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The conclusion at the end of a piece of writing often contains a summary cheap 2.5mg altace visa. They are also used within the main body of the text before a topic shift order altace 2.5mg without prescription. These periodic reviews of the content help consolidate the reader’s understanding and add emphasis to the writer’s message trusted 2.5 mg altace. When writing a summary: ° Make sure you select the key points or identify the essence of the message discount altace 2.5 mg visa. Writing a conclusion The conclusion forms the final part of a piece of writing and helps bring it to a satisfactory closure discount 5mg altace fast delivery. A conclusion might contain: ° a summary of the main points (for example in a descriptive answer to an essay question) ° the general application of what has been discussed (for example the implications of a research project for clinical practice) ° a resolution to an argument (for example the writer proposes an answer to the questions or discussion points set within a dissertation) ° a link to the broader context (for example at the end of a dissertation, the writer might highlight the relevance of the issues under discussion to social policy). When writing a conclusion: ° Avoid writing explanations, detailed analyses or new information in the conclusion. WRITING AS AN AID TO LEARNING 139 ° Your search for information needs to be systematic, using the terms that represent the most important concept or theme in your subject. This might be in the form of a written hand­ out or text and visuals that are presented using overhead projectors, slide projectors, whiteboards or flipcharts. Add interest to your presentation Keep your audience interested by presenting information in different for­ mats. Maintain your students’ attention The attention and concentration of your students will not remain at the same level throughout your teaching session. It continues to fall until it reaches the lowest point half an hour into your lecture or seminar. Varying your presentation style by showing an overhead or using a flipchart is a useful way of gaining students’ attention at these points (Gibbs 1992). Help students remember information We know that people remember only 10 per cent of what they read and 20 per cent of what they hear. They are likely to remember 30 per cent from 140 PREPARING MATERIALS FOR TEACHING 141 visual images, which is increased to 50 per cent when this is combined with listening. Increase understanding of your message Written teaching materials provide an additional means of giving explana­ tions, examples, background facts and figures. Provide structure both for the students and yourself Overheads and handouts are useful as an aide-mémoire for the presenter and form a framework to support the spoken message. Planning Before deciding on the teaching materials you would like to use, you need to have done some essential decision making. Know your objectives Be specific about what you want to have achieved by the end of your teach­ ing session. Determine the learning outcomes What are the learning outcomes for the students? Decide on the content What information is essential to make sure you fulfil your objectives and ensure the students’ learning outcomes are achieved? This is the stage at which you will start to think about the teaching materials you will use to help you deliver this message. They can: ° Reinforce – use them to present your message using different formats. Look through your session plan and identify where you might want to use some additional teaching material. For example, we know students’ atten­ tion is low 30 minutes into a session, so material designed to alert might be of use at this point. At another point you may want to show a graph as evi­ dence to support your spoken message. There is no point in preparing slides if another lecturer has booked the projector or there is no way of dimming the lights in the teaching room. Consider timescales Designing teaching materials is one of the most time-consuming aspects of preparing for a teaching session. Check that you have enough time to PREPARING MATERIALS FOR TEACHING 143 put together your materials.

Her antiserum for rhinitis 10mg altace with amex, hay fever 10mg altace fast delivery, a term used since the 1830s 5 mg altace sale, is inaccu- reduced the death rate by almost 80% discount altace 5 mg without a prescription. Further research led to rate because the condition is not caused by fever and its symp- the use of sulfa drugs and other antibiotics in the treatment of toms do not include fever 5 mg altace overnight delivery. Her discovery prompted 46 million allergy sufferers in the United States, about 25 mil- research that has led to effective treatments for croup. While the mite itself is too large to be inhaled, its feces are about the size of pollen grains and can lead to allergic rhinitis. Other types of allergy can be traced to the fur of animals and pets, food, drugs, insect bites, and skin contact with chemical substances or odors. In the United States, there are about 12 million people who are allergic to a variety of chemicals. In some cases an allergic reaction to an insect sting or a drug reaction can cause sudden death. Serious asthma attacks are sometimes associated with seasonal rhinitis and other allergies. Some people are allergic to a wide range of allergens, while others are allergic to only a few or none. The reasons for these differences can be found in the makeup of an individ- ual’s immune system. The immune system is the body’s defense against substances that it recognizes as dangerous to the body. Lymphocytes, a type of white blood cell, fight Hayfever allergy triggered by oilseed rape plants. When an allergen first enters the body, the lymphocytes pro- duce an antibody called immunoglobulin E (IgE). This knowledge makes it possible to develop med- antibodies attach to mast cells, large cells that are found in icines that will be more effective in reducing the symptoms of connective tissue and contain histamines along with a number various allergies. Corticosteroids are sometimes prescribed to allergy Studies show that allergy sufferers produce an excessive sufferers as anti-inflammatories. Decongestants can also bring amount of IgE, indicating a hereditary factor for their allergic relief, but these can be used for a short time only, since their responses. How individuals adjust over time to allergens in continued use can set up a rebound effect and intensify the their environments also determines their degree of susceptibil- allergic reaction. The second time any given allergen enters the body, it See also Antibody and antigen; Antibody-antigen, biochemi- becomes attached to the newly formed Y-shaped IgE antibod- cal and molecular reactions; Antibody formation and kinetics; ies. These antibodies, in turn, stimulate the mast cells to dis- Antigenic mimicry; Immunology charge its histamines and other anti-allergen substances. H1 histamines travel to receptor sites located in the nasal passages, respiratory system, Amebic dysenteryAMEBIC DYSENTERY and skin, dilating smaller blood vessels and constricting air- ways. The H2 histamines, which constrict the larger blood ves- Amebic (or amoebic) dysentery, which is also referred to as sels, travel to the receptor sites found in the salivary and tear amebiasis or amoebiasis, is an inflammation of the intestine glands and in the stomach’s mucosal lining. The severe form play a role in stimulating the release of stomach acid, thus of the malady is characterized by the formation of localized contributing to a seasonal stomach ulcer condition. In such by vomiting, severe diarrhea with fluid loss leading to dehy- cases, desensitization to the allergen is sometimes attempted dration, and abdominal pain. The other is Antihistamines, which are now prescribed and sold over infection with bacteria of the Shigella group. Amebiasis is contracted mainly by ingesting the para- There are a number of different antihistamines, and they either site in contaminated food or water. Person–to–person trans- inhibit the production of histamine or block them at receptor mission is less likely, but can occur. After the administration of antihistamines, IgE receptor common where sanitation is poor, in the developing world. Run–off from fields can allergens are still there, but the body’s “protective” actions are contaminate wells contaminating the drinking water. Antihistamines also constrict the smaller blood vessels mate, excluding polar areas and mountainous high altitudes. Recent Even now, approximately 500 cases are reported each year in research has identified specific receptor sites on the mast cells New York State. The latter is a concern to oth- ers, as the asymptomatic person can still pass the parasite in his/her feces and so potentially spread the infection to others. Indeed, such transmission can persist even years after expo- sure to the parasite.

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In Nora’s words buy 5 mg altace free shipping, “I really do think that allopathic medicine is really slam bang buy altace 2.5 mg on-line. Invasive Most of the people who participated in this research said that alternative therapies are different from allopathic medicine because they are non- invasive (Coward 1989; Cant and Calnan 1991; Goldstein et al altace 2.5mg for sale. In telling me why she chose a midwife for the birth of her child altace 5 mg on-line, Laura said generic 10mg altace mastercard, “I wanted a home birth because I wanted to avoid unnecessary medical intervention during the labour and delivery. If you’re prepared to undergo the knife, and all the problems and complications that could happen, rather than looking at another method that may be able to prevent surgery, why would you not think about it? These people also believe that the invasive nature of allopathic medical therapy puts them at risk of “clinical iatrogenesis” (Illich 1975:22). For example, more than half the people I spoke with were concerned about unpleasant and/or dangerous side effects caused by medication (Monson 1995; Pawluch et al. In Laura’s words, “Garlic and vitamin C may not work as well as an antibiotic, but it works enough to justify its use and it doesn’t have the side effects. An Alternative Model of Healing | 59 According to Marie, “It was very hard getting off the muscle relaxants, the codeine, the over-the-counter pain medication. I’ve had high blood pressure for five years now, because anyone I know who has gone on the medication, you never come off of it. Some people when they come off the pills, boom: they’ve had a stroke or a heart attack because the body can’t regulate itself without that medication any more. In contrast to the dangers they felt were inherent in allopathic medical treatment, these informants believe that alternative therapies are non- invasive, non-iatrogenic, and consequently safe to use, a belief mirrored in general lay perceptions of alternative approaches to healing (Boon et al. Grace put it this way: “What the ear candling can do, they go back to their doctor after it’s been done and the ear’s fine, or maybe just a little more cleaning needs to be done. You could take the whole rack and other than having a real lactose kind of over-reaction and sugar reaction, you know it’s not going to harm you. In describing their encounters with alternative practitioners, they often began by giving an account of an unpleasant interaction with a physician, which they then contrasted with a positive depiction of their relationships with alternative practitioners. Simply put, what they value about alternative practitioners is that they are not medical doctors. The major distinguishing criteria they mentioned were attitude of the doctor or practitioner (Furnham and Bhagrath 1993), time spent with the patient or client (Cant and Calnan 1991),4 and whether or not they feel their doctor or practitioner cares about them (Campion1993; Lowenberg 1992; Sharma 1992; Taylor 1984). Some, such as Hanna, said their doctors wouldn’t listen to them: I went to see the doctor, then she sent me to a neurologist and there was a blood clot on the brain. But it had started to heal itself because it had been a few years since it happened. And because they really wouldn’t listen at that time, there were a lot of things that could have helped that they didn’t do. On the other hand, these informants described their alternative practi- tioners as respectful and unpretentious. She never badmouthed doctors or said anything that made me feel that she was at all negative about conventional medicine. Similarly, Nora linked the differences she saw in attitude between alterna- tive practitioners and allopathic physicians to issues of professional power: Trying to talk to an allopathic medical person about medication, saying ‘I prefer ampicillin because sulpha really has a bad effect on me. Furthermore, Lucy pointed out that, in her experience, alternative prac- titioners were more likely than allopathic physicians to admit that they are An Alternative Model of Healing | 61 not omniscient: “I find the naturopaths are much more willing to say, ‘I don’t have the answer, I’ll do research on it to find out what the answer is. For example, Lucy and Grace both stressed that what is different about alternative practitioners is that they devote more time to consultation. Lucy put it this way: “They’ve got it timed that their visits are about ten minutes apart and you feel like you’re in a factory. When you go to see [a naturopath] you know you’re going to be a little while because you have to go through all these symptoms. Lorraine was the only informant who speculated that allopathic physicians’ work loads constrain the amount of time they are able to spend with patients: As good as my doctor is, they’re so busy now, it’s just patient after patient after patient and I get the feeling that there’s just not time for me to sit down and have a good talk with him. Not that she doesn’t have her patients booked on a regular basis, but you’re going there once a month, which helps. Caring Finally, caring was another criterion many of these informants used in distinguishing between allopathic and alternative healing. Over half of them said that, unlike allopathic physicians, alternative practitioners sincerely care about their clients.

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Some worry that these cuts have gone too far altace 10 mg overnight delivery, especially for home-care recipients who are frail and medically vulnerable generic altace 10 mg amex. Exactly how home-based care will fit into Medicare and private health in- surance plans in the future is unclear discount altace 2.5 mg overnight delivery. Yet when it comes to day-to-day detailed decision-making about whether individual persons will get specific items or services generic 5mg altace mastercard, physi- cians rule discount 2.5 mg altace overnight delivery. On the front lines, physicians must write prescriptions and devise and oversee treatment plans for their patients to receive therapy and assistive technologies. Public and private plans will not pay without explicit physi- cians’ authorization. For example, for Medicare PT and OT, physicians must review and sign plans of care at least every 62 days for home-health services (42 C. How ironic: as described in prior chap- ters, most physicians have little knowledge of physical or occupational therapy or of assistive technologies. Cynthia Walker has commercial HMO insurance through her hus- band’s employer, which required her to change her rheumatologist: “My insurance is set up that I am forced to work with this man, and I want to make the best of it. Burton, wastes time and doesn’t recognize the varying expertise of different clinicians. The ball always seems to have to come pinging back to the middle, to Burton, before it can go anyplace else. Masterson acknowledges that his neurologist’s clinical role is lim- ited, given that no effective treatments yet exist for ALS. There are roles for other specialists to play where there didn’t appear to be any in the beginning. Patrick O’Reilley, a primary care doctor at a neighborhood health center, generally ignores what he sees as byzantine rules about prescrip- tions and approvals set by health insurers. If they kick out something I prescribe, then I’ll find out about it, but I just go ahead and do it. O’Reilley does worry about his patients, who are poor, being sent large bills by providers because their in- surer denies coverage and he didn’t follow rules. Of the insured people with various disabilities, including mobility problems, 28 percent report they have special needs that are not covered—for particular therapies, equipment, medications—compared to 7 percent of those without disabilities. Among those with very severe disabilities, 40 percent note un- covered special needs (Harris Interactive 2000, 56, 57). Overall, 19 percent of disabled persons report that they needed medical care within the last year but didn’t get it, compared to 6 percent of nondisabled persons (Harris In- teractive 2000, 60). Disabled people attribute these failures to lack of insur- ance coverage (35 percent), high cost (31 percent), difficulties or disagree- ments with physicians (8 percent), problems getting to physicians’ offices or clinics (7 percent), and inadequate transportation (4 percent). Department of Health and Human Services (2000, 6-5) recognizes that, “As a potentially underserved group, people with disabilities would be expected to experience disadvan- tages in health and well-being compared with the general population. When the canaries keeled over, the miners knew the air wasn’t good—they’d better get out. People with disabilities tend to be the most vulnerable persons in the health care system. Unless there’s a lot of advocacy, their needs tend to be put on the back burner and dealt with as an afterthought. Problems in the health care system hit people with disabilities first, but ultimately almost everyone is affected. Basic restructuring of our health-care sys- tem is essential, but intractable societal forces and cost concerns have, thus far, blocked fundamental reforms. While often maligned, public and private health insurance has protected much of the public from the full brunt of acute health-care costs, although uninsured and chronically ill people might tell different tales. As a country, we have not yet explicitly con- fronted what the health-care system should pay for and why. Even Christopher Reeve had trouble getting his private insurance com- pany to extend his stay in a rehabilitation facility and to purchase equip- ment. She lives in a low-income apartment, one of those little places like a motel room. Some friends raised the money and gave her an electric wheelchair—a real cheap one, but it allowed her to get out the door and up to a small park. On a nice spring day, she can go out and sit under a tree and come back in.

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