Colleen M. Kennedy, MD, MS
There is very little experience for long-term antiphlogis tic therapy with a daily dosage of up to 5 g pain medication for dogs advil purchase rizact 10 mg online. The 16-day-old infant of another mother who took 4 g of acetylsalicylic acid daily pain medication for dogs in labor purchase generic rizact from india, as antiphlogistic therapy pain treatment for ovarian cysts rizact 10 mg visa, showed toxic symptoms with a salicylate con centration of 240 mg/l in the plasma (Clark 1981) pain management for dogs after spay purchase rizact 5 mg without prescription. The occasional use of acetylsalicylic acid as a measure against pain seems justifiable, up to 1. In one study of a total of five mothers, a maximum of 500 g of mor phine per liter was found in the milk of the mothers after they had 4 received first 10 mg i. Another report describes concentrations of up to 100 g/l of milk following a daily intake of four times 5 mg in a mother who had already received morphine in the third trimester of pregnancy. Her infant was calculated to have received up to 12% of the maternal weight-related dosage; with 4 g/l, there were near analgesic values in the serum (Robieux 1990). The authors explain this as the habituation of the infant, who was already exposed prenatally, or as the slow reduction of his serum values because of the extended half-life in newborns. Other authors also mentioned the potential effects on behavioral and cognitive development, but these are unlikely with the temporary use of opiates. The limited oral availability of about 26% speaks against substantial drug transfer to the breastfed infant (Bar-Oz 2003). There are no reports to date on severe side effects via breast milk (American Academy of Pediatrics 2001). Buprenorphine enhances the pain-relieving action of bupivacaine when they are both administered epidurally. Furthermore, it is increas ingly used in opioid replacement therapy (see also Chapter 4. Buprenorphine and norbuprenorphine levels were determined from 10 random breast-milk samples collected over 4 successive days from a lactating woman during buprenorphine maintenance therapy with 8 mg/d. Another case report of a mother taking 4 mg/d calculated a relative dose of 1% (Marquet 1997). After administering 665 mg dextropropoxyphene to six study sub jects, using the highest concentration in the milk as a basis, a dosage of 1. In another study of 13 moth ers, a maximum of 19 ng/kg via the colostrum was calculated (Steer 1992). Five lactating women underwent induction of anesthesia with propofol and fentanyl (Nitsun 2006). However, immediately after the injection, distinctly higher concentrations could be measured in the milk, although they decline rapidly. Alfentanil and sufentanil can, apparently, be similarly evaluated (Madej 1987, Giesecke 1985). Alfentanil, with a half-life of about 1 hour, has a shorter half-life than fentanyl and sufentanil. Up to the third day postpartum, measurement of sufen tanil in the milk indicated values of 0. There were no side effects reported in breastfed infants (American Academy of Pediatrics 2001). However, the long half-life of pethidine (up to 13 hours) and its metabolite norpethidine (63 hours) may result 4. Flupirtin, hydromorphone, meptazinol, nefopam, pentazocine, pir itramide, remifentanil, and tilidine are not sufficiently studied. Because of their depressive effect on respiration, particular care should be taken with children with a tendency towards apnea. Codeine (in combination with paracetamol or acetylsalicylic acid), fentanyl, and morphine are, depending on the indication, the opiate analgesics of choice during breastfeeding. However, these drugs also require close observation for somnolence in case of repeated dosages. If alfentanil, dextropropoxyphene, nalbuphine or pethidine are necessary, these are also acceptable. Other med ications, such as buprenorphine, flupirtin, meptazinol, nefopam, pentazocine, piritramide, tilidine, and tramadol, as well as the opiate antagonists mentioned above, do not require any limitation on breastfeeding when they are given as single doses. The continuation of prenatally-initiated substitution for heroin addicts is viewed less critically than beginning a high-dosage opiate analgesia during breastfeeding (see Chapter 4. Following the ingestion of indomethacin, a seizure attack was observed in one breastfed infant (Eeg-Olofsson 1978). In the case of long-term therapy of a mother with naproxen, a max imum relative dosage of 3. In another case of long-term therapy, a prolonged aggregation time for prothrombin and thrombocytes was found (Fidalgo 1989). Of 20 treated mothers, 10 reported slight sedation in their breastfed infants (Ito 1993). However, no substance could be detected in the serum of the clinically unre markable infant (Ostensen 1988). There is insufficient experience to evaluate the other nonsteroid antirheumatics, including acemetacin, dexketoprofen, etofenamat, fen bufen, ketoprofen, lonazolac, lornoxicam, meloxicam, nabumetone, niflumic acid, nimesulide, proglumetacin, sulindac, and tiaprofen. Among the nonsteroid antirheumatics, the acidic antiphlogistics ibuprofen and flurbiprofen are the drugs of choice during breastfeeding. Occasional use of azapropazon, diclofenac, and flufenamic acid is also permissible. Accidental administration of one of the other non steroid antirheumatics does not require any limitation of breastfeeding, although the medication should be changed. Celecoxib is a lipophilic substance, of which 97% is bound to plasma protein, and it exhibits a high distribution volume. A peak concentration of 133 ng/ml was measured in the milk 5 hours after the administration of 100 mg, which corresponds to 20 g/kg per day 4 to a breastfed infant, or a weight-adjusted dose of approximately 1% (Knoppert 2003). A more recent publication studied oral administra tion of celecoxib 200 mg to six lactating volunteers. Because cardiotoxic side effects were suspected, rofecoxib was withdrawn from the market. Taking its four main metabolites into consideration, an M/P ratio of about 1 was calculated for metamizol. In one case, very similar serum concentrations were found in both mother and child (Zylber-Katz 1986). Another report describes cyanotic attacks in an infant after his mother took metamizol (Rizzoni 1984).
But pain treatment center st louis cheap rizact 5 mg on line, in Land of Desire: Merchants joint pain treatment natural purchase rizact cheap, Power and the Rise of a New American Culture (1993) pain treatment center nashville tn cheapest generic rizact uk, he states that the book is not about behavior or social consensus but about the creation of a new culture through the eorts of a small set of business elites (p pain treatment center tn buy cheap rizact 5 mg on-line. In par ticular, children, even infants, were discussed as if they had pre-existent tastes and desires for specic kinds of clothes and retail settings. I present materials and cases in support of my argument that children have gained increasing degrees of social personhood largely, but not exclusively, through market processes and trade constructions by being legit imized as agentive economic actors, i. Trade publications can reach beyond their immediate constituency and have a larger, civic impact. In her history of the clashes between the advertising industry and what is commonly referred to as the 1930s consumer movement, Inger L. Stole shows how the advertising trade press served as a microphone or prosthesis for business interests over and against those of the public. To the chagrin of the advertising industry, consumer advocates found their message particularly welcome in schools and institutions of higher learning, a trend which prompted one trade journal to move beyond its traditional function. Not emphasized to any extent above is how each author took pains to compare, verify or otherwise triangulate the views and technical facts proered by the trade with other forms of evidence, including government reports and stories in consumer magazines and newspapers. Whether imperfect reections of reality to be deciphered, sources of multi ple perspectives, microphones of commercial interest or a forum for the exchange of sym bolic currencies, trade materials were examined by each author so as to discern the particular viewpoints made possible by their consultation. Ethnographies Since the latter part of the 1990s, there has been a growing interest in the inner workings of the advertising industry. Public images of the advertising profession, images which unfortunately many academics often accept uncritically, have presented it in one of two 540 Handbook of qualitative research methods in marketing general ways: either as a highly scientized and therefore manipulating undertaking where researchers have their nger on the pulse of consumer desire, or as a thoroughly creative endeavor arising from the inspiration and perhaps genius of creatives. Indeed any con versation with entering undergraduate advertising majors will conrm that both of these views still hold sway. Perhaps owing to the explosion of electronic and globalized media, to the aggressive corporate sponsorship of events and to the never-ending eorts to make brands a ubiquitous part of public culture (Klein, 1999), some scholars have sought to penetrate the facade of readily visible advertisements in an eort to grapple with the per vasive societal power of the advertising industry. Recognizing that much of the work done by advertising professionals has been opaque to scholars as well as to the public, it is not surprising that the turn to the inside view in recent years has taken an ethnographic tendency. Through interviews, participation and observation, a number of scholars have trained their research gaze on the persons, contexts and social relations informing the creation of advertisements and ad campaigns, rather than only on the ads themselves. When researchers approach advertising practitioners as informants and conceptualize their profession as a eld site, questions of the social use and status of knowledge come to the fore in a number of ways. The point and function of advertising, they claim, is to reduce producer anxiety (see also Mazzarella, 2003a, 2003b). Advertising rms rely on market research rms who, in a similar manner, sell not only their particular service or product, i. She concludes that brand managers deploy research to manage their Training the research gaze on advertising and market practitioners 541 clients and that the validity of research in this context comes to be dened in terms of its utility (pp. The presence of the researcher who can follow campaigns and decisions as they change in response to changing situations and priorities, or who can interview about these processes, brings into relief the multiple actors and positions involved in the making of an advertisement, such as clients, creatives, account planners and research rms (Malefyt and Moeran, 2003). Consequently, as Kover (1995) points out in his study of implicit theories of advertising copyrighters, interpretive inquiry details how knowledge is a co-creation which cannot be simply located within individuals or in mere creative genius. Problems of knowledge always accompany any kind of study and any sort of method regardless of topic or technique. The dierence here resides in the fact that, in ethnographic research, the researcher also must deal with the way her or his cultural position and presence inform the social shape and character of the materials gathered, a point barely touched upon in the studies discussed above. A number of recently published ethnographic studies on advertising, marketing and marketplaces oer dierent takes on problems of knowledge, or knowledges, in the context of commercial enterprise. The tensions and interactions reinforcing the tendency toward generic depictions are multiple and cross-cutting. Latino marketers and advertisers often scrutinize the authen ticity of newcomers to their agencies in terms of country of origin, skin tone and the kind 542 Handbook of qualitative research methods in marketing of Spanish they speak (pp. Consequently many creatives, account mangers and researchers need to demonstrate or perform their Latin-ness to each other, sometimes in stereotypical ways. 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Derrida stomach pain treatment home order 10 mg rizact free shipping, Jacques (1978) pain treatment center new paltz buy rizact overnight delivery, Writing and Dierence urmc pain treatment center sawgrass drive rochester ny order rizact us, Alan Bass pain medication for dogs with hip dysplasia discount rizact 5 mg with amex, trans, Chicago: University of Chicago Press. Firat, Fuak and Nikhilesh Dholakia (1998), Consuming People: From Political Economy to Theaters of Consumption, London: Routledge. Gallop, Jane (1988), Thinking Through the Body, New York: Columbia University Press. Miller, Daniel (1987), Material Culture and Mass Consumption, Oxford, New York: Basil Blackwell. Spradley, James (1980), Participant Observation, New York: Holt, Rinehart and Winston. Durgee and Manli Chen Background Marketers have been using metaphors for many years in marketing and marketing research in all three stages of the marketing process: need nding (Zaltman, 2003; Rapaille, 2001), new product idea generation (VanGundy, 1988; Cougar, 1995; Schon, 1979; Dahl and Moreau, 2002) and marketing actions including advertising (Mick and McQuarrie, 1999), product naming (Durgee and Stuart, 1987) and new product design (Dumas, l994). In each phase, marketers, consumers and new product development people use metaphors to understand each other better, and they use them to see needs, new product concepts and other marketing actions from fresh perspectives, perspectives which help marketers and product developers conceive new variations on these needs and products. Consequently, in this chapter, we are concerned with the question of how marketers can creatively redene or reconceive their oerings. We review the metaphor concept as well as literature dealing with the way market needs and metaphors are used to generate new product ideas. We also describe a series of exploratory projects aimed at improving the eectiveness of metaphor usage in new product ideation, in particular how needs might be incorporated more directly in the metaphor-seeking process. A metaphor depends upon the drawing of implications grounded in perceived analogies of structure between two subjects belonging to dierent domains (Black, 1962, 1979; Ortony, 1979), but it needs to be recognized that a metaphor also stretches beyond a declaration of simi larity in order to be a heuristic device of value. When a metaphor is generated, similar attributes of phe nomena, subjects or domains are actually identied to form an analogy (the implied simile), whereas dissimilar attributes of the referents are identied to produce semantic 291 292 Handbook of qualitative research methods in marketing anomaly (Mac Cormac, 1985). However, these dissimilar attributes, while being semantic ally anomalous or grammatically deviant when taken literally (Mac Cormac, 1985; Stern, 2000), might nevertheless provide fresh and previously nonexistent insights into the reality of marketing by oering a hypothesis of the dynamics and identity of a marketing phe nomenon (Cornelissen, 2003). Nowadays, with the increasing recognition of signicant usefulness of metaphors, we can see a lot more examples of metaphors in qualitative marketing research. In projective methods (see the Rook chapter in this volume), respondents are asked to describe some category A in terms of non-related categories B, C and D. In consumer research, categor ization studies examine how consumers understand new product introductions by inter preting them in terms of categories of objects they already know (Moreau, Markman and Lehmann, 2001), and interpretive research uses metaphors to capture and explain con sumer behaviors and lifestyles (Mick et al. Good qualitative marketing research is research that is creative, that facilitates new, excit ing understandings, theories and interpretations. Creativity is about banging two previously unrelated things together (Csikszentmihalyi, 1996) to bring new meanings into the world, so the study of metaphor ts perfectly with creative and qualitative marketing eorts. Using metaphors in new product ideation Designers and planners use metaphors in a variety of ways to come up with new product ideas. This is generally a good method for opening up the creative process to maximize creative possibilities. If the starting category was vacuum cleaners and we want ideas for new vacuum cleaner products, for example, the list might include things like brooms, waste baskets, garbage disposals and sh that suck on pond bottoms. The designer then selects an individual item from this list, and breaks it into separate Metaphors, needs and new product ideation 293 properties, anticipating that each property might suggest a way to redesign the original category. The garbage disposal can also accommodate a lot of dierent food (and nonfood) items. Would it be useful to have a vacuum cleaner that could suck up a wide range of small and large things Michalko pro vides a list of 150 parallel worlds; for example, biology, library, cemetery, nance, ying, cartoons, shing, Germany, calculus, ballet and grocery stores. Next, the researcher examines each of the parallel worlds individually for properties which might apply to the starting category. The next task is to scan one of these for all of its properties, which might suggest improvements to vacuum cleaners.
Trauma includes affected person may eat emotionally joint and pain treatment center fresno ca generic rizact 5 mg mastercard, which can lead physical pain management for osteosarcoma in dogs buy rizact 5 mg free shipping, sexual pain treatment pancreatitis purchase 5 mg rizact overnight delivery, and institutional abuse; neglect; to weight gain and/or an eating disorder pain treatment with antidepressants cheap rizact 5 mg with amex. Emotional intergenerational trauma; and disasters that induce eating and compulsive overeating are ways to cope powerlessness, fear, recurrent hopelessness, and a with issues such as stress, depression, and low self constant state of alert. Emotional eating is a behaviour that can persons with the most serious mental health usually be controlled; however, with compulsive problems are interpersonal in nature, intentional, overeating, it is difficult for the person to control their prolonged, and repeated; occur in childhood and impulses to eat. They include sexual abuse or incest, physical people with histories of trauma that acknowledges the abuse, severe neglect, and serious emotional role that trauma has played in their lives. They may also include informed care creates a "to do no harm" environment the witnessing of violence, repeated abandonment, that reflects physical and emotional safety, and that and sudden and traumatic losses. As adults, provides a non-judgmental atmosphere where these individuals often experience trauma and consumers have opportunities to understand the revictimization through domestic violence, sexual stories of their lives and find validation, learn to trust, assaults, gang and drug-related violence, homelessness, 389 and heal and grow. Registered Dietitians can create often results in recurring feelings of shame, guilt, rage, 390 safe and consumer-centred environments with isolation, and disconnection. When a lack of individualized nutrition care plans as means of nutrition is part of this equation, it can be difficult to trauma-informed care. Most research focuses on collaborative practice to increase awareness of traumatic experiences of childhood and their service-use triggers and use approaches that reduce relationship with depression, alcohol and drug abuse, the rate of retraumatization. The highest probability of poor treatment outcomes, relapse rates, and drop-outs in people with eating disorders has been observed in those who experienced childhood trauma393. Drop-out could represent an expression of victimization or hopelessness that interferes with compliance. There are often fewer Food insecurity is broadly defined as limited, grocery stores with fresh whole foods in low-income inadequate access to sufficient, safe, nutritious, neighbourhoods, and cheaper high-fat, high-sugar, personally acceptable food that meets dietary 394 and high-calorie food is often more readily available requirements for a healthy and productive life. Lack of personal insecurity negatively affects all dimensions of transportation and the limitations of public transit individual health and wellness. People living in basic food insecurity are more likely to have multiple accommodations may have limited preparation and chronic conditions, including heart disease, diabetes, 395;396 storage facilities, which can reduce their ability to obesity, high blood pressure, and impaired 397 purchase lower-cost bulk foods. Food insecurity is also functionally impaired may have reduced ability to associated with mental health issues such as higher prepare and consume food404. Questions to ask would be whether the lower levels of positive parent-child interaction. A person has worried that there would not be enough to few studies have examined food insecurity in eat because of lack of money, not had enough food to individuals with mental health conditions. One cross eat because of lack of money, or if they access the sectional survey indicated that about 41% of services of any food assistance programs. There food security and these participants showed a higher is also a need to advocate for food access services level of psychological distress than food-secure 401 that are dignified, capacity building, and help reduce individuals. Dietitians can work at all levels associated with being diagnosed with a clinically 402 of the food security continuum ure 5) to build food defined mental health condition. Some specific capacity building examples Insufficient income underlies the issues of food include community gardens where people can grow security and mental health. Comparisons of foods their own food, community kitchens where people can based on calorie per calorie analysis (not nutrients per learn food-related skills and connect with their calorie) have demonstrated that healthy foods are community, and food buying clubs. Resources such as more expensive compared with foods with a high local listings of food programs should be available to energy content primarily derived from fat and refined mental health consumers. In Canada, people with limited incomes who food costing studies are conducted on a regular basis are food-insecure will often chose cheaper, unhealthy 403;404. Those who work with food food prices and the changing nature of our food insecure groups can use this tool as a means to supply. Studies have noted sex and the therapies, a desire to reduce side effects of gender differences in different mental health medications, and dissatisfaction with conventional conditions such as depression and bipolar disorder425 therapies413;414. Gender may also be related to differences in Ginseng has been associated with depression and food choices and in energy and nutrient intake432. Melatonin may worsen food relations are shaped by various structuring depression and interact with sedatives and 420 differences, including gender, that define people. Interacts with sedatives and benzodiazepines420; Short-term mild impairments in vigilance, concentration, and processing time for complexb thoughts435-437. Positive economic anxiety, attention deficit hyperactivity disorder, returns were found for interventions aimed at early and substance use as well as relapse and treatment 433 childhood education, home visiting, or parent challenges. Some of the largest net controversial, but the dietitian may find it helpful to benefits were for programs that undertook long-term utilize some of the tools available, such as the Yale 434 follow-up so measurements of the impact on other Food Addiction Scale, when working with sectors. For children and youth with mental health guide approaches to address food-related issues. Marginality, or the social interventions that promote mental health for children exclusion from meaningful participation in society, is and adolescents need to incorporate family-based an experience affecting many people, but particularly approaches that support healthy eating and should those with mental health conditions439. About 5% of those between physiological changes, compounding medical the ages of 4 and 17 years have extreme 448 conditions, and drug side effects. There is evidence to suggest that suggested that individuals with serious mental health eating disorder issues are becoming increasingly conditions are substantially less likely than others to significant in this group. Well-controlled studies indicate that eating Geographically Isolated Regions disorders in adolescent females with Type I diabetes are twice as common as in control groups455. The co the health of a community is inversely proportional to occurrence of diabetes and eating disorders presents the remoteness of its location. Health indicators many unique challenges to health such as the consistently reveal that significant disparities exist in development of depression456. The needs of those health outcomes between people who live in northern with comorbid conditions are not being addressed in versus southern regions of Canada, as well as terms of either prevention or treatment457. Many rural community agencies also have asthma, chronic fatigue syndrome, chronic infection insufficient funds to hire Registered Dietitians. A particular telehealth-based nutrition counselling services are challenge in diabetes care is the growing population likely to benefit those who have nutritional issues and of individuals with mental health conditions who are geographically isolated. Treating the mental health condition of the interdependence of central nervous, is essential to stabilize blood glucose levels, but cardiovascular, immune, and endocrine systems. The many of the psychotropic medications used in interplay of biology, illness experience, and the social treatment are diabetogenic. Interventions need to focus on and environmental factors such as poverty resulting early engagement; providing easy-to-understand in malnutrition or inadequate medical care462. The most commonly monitoring impact of concurrent medications and occurring conditions include major depressive conditions; and using concrete short-term goals. Anxiety, compulsions, and rituals that may result in challenging behaviours are common. Fetal Alcohol Spectrum Disorder Permanent neurodevelopmental deficits, growth impairment, and other birth defects. Prader-Willi Syndrome Development of appetite deregulation in childhood that often leads to morbid obesity470. Down Syndrome Three forms: 1) extra chromosome 21 (95%); 2) translocation of chromosome 21 material (5%); and 3) partial trisomy 21 (rare). Prone to develop hypothyroidism, Alzheimer-like dementia at an earlier age, depression, and anxiety disorders. Fragile X Syndrome In its full form, it affects males, but lesser forms of the condition are found in females. It is important to determine if food preparation skills, nutrition and food safety challenging eating behaviours are linked to knowledge, and physical activity477. Other intake, eating non-food or unsafe food items, techniques include differential reinforcement, regurgitating, taking excess fluids, hoarding food, planned ignoring, simultaneous presentation, eating very quickly, eating a limited range of foods, physical guidance, demand fading, short meal hyperactivity, or involuntary movements. Dietitians can help design suggest high rates of malnutrition based on body services that enhance the quality of life for individuals mass index and skinfold measures497;498. A study improve attitudes toward physical activity and of diabetes management among the homeless in satisfaction with life487;488. Nutritional interventions that focus on linking consumers with low-cost meal options, community 4. People with conditions such as person who has registered or is entitled to be schizophrenia, substance abuse, and major registered according to the Indian Act; 2) Metis depressive disorders are more likely to become people; and 3) Inuit. Individuals Canada are considered within these three cultural at varying stages of homelessness tend to have groups, it is important to recognize, for example, that higher than average rates of malnutrition, suboptimal there are over 600 unique First Nations governments intakes of various micronutrients. |
