pps/documents/ppm_forms/policy_and_procedure_manual.pdf
  • https://ct1.medstarhealth.org/content/uploads/2015/12/10-Lumbar-decompression.pdf
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