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Roger Ulrich conducted a comparative analysis of 23 matched surgical patients where half of the patients were assigned to a view overlooking a nature scene out the patient room window and the other half assigned to view overlooking a brick building wall. Results found that patients overlooking the natural setting had shorter postoperative hospital stays, fewer complaints, and took fewer pain medications (Ulrich, 1984). The tradition of blending natural and built environments to foster healing and wellbeing continues today. For example, interaction with plants, animals and landscape views can be achieved through outdoor contact, indoor contact or indirectly. It has also been shown that outdoor nature contact offers the most benefit perhaps because of the multisensory stimulation occurring from seeing, hearing, and smelling natural elements (Largo-Wight, 2011). Green and "blue" spaces (environments with running or still water) are especially beneficial for healthy aging. A study investigating the relationship of blue and green spaces, therapeutic landscapes, and well-being in later life revealed that features such as a koi pond or bench with a view of flowers promoted feelings of renewal, restoration, and spiritual connectedness as well as 122 Aging, Technology and Health places for multigenerational social interactions and engagement (Global News Connect, 2015). Interaction with outdoor plants through horticulture therapy has also shown to have significant health benefits (Largo-Wight, 2011). Two large-scale studies that link the health of seniors with exposure to greenspace in the urban environment are noteworthy. Results indicated that people living in a green environment between 1 and 3km away were significantly healthier than those with less greenspace. Similarly, in many Asian countries, forest bathing, or spending extended time in a forest, is widely adopted by people. A study of young male forest bathers found that compared to those in an urban environment, they experienced stress reduction Figure 5. Technological supports to increase nature contact 123 mechanisms such as parasympathetic nervous system stimulation, reduction of cortisol, and reduction of pulse rate. Forest bathers also reported feelings of being soothed and refreshed, reported enhancement of positive mood states, and decreases in negative mood state compared with the urban environment subjects who experienced an increase in negative mood state (Lee et al. Susan Rodiek has conducted multiple research studies and concluded that older adults who have outdoor nature contact enjoy better quality of life, improved recovery from illness, stimulated sensory perception, increased physical activity, increased social interactions, and an enhanced sense of self and well-being. She found that exposure to daylight had specific health benefits through increased levels of vitamin D, serotonin, and melatonin, improved hypertension management, hormone balance, sleep, mood, distraction from pain, as well as the reduction of reported pain and use of pain meds (Rodiek, 2009a). Dementia patients can have particular benefits from being outdoors as it helps elicit memories by stimulating senses, increasing brain plasticity, and reducing agitation (Rodiek, 2009b). Indoor nature contact through interaction with plants, animals, or landscape views experienced inside of buildings also benefits the health of older adults. For example, animal-assisted therapy is a proven stress-reduction activity (LargoWight, 2011). Technological supports connecting older adults to nature are showing promise as vehicles for health promotion To conclude this chapter, this section argues that simulated natural environments using technological supports are advantageous for promoting health. Use of simulated natural environments to promote health As technologies become more advanced, accessible and affordable, new applications are emerging in health promotion programs. Furthermore, technology is capable of reproducing high fidelity, realistic environments with multisensory enhancers. Thus, the question at hand is: Can technology make people feel like 124 Aging, Technology and Health they are outdoors? While immersion in real natural settings is known to be therapeutic as noted in the previous section, the question remains whether simulated natural environments are effective substitutes for the actual experience of being outdoors in nature (see. While physical activity such as walking occurs naturally in well-designed green spaces, not everyone has access to safe walkable green areas. For example, people recovering from injuries, elders who are frail, and people who do not feel safe walking in their outdoor environments are ideal recipients of simulated therapeutic landscapes. In these cases, technology may be used to display therapeutic landscapes, which appear as art on the wall, images on a computer, phone, or exercise machine, and in video displays. Photographs have been found to be as effective as real immersive experiences in research studies and are often used to simulate nature indoors (Stamps, 1990).

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With the rapid development of information and communication technologies over the past few decades, particularly with the internet, the way that people interact socially has dramatically changed. Though these technologies have impacted how individuals of all ages interact socially, we focus here on the current and potential opportunities these technologies have to bolster social engagement in older adults. Social engagement technologies allow older adults to keep in contact with friends and family members who may no longer reside in the same geographical area. This has the potential to strengthen existing social ties by allowing new forms of communication and the sharing of information between older adults and their social connections. Furthermore, these technologies also afford older adults the opportunity to forge new social ties by connecting with others who share similar interests or experiences. Our goal in this chapter is to assess the relationship between social engagement and health outcomes for older adults, specifically with respect to the role technology can play in supporting and facilitating social engagement. Social engagement technologies include established forms of electronic communication such as email and social networking sites. Our analysis of the literature revealed that there are barriers for older adults in the adoption and use of technologies that foster social engagement. We make recommendations about how designers can overcome these barriers to better suit the needs and interests of older adults. Social engagement Defining social engagement Social engagement has been defined and operationalized in different, and sometimes inconsistent, ways in the literature. We propose the following definition: Social engagement refers to the degree of participation in interpersonal activities and the maintenance of meaningful connections with other people. This definition relates to a number of terms that have been used in the researched literature, such as social integration, social support, and social connectedness. Though differences exist between the exact characteristics of these related terms, all deal with the extent that an individual is living an interpersonally engaged and active lifestyle while maintaining meaningful relationships with others. Social networks deal with the interconnections of a group, whereas social capital deals with the level of social participation or social resources available for a particular community or geographical area. The structure of a social network and the degree of social capital present in a given community will likely influence the level of social engagement experienced by individual group members. Enhancing social engagement of older adults through technology 181 Measuring social engagement Social engagement can be measured in a number of ways. For instance, researchers can have participants self-report on the number of people they interact with socially during a specified length of time. This numerical frequency-based measure of social engagement can provide information about the level of social connectedness for a particular individual. However, even though a numerical count of social contacts can give an impression of the scope and size of the social network an individual resides in, it does not provide any information about the quality of the particular social relationships. For example, an individual may have to interact with another person on a frequent basis. As a result, other measures of social engagement have individuals rate the quality of their social relationships on a variety of functional dimensions. For instance, Zunzunegui, Alvarado, Del Ser, and Otero (2003) had participants qualify their relationships with social connections. Other measures of social engagement do not focus on particular social connections themselves, but instead on the degree of social activity or participation experienced by the individual. In these measures, participants self-report on whether they attend a variety of social events. Higher attendance and participation in social activities is taken as evidence of a more socially engaged lifestyle. For any intervention or technology designed to enhance social engagement to be successful, it is critical that the values and social preferences of individuals are taken into account. Individuals vary in their social relationship preferences, as evidenced by individual differences in typologies of social networks (Fiori et al. Whereas some social networks consist of individuals with a few strong ties, other networks consist of individuals with many ties that are weaker in strength. Moreover, whereas some social networks consist mainly of ties with family members or close friends, other networks consist of a greater variety of social 182 Aging, Technology and Health relationships. Insofar as different social network typologies stem from the values and preferences of individuals who make up the network, any intervention or technology designed to target social engagement must accommodate these differences.

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If the cable is cut, even with the aid of a microscopeit is impossible to line up each individual axon in its original position. A young person can learn new pathways so that eventually the brain will automatically reinterpret sensations without a hitch. They complain bitterly about odd tingling sensations and a feeling like "static" in the nerves. No matter how strongly I warned them in advance, they seemed disappointed to find that our surgeries did notrestore velvet. They gained the ability to shake hands, but could not feel the warmth and texture and firmness of the hand they were shak- sensation. Yes, they could now curl their fingers around a gummy ball of rice, but the rice felt neutral, the same as woodorgrass or ing. On tour after completing a visiting professorship in Lahore, Pakistan, he stopped by Vellore Shortly after I began attempting tendontransfers I received an unexpected visit from Dr. I felt relieved to step aside and three hours, with White giving detailed explanationsof every step. Thepatient, insensitive to pain, neededlittle or no anesthetic and stayed alert, observing the whole process. We sutured him, White said a few encouraging words, and then held up his own hand in demonstration. We watched dumbfoundedasthe patient,still reclining on the operating table, mimicked the doctor by straightening out his own fingers. The procedure took almost That experience, and otherslike it, forced us to come up with rigorous safeguards for postoperative recovery. Normally, pain sets the limits: a person whohasjust undergone hand surgery will not flex his fingers, just as an appendectomypatientwill not dosit-ups in bed. But our leprosy patients, without a pain reflex, had no Loosening the Claw 117 ness to be the single most destructive aspect ofthis dread disease. The same hand therapist treating two identical tendon transfer recipients, one due to polio and the other to leprosy, would urge one on to greater effort, and strive to hold the other one back. Several times I had to repair tendons that had been yanked out by an overeager leprosypatient. Our therapists much preferred working with the leprosy patients, because they never complained about pain and their hands seldom stiffened from lack of movement. In recuperation from surgery, the strange quality of insensitivity to pain seemed at first like a blessing. All day long I heard the words "Gently now" and "Just a little" from Ruth Thomas and the other physiotherapists. In working with leprosy patients, we fought the opposite problem of preventing them from moving their fingers too recuperating patients to movetheir fingers a little more each day. Unless the patient pushes into the pain zone little bit, the ten- built-in safeguards for repair and healing. Leprosy workers had long recognized that the disease silenced pain signals, workers alike believed that leprosy caused even worse damage directly. The more I worked with leprosy patients, however, the more I questioned the commonview of how the disease accomplished leaving the patient vulnerable to injury. I learned early on that the scenes depicted in popular novels and movies (Papillon, Ben Hur) are based on myth: the limbs and appendagesof leprosy patients do not simply dropoff. Patients told me they lost their fingers and toes over a long period, and my own studies confirmed that gradual change. Even an inch- X rays revealed bones that had mysteriously shortened, apparently from sepsis, with the skin andother soft tissues shrinking back to the length of bone. If one or two fingers were very short and the others normal, he judged that Detective Hunt 119 and years. I found some of the most severe loss of digits was occurring in people who nowtested negative for leprosy.

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Where flank pain or costal fullness is usually part of the pattern of liver qi stuck in the upper burner, abdominal distension is the chief sign of the "liver invading the spleen" pattern. Common signs of qi stagnation treated by this formula include symptoms that come and go, symptoms made worse with intensified emotional states, and pain that is relieved by activity and worse at night. It can be used for various types of acute and chronic joint pain, stiffness, and swelling, but is especially effective for treating wind bi or bi syndrome that affects joint in both upper and lower extremities. If heat is present (joints swollen or hot to the touch), combine with Curcuma Longa Formula. In cases of severe deficiency, this formula can be combined with a supplementing formula, such as 16 Restorative Formula. The combination of these two formulas plus the addition of pueraria (ge gen), mulberry leaf (sang ye), and scrophularia (xuan shen) expands the application to help (respectively) release wind, dredge the lymph glands, and cool and protect the lungs. Indications Aches, generalized, from acute illness Chicken pox, early stages Common cold, early stages Cough, dry Fever Flu, early stages Headache Lymph glands, swollen Nasal discharge or congestion Roseola, early stages Sore throat Viral diseases, early stages Tongue: Red on tip, or whole tongue red. Contraindications: Avoid taking tonic formulas concurrently with this formula, as they can trap exogenous pathogens in the body. Note: the best results are obtained in the treatment of external patterns when the formula can be administered during the initial stage of onset. This formula addresses acute cough presentations from lung fire or phlegm-heat patterns. It is especially appropriate for children, whose coughs tend to progress rapidly from throat tickle to lung fire. In early-stage cough, pathogenic heat quickly causes the body to respond with phlegm in order to protect the lung tissue, after which, the phlegm can become difficult to expel. This formula clears lung heat with belamcanda (she gan), scutellaria (huang qin) and white mulberry root bark (sang bai pi). Herbs that transform phlegm and stop cough include fritillaria (zhe bei mu), pinellia (zhi ban sha), platycodon (jie geng), and peucedanum (qian hu). Herbs that stop cough and direct qi downward include armeniaca (xing ren), perilla seed (zi su zi), and cynanchum (bai qian). This is a balanced formula that helps to protect the lungs while correcting the flow of lung qi, draining heat, and resolving phlegm. Cautions: Cold and phlegm-resolving substances may cause loose stools as a mechanism for discharging phlegm. This is a normal response, but if diarrhea develops, discontinue or lower the dose. Given orally, it will usually stop the pain of otitis media (middle ear infection) and otitis externa (outer ear infection) within two hours. It is intended for painful ear infection, but is also appropriate for inflamed or bulging eardrum without pain. Indications Ear infection with pain in infants and young children Eardrum, inflamed or bulging, without pain Ears, congested Fever, in children prone to ear infections Headache, with phlegm-heat Note: this formula is to be taken orally, not put in the ear. This formula is an alternative to antibiotics, which can increase the chance of a recurrence of the ear infection within six weeks. If ear infection is not responsive in 24 hours, reevaluate the condition and strategy. Other appropriate formulas may include, Gentiana Drain Fire Formula (for damp-heat in the gallbladder channel), or Neck Formula (if ears remain plugged after all other symptoms have resolved). Its main uses are to prevent invasion from the exterior and stop spontaneous sweating. It can be helpful to repair and strengthen intestinal epithelium for those who suffer from food allergies. Atractylodes (bai zhu) strengthens spleen qi and resolves the dampness that can impede efficient functioning of the spleen, while astragalus (huang qi) reinforces the wei qi and helps to radiate it outward to support the exterior. Chrysanthemum (ju hua) cools the lungs and liver and is included to compensate for the tendency of exterior invasions in children to turn to heat, and also to compensate for the warming nature of the tonic. Indications Allergies Common cold, prevention Fatigue, mild Immune system, weak Lethargy Wind-cold invasions, frequent Tongue: Normal, puffy and pale, or moist. This formula opens the collaterals to eliminate blood stasis and facilitates the complete discharge of the endometrial lining, so that the new endometrial lining can grow on a smooth, clean base. Use with Blood Palace Formula for strong blood stasis causing significant menstrual pain.

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Nine percent of treated patients demonstrated an increase in 2 or more visual acuity lines and none demonstrated a worsening of vision. The presence or absence of antibody itself should not be used to initiate or terminate therapy, because antibody is not demonstrable in a small percentage of people with the disease and the antibody may be present in patients without active disease. For other etiologies, the current approach to therapy includes replacement of defective hematopoiesis by stem cell transplantation, or suppression of an apparent autoimmune process. The thermal amplitude of a cold agglutinin may be more predictive of the severity of hemolysis than its titer. Several cases of neonatal babesiosis acquired by transplacental transmission have been reported. Thus, this combination should be used when patients do not respond well to atovaquone and azithromycin. In persistent relapsing disease, antibiotics should be given for a minimum of six weeks and for at least two weeks after the last positive blood smear. Maintenance immunosuppression uses three classes of drugs: calcineurin-inhibitor (cyclosporine or tacrolimus), antiproliferative agent (mycophenolate mofetil or azathioprine) and corticosteroids. The sites most commonly affected by thrombosis are small vessels of the kidneys, lungs, brain, heart and skin, although large vessel thrombosis may also occur. The hallmarks of the syndrome are intractable focal seizures (epilepsia partialis continua) resistant to anticonvulsant drugs, and progressive unilateral cerebral atrophy leading to progressive hemiparesis, loss of function in the affected cerebral hemisphere and cognitive decline. The etiology is unknown, but antecedent infection with Epstein-Barr virus, herpes simplex, enterovirus, or cytomegalovirus has been implicated. Subtotal, functionally complete hemispherectomy may markedly reduce seizure activity in a majority of patients but results in permanent contralateral hemiplegia. Double cascade filtration, which separates plasma out of whole blood in the first filter and removes high molecular weight proteins in the second filter (such as IgM), has also been used to treat cryoglobulinemia. Last resort therapies include distal ileal bypass, portacaval shunting, and liver transplantation. Long-term outcome studies have demonstrated significant reductions in coronary events. Timing of clinical response is quite variable and complete abolishment of proteinuria may take several weeks to months. Description of the disease this inherited disorder results in iron deposition in the liver, heart, pancreas and other organs. Iron accumulation in organs slowly results in liver failure (cirrhosis, hepatocellular carcinoma), diabetes, hypogonadism, hypopituitarism, arthropathy, cardiomyopathy and skin pigmentation. At diagnosis, the saturation of serum transferrin or iron binding capacity will be elevated (! Phlebotomy therapy should be started in all patients whose serum ferritin level is elevated despite older age or the absence of symptoms. Prophylactic leukocytapheresis offers no advantage over aggressive induction chemotherapy and supportive care, including those with tumor lysis syndrome. Adequate information was not provided to ascertain the comparability of the two groups. In two additional cases, patients were treated prophylactically because of a history of pancreatitis. As blood viscosity rises, a nonlinear increase in shear stress in small blood vessels, particularly at low initial shear rates, produces damage to fragile venular endothelium of the eye and other mucosal surfaces. Specific signs and symptoms include headache, dizziness, vertigo, nystagmus, hearing loss, visual impairment, somnolence, coma, and seizures. Plasma exchange dramatically increases capillary blood flow, measured by video microscopy, after a single procedure. Conventional calculations of plasma volume based on weight and hematocrit are inaccurate in M-protein disorders because of the expansion of plasma volume that is known to occur. A direct comparison trial demonstrated that centrifugation apheresis is more efficient than cascade filtration in removing M-protein. Histological abundance of leukocytes and monocytes in the mucosa of the bowel incriminate these cells, along with accompanying cytokines and proinflammatory mediators, in the disease process. The Adacolumn1 is relatively selective for removing activated granulocytes and monocytes. Muscle weakness, hyporeflexia and autonomic dysfunction constitute a characteristic triad of the syndrome. Antibody levels do not correlate with severity but may fall as the disease improves in response to immunosuppressive therapy.

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Another way to identify interphase is to look for the nucleolus inside of the nucleus. Interphase (A) and prophase (B) Prophase the first clue that mitosis has begun is the appearance of chromosomes. Metaphase Metaphase In metaphase, you can see the chromosomes lined up across the center of the cell. Anaphase is the phase of mitosis where the doubled chromosomes separate from each other. Anaphase Telophase You can identify telophase by finding cells where the chromosomes are clustered at separate ends of the cell. Two types of reproduction Asexual There are two types of reproduction: asexual and sexual. Then the parent cell divides, forming two cells that are exact copies of the original. Sexual Sexual reproduction is a type of reproduction that involves special reproduction types of cells called sex cells. Sex cells contain half the number of chromosomes as body cells (all of the other cells in a multicellular organism). The chromosomes chromosomes in each pair are called homologous (equivalent) pairs. Meiosis is cell division that produces sex cells with half the number of chromosomes. During meiosis, a cell undergoes two divisions to produce four sex cells, each with half the number of chromosomes of the parent cell. The first division In the first division of meiosis, the homologous pairs of of meiosis chromosomes separate. The second In the second division of meiosis, the doubled chromosomes division of are split apart. The final result of the final result of meiosis is four sex cells, each with half meiosis the number of chromosomes of the original parent cell. When male and female sex cells combine to form offspring, each sex cell contributes half the normal number of chromosomes. The offspring has the normal number of chromosomes, half from the male parent and half from the female parent. Most animal haploid sets cells except the sex cells have a diploid set of chromosomes. Sex cells have half of a complete set of chromosomes, or only one chromosome from each homologous pair. When an egg is fertilized by a sperm, the haploid set of chromosomes from the father unites with the haploid set of chromosomes from the mother. For each homologous pair, one chromosome comes from the mother, and one from the father. The final outcome is a multicellular organism with many different types of specialized cells. You have brain cells, stomach cells, skin cells, and muscle cells to name just a few. For example, cells that eventually divide to become part of the stomach are different from those that will become part of the nervous system. For example, some cells in the retina of your eye become rod cells (for vision in dim light) and others become cone cells (for color vision). After differentiation is complete, most cells lose the ability to become other types of cells. Mitosis Type of cell produced Number of cell divisions Number of cells produced Number of chromosomes in each cell (diploid or haploid) Meiosis 2. How does the process of fertilization explain the need to have half the number of chromosomes in sex cells? You started out as a single cell and are now made of over 200,000 different types of cells.


  • Use cool bath water.
  • Difficulty talking (temporary)
  • Fluids by IV
  • Peripheral neuropathy
  • Scarring of the skin
  • Esophagogastroduodenoscopy (EGD)
  • Calm and reassure the person. Wear latex gloves or wash your hands thoroughly before attending to the wound. Wash hands afterwards, too.
  • Sheehan syndrome, a condition that may occur in a woman who bleeds severely during pregnancy or childbirth and causes the destruction of the pituitary gland
  • CT scan of the abdomen
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Today I know that the consequences of not feeling are much worse than the consequences of feeling. I was dumped recently, and instead of dwelling on the rejection, I took inventory. With the help of others and the steps, staying teachable and reachable, I am not afraid. I have learned that my story is continually unfolding, with each day being a few pages in the book. I have the right to be happy, sad, fallible, joyful, ignorant, stupid at times, in debt or out, dumped by a guy or happy together, and so many other things. I see so many coincidences and miracles each day that I cannot deny the value of my life anymore. A string of "coincidences" led this addict to find a sponsor and to see that our acts of service can have far-reaching effects. Sometimes the smallest selfless act takes on a life of its own and makes a difference in the lives of countless other people. After winding up in a treatment center in my hometown, I went into a halfway house about a thousand miles away. I had recently lost my sponsor, and knew that I needed a new one to help me through all the stresses and changes of relocation. But I stayed, remembering that my purpose at this convention was to find a new sponsor, even if I felt alienated. Sometimes I just need to do a little bit of footwork, face a little fear, and hope for the best. At the workshop on Traditions Ten through Twelve, 365 366 Narcotics Anonymous the second speaker introduced himself as Jim. This was intimidating: He had a lot of clean time, and was already talking to a bunch of other people. What were the odds of me running into this man during my first week home, out of several thousand recovering addicts in the region? The full cycle of recovery-one recovering addict helping a newcomer get clean, and that newcomer growing and himself starting to carry the message-had taken place, all without his knowledge. Five years later, the fellowship had grown, but she had drifted away from the program. I was born to an upper-middle-class family in which everyone was pretty well educated and successful, but I felt different. I was afraid of expressing myself since I did not want to be exposed as different or weird. I wanted to be a good daughter and worked hard to please others, but it seemed like I never could. I would be successful for a little while, only to lose hope and feel guilty and powerless to change. I started smoking cigarettes when I was sixteen and kept wanting to try new things. While I was attending college, I decided to get married to fill the hole that I felt inside me. However, anything that I tried kept my interest only for a short while and eventually led to more problems and headaches. On the surface I seemed to have a good, comfortable life, but on the inside I was ready to explode. However, my disease had become active and gradually spread to different parts of my life. After seven or eight years of using, the only bond left between me and my husband was the drugs. Finally I came to the conclusion that the only way to free myself from drugs was to separate from my husband. All of my biggest decisions amounted to running away, escaping reality, and staying in denial.

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In those days before microvascular surgery, skin grafts from allowing time for a new blood supply to grow between the graft and arm,at which point the surgeon cuttheflap of skin free of the nose, again strapping the arm in place. Eventually a blood supply would develop on the facial graft site and the skin could be cut abdomen and movedit up to the new site on forehead, cheek, or free of the arm. He had come to Bombaynear retirement age did not mergeperfectly with the fine skin of the cheek. AnotherBritish plastic surgeon, Sir Harold Gillies, taught us even morepleased with the new nosesthatresulted, but those ofus on the surgery team did notshare their enthusiasm. Weleft a permanent scar on the forehead, and the bulky edges of the new nose swung it down to form a new nose, attachingit to the cut edges where the old nose had been. We lifted the whole of the forehead skin as a single flap, keeping the blood supply intact, and leprosy deformities, so the patients went awaysatisfied. Then I learned about a new technique which had much in and unwieldy,it offered little visual improvementover the saddlebacknose. Yet although these first crude attempts may not have produced beautiful noses, at least the new ones did not look like abdominal skin was inherently unsuitable for rhinoplasty: thick "I learned this method from Jack Penn, a renownedplastic surgeon in South Africa, who had adapted a procedurefirst performed by the ancient Hindu surgeon Susruta eleven centuries before Christ. Hindu warriors sometimes punished their vanquished enemies by cutting off their noses with a saber, and Susruta devised a remarkably advanced technique of transplanting a section of skin from the forehead down to the nose area. An odd event in 1992 revealed just how commonthis ancient form of vengeance used to be. To right a historical wrong, Japan agreed to return twenty thousand nosesthatits army had amputated from Korean soldiers and civilians during a military invasion in 1597. The noses, along with some heads of Korean generals, had been preserved in a special memorial for nearly four hundred years. In order to get a long enoughflap ofskin, he included a patch ofthe hair-growing scalp beyond the forehead, folding the skin double to form the underside of the lip. Bristly scalp hair was growing inside his mouth, scraping acrosshis swollen, bleeding gums every time he spoke or the underside of his cheeks, a procedure which made the former landlord much happier. That hairy skin had to be replaced with mucous membrane grafts from at the invitation of Dr. Encounteringleprosy patients in Bombay, Gillies remembered a technique he had tried on leprosy patients manyyearsbefore, on a trip to Argentina. Gillies was probably the first surgeon ever to operate on a leprosy nose, and at Dr. The resulting inflammation destroys cartilage, and without cartilage to support it the expanse of skin collapses like a tent without poles. Gillies picked up a nose, I found it hard to imagine that anything worthwhile could be Weprepped patient for surgery. Peeling back the upperlip, he cut inside the mouth between teeth and gum andlip until he could lift the lip high enough to expose the nasal cavity. He freed the whole upper lip and then the nose from its attachmentto facial bones. He took a roll of gauze and stuffed it inch by inch into the cavity of the shrunken nose. As if by magic the skin spread apart, stretched, and plumped up to form a quite respectable nose. Gillies assured us that if properly supported the nose would retain its new shape. We used nose-shaped plastic splints, then acrylic, then bone grafts from the pelvic rim. For thosepatients who had insufficient blood supply in the nasal tissue to sustain a bonegraft, we borrowed material from the dentists. The patient, awake, could choose his or her nose on the spot: "A touch longer and not quite so wide, please. I remember one very pretty young woman whocameto Vellore with no marks whenthe clean under-noseis again inserted. Like the transplanted eyebrows, our artificial noses had an mucous membrane, the gap between upperlip and jawdoes not reclose, andit is a simple matter for the patient to peel back the upperlip andslide out the bright pink under-nose. The new noses serve them well as long as they follow a rather bizarre maintenance procedure: they musttake outthe artificial supportperiodically for cleaning in order to remove foreign matter and guard against infection. WhenI first started working with leprosy patients, old-timers told methat blindness,like paralysis and tissue destruction, wasa tragic but unavoidable consequenceofthe disease. As I have mentioned,blindness presents an unusual hardship for leprosy patients who havealso lost the sense of touch andpain.

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Nadine Saubers, R the Series these handy, accessible books give you all you need to tackle a difficult project, gain a new hobby, or even brush up on something you learned back in school but have since forgotten. You can read cover to cover or just pick out information from the four useful boxes. J I H G F E D C B A Library of Congress Cataloging-in-Publication data is available from the publisher. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional advice. If legal advice or other expert assistance is required, the services of a competent professional person should be sought. Where those designations appear in this book and Adams Media was aware of a trademark claim, the designations have been printed with initial capital letters. In light of the complex, individual, and specific nature of health problems, this book is not intended to replace professional medical advice. The ideas, procedures, and suggestions in this book are intended to supplement, not replace, the advice of a trained medical professional. Consult your physician before adopting the suggestions in this book, as well as about any condition that may require diagnosis or medical attention. The author and publisher disclaim any liability arising directly or indirectly from the use of this book. Call 911 or shout for help until you know someone has heard and called 911, or go for help (either you or someone else needs to call 911). Manage for shock if the person is chilled, short of breath, nauseous, clammy, and pale. The correct principles for action are covered in detail in the book, but the following list briefly outlines some of the more common first-aid myths. Never cut and suck the skin of or apply a tourniquet to a person with a snakebite. Sucking may introduce more bacteria and spread the venom, and a tourniquet will cut off blood supply to the area. If you have something embedded in your skin, you should not pull it out if there is a chance the object is sealing a wound and preventing bleeding. This manual contains simple instructions and in some cases life-saving health-care techniques for you to study and refer to in order to take care of the most common nonserious illnesses and injuries. Emergencies large and small happen fast and there may not be any time to read instructions, so review some of the basic procedures in this book ahead of time. Every section is designed to give you an overview of what symptoms to look for, how to treat symptoms of illness or injury, when to call 911 for life-threatening emergencies, and xiii when to see your doctor or go to an emergency department. Follow the instructions in this manual carefully and call for help when you need to. That is why signs and symptoms are clearly outlined in each section, as well as when it is absolutely necessary to call for help. Although this manual is intended to be a complete guide, it is not intended to take the place of professional medical advice. Nor should it be used to diagnose and treat illnesses and injuries or to develop a treatment plan for any health problem without consulting your doctor or other qualified medical provider. Remember, take good care of yourself and of your family, see your doctor for regular checkups, and be prepared for anything in between. When someone suffers an injury or sudden illness, first aid is your initial course of action. You can treat most common illnesses and injuries when you know what to do, but first you must decide if first aid will be adequate or if you need professional help. Being ready for anything will help you to stay calm, sum up the situation quickly, and proceed with more efficient, capable action. Being prepared will ensure you are composed and self-assured, which will help calm the injured party.

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They are often excluded from normal basic training in health and safety and fire procedu res, and many employe rs are ignorant of the risks associated with cleaning material s. Contract cleaners are particularly at risk, since they have no control over the workplac e, and because health and safety measure s are addition al costs unlikely to be welcome d by contracto rs under pressure to minimis e their operatin g costs. Few cleaners take part in fire drills because they are not on the premises when these are carried out. Major safety concerns of cleaners in London are of exposure to asbestos and other harmful dusts in buildings, lack of protel. There is no-one to call for help in the event of an accident, and no proper supervision on hand. There was no training in how to use the fire extinguisher, and we were not told how to get out if there was a fire. Often the security staff also work for contractors, further removing control over their actions. This extensive illegal or unreported part of the economy is not reflected in official employment figures, is not documented in statistical data, and makes attempts to quantify cleaning employment very unreliable. As women and part-time workers tend to be hidden from the unemploymen t records, so women in cleaning work, outside the official labour market, are also hidden. The contractor, of course, continues to be paid his tender price even when he does not provide the number of cleaners specified in his contract. This involves paying people in false names - by cheque or cash recorded in a false name on the books. Thus some cleaning workers are trapped 452 London Industrial Strategy - Cleaning by working illegally. Their understan dable reluctance to join unions or protest against bad industrial practice is an important obstacle to organisati on amongst cleaning workers. The difficulties are enormous, because of the isolation and unsocial hours of many cleaning workers. Success tends to be limited to premises where there is a union organisati on amongst the other staff. Sadly, many union members forget to organise cleaners into unions and, even if they do, union meetings and activities tend to take place at times when cleaners are not at work. Many cleaners are women with children at home to look after, and therefore there are many practical obstacles to their active involvem ent in union affairs. There is in addition a great need for more attention to be paid by unions to the problems of ethnic minority workers in cleaning employme nt, particularly to the question of language barriers and the need to distribute multi-lingual publicity materials about union membersh ip, policies, and basic employme nt rights. There are, neverthele ss, a growing number of examples of successful joint trade union campaign s to recruit, organise and support cleaning workers, in the defence of their jobs. There is a long history of competiti on between them but until recently direct labour was standard for public services. Contracto rs provided services mainly to private industry, particular ly in manufactu ring and retail trades and offices. In-house cleaning at that time was literally just that - in private household s, large and small. Contract services were less popular, and many large employers used in-house services instead. New laws were introduce d aimed at controlling condition s under which many workers were employed, including the early Wages Councils and Cleaning - London Industrial Strategy 453 the forerunner of the 1946 Fair Wages Resolution governing the employmen t conditions of labour on governmen t contracts. Economies were being forced on governmen t department s, and undercuttin g was rife. Their reputation was very poor, and many cleaning services were brought back in-house. Contractors provided services to the fast-growin g office sector, and to local authorities on the maintenanc e and construction side with the building expansion programmes of the 1950s and 1960s. Factory closures and relocation of offices and manufactur ing units meant that lucrative cleaning and maintenanc e contracts were lost for the contract cleaning industry. Right-wing organisation s such as the Adam Smith Institute and the Institute of Directors influenced governmen t thinking, and they welcomed the move. They stressed the advantages of privatisation as a stick with which to beat the unions. Some obstacles remained in the way of more widespread competitive tendering for services in the public sector.


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