By T. Jarock. Florida A & M University.

However cheap rosuvastatin 10 mg without prescription cholesterol levels measured in mmol/l, as time passed order rosuvastatin 10mg line cholesterol medication and diabetes, I not only found the hypothesis to be accurate but found much of the answer within the sym- bolic metaphor. Fire, a precious resource, was revered as a god by primitive cultures (Tresidder, 2000). It was not until our early ancestors learned to control its power and created techniques to call it forth at will that it took on the symbolism of power, love, and sexuality. This new perception is found within "the ancient Hindu Vedas," for whom "creating fire by rub- bing two pieces of wood together represented copulation" (Gutheil, 1951, pp. One of the best observations on fire as sexual symbolism comes from Shat- tuck (1996): "Fire speaks a single message: My lust will destroy all" (p. Presently, fire is often represented in the popular media as a manner in which to pay homage: the candlelight vigil, sacred in its use of undying flame, epitomizes our spirit of togetherness and community. Yet fire con- 168 Interpreting the Art tinues to stand as a duality of destruction and protection, a symbol that can both inhibit and offer hope. Ultimately, art projective assessments should not rely simply upon for- mal scoring systems that quantify and qualify results. This manner of study removes all expression and perception from a very personal and intimate production, one created from a simple directive that begins and ends with the client’s unconscious selection and one that contains interrelated pat- terns found within the symbolic abundance of ideas, the client’s personal history, his or her verbal statements, his or her choice of defense mecha- nisms, and in due course a personal myth that provides meaning. It is my belief that this multifaceted approach yields a plethora of clini- cal information that will help to define treatment success with a client who historically has been labeled as resistant. As an adjunct to psychotherapy, art projective testing can see beyond the conflict and delve within the ex- treme anxiety and pain that conceals the self. In the words of Anderson (1951), "projective tests, as such, test not only projection but practically all conceivable mental mechanisms, both ex- pressive and defensive" (p. Throughout the first part of this book the great majority of drawings re- sulted from directives. These directives were not offered haphazardly but were designed around the client’s maturation process. Based upon Erikson’s premise that emerging conflict must be mastered in order to prepare the in- dividual for future growth and integrity, the use of directives allows the cli- ent to reveal unconscious material in a safe forum. Consequently, I cannot overemphasize the importance of directives in a process-oriented frame- work. It is the therapist’s responsibility not only to evaluate where the client is developmentally but to take into account the defense mechanisms that protect the individual and block communication. To this end, art therapy directives allow a freedom that purely verbal therapy deters. Directives can be designed to meet the client’s changing needs and thus allow each indi- vidual to produce, share, and express on a multiplicity of levels. As a result, if we return to Erikson’s (1963) theory on psychosocial de- velopment and distinguish each period by the client’s inner conflicts, we see that directives can be developed to enhance ego functioning, confront maladaptive patterns, identify similarities, and clarify life transitions. However, it is imperative that the clinician arrive at the client’s developmental stage, regardless of chronological age, to assess the most effective directive in any category. Additionally, note that this list of directives is not intended to be all 171 Table 4. This type of directive translates well when looking toward personality forma- tion that favors a hopeful outlook. However, it is imperative that the clinician, when evaluating the devel- opmental progression of a client, take into account a complete assessment of the individual and the artwork, lest an inaccurate picture of maturity emerge. Both drawings were completed by teenage females in separate group therapy sessions in response to the directive "Draw anything you wish. For that reason, one may assume that both of these adolescents are fixated in Freud’s anal stage of psycho- 4. The upper drawing shows a cat endowed with human facial features and a stick figure with balloon hands (5-year-old style), while the lower image shows an attempt at perspective with a female’s back turned from the viewer (teenaged style). It is evident that the upper drawing appears re- gressive (lack of proportion and detailing, repetitious schema for facial fea- tures) when compared with the bottom rendering’s obvious statement of disdain (back to viewer while defecating). If we now add the client’s history to the evaluation, we learn that the up- per drawing was done by a chronic schizophrenic who when decompensat- ing tends to add fecal matter to her images just prior to destroying property or assaulting others. Thus, the upper rendering bespeaks of the anal stage of development or Erikson’s shame and doubt with its concomitant destructive forces and residual rage, confusion, and mistrust of the environment. The bottom image was completed by a female who challenges the environment with her "uniqueness" of being; the intensity of her persona influences all of her interpersonal relationships, and she is cruel toward peers who are per- ceived as different from her.

Having one’s medical record available online for emergency or for out-of-area physicians to use can improve both quality and con- venience for patients and give them confidence when traveling discount rosuvastatin 20mg with visa cholesterol levels genetic factors. All forms of mar- keting communications in healthcare seem to be increasing buy cheap rosuvastatin 20mg on line cholesterol in pastured eggs, particularly direct-to-con- sumer advertising by pharmaceutical firms. Advertising alone is estimated as a $1 billion annual expenditure for healthcare providers and a $2 billion annual expenditure for phar- Other Marketing Processes A variety of other marketing concepts could be introduced at this point. The following sections present selected concepts that are likely to be use- ful to reader in later chapters. Marketing Planning Marketing planning may be defined as the development of a systematic process for promoting an organization, service, or product. This straight- forward definition masks the wide variety of activities and potential com- plexity that characterize marketing planning. Marketing planning can be limited to a short-term promotional project or comprise a component of Basic M arketing Concepts maceutical companies. While most of these expenditures are devoted to attracting new transactions, a considerable portion is devoted to maintaining relationships. Promotion, which covers all forms of marketing communication, has entirely new applications in relationship marketing. While communications discussions are often limited to the use of databases about consumers to improve the efficiency and effective- ness of healthcare organization advertising, the potential benefit to consumers, plans, and providers is far greater. Communications can be used, for example, to prompt consumers to obtain needed immunizations and screenings, initiate or persist in beneficial lifestyle changes, and make or keep appointments that will deliver value. MacStravic (2000) argues that the four Ps are alive and well and indeed essential to mar- keting until something truly replaces them. The latest set of recommended letters adds to the list of functions that marketing can and must perform but is far from displacing the old set. When it comes to the most important components of the new set—relation- ships and results—they should be supplemented to include new possibilities: a fifth P, prompting consumers to adopt changes in behavior and make contacts with providers that will enhance their health and quality of life, and a fifth R, reminding consumers of the differences that plans and providers (as well as their own efforts) have made and can continue to make in their lives as perhaps the best reason for maintaining such efforts and existing relationships. The marketing plan should summarize a com- pany’s marketing strategy and serve as a guideline for all those involved in the company’s marketing activities. Of the various types of planning that could be carried out by a healthcare organization, marketing planning is the most directly related to the customer. Marketing plans are by definition market driven, and they are single minded in their focus on the customer. Whether the tar- geted customer is the patient, referring physician, employer, health plan, or any number of other possibilities, the marketing plan is built around someone’s needs. Although a consideration of internal factors is often pertinent (and internal marketing may be a component of many market- ing plans), the marketing plan focuses on the characteristics of the exter- 104 Box 5. M arketing and the Healthcare Organization M arketing and the Healthcare Organization cosmeceutical natural This page intentionally blank THE NATURE OF HEALTHCARE MARKETS The Nature of Healthcare M arkets 144 composition, consumer attitudes payer mix question and at the lowest level of geography possible. Projecting trends into the future is important, as few health services can be introduced overnight. Many projects require a two- or three-year startup period, so the characteristics of the population today are not nearly as important as their characteristics tomorrow. Depending on the service, the market evaluation involves an assess- ment of existing providers of the service in question. To the extent possi- ble the characteristics of competitors, including their strengths and weaknesses, should be determined so that the organization can determine its market position and assess the extant level of competition. This becomes valuable later in making a realistic assessment of the capturable market. The basic question to be addressed is how to differentially weigh the data that have been collected. While a high concentration of elderly peo- ple may be judged to be an essential characteristic of a prospective market, a high concentration may not be sufficient to declare this market viable. The high-concentration variable may provide the initial screening criterion, allowing other, less attractive market areas or populations to be eliminated from consideration. First, floor or ceiling values can be set for essential criteria, and any values that fall outside the specified range can result in the elimination of a market from consideration.

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Double fixation of metastatic lesions of the lum- bar and cervical vertebral bodies utilizing methylmethacrylate compound: report of a case and review of a series of cases discount rosuvastatin 10mg on-line xanax cholesterol. Recurrence of giant-cell tumors of the long bones after curet- tage and packing with cement buy 10 mg rosuvastatin with visa cholesterol lowering diet books. The use of acrylic plastic for vertebral replacement or fixation in metastatic disease of the spine. Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization. Percutaneous vertebroplasty with acrylic cement in the treatment of osteoporotic verte- bral crush fracture syndrome. Percuta- neous polymethylmethacrylate vertebroplasty in the treatment of osteo- porotic vertebral body compression fractures: technical aspects. Percutaneous vertebroplasty: a de- veloping standard of care for vertebral compression fractures. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the Na- tional Osteoporosis Foundation. Incidence of clinicallly diag- nosed fractures: a population based study in Rochester, Minn. Percutaneous vertebroplasty in the treatment of osteoporotic ver- tebral compression fractures: an open prospective study. Cotten A, Boutry N, Cortet B, Assaker R, Demondion X, Leblond D, Chas- tanet P, Duquesnoy B, Deramond H. Preoperative percutaneous injection of methyl methacrylate and N-butyl cyanoacrylate in vertebral hemangiomas. Cotten A, Dewatre F, Cortet B, Assaker R, Leblond D, Duquesnoy B, Chas- tanet P, Clarisse J. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Cyteval C, Sarrabere MP, Roux JO, Thomas E, Jorgensen C, Blotman F, Sany J, Taourel P. Acute osteoporotic vertebral collapse: open study on References 271 percutaneous injection of acrylic surgical cement in 20 patients. Percutaneous vertebroplasty with methylmethacrylate: technique, method, results [abstract]. Dousset V, Mousselard H, de Monck d’User L, Bouvet R, Bernard P, Vital JM, Senegas J, Caille, JM. Percutaneous vertebro- plasty: a therapeutic option for pain associated with vertebral compression fracture. Value of bone scan imag- ing in predicting pain relief from percutaneous vertebroplasty in osteo- porotic vertebral fractures. Vertebroplasty in patients with severe ver- tebral compression fractures: a technical report. Percutaneous vertebroplasty for severe os- teoporotic vertebral body compression fractures. Percutaneous vertebroplasty in the treatment of osteo- porotic compression fractures. An in vitro biomechani- cal evaluation of bone cements used in percutaneous vertebroplasty. The effect of monomer- to-powder ratio on the material properties of cranioplastic. Percutaneous vertebroplasty treatment of steroid-induced osteoporotic compression fractures. Commentary: is intraosseous venography a signifi- cant safety measure in performance of vertebroplasty? Relevance of antecedent venography in percutaneous vertebroplasty for the treatment of osteo- porotic compression fractures. The biomechanics of vertebroplasty: the effect of cement volume on mechanical behavior. Biomechan- ical efficacy of unipedicular versus bipedicular vertebroplasty for the man- agement of osteoporotic compression fractures. Percutaneous vertebroplasty for os- teoporotic compression fracture: quantitative prospective evaluation of long-term outcomes.

Some major museums and galleries are large cheap rosuvastatin 20mg cholesterol definition, making it difficult to walk or wheel all the way round in a single visit safe 20 mg rosuvastatin cholesterol reduction medication. Like most visitors, you may prefer to look at a museum/gallery map before or when you arrive, so you can select some of the things of greatest interest and plan the easiest route round. Some places will have on-site wheelchairs to borrow, but check and book these in advance if they are going to be a necessity. Some arts centres are housed in modern, purpose-built buildings; others are based in old buildings such as Victorian town halls and churches that have been adapted for the purpose. Accessibility varies, but efforts have been made in recent years to cater better for disabled visitors. Many arts venues have multiple functions, and may include a cinema, theatre, concert hall, and an exhibition area. If you are in London, you may find it practical as well as interesting to visit a site or complex that has a number of such accessible possibilities within easy reach of each other, such as the South Bank or the Barbican centre. If you are going to a theatre, cinema or other venue in London, you could contact the London arts access information service, Artsline. You should also check to see whether there are any services giving similar information in your area, from DIAL (see Appendix 2 for details). Some past or present experiences may provoke you into joining one of the many local groups campaigning for better local access to public buildings and places. If you like visiting stately homes and gardens, the National Trust Handbook (see Appendix 2) gives information about the suitability of its LEISURE, SPORT AND HOLIDAYS 179 properties for people in wheelchairs, and there is a separate guide from them for properties that are particularly suitable. All give free admission to someone escorting a person in a wheelchair, and some have motorized buggies for those with mobility problems. Three other books give details of wheelchair access: • Places that care by Michael Yarrow • The National Gardens Scheme handbook, and • Historic houses, castles and gardens which list over 1300 properties of all types and gives information about access. Other possible sources of information are RADAR (the Royal Association for Disability and Rehabilitation), and local disability groups, or your local MS Society may have information about access issues to places near to you. Holidays If you plan your holiday carefully, you should have no major problems with travelling. Try and stick to a schedule that is not too demanding and, perhaps just as important, allow yourself time to rest at the other end. You might also consult your doctor when you are planning your journey to see if he or she has helpful advice. By and large most airlines are very good at providing extra help and assistance for people with disabilities, including those in wheelchairs, as long as they are notified well in advance of your requirements. If you have vision problems and you are travelling by car, you could enlarge any maps or written instructions before your journey begins. You could also use a highlighter pen on the map to mark out your journey or a magnifying glass with a light on to help you see the map. In relation to air travel make sure that you give notice on any special requirements you have (such as meals) well in advance. Do take advantage of these, and of porters if you can – you do not want to be too tired out before you have even got on the plane! Ask at the check-in (but preferably before) to try and ensure that your seat allows you to get in and out, and to move as freely as you can. If you take your wheel- chair or scooter with you, do make sure that it is properly and securely labelled and, if it has to be disassembled for travel, it might be wise to take the assembly instructions with you in case someone else has to assemble it again. You might find it helpful, if you are travelling with a companion, to have a change of clothes in each other’s luggage, just in case one of the bags is lost – it has happened! Investigate whether laundry facilities are available at your place of stay – if they are, you can often take fewer clothes with you. Obviously do check in advance whether your hotel, guest house or motel has any specially prepared rooms for people with disabilities, and especially people in wheelchairs. There are now a strikingly wide range of support services and organi- zations for people with MS, almost whatever their disabilities, who wish to take holidays at home or abroad. The key, as we have noted is to plan well in advance, and undertake thorough research about where, and particularly how, you wish to go. Information on holidays for those with any form of disability can be obtained from a number of sources and there are a rapidly increasing number of sites on the internet giving wide-ranging information (see Appendix 1 for some good websites). Perhaps a feature of these and other sites is what many people might think of as increasingly adventurous holidays for people with disabilities from skiing to sailing. For sailing the Jubilee Sailing Trust has for many years been offering active sailing holidays for those with disabilities as well as able-bodied people on its two tall ships; it also has a very comprehensive list of the websites of other disability organizations.

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