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The agreement between raters purchase kamagra polo 100mg on-line impotence icd 10, determined by dividing the number of identical judgments by the total number of codes discount kamagra polo online erectile dysfunction therapy treatment, was 87%. When discrepancies occurred the raters met to discuss their differences and to re-examine the original transcripts until a consensus was reached on how a particular item was to be scored. HyperResearch software (Hesse-Biber, Dupuis, & Kinder, 1992) enabled the researchers to perform a thorough content analysis of interview transcripts (totalling over 8,000 double-spaced pages) and identify, catalogue, and organize specific interview passages on which categorical codes were based. In the second or current phase of the study, we re-examined the codes so as to prepare the data for quantitative analysis. Many variables were re-coded into dichotomous categories. For example, psychological intimacy was originally coded into three categories (positive, mixed, and negative). Because we were interested in understanding factors that contributed to psychological intimacy during recent years, the positive category was retained and compared with a recoded mixed/negative category. Vignettes from the transcripts are used in the following pages to illustrate the meaning of psychological intimacy to participants during recent years. The coded data from the scoring sheets yielded frequencies that were analyzed using SPSS software. The chi-square statistic seemed appropriate, since certain conditions were met. First, it has been very difficult to ensure randomness of samples in social and behavioral research, especially in studies that focus on new territory. This nonprobability sample was selected deliberately to include older couples who have been understudied in previous research--namely, heterosexual and same-gender relationships that had lasted an average of 30 years. The goal was to identify factors that contributed to satisfaction from the perspectives of individual partners rather than to test hypotheses. Second, compared to other tests of statistical significance, chi-square has fewer requirements for population characteristics. Third, the expected frequency of five observations in most table cells was met. To assess the strength of the associations between psychological intimacy and the independent variables, a correlation analysis was conducted. Because of the dichotomous nature of the variables, a phi coefficient was computed for the dependent variable and each independent variable. Variables that had been related significantly to psychological intimacy in the chi-square analysis and identified in previous studies as having importance to understanding psychological intimacy were selected for building a theoretical model. Based on the phi coefficients, communication was not included in the model (see next section). Two models were tested using logistic regression: one model included the sexual orientation of couples (heterosexual, lesbian, and gay males), the other substituted gender (male and female) for the sexual orientation of couples. Logistic regression was a useful tool in this exploratory research, where the goal was to develop theory rather than test it (Menard, 1995). TOWARD A DEFINITION OF PSYCHOLOGICAL INTIMACY The dependent variable was psychological intimacy. Participants talked of experiencing psychological intimacy when they were able to share their inner thoughts and feelings they felt to be accepted, if not understood, by the partner. Such experiences were associated with feelings of mutual connection between partners. When participants talked of being psychologically intimate with their partners, a sense of peace and contentment permeated their remarks. Coding this variable involved an assessment of responses to questions that asked each partner to talk about their relationships. These questions included a range of topics such as what the partner meant to the participant, how their relationships may have been different from other relationships, how participants felt about being open with their partners, what words best described the meaning of the partner to a participant, etc. Of particular importance were questions that elicited responses about the quality of communication such as, "How would you describe the communication between you? Although positive communication could be present without having a sense that the relationship was psychologically intimate, at least in a theoretical sense, the two factors were correlated substantially (phi =. Therefore, we decided not to include communication as an independent variable in the regression analysis. Psychologically intimate communication captures what we are referring to as "psychological intimacy. I can say stuff to her that I would never say to anyone else. The partner spoke of how their psychological intimacy had evolved:Although we like a lot of the same things, our interests are different... I think we both each really like the other one a lot... There was a bond early on, in part because it was a different kind of relationship... As the couples in this study grew older together the experience of psychological intimacy was marked by a deepening sense of relational communion between them, yet a respect for their differences, as illustrated in the relationships of that couple. A heterosexual couple reflected on the meaning of intimacy in their relationship that had lasted 30 years. The wife experienced her spouse as: My best friend, best lover... Unfortunately, we have not had parents for many years. He is the person who most cares what is happening to me. The meaning of intimacy to her husband was described by him:I just like her to be next to me, near me. I think we are our own people, but we do it together. The responses of these four partners reflected several themes that were central to understanding and defining psychological intimacy. The second theme, interdependence, referred to maintaining separateness within the attachment to a partner. Maintaining interpersonal boundaries in these relationships apparently helped to sustain a sense of psychological intimacy; that is, individuals felt "safe" in revealing their inner thoughts and feelings because they could count on a partner to respect their separateness and to accept, if not understand, them. For both women and men, themes of connectedness, separateness, and mutuality were apparent in their responses, although men tended to emphasize proximity and women mutuality. In selecting the independent variables, two criteria were used:1. The variable had to be identified in previous studies as a significant factor in shaping psychological intimacy. The variable had to be related significantly to psychological intimacy in the chi-square analysis (see Table I) and not be correlated substantially with the dependent variable.

How do you find the Parent Training and Information Centers? Judy Bonnell: The parent organization is PACER ( Parent Advocacy Coalition for Educational Rights ) and it is easy to find on the web 100mg kamagra polo with amex erectile dysfunction medication muse. They are in every state and are there for the families order kamagra polo 100 mg erectile dysfunction 55 years old. David: My guess is you can also call your county and/or state board of education and they can point you in the right direction. Judy Bonnell: Every State Department of Education is mandated to work with these centers. Believe me, the local school administrators have the regulations practically memorized. The law was written to protect children, not written for the convenience of school districts. But often that information is not easily available to parents. David: What kind of things should a parent expect the school district to do, to accommodate their ADD, (Attention Deficit Hyperactivity Disorder) ADHD child? Judy Bonnell: First of all parents need to understand that not all children with ADD/ADHD qualify for assistance. If children just need minor help, such as shortened assignments, less homework, oral testing, etc. If they need big-time help with services they should qualify for IDEA which lets them have an individualized plan. IDEA means Individuals with Disabilities Education Act. It says all children with disabilities will have access to the same things as children without disabilities. For the past 5yrs of dealing with the school board and Individualized Education Plan - IEP teams, it took forever to get my son in the right setting. After a long 5yrs of public schools (three different schools to be exact), I felt my son was not getting the education he so deserved. My question to you is, how beneficial are private schools for adhd children? This is a big cost factor, but after dealing with the public school, this was my only solution, to put him in a private school. Some schools are geared to meet the needs of children with learning problems. Some schools are very conservative and the emphasis is on strict regimentation. Judy Bonnell: School officials who are easily intimidated are usually school officials who are either uninformed as to what they must do, or they are in personal ivory towers and have a great fear of losing control. What must happen is to put aside other considerations and focus on the needs of the child and what teachers need to be successful with that child. When that eventually becomes the focus, and it will with effective advocacy, everyone ends up a winner and a smiler:-)Special education is rapidly becoming a team effort. There is no room for people who are uncomfortable with that. Those people seem to be leaving the profession as it is too stressful for them. Ask for a full educational evaluation including executive functions and do it in writing. Then, if they still deny services, parents can ask the district to pay for an independent evaluation by a neutral party. As always, request it in writing and they must meet a timeline to complete it. When you make a request, always ask for a reply within say 10 or 12 working days. David: Sometimes, it helps to be complimentary to the teacher or school officials when things are going right. Judy Bonnell: Again, ask for that evaluation and also testing for gifted. Being gifted does not let the district off the hook for services! In fact, doing just so-so is not good enough for a gifted child. Pat B: What do you do when a special education coop continuously has a power struggle and forgets what the needs of the child is? Judy Bonnell: You write that Letter of Understanding:-) State what you understand that is not happening, that should be happening. Ask for a meeting and state the expectation that district recommendations and denials of your requests be in writing as required by law. Nadine: I was told my son has inattentive type of ADD (Attention Deficit Disorder), however he is at the top of his class and he has no behaviour problems, so therefore, the school will not step in and help. So it will cost me over a $1000 to have a full evaluation done here in Canada. David: Is there anything she can do, Judy, to get the school district to help with the evaluation? Judy Bonnell: Not all children with Attention Deficit Disorder, ADD, are going to need services. She needs to get a copy of her law and see what it says about evaluations. Always learn what the law is that covers your child. Judy Bonnell: The problem with due process and lawyers is that it can drag on for years. In any case, parents should start building that all powerful documentation because a lawyer will bless them for it! I have found the Office for Civil Rights very helpful in many instances for ADHD. David: Yes, I imagine that because of the slowness of the legal process, if you start with lawyers while your child is in 5 grade, by the time that issue is resolved, your child is a college graduate:) Judy Bonnell: Not always. And we have some very fine, caring, advocacy lawyers. Judy Bonnell: I think the psychologist went far beyond her authority. Judy Bonnell: I think you would have a good issue for the Office for Civil Rights with that one. First I would get the psychologists position on paper, of course. Since he was only recently diagnosed and trying to come to grips I am considering an attachment to IEP sent to all his teachers. I do recommend parents look ahead and see that such recommendations are in the IEP long before testing is due.

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Fatalities with benzodiazepines rarely occur except when other drugs order generic kamagra polo online erectile dysfunction doctors los angeles, alcohol or aggravating factors are involved order kamagra polo toronto erectile dysfunction low testosterone treatment. In addition, fatalities have been reported in patients who have overdosed with a combination of a single benzodiazepine, including alprazolam, and alcohol; alcohol levels seen in some of these patients have been lower than those usually associated with alcohol-induced fatality. Vomiting may be induced if the patient is fully awake. Vital signs should be monitored and general supportive measures should be employed as indicated. Gastric lavage should be instituted as soon as possible. Flumazenil (Mazicon), a specific benzodiazepine receptor antagonist, is indicated for the complete or partial reversal of the sedative effects of benzodiazepines and may be used in situations when an overdose with a benzodiazepine is known or suspected. DO NOT EXCEED THE RECOMMENDED DOSE or take this medicine for longer than prescribed. Exceeding the recommended dose or taking this medicine for longer than prescribed may be habit forming. If you miss a dose of this medicine and you are using it regularly, take it as soon as possible. If you do not remember until later, skip the missed dose and go back to your regular dosing schedule. Must be individualized and carefully titrated in order to avoid excessive sedation or mental and motor impairment. As with other anxiolytic-sedatives, short courses of treatment should be the rule for the symptomatic relief of excessive anxiety and the initial course of treatment should not last longer than 1 week without reassessment. If necessary, drug dosage can be adjusted after 1 week. Prescriptions should be limited to short courses of therapy. Treatment for patients with anxiety should be initiated with a dose of 0. The dose may be increased to achieve a maximum therapeutic effect, at intervals of 3 to 4 days, to a maximum daily dose of 4 mg, given in divided doses. The lowest possible effective dose should be employed and the need for continued treatment reassessed frequently. The risk of dependence may increase with dose and duration of treatment. If necessary, this dosage may be increased gradually depending on patient tolerance and response. Each alprazolam (Xanax) tablet, for oral administration, contains 0. With multiple doses, given 3 times daily, steady state is reached within 7 days. Patient Information: Do not take any other sedating drugs or drink alcohol while taking this medication. Withdrawal symptoms may occur after you stop taking it. The information in this monograph is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects. This information is generalized and is not intended as specific medical advice. If you have questions about the medicines you are taking or would like more information, check with your doctor, pharmacist, or nurse. Find out why Xanax is prescribed, side effects of Xanax, Xanax warnings, effects of Xanax during pregnancy, more - in plain English. Other brand name: Xanax XRXanax is a tranquilizer used in the short-term relief of symptoms of anxiety or the treatment of anxiety disorders. Anxiety disorder is marked by unrealistic worry or excessive fears and concerns. Anxiety associated with depression is also responsive to Xanax. Xanax and the extended-release formulation, Xanax XR, are also used in the treatment of panic disorder, which appears as unexpected panic attacks and may be accompanied by a fear of open or public places called agoraphobia. Only your doctor can diagnose panic disorder and best advise you about treatment. Some doctors prescribe Xanax to treat alcohol withdrawal, fear of open spaces and strangers, depression, irritable bowel syndrome, and premenstrual syndrome. Tolerance and dependence can occur with the use of Xanax. You may experience withdrawal symptoms if you stop using Xanax abruptly. The drug dosage should be gradually reduced and only your doctor should advise you on how to discontinue or change your dose. If you are less than 1 hour late, take it as soon as you remember. Otherwise skip the dose and go back to your regular schedule. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Xanax. Your doctor should periodically reassess the need for this drug. Side effects of Xanax are usually seen at the beginning of treatment and disappear with continued medication. However, if dosage is increased, side effects will be more likely. More common side effects may include: Abdominal discomfort, abnormal involuntary movement, agitation, allergies, anxiety, blurred vision, chest pain, confusion, constipation, decreased or increased sex drive, depression, diarrhea, difficult urination, dream abnormalities, drowsiness, dry mouth, fainting, fatigue, fluid retention, headache, hyperventilation (too frequent or too deep breathing), inability to fall asleep, increase or decrease in appetite, increased or decreased salivation, impaired memory, irritability, lack of or decreased coordination, light-headedness, low blood pressure, menstrual problems, muscular twitching, nausea and vomiting, nervousness, painful menstruation, palpitations, rapid heartbeat, rash, restlessness, ringing in the ears, sedation, sexual dysfunction, skin inflammation, speech difficulties, stiffness, stuffy nose, sweating, tiredness/sleepiness, tremors, upper respiratory infections, weakness, weight gain or lossLess common or rare side effects may include: Abnormal muscle tone, arm or leg pain, concentration difficulties, dizziness, double vision, fear, hallucinations, hot flushes, inability to control urination or bowel movements, infection, itching, joint pain, loss of appetite, muscle cramps, muscle spasticity, rage, seizures, shortness of breath, sleep disturbances, slurred speech, stimulation, talkativeness, taste alterations, temporary memory loss, tingling or pins and needles, uninhibited behavior, urine retention, weakness in muscle and bone, yellow eyes and skinSide effects due to decrease or withdrawal from Xanax or Xanax XR: Anxiety, blurred vision, decreased concentration, decreased mental clarity, depression, diarrhea, headache, heightened awareness of noise or bright lights, hot flushes, impaired sense of smell, insomnia, loss of appetite, loss of reality, muscle cramps, nervousness, rapid breathing, seizures, tingling sensation, tremor, twitching, weight lossIf you are sensitive to or have ever had an allergic reaction to Xanax or other tranquilizers, you should not take this medication. Also avoid Xanax while taking the antifungal drugs Sporanox or Nizoral. Make sure that your doctor is aware of any drug reactions that you have experienced. Do not take this medication if you have been diagnosed with the eye condition called narrow-angle glaucoma. Anxiety or tension related to everyday stress usually does not require treatment with Xanax. Xanax may cause you to become drowsy or less alert; therefore, driving or operating dangerous machinery or participating in any hazardous activity that requires full mental alertness is not recommended. If you are being treated for panic disorder, you may need to take a higher dose of Xanax than for anxiety alone. High doses--more than 4 milligrams a day--of this medication taken for long intervals may cause emotional and physical dependence.

Carbonell: And on my site discount kamagra polo erectile dysfunction korean ginseng, there are instructions purchase kamagra polo 100 mg line erectile dysfunction medication list, and a video clip, for the breathing. Carbonell: You really do need to learn those skills. Therapy without the skills is really missing something important. Sweetgirl01: Can severe anxiety be caused by biochemical factors? Carbonell: It seems to be the case that there are biological predispositions to panic disorder and other conditions. Learning and habit are what maintain the problem, and also offer the way out. David: I mentioned earlier that many people who suffer from anxiety and panic feel helpless and pessimistic about recovery. So all I could suggest is, be aware that your discouragement can prevent you from finding the help that may be more available now than when you first looked. Carbonell: In general, recovery is more difficult for those who have suffered longer. They tend to feel more discouraged, and they tend to have incorporated the phobias into their life to a greater degree. I have had severe anxiety disorders for 55 years and there is no one near where I live that offers the kind of treatment you are proposing. The only thing that has given me a measure of relief is finally finding some anxiety medications that help----but I do feel that it is now a little late in life to ever get well. Some of the treatments for anxiety have been worse than the disease. David: On the other side, here are some positive audience comments regarding recovery from anxiety and panic attacks, so everyone knows that it is possible:kappy123: I am currently in cognitive behavioral therapy (CBT) seems to be working and I feel better. When you accept the panic, you start getting better. Neecy_68: I have been on anti-anxiety medications for two years. I am afraid I will have worse panic attacks than before I was on the anxiety medications. Carbonell: You should really develop a plan with the physician who prescribes them. As to long-term effects, it depends on the medication. David: Here is information on specific anti-anxiety medications and their side effects. Lexio: Birth control pills brought on my anxiety and panic after 10 years of being panic free. David: Here are some of the things that have worked for audience members in relieving their panic and anxiety:SaMatter: I try to hypnotize myself through an intense/in-depth thought or daydreaming type of situation. I have also been trying to imagine something I really like when they come on. After six weeks into the tapes, I was out of my house again. Carbonell: It still amazes me, after many years of practice, how powerful the breathing is. This is often what I find when I review this carefully with clients. David: I am getting some general questions about what is anxiety and the diagnosis for it. We have a lot of excellent information on our site in the Anxiety-Panic Community. Carbonell: You mean, when they leave you home alone? I suppose she has a safety zone that she feels comfortable in. Carbonell: You could look at what precisely you fear as a result of being away. Many people, for instance, get focused on knowing where a hospital is, thinking that they may have some medical emergency as a result of anxiety. They indicate panic, which needs to be addressed by accepting, and coping with, the symptoms themselves. And it will make a difference if your family is understanding of these fears. Carbonell, who are apparently affected by travel:codequeen: On the same note... SaMatter: A tip I use is to let people know that I am experiencing a panic attack. It was a tremendous help and a very different experience than when I kept it a deep dark secret. Mucky: I have a service dog that alerts to my panic attacks. In general, secrecy hurts, self disclosure will help. And, since most panic attacks involve a feeling of being "trapped", giving yourself an out is a good strategy. Carbonell: You could evaluate how realistic the need is. And perhaps then you could work with him to gradually increase the amount of time you can spend alone. Getting some help from others to ease the burden on your husband will help too! Carbonell: I think everybody gets more tense during Christmas shopping! A few techniques you can use is breathing, relaxation and take breaks. Carbonell: Certain symptoms, like dizziness, numbness/tingling, and shortness of breath, can last as long as you engage in short and shallow breathing. Most of the most distressing panic symptoms come from short, shallow breathing and hyperventilation. Not an inhale, an exhale, even though that is the opposite ofwhat you expect. The reason is, you need the exhale, or a sigh, to relax your upper body enough that you can breathe deeply. RiverRat2000: Along panic attacks and anxiety disorder, I suffer from PTSD (Post-Traumatic Stress Disorder) and agoraphobia is there any help? Carbonell: The treatment for agoraphobia, (lots of avoidances caused by fear of panic attacks) depends on getting better at managing the attacks, then gradually re-entering the feared situations.

By K. Killian. Nyack College.

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