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His family was of old colonial stock discount viagra 50mg free shipping, and his father was a successful stockbroker who counted Jay Gould and Jim Fisk among his acquaintances buy 25 mg viagra with mastercard. Stimson graduated from Yale in 1863 cheap 50mg viagra visa, just in time to see active service in the final period of the Civil War order viagra 100 mg mastercard. In the next few years cheap 75 mg viagra, he became interested in the study of medicine, perhaps because of the chronic illness of his wife, who had become diabetic. In 1871, he took his family to Paris to seek help for Frank STINCHFIELD his wife and to begin his medical education. At this time, he studied with Pasteur, Nelaton, Gos- 1910–1992 selin, and others. Returning to the United States, he obtained his medical degree from Bellevue Dr. Stinchfield had made the most outstanding Hospital Medical College in 1875. At graduation contributions to the unique 125-year history of the he was awarded the Wood Prize of the Alumni New York Orthopedic Hospital. He combined Association of Bellevue Hospital Medical the qualities of a superb clinician who developed 323 Who’s Who in Orthopedics numerous advanced techniques, particularly in techniques. The year abroad turned out to be one the treatment of the spine and the hip, with a gift of the most exciting and educational periods of for leadership that transformed not only New his life, as it coincided with the outbreak of World York Orthopedic Hospital, but also the practice War II. Stinchfield recalled having his of orthopedic surgery, both nationally and American identity concealed by his hosting internationally. Stinchfield was one of two sons of Charles avoid potential problems throughout his Euro- and Mary-Frank Stinchfield, and was born on pean travels. His father Despite the danger seen during his travels, managed a grain elevator company and there was Dr. Stinchfield felt compelled to join the Allied no history or succession of physicians in his Forces in Europe, and between 1942 and 1946 his family, but by the age of 12 Dr. Stinchfield knew medical services were enlisted to the army of the that he wanted to become an orthopedic surgeon. This second excursion to Europe Like most young boys, he enjoyed playing sports was both stimulating and horrific as he witnessed and was fortunate to have never suffered any some of the worst wounds seen in his medical serious injuries. Many of the bloodiest casualties were seen fascination with bones, and he became commit- while he was running the American Army Field ted to the idea of healing, researching, and explor- Hospital in Oxford, Britain. As one of two physicians tending make funding for his education possible (he grate- medical needs during the liberation of Buchen- fully paid back his benefactors in full less than 1 wald, he was asked to be the orthopedic consult- year after he began working as a full-time ortho- ant in the Surgeon-General Headquarters to the pedic surgeon). By 1946, he had been He received a BS in Medicine in 1932 from the decorated with a Legion of Merit, First Bronze University of North Dakota after transferring Star, European Theater Operation Unit Citation, from Carleton College, and received his MD in and Second Bronze Star. Stinchfield’s 1934 from Northwestern Medical School in army service, his wife, Margaret Taylor Stinch- Chicago. He remained in Chicago, and began field (whom he wed in 1939), supported the Allied his internship, and later residency, at the Wesley Forces as a liaison to the British lend-lease Memorial and Passavant Memorial Hospitals. Stinchfield’s active military service ended clinics and even briefly worked with the illustri- in 1946, and he returned to the United States, ous Mayo brothers. Stinchfield traveled to New York in chairman of the Department of Orthopedic 1936 and did 1 year of residency on the fracture Surgery and director of the hospital. In 1968, he impressed his instructors and the senior attend- presented Sir John Charnley’s hip replacement ings as being bright, talented, and amiable, but technique to the hospital, thereby establishing grossly underexposed. He was chosen for a trav- it as one of the few American hospitals to eling fellowship throughout various clinics offer such an operation to patients. This was tion to research of the hip helped motivate his the beginning of his exposure and insight into founding of the Hip Society, USA in 1969, where other orthopedic surgical techniques and method- he served as president until 1972, when he was ology, as well as other cultures. While in Europe, elected president of the Presbyterian Medical he trained under Sir Reginald Watson Jones, Sir Board. Vittorio Hip Society in 1975, where he also served as Putti in hip, shoulder and replacement surgical president. Stinchfield was awarded Honorary Fellow by the Royal Australian College of Surgeons in 1976, and Honorary Fellow by the Royal College of Surgeons in 1979. He served as liaison between the orthopedic commu- nity and Congress while serving as orthopedic adviser to presidents such as Harry Truman. By the 1980s he was on the Presidential Advisory Committee on National Health to President Ronald Reagan. Stinchfield, prima- rily on hip replacement and arthroplasty, were published by the time he retired.

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He didn’t think he had a sexual issue; although during his drinking days he occasionally had been impotent discount 25mg viagra free shipping, he thought this was due to the alcohol discount viagra 100mg free shipping. He obviously had a mother who suffered from unknown illnesses her whole life (she was probably a somatizer herself) trusted viagra 100mg. Assuming she was purchase 75 mg viagra, then he cheap viagra 100 mg on line, as a first-degree male relative, followed the pattern by the fact that he had a substance abuse problem. His problems had been lifelong, starting in childhood, and while he generally received a diagnosis for whatever com- plex of symptoms he was having at the time, no laboratory tests revealed objective findings. Most of the tests administered to him ruled out serious conditions more often than they actually confirmed whatever condition he had at the time. It said that recent studies linked childhood abuse, particularly physical and sexual abuse, with somatization disorder. Gordon returned to the doctor, who was extremely sympathetic and explained that while this disorder is currently classified as psychological, it is clinically more complex than that. He explained that because studies on the effects of trauma on the human body are in their infancy, the medical community has not yet discovered specifically how trauma affects the immune system, digestive system, and brain functions that control pain, sleep, and depression. He offered his own opinion that one day science might be able to prove that these conditions were a direct physical result, rather than just a psy- chological one, of trauma on the body. In any case, Gordon was assured that his condition was not under his control. In other words, he had not made up his symptoms in any deliberate or voluntary manner. Research studies to date show that a somatizer’s symptoms represent a coping strategy to deal with emotional discomfort at an unconscious level that results in the patient’s diminished function. When a patient can iden- Could Your Symptoms Be All (or Partly) in Your Mind? Gordon’s doctor asked him to do one last step—Step Seven—in the hope that understanding his belief system might help his recovery. He sug- gested that Gordon take a close look at how he reacted or what happened to him when his symptoms arose. He asked him to look at how his day was modified by his current illness, how he coped with stress, whether he ever felt like the past affected his behavior, and whether he felt he was adequately taking care of himself. These are Gordon’s notes for this section: Every time I get sick, I get anxious. My mother was always sick—like me, I guess—and my father was often drunk or gone. And since I was abused, I felt ashamed of myself even though I understand now that it was not my fault. My drinking used to help me escape from these feelings, but now I don’t drink and even though I feel like I’ve worked through these feelings, perhaps there’s still more work to do. Maybe I keep working at my job in spite of my illness as a way of escap- ing. Maybe I am angry all the time in the same way I feel ashamed, and it’s easier to get angry at my illness than at those I really want to be angry at. He called his doctor and said he thought it was time for him to return to psychotherapy. Working through Step Seven raised a lot of unanswered questions, and perhaps dealing with them would help resolve his somatization disorder. The doctor suggested that Gordon con- 184 Diagnosing Your Mystery Malady sult a psychiatrist to determine whether an antidepressant medication might be helpful. But he also concluded that he thought Gordon was well on his way to becoming truly healthy, perhaps for good. Conclusion Somatization disorder is a difficult diagnosis and one that should not be made without proper evaluation by an experienced psychiatric expert. Nor should this diagnosis be assigned simply because someone has a mystery ail- ment that has not yet been identified. In Gordon’s case, his orthopedic sur- geon had studied much about this illness after the pioneering work that had been done by John Sarno, M. That, together with Gordon’s lifelong pattern of illnesses, pointed the physician in the direction of a somatization disorder diagnosis. Finally, Gordon’s history of sexual abuse coupled with his high func- tioning in all areas made his doctor wonder what Gordon did and still does with the rage and emotional pain that would be a natural by-product of his history of sexual abuse. That rage needed an outlet, and based on Gordon’s history, physical disorders may have been the only acceptable, albeit painful, way to release his rage. Famed psychotherapist Alice Miller, in her book Thou Shalt Not Be Aware: Society’s Betrayal of the Child summed it up this way: “The truth about our childhood is stored up in our body and although we can repress it, we can never alter it.

Finding out whether someone is interested in something is not actually the same as finding out whether someone would use the service viagra 25mg on-line. For example buy discount viagra 75mg, I might think a play scheme is a good idea for other children as it might keep them off the streets viagra 75mg with amex, but not for my little darlings who are too occupied with their computer buy viagra 25mg on line. If I said ‘yes purchase 25 mg viagra mastercard, I am interested’, this could be misleading as I have no in- tention of using the service. However, if the purpose of the research is to obtain funding for the scheme, then the more people who express an interest, the better, although the tenants’ association would have to be careful not to produce misleading information. I would also find out whether the tenants’ association was interested only in the issue of how many people were interested in it and would use the play scheme. If they were doing this research anyway, would it be a va- luable addition to find out what sort of scheme resi- dents would like, and what activities their children would like? HOW TO DEFINE YOUR PROJECT / 13 SUMMARY X You must take time to think about your research as this will save you problems later. X When you’re thinking about your research, ask your- self the five ‘Ws’: – What is my research? X Discuss your sentence with your tutor or boss and re- vise if there is any confusion. The first thing you need to do is to think about your research methodology. This is the philosophy or the general princi- ple which will guide your research. It is the overall ap- proach to studying your topic and includes issues you need to think about such as the constraints, dilemmas and ethical choices within your research. Now that you have read Chapter 1, some of these issues will be fresh in your mind. Your research methodology is different to your research methods – these are the tools you use to gather data, such as questionnaires or interviews, and these will be discussed in Chapter 3. UNDERSTANDING THE DIFFERENCE BETWEEN QUALITATIVE AND QUANTITATIVE RESEARCH When you start to think about your research methodol- ogy, you need to think about the differences between qua- litative and quantitative research. Qualitative research explores attitudes, behaviour and ex- periences through such methods as interviews or focus groups. As it is attitudes, behaviour and experiences 14 HOW TO DECIDE UPON A METHODOLOGY / 15 which are important, fewer people take part in the re- search, but the contact with these people tends to last a lot longer. Under the umbrella of qualitative research there are many different methodologies. If you wish to pursue any of these in more depth, useful re- ferences are included at the end of this chapter. Quantitative research generates statistics through the use of large-scale survey research, using methods such as questionnaires or structured interviews. If a market re- searcher has stopped you on the streets, or you have filled in a questionnaire which has arrived through the post, this falls under the umbrella of quantitative research. This type of research reaches many more people, but the con- tact with those people is much quicker than it is in quali- tative research. Qualitative versus quantitative inquiry Over the years there has been a large amount of complex discussion and argument surrounding the topic of re- search methodology and the theory of how inquiry should proceed. Much of this debate has centred on the issue of qualitative versus quantitative inquiry – which might be the best and which is more ‘scientific’. Different meth- odologies become popular at different social, political, historical and cultural times in our development, and, in my opinion, all methodologies have their specific strengths and weaknesses. At the end of this chap- ter references are given if you are interested in following up any of these issues. Certainly, if you were to do so, it 16 / PRACTICAL RESEARCH METHODS would help you to think about your research methodology in considerable depth. Deciding which methodology is right for you Don’t fall into the trap which many beginning (and ex- perienced) researchers do in thinking that quantitative re- search is ‘better’ than qualitative research. Neither is better than the other – they are just different and both have their strengths and weaknesses. What you will find, however, is that your instincts probably lean you towards one rather than the other. Listen to these instincts as you will find it more productive to conduct the type of re- search with which you will feel comfortable, especially if you’re to keep your motivation levels high. Also, be aware of the fact that your tutor or boss might prefer one type of research over the other. If this is the case, you might have a harder time justifying your chosen methodology, if it goes against their preferences.

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Waving at two men dressed as janitors 50 mg viagra visa, who tensed cautiously discount 50mg viagra otc, I gesticulated downward generic 75 mg viagra fast delivery, hoping to convince them that my verticality was temporary effective viagra 75 mg. I was bedraggled order 50 mg viagra otc, wet, a woman, and in a wheelchair—probably not a threat. Although several people live in one-story houses, these homes had one or two entry stairs without railings, actually a daunting barrier. Esther Halpern performs a complicated ballet getting into and out of her house: I hold onto the door. Well, actually, I can use the walker, too, as long as somebody holds the door open. Or if I have to do it myself, I could push that door open, hold on, and then push the door to where it would stay open, and then I can get the walker up onto the first step. And then I can lift it and get onto the second step, and then I would release the door.... Every morning, they drop the newspaper right outside the door, beyond the step. But instead of going down the step, I use my grab- ber to pick it up so I don’t have to go up and down the step. Esther’s “grabber” is a rodlike device with pinchers to reach inconveniently placed items. Many people resist changing their houses or decor, living with incon- veniences—and safety risks (chapter 10). One woman with severe back pain has “three stairs to get into my house, but that’s all right. Tina DiNatale installed a grab bar At Home—with Family and Friends / 89 in her bathroom but told the workman,“ ‘I don’t want anything to look too handicapped. A few wealthy people built new houses or performed substantial renovations. But for renters, finding exist- ing and accessible housing with reasonable rents is hard. Lonnie Carter, the disability activist, worried, “Landlords want to rent their apartments at market value. It’s bad news about acces- sible housing—its getting cut for minorities, for whoever you are. But mice was all on the table, the stove, all over the furni- ture they crawled. Then I live in the basement floor, which was like a handicap unit, and it was easy for me. After they start to broke into my house, I got this house where I’m right now. I get very scare sometime because I slip coming out of the bathroom, nothing to hold onto, and I hit my head. Joe Warren, a wheelchair user, had been in his mid twenties when he moved into a public apartment complex constructed specifically for the “elderly and handicapped. The older people that didn’t have anything to do saw me come in with friends and just made up stories. A half-dozen interviewees temporarily or permanently moved their bed- rooms from an upper floor to the ground level. Two put in lifts along stair- cases, although one didn’t use his because he was “insecure getting on and off. Tina DiNatale replaced her wall-to-wall 90 / At Home—with Family and Friends carpets with highly polished hardwood floors, which she viewed as both el- egant and functional, but they proved too slippery. According to a 1990 nationwide survey, the most common home adap- tation is installing grab bars or special railings, followed by ramps, making extrawide doors, and raised toilet seats (LaPlante, Hendershot, and Moss 1992, 3). Some men start using a urinal at night rather than getting to the bathroom. Some use “life- line” services that summon emergency assistance if they press the button on a pendant worn around the neck. Tom Norton replaced a pic- turesque but irregular flagstone walkway with smooth pavement. Interviewees who still walk frequently rearrange household items for “furniture surfing”—placing objects strategically to grab for balance. This tactic won’t work unless furnishings are tall enough to be within easy reach. Many people, especially those with arthritis, avoid low furniture al- together.

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