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Partnership with the Centers for Disease Control and Preventon Technology/data: 6 impotence in women purchase kamagra soft 100mg fast delivery. Public health and mental health not connected Technology/data: Partnership and collaboraton: 1 erectile dysfunction after 70 purchase 100 mg kamagra soft fast delivery. Not telling public health stories to wellbutrin erectile dysfunction treatment order kamagra soft 100 mg online legislature/partners adequately (or if at all) Government/policies: 2. Poor cultural competence *both a positve and negatve identfed by groups 70 Indiana State Health Assessment and Improvement Plan Opportunities External factors that can be utlized and considered as an asset and be taken advantage of Educaton: Partnership and public health system (cont. Natonal spotlight for Indiana Chamber for Corporate Wellness as a model for public health 2. Expansion of state agencies collaboraton and increasing understanding of their role in the public health system 9. Partnerships with universites to conduct, share and translate research into practce 10. Changes to state code to improve funding (allow it to be more sustainable, include 1. Health is on the agenda for the current federal and state legislaton valued-based market? Collaboratng with hospitals and other organizatons on health assessments Technology/data: 5. Identfy ?best practces and them disseminate informaton to the communites a potental to coordinate eforts (Guidance for opioids, health housing, identfying funds) 6. Strengthen partnerships between state and local level health departments and agencies 5. Educatng local communites on available data 72 Indiana State Health Assessment and Improvement Plan 71 Threats External factors which may potentally impact the public health system or the health of Hoosiers Partnership and public health system (cont. Facilitatng/developing relatonships with local and state chamber of commerce something new comes out it has to wait Communicaton: 10. Changes to state code to improve funding (allow it to be more sustainable, include 6. Social perspectves/norms in regards to health community development funding, economic development) Partnership and public health system: 6. Social economic status inequites growing and contribute to poor health outcomes 8. Identfy ?best practces and them disseminate informaton to the communites (Guidance for opioids, health housing, identfying funds) 9. Changes or loss of health insurance if laws change 72 Indiana State Health Assessment and Improvement Plan 2018 2021 Forces of Change Factors, trends, and events that shape the health of Indiana (Environmental, Social, Politcal, etc. These interviews will be conducted face to face if at all possible, however a phone call is acceptable, as well. Tier two: Individuals that the commitee feels would have valuable informaton, but might have duplicatve or similar informaton as ter one. These individuals might be recommended by ter one interviewees, or provide context to answers from ter one interviewees. Tier two interviews can be conducted via phone call or online survey monkey questonnaire. Tier three: Tier three individuals are those that are recommended by other informants to provide additonal informaton, but may provide duplicatve or similar infor maton. These are less targeted, and chosen more for opportunity to collect additonal informaton. Procedure: Interviewer can either take paper notes, or notes directly in the survey monkey site. If taken by paper, the notes should be legible, and sent to Eden Bezy, [email protected] If conductng the interview via phone or in-person, the interview can be recorded using a conference line, or using a voice recording app for the phone. We are seeking key informants to help us understand why some populatons are not achieving the same health outcomes as others. You were recommended because of your knowledge, insight, and familiarity with the community that you serve. I hope you will consider joining us in this efort by partcipatng in a phone interview that will help inform our understanding of the health challenges Hoosiers face. The themes that emerge from these interviews will be summarized and made available to the public, but individual interviews will be kept strictly confdential.

Soft cups are also more 6 often associated with detachments and are less maneuverable within the birth canal because of the design; therefore impotence nasal spray order kamagra soft 100mg without prescription, they are recommended mainly in outlet extractions (13 gonorrhea causes erectile dysfunction buy kamagra soft 100 mg lowest price, 14) erectile dysfunction yahoo answers trusted kamagra soft 100 mg. Attached to this cup is a suction tube and handle placed either at the center of the cup (Malmstrom cup) or placed more eccentrically on the dome of the cup (Bird cup, Omnicup). The suction tube is attached either to an external vacuum source or an external handheld pump. The external electric vacuum pump and the handheld pump are both designed to create a negative pressure between 60 kPa to 80 kPa or 2 2 in another unit of measurement, 0. As a result, when the cup is placed on the fetal scalp and the vacuum is applied, an artificial caput succedaneum (also called a chignon) is formed and fills out the cup. In Sweden, a prolonged second stage is defined as occurring when the second stage of labor exceeds two hours without a regional or epidural block or exceeds three hours with a regional or epidural block for nulliparous women. The suspicion of fetal compromise, often referred to as fetal distress, includes a non-reassuring fetal heart rate, pattern, or abruption. Elective shortening of the second stage may include situations when pushing is contraindicated because of conditions such as maternal cardiovascular or neurologic disease. Maternal exhaustion as an indication is largely subjective and not well defined (18 20). Empty bladder and ruptured membranes Other prerequisites such as adequate analgesia, a fully dilated cervix, the possibility of abandoning the procedure, gestational age >33 weeks, and an experienced operator are not considered absolute but are recommendations that are relative to the clinical situation. In addition, the uterine contractions and maternal expulsion efforts should be evaluated (18, 25, 26). To ensure engagement (biparietal diameter beneath pelvic inlet), only one fifth of the fetal head should be palpated abdominally and the vertex should be palpated at least at or just below the level of the ischial spines. Fetal lie refers to the relationship between the fetal (sagittal suture) and maternal midline pelvic axis, which may be longitudinal, oblique, or transverse. Fetal position refers to the position of the occiput, that is, the occiput anterior, occiput posterior, and occiput transverse position. Being certain of the fetal position and lie is essential because this information will help the operator identify the flexion point and use the right traction angle during traction (29). Fetal disproportion Fetal disproportion is a complex assessment, evaluated based on a summary of clinical observations, such as excessive moulding of the fetal head, slow labor, very heavy traction, and an estimated large fetus. Ruptured membranes and empty bladder Membranes must always be ruptured in order to attach the cup to the fetal head. The urinary bladder should be emptied to avoid damage to the urethra and bladder and because a full bladder might obstruct the passage of the fetal head through the birth canal. Cervix the cervix should be completely dilated to avoid a rim of the cervix becoming caught under the vacuum cup, which will increase the risk of lacerations leading to heavy bleeding (17, 30). Contractions, expulsion efforts, and maternal cooperation To reduce the force during traction, strong contractions, effective expulsion efforts, and maternal cooperation are of utmost importance. If the contractions are insufficient, an oxytocin infusion is often used to increase the strength of the contractions. A higher traction force has been associated with maternal sphincter injury and neonatal scalp laceration (31). Most of the training takes place on the job under the supervision of skilled practitioners. In addition, self-acquired knowledge gained from teaching materials and courses arranged at local hospitals and information from practice guidelines is important. Abandoning the procedure Not all attempted extractions are successful, and failure sometimes occurs. Most guidelines recommend that the extraction should be abandoned if the fetal head does not follow with each pull or after a maximum of two detachments of the cup. Usually, no more than six pulls should be used and/or it should take no more than 15 to 20 minutes to complete the extraction (26, 27, 31, 36). There are two population-based studies indicating that the use of sequential methods constitutes an incremental risk of injury to the infant (37, 38); others claim that the sequential use of forceps is safe for infants (39-41). Anatomically, the flexion point is an Figure 2: Flexion point imaginary spot over the sagittal sutures of the fetal skull, located approximately 6 cm posterior to the center of the anterior fontanel or 1 to 2 cm anterior to the posterior fontanel (Fig. If the cup is displaced, this will result in deflexion of the fetal head and a greater diameter of the fetal skull has to pass through the birth canal, increasing the risk of failure, detachments, and force needed to deliver the infant (16, 29, 30). In outlet extractions, when the fetal head is in a direct occipito anterior position, any cup would be appropriate (metal, plastic, or soft rubber cups) (13). Once the cup has been placed on top of the fetal skull, the operator must ensure that no maternal tissue is caught under the rim of the cup.

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The doses for anticonvulsant treatment noted above are those that are common to impotence erectile dysfunction purchase 100 mg kamagra soft with visa the forms and routes of benzodiazepines noted in this guideline b circumcision causes erectile dysfunction purchase genuine kamagra soft. A comparison of lorazepam erectile dysfunction drugs prostate cancer buy genuine kamagra soft, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus. Intranasal versus intravenous lorazepam for control of acute seizures in children: a randomized open-label study. A prospective, randomized study comparing intramuscular midazolam with intravenous diazepam for the treatment of seizures in children. Treatment of community onset, childhood convulsive status epilepticus: a prospective, population-based study. Effects of intranasal midazolam and rectal diazepam on acute convulsions in children: prospective randomized study. The short-term outcome of seizure management by prehospital personnel: a comparison of two protocols. Comparison of interventions in prehospital care by standing orders versus interventions ordered by direct (on-line) medical command. Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomized study. Comparison of intranasal midazolam with intravenous diazepam for treating acute seizures in children. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomized controlled trial. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Comparative study of intranasal midazolam and intravenous diazepam sedation for procedures and seizures. Comparison of buccal midazolam with rectal diazepam in the treatment of prolonged seizures in Ugandan children: a randomized clinical trial. Pharmacokinetics and clinical efficacy of midazolam in children with severe malaria and convulsions. Pharmacokinetics and clinical efficacy of lorazepam in children with severe malaria and convulsions. Detailed analysis of prehospital interventions in medical priority dispatch system determinants. Lorazepam versus diazepam-phenytoin combination in the treatment of convulsive status epilepticus in children: a randomized controlled trial. Efficacy of buccal midazolam compared to intravenous diazepam in controlling convulsions in children: a randomized control trial. Peripheral intravenous catheters started in prehospital and emergency department settings. Initiate early fluid resuscitation and vasopressors to maintain/restore adequate perfusion to vital organs 2. Differentiate between possible underlying causes of shock in order to promptly initiate additional therapy Patient Presentation Inclusion Criteria 1. Signs of poor perfusion (due to a medical cause) such as one or more of the following: a. Other risk of infection (spina bifida or other genitourinary anatomic abnormality) 2. Airway/breathing (airway edema, rales, wheezing, pulse oximetry, respiratory rate) b. If there is a history of adrenal insufficiency or long-term steroid dependence, give: a. Norepinephrine there is recent evidence that supports the use of norepinephrine as the preferred intervention. Although dopamine is often recommended for the treatment of symptomatic bradycardia, recent research indicates that patients in cardiogenic or septic shock treated with norepinephrine have a lower mortality rate compared to those treated with dopamine (initial norepinephrine dose: 0. For anaphylactic shock, treat per the Anaphylaxis and Allergic Reaction guideline 15. Recognition of cardiogenic shock if patient condition deteriorates after fluid administration, rales or hepatomegaly develop, then consider cardiogenic shock and holding further fluid administration Notes/Educational Pearls Key Considerations 1.

What About Sex During Pregnancy Minnesota: Internation Childbirth Education Association erectile dysfunction yeast infection generic kamagra soft 100 mg on line, Inc erectile dysfunction cure cheap kamagra soft 100mg with visa. California: Mindbody Press erectile dysfunction treatment cincinnati 100mg kamagra soft mastercard, 1984 Prepared Childbirth Association of Portland, Oregon, ed. The Parent Manual: Handbook for a Prepared Childbirth, New Jersey: Avery Publishing Group, Inc. If a pregnant woman suspects a decrease or change in fetal movements from the th 26 week of pregnancy or after, she should: a. Place her hands on either side of her abdomen and gently shake her abdomen from left to right. Eat a small meal or drink orange juice, lie on her left side for one hour and record the number of fetal movements felt. According to the American College of Obstetricians and Gynecologists, an informed consent includes: a. The process(es) contemplated by the physician as treatment, its risks and hazards. There is no drug, whether prescription or over-the-counter remedy, which has been proven safe for the unborn child. Over-the-counter medications with no disclaimer against use during pregnancy are safe for the unborn child. Properly prescribed medications used after the 4 month of pregnancy are safe for the unborn child. Over-the-counter medications with no disclaimer against the use after the th 4 month of pregnancy are safe for the unborn child. Maternal health habits such as smoking, alcohol ingestion, drugs or medications taken. Prevent formation of lower extremity blood clots due to pressure of the growing fetus on major blood vessels. Ask questions fully clothed and across the desk from ones primary caregiver, not in the examining room. The release of epinephrine, as in the Fight-or-Flight Response, tends to cause: a. That the cerebral cortex can only process one set of signals as a primary signal relegating all other incoming signals to a secondary position. That the cerebral cortex can only process one set of signals as a primary signal while completely ignoring all other incoming signals. Because I wrote parts one, two, and three for different classes, I have not attempted to connect their themes. Nevertheless, I would like them to be laid to rest in one document because of their shared subject. Parts three and four, however, are interrelated and should, ideally, be read in sequence. Together, parts three and four form the heart of my capstone project and were completed between January and June 2017 under the patient and helpful guidance of Dr. Thanks also to Bruce Kinzer and Christine Johnston for your advice and encouragement; to Dr. Scott Linneman for approving this project; to my mom for sharing her stories with me at a young age; and to Dylan, Meera, Willa, Hazel, Nell, Maya, Kate, Evan, Karen, Caroline, and Eric for editing portions of my papers, for listening to me process my ideas, for asking questions, and/or for insisting that everything was going to work out. It has drawn me closer to family members and friends and has taught me about religion and science and culture and art and a dozen other subjects. I encourage you to share your own stories and ideas of childbirth and ask for those of others. Enjoy, Quinn Rathkamp Rathkamp 2 Professor Christine Johnston History of Ancient Mesopotamia (Western Washington University) Part I Pervasive Practices and Divergent Cultural Traditions Surrounding Childbirth in Ancient Egypt and Ancient Mesopotamia In the ancient Near East, cultures and traditions collided on a regular basis. Makers of monumental architecture in Egypt constructed drastically different structures from those found in ancient Babylon or Israel. Tombs held different objects, economies produced different goods, servants were set to different tasks and ate different foods: Near Eastern cultures diverged from one another in a wide variety of ways. It is, thus, important to underscore cultural similarities where they can be found. Practical materials and rituals employed during childbirth were strikingly similar throughout ancient Egypt and the Near East. However, the spiritual rituals, metaphors, and social significance of childbirth varied drastically, especially between the world of ancient Egypt and that of the Hebrew Bible.