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This will also apply to any text in tables buy discount viagra soft 50mg on-line erectile dysfunction essential oil, the index and captions for illustrations purchase 50 mg viagra soft with mastercard erectile dysfunction jelly. Margins Check your publisher’s house style rules on the required width for mar­ gins. For instance, some like to have the first line of a para­ graph indented by several spaces. Never justify text so that spacing between words is altered to produce lines of equal length. Font The design of lettering will affect the readability of a manuscript. Fancy scrolls may look attractive, but make text very difficult to read. You can see the effects of different fonts in the example below: font font font font font font Choose a font with simple lettering of medium density. Remember to check that your printer is able to produce the font you are using on your computer screen. A font that appears on the screen and the printer is known as a TrueType font. Choose a font size that makes the text easy to read without being overlarge. Compare the word ‘font’ when produced in various sizes: Font (8) font (10) font (12) font (14) Font size 12 is easily read. Style Various characteristics can be applied to lettering like italic or bold. Avoid overusing these style formats, as this can make the text confusing to read. Use any special effects judiciously and be consistent in applying them, for instance using a particular style to indicate all the main headings. Always PRESENTING YOUR WORK 261 check your publisher’s house style rules, which may give specific instruc­ tions on adding style to text. Some stipulate that certain characteristics are omitted, for example using bold. It is not your job to arrange and design the manuscript as if it were the final printed version. Your role is to prepare and present your work in a form that the editor can deal with quickly and efficiently. Spelling Computers help us by providing tools that check spelling and grammar in a document. For example, a computer will not correct mistakes such as ‘The children took their dog fore a walk’ or ‘The children took there dog for a walk’. Make sure you have manually checked the spelling and grammar of your final draft. This is especially im­ portant if somebody else has typed or word-processed your manuscript. There are certain spelling conventions to which you will need to ad­ here. Always check your publisher’s house style rules on the following: ° Variant spellings. For instance, the use of ‘z’ is applicable if selling to the North American market. Words are always spelt out in full, unless you want an abbreviation to appear in the final text. In that case, write out the word in full followed by the abbreviation the first time it appears in the text, for example, electronic mail (e-mail). Check whether your publisher accepts the use of common abbreviations in your manuscript, such as e. Write these out in full the first time they appear in the text, followed by the acronym in brackets.

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A sense of low expectations has converged with a heightened sense of risk to restrict the scope of individual activity and diminish our common humanity proven viagra soft 100mg impotence pump medicare. The impasse reached by Western society in the 1990s was experienced differently by different sections of society cheap viagra soft 50mg impotence effects on marriage. Perceptions were strongly influenced by parallel economic and social developments, in particular by the demise of traditional forms of collectivity and the accelerated erosion of familiar institutions, from the Royal Family to the nuclear family. The decline of old-style class conflict brought an end to long-established patterns of industrial and political conflict. It also removed a key source of cohesion on both sides of the great divide, compounding wider atomising forces to produce an unprecedented degree of individuation in society. If the proletarian solidarity of the trade unions and the labour movement effectively disintegrated, so too did the spirit of class loyalty that had made the Conservative Party such a successful social movement. For this cynical aristocrat, the loss of nerve of the upper crust clique, which had always informally appointed the leader of the Conservative Party, was revealed in the debacle which resulted in the replacement of Mrs Thatcher by John Major in November 1990. The abdication of leadership by the traditional elite of British society has become increasingly apparent throughout society, from industry and commerce to culture and services. In the business enterprise, it became standard practice for directors to defer to management consultants, public relations experts and ethical investment advisers. In a similar spirit of uncertainty, employers called in facilitators and counsellors to deal with workplace conflicts, drew up mission statements in an attempt to discover a sense of purpose, used codes of conduct to regulate working relationships and charters to appeal to customers. In the professions, the crisis of confidence was expressed in the quest for new forms of reassurance through audit, inspection and reaccreditation. In medicine, as we have seen, this has led to the emergence of guidelines, evidence-based medicine, clinical governance and revalidation. It has also encouraged a major expansion of the sphere of medical ethics, as doctors refer decisions in what were formerly regarded as clinical matters to ethical committees (and even to the courts). Thus, technologicial development continues despite the stagnation of intellectual life. However, though there are still many people who are committed to experimentation and innovation, the prevailing climate is suspicious if not hostile to such activities, inducing a remarkably diffident outlook. Scientists, particularly those working in politically sensitive areas such as genetics, are reluctant to take responsibility for their own work, preferring to invite some external agency to regulate it. For the mass of people, the main effect of the stagnation of society has been to foster a sense of apprehension and diminished expectations for the future. If collective aspirations are no longer viable, then the scope for individual aspirations is also reduced. The contemporary preoccupation with the body is one consequence of this: if you cannot do much to change society or your place in it, at least you can mould your own body according to your own inclinations. The consequences of this narcissistic outlook range from the fads for body-building, tattooing and body-piercing to the increasing prevalence of morbid conditions of self-mutilation, anorexia and bulimia (Porter 1999). The intense social concern about health is closely related to the cult of the body: once you give up on any prospect of achieving progress in society, your horizons are reduced to securing your own physical survival: Investing in the body provides people with a means of self- expression and a way of potentially feeling good and increasing the control they have over their bodies. If one feels unable to exert control over an increasingly complex society, at least one can have some effect on the size, shape and appearance of one’s body. The dramatic increase in state intervention in the health-related behaviour of the individual over the past decade has taken place in parallel with the contraction of the traditional sphere of politics. The 160 CONCLUSION ending of the Cold War also brought to an end the polarities of left and right that had dominated parliamentary and electoral politics over the previous century. The unchallenged ascendancy of the capitalist system meant that debates about policy became superfluous and government was reduced to administration. Yet, conservative propagandists immediately felt the loss of their old adversaries and were now forced to find new ways of securing popular approval for a system which had an inescapable tendency to generate social instability and dissatisfaction. In this wider context, intervention in health served a number of purposes. By projecting an image of concern about issues of health and disease, the government hoped to bolster its flagging legitimacy. It also welcomed a mechanism for establishing more direct relations with citizens and thereby strengthening the authority of government over an increasingly fragmented society.

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No patient survived who had a surgical cut-down venous access cheap viagra soft 50 mg online erectile dysfunction age 21, chest drain insertion viagra soft 100mg discount erectile dysfunction treatments diabetes, and non-shockable rhythm when the first ECG was recorded. This resulted in an algorithm for ambulance personnel 105 ABC of Resuscitation encountering death in these conditions, which has been The involvement of relatives and close friends accepted by the Professional Advisory Group of the Scottish Ambulance Service and the Central Legal Office to the Bystanders should be encouraged to undertake immediate basic life support in the event of cardiorespiratory arrest. Traditionally, The validity of the proposed guidelines depends on the relatives have been escorted away from the victim when the accurate diagnosis being cardiac arrest within the first 15 or so healthcare professionals arrive. The Resuscitation unsupported arrest could be less—perhaps much less—than Council (UK) has confirmed the need to identify and respect 15 minutes. In these circumstances, resuscitation could possibly relatives’ wishes to remain with the victim. Clearly, care and consideration of the relative in these stressful situations become still be successful. When the 15 minute asystole guideline has of increasing concern as the invasive nature of the resuscitation been used in the United States, however, this concern has attempt escalates from basic life support, to defibrillation and proved to be unfounded. These must be disseminated throughout the service and to all other concerned groups. Legal aspects Doctors, nurses, and paramedical staff functioning in their official capacity have an obligation to perform CPR when medically indicated and in the absence of a “Do Not Further reading Resuscitate” decision. The emergency services must avoid such 1 complications in unconscious patients by being aware of the 2 3 possibility of spinal cord injury from the nature of the accident, 4 and in conscious patients by suspecting the diagnosis from the 5 6 history and basic examination. If such an injury is suspected the 7 40% patient must be handled correctly from the outset. Spinal injuries most commonly result from road trauma involving vehicles that overturn, unrestrained or ejected occupants, and motorcyclists. Falls from a height, high velocity crashes, and certain types of sports injury (e. Particular care must be taken moving unconscious patients, those who complain (a) Coma position—note that the spine is rotated. Impaired consciousness (from injury or alcohol) and distracting injuries in multiple trauma are amongst the commonest causes of a failure to diagnose spinal injury. All casualties in the above risk categories should be assumed to have unstable spinal injuries until proven otherwise by a thorough examination and adequate x rays. It must also be remembered that spinal cord injury without radiological abnormality (SCIWORA) can occur, and may be due to ligamentous damage with instability, or other (b) Lateral position—two hands from a rescuer stabilise the soft tissue injuries such as traumatic central disc prolapse. The unconscious patient It must be assumed that the force that rendered the patient unconscious has injured the cervical spine until radiography of its entire length proves otherwise. Until then the head and neck must be carefully placed and held in the neutral (anatomical) position and stabilised. A rescuer can be delegated to perform (c) Prone position—compromises respiration. However, splintage is best achieved with a rigid collar of appropriate size supplemented with sandbags or bolsters on each side of the head. The sandbags are held in position by tapes placed across the forehead and collar. If gross spinal deformity is left uncorrected and splinted, the cervical cord may sustain further injury from unrelieved angulation or compression. Alignment must be corrected unless attempts to do this increase pain or exacerbate neurological symptoms, or the head is locked in a position of torticollis (as in atlanto-axial rotatory subluxation). In these situations, the head must be (d) Supine position—if patient is supine the airway must splinted in the position found. During turning or lifting, it is vital that the whole spine is maintained in the neutral position. While positioning the patient, relevant information can be obtained from witnesses and a brief assessment of superficial wounds may suggest the mechanism of injury—for example, wounds of the forehead often accompany hyperextension injuries of the cervical spine. Although the spine is best immobilised by placing the patient supine, and this position is important for resuscitation and the rapid assessment of life threatening injuries, unconscious patients on their backs are at risk of passive gastric regurgitation and aspiration of vomit. This can be avoided by tracheal intubation, which is the ideal method of securing the airway in an unconscious casualty. If intubation cannot be performed the patient should be “log rolled” carefully into a modified lateral position 70–80˚ from prone with the head supported in the neutral position by the underlying arm.

Girdlestone was always interested the piety and some of the haughty individualism in operative technique and every detail was of an Elizabethan discount viagra soft 100mg with mastercard erectile dysfunction 29. He was a devout Christian and worked out with extraordinary thoroughness order 100mg viagra soft crestor causes erectile dysfunction. It his patients knew it; when professional skill had was a healthy discipline and, after a time, a pleas- reached its limits, his sympathy and concern for ure to work in his well-run theaters. In his end- their future gave fresh confidence and hope to eavors to eliminate infection at operation, no those who were permanently disabled. Yet his possible factor escaped examination; he enlisted belief in his mission was so intense that he some- the aid of R. Bourdillon in determining the part times alienated those whose ideas did not cor- played by aerial contamination and the results of respond precisely with his own. In pursuing that work will undoubtedly have a profound influ- any scheme on which he had set his heart, he ence on the question of the ventilation of operat- was indefatigable and quite fearless; he was no ing theaters. But for his insistence there would have In 1930, Lord Nuffield (Sir William Morris, as been no chair of orthopedic surgery at Oxford; yet he then was) became attracted by Girdlestone’s he sought it not for himself but only for the work and, through the generous aid of that great advancement of orthopedics. Oxford owes the benefactor, the old huts were replaced by modern Churchill Hospital to Girdlestone’s efforts; buildings, which incorporated features over the obstacles to this achievement would have which Girdlestone had pondered so carefully and broken the spirit of many men. It was Girdlestone who encouraged chiefly responsible for installing that gallant little Lord Nuffield to interest himself still further in company of American surgeons who formed what British medicine, with results that are now well was called the American Hospital in Britain in known. The Oxford Medical School benefited to this new hospital, with buildings and facilities the extent of two million pounds. Nuffield’s request, Girdlestone visited South There were occasions in the affairs of the Africa to prepare a scheme for the development Wingfield when his committee, devoted to him as of orthopedic surgery in that vast dominion; and they were, had to tell him that there was no money the national Council for the Care of Cripples in for some addition that he wanted; on more than South Africa was the result of this visit. In the one occasion his answer was that he would pay same year, Girdlestone was appointed Nuffield for it himself—and he did. Professor of Orthopedic Surgery, this being the The hospital was an extension of his home life, first chair in the subject in the British Empire. At a few minutes before nine (half-past more urgent work; he was a regional orthopedic eight for operations), Girdlestone’s handsome consultant in the Emergency Medical Service and upright figure appeared on the path between his honorary consultant to the army and to the Min- house and the hospital, and the place sprang to its istry of Pensions. In 1942 he was elected Presi- ordered life like an orchestra under the baton of a dent of the British Orthopedic Association; in conductor. He knew all the older members of the 1948 he applied his unparalleled experience to the staff by name, he had a friendly word for every- formulation of a plan for regional orthopedic one (sometimes one of fatherly reproof) and there and accident services within the framework of were many who at one time or another had been 117 Who’s Who in Orthopedics helped by him in some serious personal difficulty. But in his chosen sphere his intense zeal was In appearance he was a striking figure—tall, matched by his generosity. His many when someone connected with the Wingfield was contributions to the literature of his subject were in need of money, and more than a small sum. The expressed in delightful prose; they bore the mark usual deliberations provided no solution. He was Girdlestone would say that he was trustee of a also a devoted listener to classical music. He fund that could be drawn on in such circum- shared all these tastes with his wife in an idyllic stances and that the matter could be left to him. It was not, therefore, Championship after leaving Oxford and he might surprising that the hospital had an esprit de corps have gone far if his busy professional life had not that was apparent even to the casual visitor. Girdlestone used to refer very frequently to the No memoir of this man of high quality—one of Wingfield spirit—it sometimes became rather an the most distinguished surgeons of his genera- old joke—but it was a very real thing, an influ- tion—would be complete without reference to the ence that made for happiness and good work, and deep religious convictions that sustained him in it was felt throughout the region. This was a Girdlestone known to a There is a tendency, a natural and a proper host of witnesses. The price to be paid for work in a wider field, and paid often with sorrow, is the abandonment of many local interests, which the passage of years and old associations have made peculiarly sweet. He knew what he could do well and he stuck to it; in his own line of work he was as confident and superbly skillful as in the two games he played (he was outstanding at tennis and golf and reached the semi-finals in a competition at St. He directed all his energies to the development of his hospital, his region, the scheme that they embod- ied, and the link he had forged with his univer- sity. His influence extended far and wide, but it was chiefly in virtue of what he did in Oxford. He had pedic surgery in Australia—one of the first three become a general practitioner surgeon in Shrop- Australians who trained in orthopedic surgery shire and went to Baschurch first as a spectator and who specialized in this field in Australia and later to assist at operations. Before that there was 118 Who’s Who in Orthopedics one orthopedic practitioner, a German; Gordon standing of his surgical results.

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