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On the other hand buy acivir pills 200 mg online, if your eyes wander all over the place and only briefly make contact with the eyes of the interviewee acivir pills 200mg overnight delivery, low self-esteem discount 200 mg acivir pills overnight delivery, deceit or boredom HOW TO CONDUCT INTERVIEWS / 71 can be indicated. Conversely, watch the eyes of your interviewees which will tell you a lot about how the interview is progressing. Try not to sit directly opposite them – at an angle is better, but not by their side as you will have to keep turning your heads which will be un- comfortable in a long interview. By watching the eye movements and body language of the interviewees, and by listening to what they’re saying, you’ll soon know when you’ve established rapport. If, however, you notice the interviewees becoming uncomfortable in any way, respect their feelings and move on to a more general topic. Sometimes you might need to offer to turn off the recorder or stop taking notes if you touch upon a particularly sensitive issue. Negotiate a length of time for the interviews and stick to it, unless the interviewees are happy to continue. Make sure you thank them for their help and leave a contact number in case they wish to speak to you at a later date. You might find it useful to send a transcript to the inter- viewees – it is good for them to have a record of what has been said and they might wish to add further information. Do not disclose information to third parties unless you have received permission to do so (see Chapter 13). ASKING QUESTIONS AND PROBING FOR INFORMATION As the interview progresses, ask questions, listen carefully 72 / PRACTICAL RESEARCH METHODS to responses and probe for more information. When you probe, you need to think about obtaining clar- ification, elaboration, explanation and understanding. There are several ways to probe for more detail, as the fol- lowing list illustrates. PROBING FOR MORE DETAIL X That’s interesting; can you explain that in more de- tail? You’ll find that most people are uncomfortable during silences and will elaborate on what they’ve said rather than experience discomfort. Also, you may find it helpful to summarise what people have said as a way of finding out if you have understood them and to determine whether they wish to add any further information. Another useful tactic is to repeat the last few words a per- son has said, turning it into a question. The following piece of dialogue from an interview illustrates how these techniques can be used so that the researcher does not in- fluence what is being said.

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The issue of whether a child is neurologically normal or not does not enter into the definition generic 200 mg acivir pills overnight delivery. Complex features are relatively common and occur in a quarter to a third of febrile seizures buy acivir pills 200mg online. In North America and Western Europe cheap acivir pills 200mg without prescription, approximately 2–5% of all children will experience a febrile seizure by age 7. In Japan, however, 9–10% of all children experience at least one febrile seizure. Interestingly, there is no increased risk of epilepsy in Japan compared with North America and Western Europe attesting to the generally benign nature of febrile seizures. In all these countries, despite differ- ences in the risk of having a febrile seizure, the peak incidence of febrile seizure onset is between 18 and 22 months, and the majority of cases occur between 6 months and 3 years of age. Factors that predispose a child to have a febrile seizure during the first few years of life include a family history of febrile seizures in a first or second degree relative, attendance at day care, developmental delay, and a neonatal nursery stay of 73 74 Shinnar > 30 days. While children with one or more of these factors are at increased risk of having febrile seizures, more than half the cases occur in children with no known risk factors. Clearly, not every 18 month old with a febrile illness experiences a seizure. The most important factors associated with an increased risk of having a seizure during a febrile illness are the peak temperature (as distinct from the temperature at the time of the seizure), and a family history of febrile seizures in a first or second degree rela- tive. Children with gastroenteritis are less likely to experience a febrile seizure than are children with otitis media or an upper respiratory tract infection. DIAGNOSTIC EVALUATION The diagnostic evaluation of a child who presents with a seizure in the context of a febrile illness is primarily aimed at excluding other types of acute symptomatic sei- zures. Between 2% and 5% of children who present with seizures and fever will turn out to have meningitis rather than a febrile seizure. Risk factors for meningitis include focal or prolonged seizures, suspicious findings on neurological or physical examination, and a visit for medical care within the previous few days. Lumbar puncture is therefore recom- mended in all children with a complex febrile seizure, particularly a prolonged or focal one. In 1996, the American Academy of Pediatrics issued guidelines for the evalua- tion of a child with simple febrile seizures between age 6 months and 5 years. It recommended that a lumbar puncture should be strongly considered in an infant less than 12 months of age. Since the signs of meningitis may be subtle in the 12–18 month age group, a careful assessment is mandatory. A lumbar puncture is not necessary in a child above 18 months of age if the history and physical examination are not suspicious for meningitis. In children older than age 5, one must also con- sider a lumbar puncture to exclude encephalitis, as febrile seizures in this age group are relatively uncommon. It is important to realize that ‘‘having a source’’ for the fever is not a useful criterion in the decision about whether to do a lumbar puncture.

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I have also demonstrated that people who use alternative health care are not marked by particular characteristics; rather discount acivir pills 200 mg amex, they are individuals who reflect the general population buy acivir pills 200mg fast delivery. The people who took part in this research began using alternative therapies through a variety of different points of entrée into alternative health care networks made up of alternative practitioners and other lay users of alternative therapies acivir pills 200 mg without prescription. Acknowledging that these therapies permeate the health care system means that the only fruitful distinction we can make between forms of therapy is whether or not they are regulated in some fashion. Furthermore, how these people experience their alternative health care networks required a reconceptualization of the health care system to account for the fact that accessing alternative therapies can be a difficult process at times. However, despite the constraints on access these informants experienced, a significant finding is that they were also able to engage in experimentation with alternative therapies in ways they are unable to do with allopathic health care. In general, the people who spoke with me were not seeking forms of health care that conformed to alternative ideologies of health and healing they espoused prior to their participation in these therapies. Rather, they 112 | Using Alternative Therapies: A Qualitative Analysis sought out alternative approaches in order to address health problems, both personal and physical, for which they hitherto had found no solution. Thus the use of alternative therapies is no different than any other form of health-seeking behaviour. Moreover, it is better understood through the generic social process of problem-solving, rather than through the push/pull dynamics of particular motivating factors. While these people were not shopping for an ideology when they first sought out alternative therapies, participation in these approaches to health care led to their adoption of alternative health and healing beliefs—beliefs that inform their alternative models of health and healing. They gave meaning to their alternative model of health through what they see as the distinctly alternative conceptual categories of holism, balance and control. For these people, to be healthy is to be engaged in the process of healing, which they see as a categorically different understanding of health to that embodied in allopathic notions of health, illness, and disease. In contrast, they gave meaning to the components of their alternative model of healing by making constant reference to what they understand as the negative standard of biomedicine. While these informants value the differences they see between alternative and allopathic approaches to health and health care, critical analysis of their alternative model of health reveals that it fares no better than the biomedical model where the charge of blaming the individual for problems of ill health is concerned. Rather, their alternative model of health is equally reductionist in turning attention away from the social production of illness and disease. In addition, the benefits to health and self these people attribute to their participation in alternative therapies are only available to those with the resources (i. Finally, I have shown how espousal of alternative ideologies of health and healing can have a profound impact on individuals’ subjective perceptions of self. These ideologies affected informants’ identities in two significant ways. Some of them became so committed to their new health beliefs that they began the process of becoming alternative practitioners themselves. For others the impact was more extensive: the ideology contained within the alternative model of health and healing became a mechanism through which they transformed their personal identities for the better. In particu- lar, it became the means by which they are able to construct a sense of self that is healthy, even in the presence of biomedically defined disease and infirmity.

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With fixed rate discount 200mg acivir pills with amex, or asynchronous cheap 200mg acivir pills, pacing the generator produces stimuli at regular intervals generic acivir pills 200 mg overnight delivery, regardless of the underlying cardiac rhythm. Unfortunately, competition between paced beats and the Ventricular pacing spikes seen before the QRS complex intrinsic cardiac rhythm may lead to irregular palpitation, and stimulation during ventricular repolarisation can lead to serious ventricular arrhythmias, including ventricular fibrillation (VF). With demand, or synchronous, pacing the generator senses spontaneous QRS complexes that inhibit its output. If the intrinsic cardiac rate is higher than the selected pacing rate then the generator will be inhibited completely. If a spontaneous QRS complex is not followed by another within a predetermined escape interval an impulse is generated. This mode of pacing minimises competition between natural and paced beats and reduces the risk of inducing arrhythmias. Some pacemakers have an escape interval after a sensed event (the hysteresis interval) that is substantially longer than Atrial and ventricular pacing artefacts seen with dual chamber pacing 81 ABC of Resuscitation the automatic interval (the interval between two consecutive Principal indications for pacing stimuli during continuous pacing). This may permit more spontaneous cardiac activity before the pacemaker fires. Third-degree (complete) AV block: ● When pauses of three seconds or more or any escape rate temporary pacing systems a control on the pulse generator of more than 40 beats/min or symptoms due to the block allows selection of the pacing mode; with permanent systems occur the unit may be converted from demand to fixed rate mode by ● Arrhythmias or other medical conditions requiring drugs placing a magnet over the generator. Sinus node dysfunction with: arise because of failure of the sinoatrial node to generate an ● Symptomatic bradycardia or pauses that produce symptoms impulse or because failure of impulse conduction occurs in ● Chronotropic incompetence 3. Chronic bifascicular and trifascicular block associated with: the atrioventricular (AV) node or His–Purkinje system. Hypersensitive carotid sinus syndrome and neurally mediated Pacing is also used for tachycardia; a paced beat or sequence syncope of beats is used to interrupt the tachycardia and provides an 5. Atrial ● Symptomatic recurrent supraventricular tachycardia flutter and certain forms of junctional tachycardia may be reproducibly terminated by pacing, after drugs and catheter ablation fail to control the arrhythmia or produce terminated by atrial pacing. Ventricular burst pacing is intolerable side effects sometimes used to treat ventricular tachycardia (VT), but this ● Sustained pause-dependent VT when pacing has been requires an implanted defibrillator to be used as a backup. Pacing during resuscitation attempts In the context of resuscitation, pacing is most commonly used to treat bradycardia preceeding cardiac arrest or complications in the post-resuscitation period; complete (third-degree) AV block is the most important bradycardia in this situation. Pacing may also be used as a preventive strategy when the occurrence of serious bradycardia or asystole can be anticipated. This is considered further in the section on the Pacing may be used in the following management of bradycardia (Chapter 5).

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