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By N. Ressel. Adelphi University. 2018.

Written texts from any lit- resist with powering in creating new ways of living erary source or any art form may be the subject of the conformity-nonconformity and certainty- research with the Human Becoming Hermeneutic uncertainty of originating quality 200 mg avana, while shedding light on Method generic avana 100mg without prescription. The researcher in affirming being in light of nonbeing” (Parse, 1998a, the Parse Method is truly present as the participant p. The being-nonbeing rhythm is all-at-once moves through an unstructured discussion about living the ever-changing now moment as it melts the lived experience under study. Humans, in originating, seek to the Human Becoming Hermeneutic Method is conform–not conform; that is, to be like others and truly present to the emerging possibilities in the unique all-at-once, while living the ambiguity of horizon of meaning arising in dialogue with texts the certainty-uncertainty embedded in all change. True presence is an intense attentive- The changing diversity arises with transforming the ness to unfolding essences and emergent meanings. The contributions of the findings from edge base underpinning true presence is specified studies using these two methods is “new knowledge in the assumptions and principles of human be- and understanding of humanly lived experiences” coming (Parse, 1981, 1992, 1995, 1997a, 1998a). Many studies have been con- True presence is a free-flowing attentiveness that ducted and some have been published in which arises from the belief that the human in mutual nurse scholars used the Parse Method. Two studies process with the universe is unitary, freely chooses have been published in which the author used the in situations, structures personal meaning, lives Human Becoming Hermeneutic Method (Cody, paradoxical rhythms, and moves beyond with 1995c; Ortiz, 2003). Parse states: “To The applied research method is the descriptive know, understand, and live the beliefs of human be- qualitative preproject-process-postproject method. The different way that arises from the human number of studies have been published in which becoming beliefs is true presence” (Parse, 1987, the authors used this method (Jonas, 1995a; 1998b). Many papers are published explicating Mitchell, 1995; Northrup & Cody, 1998; Santopinto human becoming practice (Arndt, 1995; Banonis, & Smith, 1995), and a synthesis of the findings of 1995; Bournes, 2000, 2003; Bournes & Flint, 2003; these and other such studies was written and pub- Butler, 1988; Butler & Snodgrass, 1991; Chapman, lished (Bournes, 2002b). The goal of the nurse 2002; Quiquero, Knights, & Meo, 1991; Rasmusson, 1995; Rasmusson, Jonas, & Mitchell, 1991; Smith, 2002; Stanley & Meghani, 2001; among others). The goal of the nurse living the human be- True presence is a powerful human-universe coming beliefs is true presence in bearing connection experienced in all realms of the uni- witness and being with others in their verse. Nurses may be with persons in living the human becoming beliefs is true presence discussions, imaginings, or remembrances through in bearing witness and being with others in their stories, films, drawings, photographs, movies, changing health patterns. True presence is lived metaphors, poetry, rhythmical movements, and through the human becoming dimensions and other expressions (Parse, 1998a, p. The nurse with individuals or groups is truly present with the The Human Becoming School of Thought is a unfolding meanings as persons explicate, dwell with, guide for research, practice, education, and admin- and move on with changing patterns of diversity. Scholars Living true presence is unique to the art of from five continents have embraced the belief human becoming. It is sometimes misinterpreted system and live Human Becoming in a variety of as simply asking persons what they want and re- venues, including health-care centers and univer- specting their desires. R hy thm icity um an beco in g isco creatin g creatin g rhy thm ical pattern s Sy n chr n izin g rhy thm shappen s eo le live en ia liies wih a ct ua liies a ll- a t rhy thm ical pattern s frel atin g frel atin g isl ivin g the para- in dwel l in g with the pitch, y aw, n ce; he a p a r en sie fwha t is in in pen in terchan ge with the do x ical un ity freveal in g- an d r fthe in terhum an he f r e fex er ien ce is a lwa ys a lso r es- un iverse. T ran scen den ce um an beco in g istran scen din g tran scen din g with the po ssi- bil izin g tran scen den ce hap- eo le live wih cha n ge in cho sen wa ys ha t m ul tidim en sio n al l y with the bl esispo werin g rigin atin g in pen sin vin g bey o n d the evo lve in a t er n s flivin g ha t a lso un f l din g po ssibl es the pr cess ftran sf r in g. There is a Parse home page on the Toronto, Canada, is in the process of conducting an World Wide Web that is updated regularly. Each 18-month study (Bournes & Ferguson-Paré, 2004) year, most of the 100 or more members of the to evaluate implementation of human becoming as International Consortium of Parse Scholars meet a guide to nursing practice on a unit where they are in Canada for a weekend immersion in human be- also evaluating the implementation of a staffing coming research and practice. Members of the con- model in which registered nurses are spending 80 sortium have prepared a set of teaching modules percent of their time in direct patient care and 20 (Pilkington & Jonas-Simpson, 1996) and a video percent of their time on professional development recording (International Consortium of Parse (80/20 model). It is believed that learning to use the Scholars, 1996) of Parse nurses in true presence human becoming theory in practice will enhance with persons in different settings. Parse scholars nurses’ satisfaction and be responsive to health-care present lectures and symposia regularly at interna- recipients’ call for patient-centered care (Bournes, tional forums. The addition of the 80/20 nurse staffing model is to address issues raised in the nurse reten- The Institute of Human Becoming tion literature indicating that nurses want profes- sional development opportunities, time to be The Institute of Human Becoming, founded in involved in developing professional practice and re- 1992, was created to offer interested nurses and search initiatives, demonstrated commitment and others the opportunity to study, with the au- support from nurse leaders, and reductions in thor, the ontological, epistemological, and workload. There are other health centers through- methodological aspects of the human becom- out the world that have Human Becoming as a ing school of thought. Toward that goal, the in- guide to health care (see, for example, the “Scholarly stitute offers regular sessions devoted to the Dialogue” column in Nursing Science Quarterly, study of the ontology and the research and volume 17, numbers 3 and 4). There are also sessions In South Dakota, a parish nursing model was on teaching-learning, leading-following, com- built on the principles of human becoming to guide munity, and family. All of the sessions have as nursing practice at the First Presbyterian Church in their goal the understanding of the meaning of Sioux Falls (Bunkers, Michaels, & Ethridge, 1997; the human-universe-health process from a Bunkers & Putnam, 1995). Nursing of South Dakota has adopted a decisioning model based on the human becoming school of thought (Damgaard & Bunkers, 1998). Augustana College (in Sioux Falls) has human becoming as one central focus of the curricula for the baccalau- reate and master’s programs.

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A number of lifestyle factors contribute to heart failure such as smoking purchase 100 mg avana amex, obesity order avana 100mg without prescription, and diet. In many cases it is possible to prevent heart failure by controlling the risk factors that damage the heart. Maintaining a healthy diet, exercising regularly, not smoking, and reduc- ing stress can help significantly. There are also a variety of supplements that can strengthen the function of the heart. Signs and symptoms are similar to those of chronic heart failure, but are more severe and start suddenly. C • Diabetes increases the risk of high blood pressure and coronary artery disease. Your doctor will rec- ommend a combination of lifestyle measures and medications to help improve the strength of the heart and reduce symptoms of heart failure. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril), and ramipril (Altace). Examples include carvedilol (Coreg), metoprolol (Lopressor), and propranolol (Inderal). Digoxin (Lanoxin): Increases the strength of your heart muscle contractions and slows the heartbeat. Diuretics: Commonly called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. In some cases, surgery can be done to correct the underlying problem, such as replac- ing a faulty heart valve, or doing bypass surgery on severely narrowed arteries. For those with severe heart failure that can’t be helped by surgery or medications, a heart transplant may be necessary. In this section I outline dietary, lifestyle, and supplement strategies that help improve heart function. Dietary Recommendations Foods to include: • Cold-water fish contains beneficial fatty acids that can help reduce blood pressure and C cholesterol. Foods to avoid: • Alcohol can weaken heart function and interacts negatively with many heart medications. Foods high in sodium include snack foods (chips, pretzels), deli meats, soft drinks, and fast foods. Note: Those with heart failure may need to limit fluid intake to prevent water retention. Tobacco damages blood vessels, reduces the oxygen in your blood, and makes your heart beat faster. Top Recommended Supplements Coenzyme Q10: An antioxidant that naturally occurs in all cells and is involved in energy production. C Complementary Supplements Calcium and magnesium: Essential for proper muscle contractions and blood vessel health. Fish oils: Over 30 studies have shown that the omega-3 fatty acids in fish oil can help lower blood pressure, reduce atherosclerosis, and protect against heart attack. Garlic: Helps lower blood pressure and cholesterol, reduces clotting, and prevents plaque formation in the arteries. Most of the research showing benefits has been done on aged garlic extract (Kyolic). L-taurine: An amino acid that helps increase the force and effectiveness of heart-muscle contractions. Natural relaxants: Hops, lemon balm, passionflower, and valerian are herbs that can help promote calming, which can help those under stress. Lactium (milk protein extract) and Suntheanine (green tea extract) are also effective in promoting calming, reducing stress, and improving sleep. Most people experience an occasional change in bowel habits; when it is persistent, it is referred to as chronic constipation. During the digestive process, food passes from the stomach to the intestine where nutrients and water are absorbed into the body. The waste products of digestion create a stool, which travels through the intestines with muscle contractions.

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Usage subject to terms and conditions of license Immunological Test Methods 127 Antigen Detection Methods 2 Fig purchase avana 200 mg amex. The term indirect immunofluorescence is used when it is not the primary antibody being detected purchase avana 50mg fast delivery, but a secondary antibody which is directed against the unlabeled primary antibodyand has also been labeled with a fluorochrome or enzyme (b). However, an even higher level of amplification can be achieved using preformed complexes of secondary antibody and enzyme (c). For the peroxidase method the detector enzyme is bounddirectly tothe secondary antibody (peroxidase catalyzes a color reaction). In the biotin-avidin method the detector enzymes are coupled to either biotin or avidin. The antigen–antibody com- plexes that form are then detected using a labeled or “second” antibody, di- rected against the first antibody (Fig. Instead of fluorochromes, enzy- me-labeled antibodies are now frequently used for tissue sections. The en- zyme catalyzes the formation of a color signal following addition of a pre- viously colorless detector substance. This color precipitate allows the direct observation of signals using a light microscopic, and exhibits little bleaching. Indirect immunofluorescence can be used for the qualitative and quanti- tative analysis of antibodies directed against particular microbial antigens, or self-tissue antigens, within a patients serum. In the quantitative test, the anti- gen is fixed in a well or to a tissue section on a slide. The patient sample is repeatedly diluted by a factor of two and added to the antigen or section then rendered visible with a labeled anti–antibody. There are two main methods of amplifying the immunohistological color signal: Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Usage subject to terms and conditions of license 128 2 Basic Principles of Immunology & The direct ’primary’ antibody, or the detected ’secondary’ antibody, is la- beled with peroxidase. Following the antigen-antibody reaction, large pre- formed peroxidase-antiperoxidase complexes are added tothe tissue section; these complexes can attach to the peroxidase-labeled antibodies, which are alreadyspecificallybound,thusamplifyingthesignalconsiderably(Fig. Various colorants or en- zymes coupled to avidin thus facilitate the color reactions. Such reactions can be amplified on the tissue section by adding preformed biotin-avidin-perox- idase complexes that bind to those biotin-coupled antibodies which have al- ready been bound. All absorbency tests in- volve the fixation of antigens or antibodies to a plastic surface. All of these assays can be performed in a direct form (different sandwich combinations of antigen, antibody and anti-antibody, Fig. Various methods are then used to detect any inter- action between the antigen and antibody. In the direct test (a) an immobilized, unknown, antigen can be detected using a fluorescent-labeled antibody. If the im- mobilized antigen is known, this test method can also be used to detect an anti- body bound to the antigen. Detection of antibody-antigen binding is then performed using a second, labeled antibody which interacts with the antigen at a different site. The capture method (c) can be used to detect any antigen, for instance IgM anti- bodies. First, anti-IgM antibodies are immobilized, then serum containing IgM is added to them. The detection procedure next makes use of either the labeled foreign antigen or a spe- cific, additionally labeled, antibody which binds to the bound antigen but not to the plastic bound antibody. In the competition or competitive inhibition test (d) antibodies are immobilized, and labeled antigens are then bound to them. An un- labeled (unknown) antigen is added, which competes with the labeled antigen. The level of interaction between the antibody and the unknown antigen is then determined by measuring attenuation of the signal. Usage subject to terms and conditions of license Immunological Test Methods 129 or as competition assays.

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In the best drugs and fetal intrauterine surgical procedures are circumstances of perfect contraceptive compli- obvious examples cheap avana 50 mg free shipping, but the clear-cut risks involved ance purchase avana 50mg line, in a one-year exposure and at a 0. With a ment call involves the development of antiepileptic ‘typical compliance’ of the contraceptive pill, a 3% drugs. It has been failure ratewould leave about 19 fetuses exposed to estimated that exposure of pregnant women to nor- experimental entities, one-third of which would be mal therapeutic doses of valproic acid may give rise lost due to spontaneous miscarriage. This of these drugs be developed in today’s litigious ‘ghost risk’ creates ‘discrimination’ against female atmosphere? This ‘ghost’ must be able in many circumstances; they may be the only exorcised and contained; possible solutions will drugs suitable for some patients and, indeed, be discussed later. Certainly, maternal status epilepticus is very injurious to the fetus, often resulting in miscarriage or premature birth. Medical journalist Paul Cotton (1990) asked, in a Thus, even using a known ‘low-incidence’ terato- thought-provoking article, is there still too much gen could cause 40 additional cases/1000 live extrapolation from data on middle-aged white births, but to determine that accurately would men? What is the and even for phase I testing of new contraceptives likelihood of detecting low-incidence, drug- hormonal for women. Why this occurs is multi- induced congenital effects in a drug development faceted. Each Timing of mutagenicity fertility program could carry a 1 in 33 to 1 in 6 chance of and teratogenicity testing a single ‘spontaneous’ abnormality occurring. If the drug or procedure should have low teratogenic The complete battery of tests with full histology activity (at the level of an anticonvulsant), this risk and the development of a final report can take as rises to 1 in 14 to 1 in 2. In general, only some of the with a congenital abnormality in any drug devel- mutagenicity studies are completed, and perhaps opment program. Both ‘spontaneous’ or drug- one- to three-month reports of animal testing are induced abnormalities may occur, for example available when male phase I dosing volunteer stu- a neural tube defect. All animal studies do not com- the abnormalities will be indistinguishable for mence at the same time but are usually sequential. This, in turn, can lead to litigation, Some, such as postexposure weaning and subse- and certainly to a reference in the package label quent second-generation drug effect studies, will insert. Often, if muta- Wilson has estimated that both drugs and envir- genicity tests, for example Ames’ test or mouse onmental chemical exposures only account for lymphoma test, are positive (Ames test has 30% 2–3% of developmental defects in man (Wilson, false-positive rate), then females will be excluded 1972). Thus, only limited occurrence will be undeserved at least 97% of data are available prior to the first human exposure the time, but also may be the first signal of a (for further reference Federal Register, 1994, teratogenic risk. Generally, as a result of animal studies, it ical Evaluation of Drugs (Federal Register, 1993). This is unduly optimistic, as one report by Yazigi, Odem and Polakoski (1991) suggest that Of much greater concern is the issue of standardiz- spermatozoa may not be immobilized or destroyed ing the drug administration to the menstrual cycle. Evidence suggests that even The blastocyst (early embryo) is relatively resis- low-dose contraceptives can affect metabolism tant to damage in the first seven days, for up to 75% (Abernathy and Greenblatt, 1981). The logistics of cells can be destroyed before tissue differentia- of running phase I single-dose and multiple-dose tion and the embryo can still survive. What might ranging studies while controlling for a natural happen if garden pesticides, or house builders’ menstrual cycle are truly horrendous, both for the formaldehyde containing glue and chemicals, are phase I testing units and for the volunteer. If it is ever duration of any study would be extended by at confirmed, then we may have the inkling of what least one month (the time required for the last makes up the 65% of the ‘unknown’ causes of patient’s cycle to start), and each patient volunteer developmental defects mentioned by Wilson would have to be measured separately because of (1972). A small but fre- chemicals are incorporated into the blastocyst, quently argued point is timing. Which is the pre- the field of male phase I testing would be trans- ferred day in the cycle for single-dose studies? This may seem academic, but in those clini- Testing facilities cally significant drug classes where womens’ responses to drug handling are different to those Largely because early testing of drugs occurred in of men because of biochemical hormone effects males rather than females, for reasons discussed (not just gender), then the timing of drug dosing above, most commercial and hospital units devoted and measurement would be critical. Sleeping Too many young volunteer studies and bathroom facilities in the units’ dormitory accommodations did not provide for mixed gender Many volunteer studies, especially at commercial, groups. These were minor but not inexpensive academic and university clinical units, include 16. Over time, the same dosage range disappear and indeed, from such diversity, there emerges in many countries, adjusting to the may spring new understanding of both clinical and ‘real world’ as opposed to the narrow demo- therapeutic mechanisms for the development and graphics of research or cultural expectations. Generally, where dosages are the same, the inci- dence of adverse events tends to be the same in the three regions (Edwards, 1993; Papaluca, 1993). United States and Europe than between Japan Springer- and the United States, or between Japan and Verlag: Berlin. Presented at the Annual Meeting Technology, television, transcontinental travel and of the American Psychiatric Association.

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