By J. Yugul. Abraham Baldwin Agricultural College. 2018.
If it is a culture with which you already have a certain amount of familiarity buy imitrex 25mg on line, and vice versa generic imitrex 50mg online, you should find it easier to gain access buy 50 mg imitrex mastercard. However generic 50mg imitrex fast delivery, if it is a secret or suspicious community, youmayfinditmuchhardertogainaccess. If you do expect to encounter difficulties, one way to over- come this problem is to befriend a member of that com- munity who could act as a gatekeeper and help you to get to know other people. Obviously, it is important to spend time building up the required level of trust before you can expect someone to introduce you into their community. If it is not possible to befriend a member of the community, you may have to approach the person or committee in charge, firstly by letter and then in person. First impressions are important and you need to make sure that you dress and act appropriately within the community. Some people will be suspicious of the motives of a researcher, especially if they’re not familiar with the research process. In the early stages it is better to answer any questions or suspicions directly and honestly rather HOW TO CARRY OUT PARTICIPANT OBSERVATION/ 103 than try to avoid them or shrug them off. ETHICS Because of the nature of participant observation, there tends to be more issues involving ethics and morals to consider. As you intend to become part of a specific group, will you be expected to undertake anything illegal? This could happen with research into drug use or crime syndicates where people may not trust you until you be- come one of them and join in their activities. Would you be prepared to do this and put up with any consequences which could arise as a result of your activities? If the group is suspicious, do you intend to be completely honest about who you are and what you’re doing? How would you deal with any problems which may arise as a conse- quence of your deception? What if your participation within a group causes pro- blems, anxiety or argument amongst other members? Would you be prepared to withdraw and ruin all your hard work for the sake of your informants? Also, there are many personal considerations and dilemmas which you need to think about before undertaking participant obser- vation, as illustrated below: 104 / PRACTICAL RESEARCH METHODS PERSONAL CONSIDERATIONS WHEN ENTERING THE FIELD Some people will not accept you. Are you prepared to spend many months studying others and not indulging in talk about yourself? Some researchers overcome this problem by making sure that they have someone outside the community who they can talk to if they need to. If you’re going to come across people with very different social and political beliefs, can you remain neutral and keep your opinions to yourself? Some researchers may try arguing their point in the hope that they will get more information and it will deepen their understand- ing. Are you prepared for the emergence of as yet uncon- scious emotional factors? You may find out things about yourself which you do not like, especially in terms of your own prejudices. Are you prepared to be used as a scapegoat if things go wrong within the community under study? Often it is easier for the community to blame an outsider and HOW TO CARRY OUT PARTICIPANT OBSERVATION/ 105 many researchers are happy to go along with this be- cause they know they will be leaving the community at some point. Can you handle the feelings of guilt which may arise as a result of the roles you’ve got to play? Some researchers would argue that you should not do this because it is being dishonest. The le- vel to which you are prepared to do this has to be your own choice.
These favorable cogni- tive and behavioral outcomes included children with both simple and complex febrile seizures as well as children with febrile status epilepticus cheap imitrex 25 mg with visa. Approximately one-third of children who have a febrile seizure will have at least one recurrence buy discount imitrex 25mg line. Risk factors for recurrent febrile sei- zures are summarized in Table 2 purchase imitrex 25mg without a prescription. Children with two or more risk factors have a 30% recurrence risk at 2 years; those with three or more risk factors have a 60% recur- rence rate discount imitrex 50 mg fast delivery. Half of all recurrences are within the first 6 months and 90% occur within 2 years. A complex febrile seizure is not associated with an increased risk of recur- rence in most studies. In particular, children who have a prolonged initial febrile seizure and have a recur- rence are likely to have a prolonged recurrent seizure as well. Conversely, the child whose initial febrile seizure is simple in nature and has a second febrile seizure, the chances it will be prolonged are small. Thus, we can reliably identify at the time of the first febrile seizure those children at risk for prolonged recurrences who would be candidates for abortive therapy. If followed for many years, eventually between 2% and 10% of children with febrile seizures of all types will develop epilepsy. The risk of developing epilepsy after a single febrile seizure is not substantially different than that in the general population. With the possible exception of very prolonged febrile seizures, the relationship between febrile seizures and subsequent epilepsy does not appear to be causal. Rather, children with an underlying predisposition to seizures are more likely to also experience a febrile seizure when in the appropriate age window. Risk factors for epilepsy following febrile seizures are summarized in Table 2. Of these, neurodevelopmental abnormality and a family history of epilepsy are risk factors for epilepsy whether or not there is a history of febrile seizures. It is important to note that, a short duration of recognized fever prior to seizure onset is associated with not just a higher risk of subsequent febrile seizures but of epilepsy. This is the only risk factor that is the same when comparing risk factors for recurrent febrile seizures and for subsequent epilepsy. Table 2 Risk Factors for Febrile Seizures and Epilepsy Febrile seizures Epilepsy Young age of onset Neurodevelopmental abnormality Family history of febrile seizures Family history of epilepsy Low temperature at occurrence Complex febrile seizures Short duration of fever Short duration of fever Number of febrile seizures 78 Shinnar Febrile Seizures and Mesial Temporal Sclerosis. Retrospective studies from adult epilepsy surgery programs report that many patients with mesial temporal sclerosis (MTS) and intractable temporal lobe epilepsy have a history of febrile seizures in childhood. Recent studies utilizing imaging within 72 hr of the event may pro- vide the answer to this seeming contradiction. These studies suggest that very pro- longed febrile seizures lasting more than 60 min may cause acute hippocampal damage that in some cases will evolve to MTS. Febrile status epilepticus lasting 30 min accounts for approximately 5% of febrile seizures, and seizures lasting 60 min or more are 2%. Thus, even large prospective studies are unlikely to have the power to detect this phenomenon. A multicenter prospective imaging study of children with very prolonged febrile seizures is currently underway to attempt and answer this vex- ing question. In the meantime, the available data support prevention of prolonged febrile seizures as a rational treatment approach. CONCLUSIONS In summary, febrile seizures are the most common seizure type and have a mostly benign prognosis. Both human and animal data demonstrate that brief febrile sei- zures are benign and not associated with long-term sequelae. Treatment is usually not needed for either simple or complex febrile seizures. Given our current state of knowledge, a rational plan of treatment focuses on counseling and on preventing prolonged febrile convulsions. Prolonged febrile convulsions are the only ones that have been causally implicated with adverse outcomes.
As I’m writing this book generic 25mg imitrex with mastercard, the residual effects of this condition are still with me; however 25mg imitrex with mastercard, I began writing standing up and I am happy to report that I have finished sitting down! My infections have stopped buy discount imitrex 50mg on line, and I have actually had not only days purchase imitrex 50mg free shipping, but sometimes weeks, without pain. It’s not over yet, but backing out of a vicious neuropathic pain cycle takes time. Whereas once I almost lost hope, as a result of working through the Eight Steps, I now have complete faith that my pain will one day simply disappear. More on Pelvic Floor Dysfunction and Vulvodynia Sources indicate as many as 15 to 20 percent of women suffer with this little- known condition. There is even an International Society for the Study of *Although I consulted with two of the foremost recognized experts in the country on this condition, I felt my urologist was very competent to handle my case; willing to consult with other experts, when necessary; and most of all, willing to try whatever made medical sense to find a cure for me. This is why I selected him to be my lead physician and will be forever grateful to him for this. Nearly any woman can develop this condition and although there is a sub- stantial amount of scientific information documenting the clinical causes and demonstrating the absence of any psychopathology, many doctors still think of vulvovaginal pain disorders as a form of hysteria. Another sad truth is that most doctors have never even heard of this ailment. The lack of medical knowledge is coupled with the fact that most women are embarrassed to report their symptoms, and if and when they finally do, they discover the condition crosses so many medical subspecial- ties that getting proper treatment is difficult. Treatment options include anticonvulsants (antiepileptic medications), antidepressants (for alteration of pain impulse transmission, not depression), a low-oxalate diet,* anti- biotics, anti-inflammatories, anxiolytics, biofeedback and physical therapy, estrogen/testosterone creams, immune system modulators, vestibulec- tomy,** acupuncture, and pain management. Conclusion If you think you may have such a disorder, ask yourself these questions: • Have you had chronic, burning pain in the vulvar area for more than three months? There is some belief that these oxalate crystals are produced by the consumption of certain foods and act as irritants that can cause vulvodynia. It is only prescribed for those whose pain is localized in this area of tenderness. If you’ve answered yes to at least three of these questions, you may have pelvic floor dysfunction and/or a form of vulvodynia. Remember that the origins of these conditions can be different and everyone’s body systems are different, so keep searching until you find the right treatment for you. It may be understandable since more than 60 percent of Americans are overweight, about 33 percent of all adults and 15 percent of all children are classified as obese,* and gov- ernment researchers are now blaming obesity for at least three hundred thou- sand deaths a year. Unless patients bring up their weight problem or there is a disease process such as diabetes or heart disease associated with it, it will likely not be addressed in an office visit. If weight does become the subject of discussion and the doctor advises the patient to lose some pounds, they both often assume that weight loss will occur with a reduction in caloric intake. Her extra pounds were always a source of unnec- essary torment but were never successfully addressed by any doctor. Since her mother had died when she was very young, she had no one to help her understand how to make herself more attractive. Her father, especially when drunk, was abusive and would refer to her as “the fat pig. As soon as she had saved up enough money, she moved away from her family to Los Angeles, lost some weight, and fell in love and married a man she believed was totally unlike her dad. Because her husband said he wanted a big family and Ruth wanted to please him, she began having babies—three to be exact—one after another. She never had much chance to lose weight between births, and with each pregnancy she gained another twenty pounds that she couldn’t drop later. Being occupied with her children’s needs, she had little time to care for herself or her husband, Rick, who she knew was cheating on her with other women. Ruth was miserable but felt she couldn’t leave him since she had three children and no marketable skills. She tried desperately to lose some weight and dreamed of the day the kids would be old enough for her to leave her husband, but that day came and went. When the last of her kids was eighteen and on his own, Ruth was still with her husband and fifty pounds overweight.