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By C. Thordir. Saint Petersburg College. 2018.

The publication reveals how these resourceful collaborations are improving health and wellness outcomes for the broader community as well as serving individual needs purchase sildenafil 50 mg on-line impotence help. We believe you will have new insights and appreciation for the invaluable contributions produced when arts and health professionals join forces for our community now and in the future buy sildenafil 75mg amex causes of erectile dysfunction in 20 year olds. Both of these sectors were formed in response to the industrialization of Cleveland s economy, which grew rapidly during the 19th and 20th centuries, greatly increasing the area s urban population and fnancial resources. With those resources, wealthy industrialists funded the development and endowment of numerous cultural organizations, greatly improving quality of life for the growing numbers of Cleveland residents. The resulting growth of the local healthcare industry led to advances in medicine and the establishment of boards of health and other certifcation agencies which, in turn, promoted the creation of more health education resources. These assets, along with Cleveland s location on key transportation routes, helped the city s medical community grow into one of the most notable metropolitan healthcare sectors in the world. Meanwhile, Cleveland s arts and culture institutions have multiplied in number and discipline, expanded in size and reputation, and become renowned attractions for local and international audiences. While Cleveland is known for the strength of its arts and culture and health and human services sectors, the intersections of those sectors are still being explored and developed. This white paper examines the concept of such intersections frst with a brief historical perspective on the development of the feld. The organization of subsequent chapters is based on a number of examples of real-life programs and practices, both national and local, which illustrate the many ways in which arts and culture contribute to healthcare practice and human services delivery: Arts integration in healthcare environments. The infusion of arts and culture in, or the design of, settings where healthcare and medical treatment are given to individuals. The engagement of individuals and communities in arts and culture activities and therapies for the promotion of broader clinical and general wellness outcomes. The ability of arts and culture to strengthen social ties and serve as a rallying point from which communities can address public health and social equity issues. The enrichment of medical training programs through the integration of arts and culture. The fnal sections of the paper introduce best practices and policy recommendations to further strengthen Cleveland s arts and health intersections in the future. Community Partnership for Arts and Culture 5 Creative Minds in Medicine Executive Summary The Historical Development of the Arts and Health Field Throughout history, doctors and medical personnel have provided care of patients and treatment of disease. They have worked to apply scientifc methods in light of and sometimes in spite of the different cultural conditions of the period and location in which they work. The tension between the twin concerns of comfort and science has pulled prevailing medical and social thought frst one way and then another over the years. This has occurred primarily as clinical approaches based in science, diagnosis of disease and observation have competed for favor with more humanistic approaches that emphasize individualized care, compassionate doctor/patient interactions and patient empowerment in healthcare decision-making. The patient-centric approach with its stronger connection to the social sciences has emerged more recently, following a period of stricter emphasis on disease-based, standardized treatment in the vein of natural sciences methodology. Over the past 50 years, greater acceptance of whole person healthcare practices, which consider each patient s unique needs, have created fertile ground for the application of arts and culture activities and expressive arts therapies in health and wellness.

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Its onset is abrupt and of greatest intensity at the and may hang their legs over the side of the bed or go time of onset cheap 100mg sildenafil otc erectile dysfunction treatment for heart patients. Chest pain associated with tenderness is suggestive of r Cheyne Stokes respiration is alternate cyclical hy- musculoskeletal pain purchase 25mg sildenafil free shipping erectile dysfunction pump canada. Oesophageal pain is a ret- failure, in some normal individuals (often elderly), in rosternal sensation often related to eating and may be patients with cerebrovascular disease and patients re- associated with dysphagia. It is thought that this pattern retrosternal burning pain, often exacerbated by bending of breathing results from depression of the respiratory forwards. Equally,painarisingfromstructures r Patients with severe acute left ventricular failure often in the chest may present as abdominal pain, e. Dyspnoea However, the major causes of frank haemoptysis are from the respiratory system. In general dyspnoea arises from either the respiratory or cardio- vascular system and it is often difcult to distinguish Palpitations between them. The patient may notice it on strenuous a missed beat, or their heart beating irregularly. In severe failure, patients are breath- rate and rhythm (ask the patient to tap out the beat with less at rest. Associated symptoms may include breath- pnoea an underlying cause should be sought, such as lessness, dizziness, syncope and/or chest pain. This symptom normally arises when a patient s exer- r Palpitations lasting just a few seconds are often due cise tolerance is already reduced. The patient becomes aware of the mechanisms are responsible for this phenomenon: a pause that occurs in the normal rhythm after a prema- redistribution of uid through gravity in the lungs ture beat and may sense the following stronger beat. Some patients may know how to terminate propping themselves up on pillows at night, or, in se- their rapid palpitations with manoeuvres such as vere cases, sleeping in a chair. Orthopnoea is highly squatting, straining or splashing ice-cold water on the suggestive of a cardiac cause of dyspnoea, although it face. These features are very suggestive of a distinct may also occur in severe respiratory disease due to the tachyarrhythmia rather than general anxiety or pre- second mechanism. It is thought to occur by a simi- Syncope lar mechanism to orthopnoea coupled to a decreased sensory response whilst asleep. Patients awake breath- Syncope is dened as a transient loss of conscious- less and anxious, they often describe having to sit up ness due to inadequate cerebral blood ow. There may be no warning, or patients may describe feel- The distance a patient can usually walk on the at be- ing faint, cold and clammy prior to the onset. Asthenarrowing tend to be ushed and sweaty but not confused (unless ofthearteriesbecomesmoresignicant,theclaudication prolonged hypoxia leads to a tonic-clonic seizure). Eventually rest pain may occur, this r Vasovagal syncope is very common and occurs in the often precedes ischaemia and gangrene of the affected absence of cardiac pathology. The heart contracts force- fully, which may lead to a reex bradycardia via vagal Oedema stimulation and hence a loss of consciousness.

Such host cells include bacterial sildenafil 75 mg low price erectile dysfunction after zoloft, plant and animal cells buy sildenafil 75mg online erectile dysfunction trials, and there are over 400 viruses that are known to infect humans. They may be transmitted by aerial contact, as a result of an infected host coughing or sneezing. Secondly, they may be transferable by close physical contact (intimacy or transfusion of blood). Finally, they may be transmitted via food and water, leading to diseases like hepatitis A, polio and viral gastroenteritis. This disease was also responsible for the decimation of Native American tribes in North and South America during the period of European colonization. Viruses such as Ebola and Lassa fever have very high mortality rates, but fortunately the latency period between infection and display of symptoms is short and so sufferers can usually be isolated quickly. Medical scientists can envision a potential supervirus and what characteristics it would display. Fig 22 Schematic representation of a virus Structure of viruses Essentially, a virus particle consists of nucleic acid packaged in a protein/lipid case. They are extremely small, from 10-400nm and are generally only visible under an electron microscope. Viral Life cycle There are 5 steps in the life cycle of a virus: Binding The virus initially binds to a receptor on the surface of the host cell using a specific molecule on its outer coat, which is usually a glycoprotein. The net result is the release of viral nucleic acid into the cell, which is then ready to start the process of viral replication. Synthesis Viral proteins and viral nucleic acid are assembled into new naked virions called nucleocapsids. These are then released from the cell as fully developed virions in two possible ways. Release Naked virions which lack any outer layer around the nucleocapsid are released by cell lysis, in which the host cell is destroyed. Viruses that contain an outer envelope are released by a process known as budding. In the latter, viral outer coat proteins are first incorporated into the host cell s membrane. The nucleocapsid then binds to the inner surface of the host cell membrane and, simultaneously, viral proteins collect at the site and host cell proteins are excluded. The plasma membrane containing viral proteins then encases the nucleocapsid, and the newly formed virion is then pinched off from the cell. Antiviral drug targets The major challenge facing medicinal chemists attempting to treat viral infections is the fact that these pathogens reside inside host cells, utilizing their host s biochemical mechanisms to multiply.

Standard volume with a separate title and separate authors/editors for each volume 2 75mg sildenafil impotence in a sentence. Box 78 Names for cities and countries not in English Use the English form for names of cities and countries if possible buy 100 mg sildenafil amex erectile dysfunction incidence age. Moskva becomes Moscow Wien becomes Vienna Italia becomes Italy Espana becomes Spain Examples for Author Affiliation 5. Books 165 Box 83 No title can be found Occasionally a publication does not appear to have any title; the book or other short document simply begins with the text. In this circumstance: Construct a title from the first few words of the text Use enough words to make the constructed title meaningful Place the constructed title in square brackets Example: Alizai S, Zia A. Edition for the Volume (required) General Rules for Edition Indicate the edition/version being cited after the title when a volume is published in more than one edition or version Abbreviate common words (see Abbreviation rules for editions below) Capitalize only the first word of the edition statement, proper nouns, and proper adjectives Express numbers representing editions in arabic ordinals. Examples : becomes o becomes u Books 169 Do not convert numbers or words for numbers to arabic ordinals as is the practice for English language publications. Box 88 First editions If a book does not carry any statement of edition, assume it is the first or only edition 170 Citing Medicine Use 1st ed. Volume with edition Editor and other Secondary Authors for the Volume (optional) General Rules for Editor and other Secondary Authors A secondary author modifies the work of the author. Box 91 Non-English names for secondary authors Translate the word found for editor, translator, illustrator, or other secondary author into English if possible. Box 96 No place of publication can be found If no place of publication can be found on the title page or its verso (back), but one can be found elsewhere in the publication or can be reasonably inferred (e. Volume with geographic qualifier added to place of publication for clarity Publisher for the Volume (required) General Rules for Publisher A publisher is defined as the individual or organization issuing the volume Record the name of the publisher as it appears in the publication, using whatever capitalization and punctuation is found there Abbreviate well-known publisher names if desired but with caution to avoid confusion. Volume with unknown publisher Date of Publication for the Volume (required) General Rules for Date of Publication Always give the year of publication Convert roman numerals to arabic numbers. Box 104 Non-English names for months Translate names of months into English Abbreviate them using the first three letters Capitalize them Examples: mayo = May luty = Feb brezen = Mar Box 105 Seasons instead of months Translate names of seasons into English Capitalize them Do not abbreviate them For example: balvan = Summer outomno = Fall hiver = Winter pomlad = Spring Box 106 Date of publication and date of copyright Some publications have both a date of publication and a date of copyright. Box 107 No date of publication, but a date of copyright A copyright date is identified by the symbol, the letter "c", or the word copyright preceding the date. Box 108 No date of publication or copyright can be found If neither a date of publication nor a date of copyright can be found, but a date can be estimated because of material in the volume itself or on accompanying material, insert a question mark after the estimated date and place date information in square brackets Bombay: Cardiological Society of India; [1980? Box 111 Roman numerals used as page numbers If all of the pages (not just the introductory pages) of a volume have roman numerals instead of the usual arabic numbers: Convert the roman numeral on the last page of the text to an arabic number Follow the number by "p. If the entire publication has no page numbers: Count the total number of pages of the text Express the total as leaves, not pages End with a period Example: 37 leaves. Standard volume with a separate title and separate authors/editors for each volume 19. Volume in a set continuously paginated Physical Description for the Volume (optional) General Rules for Physical Description Give information on the physical characteristics if a volume is published in a microform (microfilm, microfiche, etc. Series for the Volume (optional) General Rules for Series Begin with the name of the series Capitalize only the first word and proper nouns Follow the name with any numbers provided.