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Symptoms as a Source of Medical Knowledge: Understanding Medically Unexplained Disorders in Women - Kirsti Malterud, MD, PhD

In cases where a traditional medical frame of reference does not fully offer an adequate tool for understanding, the resident may find it perplexing to apply knowledge from medical school, where disease implies symptoms, findings, diagnosis, and cure. Medically unexplained disorders, mostly occurring in women, are chronic and disabling conditions, presenting with extensive subjective symptoms, although objective findings or causal explanations are lacking. Acquiring the knowledge and skills needed for adequate care of patients with chronic fatigue or pain syndromes is not an easy task. This paper presents a strategy for teaching, intended to facilitate understanding through appreciation of symptoms as a source of knowledge. The clinical approach is based on empowering practices supported by theoretical perspectives about signs, narratives, knowing, and gender. Also examined is the impact of commonly occurring teaching traps related to gender, psychosocial labeling, universalistic understanding, omnipotence, and power. (Fam Med 2000;32(9):603-11.) An underlying assumption in medicine is that health problems present as subjective symptoms accompanied by objective findings. Objective findings are supposed to provide the keys to diagnosis, which explains the cause of symptoms and assigns treatment. It is not an easy task to provide residents with the knowledge and skills needed for evaluating patients’ symptoms when objective findings are absent. The traditional diseaseoriented medical frame of reference may be inadequate to understand the meaning of such symptoms. Unexplained disorders, especially chronic ones, impose strain on the physician-patient relationship and may contribute to mutual feelings of anger and hopelessness.1-5 However, in a substantial proportion of patients in the primary care setting, a clear-cut diagnostic label cannot be obtained, and treatment is not selfevident. In clinical practice, symptom diagnoses are most prevalent; only one out of eight patients is given a disease diagnosis as a cause of symptoms.6 Symptom diagnoses are more easily accepted as adequate ...

CYPRUS SUSTAINABLE TOURISM TOURISM POLICY ... - UNEP

One of the 4 principal aims of the Strategic Plan for “Tourism 2010 ”, approved in 2004, is the achievement of sustainable development of the tourist sector in Cyprus which should also enhance the natural, cultural and social environment. The Plan is currently under full implementation, whereas action plans are being prepare d for the development of cultural tourism, religious tourism, special interests tourism - including nature tourism , etc. The formulation of the Plan followed a process of extensive consultations with all stakeholders and organised groups in tourism as well as Government Departments, Local Authorities and the public- at - large to ensure consensus and ownership of the strategic goals. Following approval, a monitoring mechanism was also established with progress reports prepared on a regular basis and submitted to the Council of Ministers. • Quality and environmental systems/mechanisms are being encouraged, with incentives for the adoption of quality and environmental standards in tourist establishments (ISO 9001, 14001, HACCP, Green Globe , Eco-label, EMAS). • An incentive s scheme for small and medium enterprises for the encouragement of investment in agrotourism provides grants for, intera alia: the restoration of traditional houses and their conversion into accommodation units; traditional restaurants; workshops for handicrafts; theme routes; theme museums; information centres; etc. LAND USE PLANNING REGULATION (Main responsibility: Ministry of Interior) • A strong emphasis on the preservation of the environment and the quality of the landscape in tourism development is characterizing the Town and Country Planning legislation, so that both the natural environment is protected and further enhanced and the man -made environment is aesthetically upgraded, particularly in the tourist areas. • Local physical plans , area development schemes and the rural development policy are currently the instruments in force. Areas of aesthetic and landscape value have been declared as Coasts and Areas for the Protection of Nature and Protected Landscapes, with very prohibitive provisions as far as development control is concerned.

A & B DISTRIBUTION FUSE PANEL - Lineage Power

Foreword This manual is intended to help the user of the A & B Distribution Fuse Panel Manual to install, test, troubleshoot, and understand the system. If you should have any questions or problems, please contact one of the following sources: SERVICE - If for any reason further assistance is needed on any power equipment, complete engineering and field service groups are available in Galion, Ohio, to assist you in any way possible. CALL: 419.468.7700 Field Service OR 419.468.7600 and ask for Field Service PARTS ORDERING - Replacement parts for power equipment may be obtained by forwarding a Purchase Order to: PECO II, Inc P. O. Box 910 Galion, Ohio 44833 OR Fax to: 419.462.8180 Include the following information: A. PECO II part number and engineering level of equipment B. If part is electrical, give circuit reference numbers and PECO II part numbers. C. If part is mechanical in nature, give description as to where it is used. RETURN & REPAIR - Equipment may be returned to the Factory for repair. In order to do this, the procedure must be as follows: A. Call: 419.468.7700 Field Service OR 419.468.7600 and ask for Field Service B. Request a Returned Material Authorization (RMA) number for the defective equipment. C. Return material prepaid to: PECO II, Inc 1376 State Route 598 Galion, Ohio 44833 Attn: Field Service Dept Product Information Please take a moment when the product is new to fill in this information. This data will allow faster service when calling PECO II to order accessories, spare parts, or request field service. First, locate the product information label. This is typically located on the upper front of the equipment frame, or on the rear of the frame. Fill in the part number, as it appears on the label, in the space below.

Autodesk Civil Design R2 - User's Guide - Jim Richardson Home

Contents Chapter 1 Using the Grading Commands 1 Developing Finished Ground Surface Models 2 Creating Finished Grade Labels 2 Changing the Finished Grade Label Settings 2 Creating Finished Grade Labels 4 Editing Grading Points or Finished Grade Labels 4 Modifying Point Elevations 5 Changing Elevations of Points by Relative Hinge 5 Changing Elevations of Points by Absolute Hinge 6 Working with a Stratum 7 Defining a Stratum 8 Selecting the Current Stratum 9 Deleting a Stratum 9 Updating the Elevations of Selected Points Based on a Stratum 10 Updating the Elevations of a Range of Points Based on a Stratum 11 Reporting the Elevations of Selected Points Based on a Stratum 11 Reporting the Elevations of a Range of Points Based on a Stratum 12 Reporting the NEZ Point Data Based on a Stratum 13 Obtaining the Elevations from a Stratum Based on the Specified X,Y Coordinates 14 Slope Grading 15 Creating and Stationing the Grading Footprint 15 Creating Grading Objects 16 Creating a Grading Object Using the Grading Wizard 16 Creating a Grading Object Using the Apply Grading Command 17 Weeding 3D Polyline Vertices 18 Grading Settings 19 Configuring the Grading Footprint Settings 20 Configuring the Grading Targets Settings 23 Editing Individual Grading Targets 28 Configuring the Grading Slopes Settings 29 Configuring the Grading Corners Settings 33 Usage Tips for Mitered Corner Treatments 36 Editing Individual Corner Treatments 37 Configuring the Grading Accuracy Settings 38 Configuring the Grading Appearance Settings 42 Calculating General Statistics About a Grading Object 45 Editing Grading Objects 46 Object Locking 47

Classic - Kawasaki
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... New VulCAN 900 CuSTOm SpeCIAl edITION adds a blackout air cleaner, exhaust system and engine cases, with candy burnt orange valve covers for extra emphasis. Flat-black paint with tribal orange and white pinstripes completes the look. VulCAN 900 CuSTOm : Special Edition Ebony / Metallic Midnight Sapphire Blue / Candy Burnt Orange The Vulcan® 2000 powers cruiser style in a fresh direction with the confidence of the world’s largest mass-produced V-Twin engine. A sleek nacelle surrounds the four-bulb projector-type headlight while the Metallic Titanium color contrasts with the matte black frame. Adding to the Vulcan 2000’s audacious muscle are huge 46mm electronic fuelinjection throttle bodies, dual counter-balancers and rubber mounts to civilize the massive power, and a huge 200mm radial rear tire to lay down its authority on the street. The Kawasaki Vulcan 2000 cruiser. Anything else is just pretending. BeAuTY ANd THe Beef¬— Vulcan 2000’s muscular stance is further enhanced by the wide front forks, which add to the visual impact of the front end and provide 5.9 inches of plush travel. BIg 5.5-gAllON TANK gets you way down the road and back with ease, while artfully integrated chrome instrument panel features a large analog speedometer, LCD display and warning lamps for quick information assessment. Classic & C TAKE ALL RO lassic LT ADS BY STOR M Boa stin g the sam e awa rd-w inni ng 2,05 3cc V-Tw in per form anc e as the styl ing with a hos Vulc an ® 200 0, the t of eleg ant feat ure Vulc an 200 0 Clas s. The stor y beg sic feat ure s mor ins with brig ht plat hea dlig ht with chr e trad itio nal cru ing and poli shin g ome d she ll, a chr iser for the fork ass emb ome d inst rum ent ly, a uniq ue rou nd nac elle and air- clea call s, the Vulc an mul ti-r efle ctor ner cov er, a cho ice 200 0 Clas sic LT ans wer s with a high of pain t colo rs and ly effe ctiv e tour ing mor e. Whe n the for all- day ridi ng ...

Download File - The Repair Procedure

TECHNICAL INFORMATION SERVICE ACTION Fuel Cap/Filler Neck Sealing ----------------------------------- No: SB140 Ref: Issue: 2 Date: 10 MAR 2009 --------------------------------------- AFFECTED VEHICLE RANGE: NOTE: A limited number of vehicles in Retailer inventory are affected by this Action. The InfoTrail version of this document has a specific VIN list attached. To link to the list, click on the VIN range below. 3A767790 - 4A830188 Discovery Series II (LT) Build Date 26 February 2002 to 13 August 2003 ------------------------------------------------------------- SITUATION: POOR SEAL BETWEEN FILLER NECK AND FILLER CAP NOTE: The symptoms outlined for poor filler cap fit condition may also be indicative of a trickle valve failure. Discovery vehicles in Retailer inventory before the safe VIN may have a fuel filler neck thread manufactured out of specification. This can cause the fuel filler cap to bind and prevent the cap from sealing adequately prior to the start of the fuel filler cap ratchet process. A fuel vapor leak from the filler cap area can cause the MIL lamp to illuminate and fault codes P0446 and P0455 may be logged. ---------------------------------------------------------------------------------------------- RESOLUTION: TEST AND IF INDICATED REPLACE FUEL CAP AND/OR FILLER NECK NOTE: This Service Action is for un-sold vehicles held in Retailer inventory only. Prior to customer delivery test the seal integrity of the fuel filler cap on all vehicles in Retailer inventory before the above VIN. Where indicated, replace either the fuel cap or both the cap and filler neck. This Service Action covers both 2003 and 2004 model year inventory. -------------------------------------------------------------------------------------- PARTS INFORMATION: WLD500100 .............Fuel filler cap WMJ500140.............Fuel filler neck LRN0002LABEL......Campaign Label Qty 1 Qty 1 Qty 1 ...

Design a Piece of Furniture - Illinois State Museum

A Matter of Style Activity: Furniture Design Purpose: to help students recognize that traditional elements of design (shape, ornament, motif, or decoration) on furniture are viable today as a medium of expression in our environment. Objective: After viewing Nineteenth Century Furniture, the students will design a piece of furniture by incorporating three design elements from a style of nineteenth century furniture into an original design drawing. Grade Level: 4-8 Time Required: one class period Materials: sketch paper for ideas, drawing paper, pencil, illustrated glossary from A Matter of Style Web module or the label drawings of the furniture pieces (pdfs) Motivation: Review with the students the six styles of nineteenth-century furniture that are featured in the Nineteenth Century Furniture module. Discuss why they like or dislike certain styles. Ask them to differentiate the six styles with descriptive adjectives – big, curvy, old-fashioned, artistic – and tell what elements make them fit these descriptions. Procedure: • Pass out copies of the glossary and remind students how to relate it to the online images or printouts of the images of the furniture and the labeled line drawings. (post them on the board for reference). • Students need to keep in mind is that they are to choose their favorite style, then pick three design elements or ornaments from this style. They will use these three elements or motifs in their furniture design, which does NOT otherwise have to look like nineteenth-century furniture (e.g., a plastic chair with embossed roses and cut-outs of tracery on it reflecting the Rococo Style). • They can choose modern materials for their furniture. How do modern materials affect the choice of ornament? They can choose any piece of furniture they want –a bed, a bookcase. • Students will sketch their ideas until they get one they like (timed). Students will transfer their sketch clearly to drawing paper (furniture should be large enough to see the details (8" or bigger square). Publication and Closure: each student should show and explain his or her design. From what style did the elements come from (this could be guessed by the audience)? What elements were borrowed? From what materials would it be made? Why did you design it the way you did? Assessment: the piece of furniture should clearly incorporate three design elements from one style of nineteenth-century furniture from A Matter of Style or its sources.

Moving Help from the Self-Storage in Taylorsville UT

If you need self storage in Taylorsville, think of STOR-N-LOCK. Our Taylorsville storage facility is clean and convenient with a focus on providing friendly customer service and giving you peace of mind that your important belongings are close by. Whether business storage, personal items, or anything in between, STOR-N-LOCK truly strives to give all of its customers a comfortable, convenient storage experience.

Salt Lake City RV Storage - Ideal Option for All

If you need self storage in Cottonwood Heights, think of STOR-N-LOCK. Our Cottonwood Heights storage facility is clean and convenient with a focus on providing friendly customer service and giving you peace of mind that your important belongings are close by. Whether business storage, personal items, or anything in between, STOR-N-LOCK truly strives to give all of its customers a comfortable, convenient storage experience.

Global Automation Market Expected to Have double digit growth rate of  13

The old vending machine is completely replaced by high performance kiosks, which is increasing retail sector revenue. Similarly, introduction of self-checkout systems, and electronic shelf label gives a new improved face to retail industry. Various emerging products are getting introduced in the market such as touch screen kiosks. It results in the retail automation market’s double digit growth rate of 13.09% during next five years from 2013-2018. Factors such as increasing need for fast process completion, growing automation market, and the developing retail market are driving this market.

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