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Results from epidemiological and intervention research can better define diets that will prevent or delay the development of mental health conditions erectile dysfunction doctor in patna cheap 40 mg levitra super active. Cost effectiveness studies that quantify how specific nutritional interventions in mental health practice are economically beneficial are also informative what age does erectile dysfunction happen buy 40mg levitra super active free shipping. Investigations using large population databases that can examine new research questions about the role of nutrition and mental health erectile dysfunction ayurvedic drugs in india generic levitra super active 40 mg with amex, particularly within the context of the health determinants erectile dysfunction niacin buy levitra super active line, can help inform dietetics practice webmd erectile dysfunction treatment purchase cheap levitra super active on line. Finally erectile dysfunction xanax buy levitra super active from india, the effectiveness of nutritional interventions for mental health consumers needs to be examined. In order for these investigations to move forward, adequate funds for nutrition and mental health research need to be provided to support investigation of the relationship between diet and mental health and facilitate ongoing, meaningful citizen and civil society involvement in planning nutrition and mental health research. Prevalence of Mental Illnesses and Related Service Utilization in Canada: An Analysis of the Canadian Community Health Survey. The relationship between mental health, mental illness and chronic physical conditions. Prevention of Mental Disorders: Effective Interventions and Policy Options Summary Report. Nutrient intakes are correlated with overall psychiatric functioning in adults with mood disorders. Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Moving beyond hunger and nutrition: A systematic review of the evidence linking food insecurity and mental health in developing countries. High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased Km): relevance to genetic disease and polymorphisms. Lower concentration of hippocampal N-acetylaspartate in familial bipolar I disorder. Fatty acid intake and the risk of dementia and cognitive decline: A review of clinical and epidemiological studies. Obesity and systemic oxidative stress: Clinical correlates of oxidative stress in the Framingham Study. The effects of perceived stress, traits, mood states, and stressful daily events on salivary cortisol. Cognitive dietary restraint is associated with higher urinary cortisol excretion in healthy premenopausal women. Increased oxidative stress in the anterior cingulate cortex of subjects with bipolar disorder and schizophrenia. Depressive symptoms are independently correlated with lipid peroxidation in a female population: comparison with vitamins and carotenoids. Oxidative stress in psychiatric disorders: evidence base and therapeutic implications. Demonstration of immunoglobin G with affinity for dopamine in cerebrospinal fluid from psychotic patients. Monoaminergic neurotransmitters, their precursors and metabolites in brains of Alzheimer patients. Protective effect of vitamin C against the ethanol mediated toxic effects on human brain glial cells. Novel Role of Vitamin K in Preventing Oxidative Injury to Developing Oligodendrocytes and Neurons. London, Proceedings of the Nutrition Society: 70th Anniversary Conference on vitamins in early development and healthy aging: impact on infections and chronic disease. Vitamin B1, B2, and B6augmentation of tricyclic antidepressant treatment in geriatric depression with cognitive dysfunction. Dietary intake of fatty acids and fish in relation to cognitive performance at middle age. Vitamin D and the occurrence of depression: causal association or circumstantial evidence Return on Investment for Mental Health Promotion: Parenting Programs and Early Childhood Development. London, Personal Social Services Research Unit, London School of Economics and Political Science. Diabetes mellitus and risk of Alzheimer Disease and decline in cognitive function. Risk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study. Obesity in middle age and future risk of dementia: A 27 year longitudinal population based study. Circulating levels of soluble receptor for advanced glycation end products in Alzheimer disease and vascular dementia. Major depressive disorder is accompanied with oxidative stress: short-term antidepressant treatment does not alter oxidative-antioxidative systems. Association of western and traditional diets with depression and anxiety in women. Size acceptance and intuitive eating improve health for obese, female chronic dieters. The Cost of Mental Health and Substance Abuse Services in Canada: A report to the Mental Health Commission of Canada. Effects of high-dose B vitamin complex with vitamin C and minerals on subjective mood and performance in healthy males. Intersectional frameworks in mental health: Moving from theory to practice, pp 312-30. Supporting Clients on Methadone Maintenance Treatment: Clinical Best Practice Guidelines. Methadone Maintenance Treatment in British Columbia, 1996-2008: Analysis and Recommendations. Reflections on varieties of shame induction, shame management, and shame avoidance in some works of Erving Goffman. The ecological relationship between deprivation, social isolation and rates of hospital admission for acute psychiatric care: a comparison of London and New York City. Blood superoxide dismutase level in schizophrenic patients with tardive dyskinesia: association with dyskinetic movements. Vitamin K, an example of triage theory: is micronutrient inadequacy linked to diseases of aging Weight gain and metabolic risks associated with antipsychotic medications in children and adolescents. Pharmacologic and nonpharmacologic strategies for weight gain and metabolic disturbance in patients treated with antipsychotic medications. Managing weight in persons living with severe mental illness in community settings: a review of strategies used in community interventions. Improvement in hostility and depression in relation to dietary change and cholesterol lowering. Behavioral Health / Primary Care Integration and the Person-Centered Healthcare Home. Position of the American Dietetic Association: Providing Nutrition Services for Infants, Children, and Adults with Development Disabilities and Special Health Care Needs. Research and Training Center on Disability in Rural Communities, the University of Montana Rural Institute: A Center of Excellence in Disability. Nutritional support for patients with intellectual disability and nutrition/dysphagia disorders in community care. Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations. Does nutritional intake differ btween children with autism spectrum disorders and children with typical development Blood phospholipid fatty acid analysis of adults with and without attention deficit/hyperactivity disorder. Nutritional status of children with attention deficit hyperactivity disorder: A pilot study. Do artificial colors promote hyperactivity in children with hyperactive syndromes Disruptive behavior problems in a community sample of children with tic disorders. Professional Consensus Statement: the Nutritional Care of Adults with a Learning Disability in Care Settings. The psychopathology, medical management, and dental implications of schizophrenia. Substance use associated disorders: Frequency in patients with schizophrenic and affective psychoses. The epidemiology of co-occurring addictive and mental disorders: Implication for prevention and service utilization. Diet, smoking, and cardiovascular risk in people with schizophrenia: Descriptive study. Diet, smoking and cardiovascular risk in schizophrenia in high and low care supported housing. Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. Impaired glucose tolerance in first-episode drug-naive patients with schizophrenia. Hepatic insulin resistance in antipsychotic naive schizophrenic patients: stable isotope studies of glucose metabolism. Prevalence of celiac disease and gluten sensitivity in the United States clinical antipsychotic trials of intervention effectiveness study population. Community survey of bipolar disorder in Canada: lifetime prevalence and illness characteristics. Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. Clinical and health services relationships between major depression, depressive symptoms and general medical illness. Folate for depressive disorders: systematic review and meta analysis of randomized controlled trials. Preconception Health and Folic Acid: Primary Prevention of Neural Tube Defects with Folic Acid. A placebo-controlled double-blind crossover study of fluoxetine in trichotillomania. Post Traumatic Stress Disorder: Discussion paper prepared for the Workplace Safety and Insurance Appeals Tribunal. Dissociation in eating disorders: relationship between dissociative experiences and binge-eating episodes. Case report: recurrent pseudocyesis in a male patient with psychosis, intermittent hyponatremia, and polydipsia. Position of the American Dietetic Association: Nutrition intervention in the treatment of eating disorders. The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10-15 years in a prospective study. Medical complications in adolescents with anorexia nervosa: a review of the literature. Does the frequency of anxiety and depressive disorders differ between diagnostic subtypes of anorexia nervosa and bulimia The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Associations among binge-eating behavior patterns and gastrointestinal symptoms: a population based study. Binge Eating Disorder: Progress in Understanding and Treatment (educational monograph). The application of mindfulness to eating disorders treatment: a systematic review. Night eating syndrome and nocturnal snacking: association with obesity, binge eating and psychological distress. Evaluation of diagnostic criteria for night eating syndrome and binge eating disorder among persons seeking bariatric surgery: prevalence and related features. Neuroendocrine profiles associated with energy intake, sleep, and stress in the night eating syndrome. Identifying empirically supported treatments for pica in individuals with intellectual disabilities. Trichobezoar, gastric polyposis, protein-losing gastroenteropathy and steatorrhoea. Merycism or rumination disorder: a historical investigation and current assessment. The effect of melatonin, magnesium, and zinc on primary insomnia in long-term care facility residents in Italy: a double-blind, placebo-controlled clinical trial. Obesity and obstructive sleep apnea-hypopnea syndrome: the impact of bariatric surgery. Antioxidant nutrient intake and supplements as potential moderators of cognitive decline and cardiovascular disease in obstructive sleep apnea. Differences in antioxidant intake in veterans with and without obstructive sleep apnea. Probable rapid eye movement sleep behavior disorder increases risk for mild cognitive impairment and Parkinson disease: A population-based study.

Third and fourth sutures are placed as tively erectile dysfunction over 60 order levitra super active 40mg line, some surgeons mark cartilaginous landmarks needed erectile dysfunction vasectomy order genuine levitra super active. Some overcorrection is necessary during placewith several ink-dipped fine needles erectile dysfunction freedom book purchase levitra super active 40 mg with visa. Permanent horiment of the most superior suture erectile dysfunction medication new zealand generic 40 mg levitra super active free shipping, because it has been zontal mattress sutures (eg erectile dysfunction treatment with injection buy levitra super active 40mg free shipping, 4-0 Mersilene [Ethicon erectile dysfunction doctors in sri lanka buy levitra super active with amex, demonstrated that as much as 40% loss of correction at Inc. The width of the incision is estimated along with cotton impregnated in mineral oil, is applied by manually pushing the concha toward the mastoid. Sufficient soft tissue is excised to produce a pocket that will receive the concha during suture placement. Technique of Furnas the skin over the helix, antihelix, and concha is In 1968, Furnas popularized a technique of conchal setundermined with scissors, and permanent horizontal back using permanent conchomastoidal suturing. The sutures are the patient is prepped and draped in a manner simthrown through cartilage and lateral perichondrium, but ilar to that described for correction of the antihelical not lateral auricular skin. Permanent conchomastoid horizontal mattress sutures are placed at the lateral third of the concha. A full-thickness bite of cartilage and perichondrium is performed, with care taken to avoid suture placement through the anterior skin. In addition, the sutures must pull the ear posteriorly as well as medially to prevent stenosis of the external auditory canal. Otoplasty Refinement Techniques Frequently, small deformities of the auricle are present that can be corrected by subtle surgical refinements. These techniques are applicable to both congenital irregularities and deformities that are detected after more substantial otoplasty correction (ie, conchal setback and correction of absent antihelical fold). Such refinements include correction of the prominent lobule and reduction of helical prominences. Reduction of a large ear lobule rarely requires general anesthesia in the adult population. Fusiform wedge excision for reduction of shaped, wedge excision of lobule excess is performed large ear lobule. For After the infiltration of local anesthesia, a fusiform long-term successful conchal reduction, suture bites of incision is made on the outer helical rim in the case of mastoid periosteum must be taken. After may be weakened by excising small vertical ellipses of carskin elevation, excess cartilage is shaved using a blade. It is important for the conchomastoidal sutures to Skin is trimmed as necessary to ensure appropriate allow the concha to be set not only medially but posteridraping over the cartilaginous rim. The treatment of prominent ears by buried mattress the relationship of the auricle to the scalp or from dissutures: a ten-year survey. Complications arising from otoplasty may be midauricle protrudes after overcorrection of the supesubdivided into early, late, and aesthetic/anatomic in rior pole and lobule. Studies suggest a duces the suboptimal appearance of the helix positioned slightly higher incidence of hematoma formation in medial to the antihelix on frontal view. All of the above cartilage-cutting procedures compared with cartilageaesthetic complications can usually be addressed through suturing operations. Infections after surgery typically manifest on postoperative Protrusion of the ears is a relatively common deformity. Treatment involves systemic antibiotics, Successful surgical correction can relieve both children with particular emphasis on coverage for staphylococci, and adults of the psychosocial distress often associated streptococci, and Pseudomonas aeruginosa. This results in the inhibition of the location and depth and whether it is static or dyexocytosis of acetylcholine. The dose of the toxin is measured as 1 standard unit, which is equal to the amount necessary to kill 50% of Swiss-Webster mice injected with that dose. General Considerations Extrapolating the data from mouse experimentation, Meyer and Eddie estimated that a 104-kg adult male Facial contouring is a recent trend in facial aesthetic would sustain a lethal dose of botulinum toxin type A surgery. Facial injectpasses any dosing regimen in the cosmetic treatment of ables have reached tremendous popularity due to their the aging face. Both Botulinum toxin is contraindicated in patients with are discussed to provide background on an exhaustive peripheral motor neuropathic diseases or neuromuscutopic. Finally, caution should be taken when injecting commonly used facial injectables with a delineation of botulinum toxin type A to those taking aminoglycoside their advantages and disadvantages will be highlighted. Botulinum toxin A is also biopolymers, similar to the substance found in the interused for hyperhydrosis of the palms and armpits. They are used primarily for lip and nasoacetylcholine release at the neuromuscular junction. First, the toxin recent uses of hyaluronic acid derivatives include nonsurbinds the nerve. Rare cases of hypersensitivity have been reported, obviating the necessity for pretreatment skin testing. Typically, injections maintain augmentation similar to Volume enhancement with hyaluronic acid derivatives that of bovine collagen. Complications are relatively uncommon with hyalAutologous Fat uronic acid derivatives. In cases of overaugmentation, Fat transplantation has the advantage of being an autohyaluronidase can be used to decrease the amount of derlogous substance. Peter describes a recent, and surgeons recontour the face, the nasolabial case of retinal artery occlusion through retrograde flow folds, temporal fossa, prejowl sulcus, and perioral and through a peripheral branch of the ophthalmic artery. Most commonly, fat is harvested from the lateral Poly-L-lactic Acid thigh or abdominal region. Fat is then either strained or centrifuged, and injected into areas requiring volume. The main complication is nodule formamorbidity, potential for prolonged facial swelling, and tion. In addition, fat can lead to neous tissues and not in areas of significant muscle granulomas that can be treated with triamcinolone injecmotion such as the lips. Fat transplantation using fresh It has an off-label use for soft tissue augmentation in versus frozen fat: a side-by-side two-hand comparison pilot the face, primarily for reduction of nasolabial folds. The true longevity of thetic appearance versus fresh fat at 1, 3, and 5 months for fat calcium hydroxylapatite is not known. Consensus recommendations on the use of botulinum toxin type A in facial aesthetics. Zyplast is cross-linked with tion point), the influence of other variables, such as gender, glutaraldehyde (creates a longer-lasting effect) but must and assessment and retreatment issues by a consensus panel on botulinum toxin. Lip augmentation with AlloDerm acellular allogenic dermal graft and fat autograft: a comparioccur in about 3% of patients; therefore, skin testing son with autologous fat injection alone. The role of skin testing in the use of collagen injectable carries essentially no risk of hypersensitivity reactions, materials. Injected hyaluronidase reduces jectable nonanimal stabilized hyaluronic acid gel for soft tisRestylane-mediated cutaneous augmentation. Retinal branch artery occlusion following injection of hyaluronic acid (Restylane). Rish technique A line perpendicular to the Frankfort horizontal line is projected tangential to the most anterior edge of the lower lip vermilion border. Merrifield Z-angle A line is projected through the pogonion and the most anterior point of the upper lip vermilion border. Zero meridian of A line perpendicular to the Frankfort horizontal line proGonzales-Ulloa jected through the nasion. Significant is that firstand second-degree retractions are treatable with implants, but third-degree retraction is best treated with maxillofacial surgery. Complications Complications of facial implants are rare and include Hinderer In a frontal view, draw a line from the lateral hematoma, infection, nerve paresthesia (transient or commissure of the lip to the lateral canpermanent), and motor nerve injury. Another line shown a change in infection rates in extraoral versus projects from the tragus to the inferior intraoral approaches. It has been used the nasion and the nasal tip is bisected with success in a recent study with only 0. A line is drawn the advantage of being soft, with minimal encapsulafrom the inferior ala to the lateral cantion and bony resorption. Bony resorption and the line from the oral commissure increases with overlying muscle action translating to marks the point where the malar area implant mobility. In addition, subperiosteal placement Analysis of the malar and submalar region is much increases bony resorption. Well-positioned implants more complex and requires three-dimensional planwith osseous erosion should not be replaced. More commonly, midface implants may result in asymmetry due to preexisting Procedure facial skeleton imbalances. The extraoral approach has the advantage Godin M, Costa L, Romo T, Truswell W, Wang T, Williams E. Building out the malar prominences as an addithe mental nerve, which emanates from the bone approxtion to rhytidectomy. Typically, malar and submalar implants are placed New York: Churchill Livingstone, 1987. Labial incompetence: a upper gingivobuccal sulcus, and an elevator is used to marker for progressive bone resorption in Silastic chin lift the periosteum off the face of the maxilla. Drugs are listed under their generic names; when a trade name is listed, the entry is cross-referred to the generic name. See also Chest imaging, in laryngeal cancer evaluageneral considerations in, 666, 667f specic types.

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Not surprisingly erectile dysfunction diabetes cure generic levitra super active 40mg without prescription, meta phors often create an illusion of complete intellectual mastery of an 44 the Net Delusion issue erectile dysfunction treatment chicago buy discount levitra super active on line, giving decision makers a false sense of similarity where there is none free erectile dysfunction drugs purchase generic levitra super active on line. Having previously expended so much time and effort on trying to break the Iron Curtain erectile dysfunction 14 year old generic 40 mg levitra super active mastercard, Western policymakers would likely miss more effective methods to break the Information Curtain; their previous ex perience makes them see everything in terms of curtains that need to be lifted rather than erectile dysfunction pump.com generic levitra super active 40mg otc, say erectile dysfunction medicine online order 40mg levitra super active, elds that need to be watered. That democracy may still fail to take root even if the virtual walls are crushed is not a scenario that naturally follows from such met aphors, if only because the peaceful history of postcommunist Eastern Europe suggests otherwise. By infusing policymakers with excessive optimism, the Cold War metaphors thus result in a certain illusory sense of nality and irreversibility. Physical walls are cheaper to destroy than to build; their digital equivalents work the other way around. Once such language creeps into policy analysis, it can result in a se vere misallocation of resources. To continue using the cyber-wall metaphor is to fall victim to extreme Internet-centrism, unable to see the sociopolitical nature of the problem of Internet control and focus only on its techno logical side. If we want to make a start at understanding the internet in China in all its complexity, the rst step we need to take is to think beyond the Great Firewall that still has its roots in the Cold War. A piece of samizdat literature copied on a smuggled photocopier had only two uses: to be read and to be passed on. But the Internet is, by denition, a much more complex medium that can serve an innite number of purposes. Yes, it can be used to pass on antigovernment information, but it can also be used to spy on citi zens, satisfy their hunger for entertainment, subject them to subtle propaganda, and even launch cyber-attacks on the Pentagon. Similarly, the problem with understanding blogging through the lens of samizdat is that it obfuscates many of the regime-strengthening fea tures and entrenches the utopian myth of the Internet as a liberator. There was hardly any pro-government samizdat in the Soviet Union (even though there was plenty of samizdat accusing the government of violating the core principles of Marxism-Leninism). If someone wanted to express a position in favor of the government, they could write a let ter to the local newspapers or raise it at the next meeting of their party cell. Blogs, on the other hand, come in all shapes and ideologies; there are plenty of pro-government blogs in Iran, China, and Russia, many of them run by people who are genuinely supportive of the regime (or at least some of its features, like foreign policy). Many bloggers are actually more extreme in their positions than the government itself. Nor is the Iranian blogosphere any more tolerant; in late 2006 a conservative blog attacked Ahmadinejad for watching women dancers perform at a sports event abroad. By itself, the fact that the number of Chinese or Iranian blogs is increasing does not suggest that democratization is more likely to take root. This is where many analysts fall into the trap of equating liberalization with democratization; the latter, unlike the former, is a process with a clear end result. That there are many more voices online may be important, but what really matters is whether those voices eventually lead to any more political participation and, eventually, any more votes. When defenders of Internet freedom fall back on Cold War rhetoric, they usually do it to show the causal connection between information and the fall of communism. The policy implications of such compar isons are easy to grasp as well: Technologies that provide for such in creased information ows should be given priority and receive substantial public support. Because of its unexpected and extremely fast paced end, it begot all sorts of highly abstract theories about the power of information to transform power itself. The person to blame for popularizing such views happens to be the same hero many conservatives widely believe to have won the Cold War itself: Ronald Reagan. Those who reject the structural explanation and believe that 1989 was a popular revolution from below are poised to see the crowds that gathered in the streets of Leipzig, Berlin, and Prague as exerting enor mous pressure on communist institutions and eventually suffocating them. For them, by October 1989 the communist regimes were al ready dead, politically and economically; even if the crowds would not have been as numerous, the regimes would still be as dead. And if one assumes that the Eastern European governments were already dysfunc tional, unable or reluctant to ght for their existence, the heroism of protesters matters much less than most information-centric accounts suggest. Posing on the body of a dead lion that was felled by indigestion makes for a far less impressive photo op. Getting it right matters because the unchecked belief in the power of civil society, just like the 52 the Net Delusion unchecked power in the ability of rewall-breaching tools, would ulti mately lead to bad policy and prioritize courses of action that may not be particularly effective. Stephen Kotkin, a noted expert of Soviet history at Princeton Uni versity, has argued that the myth of civil society as a driver of anticom munist change was mostly invented by Western academics, donors, and journalists. Similarly, the East German dissident movement did not play a signicant role in getting people onto the streets of Leipzig and Berlin, and such movements almost did not exist in Romania or Bulgaria. Something like civil society did exist in Poland, but it was also one of the few countries with virtually no signicant protests in 1989. So are any changes in the way by which people can reveal their incentives to each other. If you know that twenty of your friends will join a protest, you may be more likely to join as well. It would be silly to deny that new means of communications can alter the likelihood and the size of a protest. On this reading, the East German regime was simply unwilling to crack down on the rst wave of protests in Leipzig, well aware that it was heading for a collective suicide. This is not to deny that they played a role, but only to deny the monocausal relation ship that many want to establish. When the Radio Waves Seemed Mightier Than the Tanks If there is a genuine lesson to be drawn from Cold War history, it is that the increased effectiveness of information technology is still severely constrained by the internal and external politics of the regime at hand, and once those politics start changing, it may well be possible to take ad vantage of the new technologies. A strong government that has a will to live would do its utmost to deny Internet technology its power to mobi lize. As long as the Internet is tied to physical infrastructure, this is not so hard to accomplish: In virtually all authoritarian states, governments 54 the Net Delusion maintain control over communication networks and can turn them off at the rst sign of protests. As the Chinese authorities began worrying about the growing unrest in Xinjiang in 2009, they simply turned off all Internet communications for ten months; it was a very thorough cleansing, but a few weeks would sufce in less threatening cases. Of course, they may incur signicant economic losses because of such in formation blackouts, but when forced to choose between a blackout and a coup, many choose the former. Even the strongest authoritarian governments are consistently chal lenged by protesters. It seems somewhat naive to believe that strong authoritarian governments will balk at cracking down on protesters for fear of being accused of being too brutal, even if their every action is captured on camera; most likely, they will simply learn how to live with those accusations. The most overlooked aspect of the 2009 protests in Tehran is that even though the government was well aware that many protesters were carrying mo bile phones, it still dispatched snipers on building roofs and ordered them to shoot (one such sniper supposedly shot twenty-seven-year-old Neda Agha-Soltan; her death was captured on video, and she became one of the heroes of the Green Movement, with one Iranian factory even manufacturing statues of her). There is little evidence to suggest that, at least for the kind of leaders who are least likely to receive the Nobel Peace Prize, exposure results in less violence. Most important, governments can also take advantage of decentralized information ows and misinform their population about how popular the protest movement really is. That decentralization and multiplica tion of digital information would somehow make it easier for the fence sitters to infer what is really happening in the streets seems a rather unfounded assumption. Some of those broadcasts even offered tips on antitank warfare, urging the Hungarians to resist the Soviet occupation; they could be held at least partially responsible for the 3, 000 deaths that followed the invasion. Nor is the decentralized nature of communications always good in itself, especially if the objective is to make as many people informed as fast as possible. While a denitive history of the Cold War remains to be written, the uniqueness of its end is not to be underestimated. On the other hand, communist hard-liners had so much room to maneuver that absolutely nothing guaranteed that the end of the Cold War would be as bloodless as it turned out to be.

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Gaines (1994) erectile dysfunction pump as seen on tv order discount levitra super active on-line, Obsession: the Lives and Times of Calvin Klein erectile dysfunction in early age levitra super active 40 mg discount, NewYork: Carol Publishing Group erectile dysfunction on coke generic levitra super active 40 mg amex. Schi (eds) erectile dysfunction japan quality levitra super active 40 mg, Critical Terms for Art History erectile dysfunction caused by obesity order levitra super active with amex, Chicago: University of Chicago Press statistics of erectile dysfunction in india order generic levitra super active, pp. Francis, Mark and Margery King (1997), the Warhol Look: Glamour, Style, Fashion, Boston: Bulnch Press. Goman, Erving (1979), Gender Advertisements: Studies in the Anthropology of Visual Communication, New York: Harper & Row. Jackson (1994), Fables of Abundance: A Cultural History of Advertising in America, NewYork: Basic Books. Lemert, Charles and Ann Branaman (eds) (1997), the Goman Reader, Cambridge: Blackwell. Roskill, Mark (1989), the Interpretation of Pictures, Amherst: University of Massachusetts Press. Schama, Simon (1988), the Embarrassment of Riches: An Interpretation of Dutch Culture in the Golden Age, Berkeley: University of California Press. Scott, Joan Wallach (1988), Gender and the Politics of History, New York: Columbia University Press. Gentry Researchers who work with qualitative data, like photographers, are instruments of data collection and at the center of the interpretive process (Patton, 1990). If the picture is to document and preserve the story, the focal subject must be illuminated and viewers must regard the picture as a credible representation of the central theme. Similarly the way a researcher focuses on and experiences data has a profound impact on the story the data tell and the meaning readers derive from that story. Like a photograph, documentary lm or slice-of-life painting, the interpretation pre sented in the write-up of a contextual inquiry represents the perspective and creativity of the researcher who follows the conventions of the research paradigm or perspective within which he/she is working. Specically, a bias is a predisposition or preconceived notion about the way that research should be framed in terms of theory, paradigm, method or perspective. Though this chapter focuses on interpretation of qualitative data, it is no less import ant to those who interpret quantitative data. When researchers interpret data, their job is to tell a story about why the data say what they say. This chapter addresses the importance of data framing and the potential impact of bias. We acknowledge that all research is biased, because all researchers have a predisposition to certain paradigms (positivist, crit ical) or perspectives (feminist, ethnic models). A concrete example of research on con sumer vulnerability shows how critically important data framing is to avoid harming those people being researched. For instance, suggesting that all women or all people with disabilities are vulnerable all the time is a data frame that can impact the group of consumers being researched and the readers who perceive the interpretation as a representation of truth. Next, the chapter sheds light on the process of data framing and potential harmful biases within the context of consumer vulnerability. Support for a contribution claim is generally based within a set of theories upon which researchers draw. That is, all researchers have a predisposition to certain paradigms (positivist, post positivist, constructivist, critical) or certain perspectives (feminist, ethnic models, cultural studies) (Denzin, 1994). Thus bias in framing and interpreting data is inevitable, with the interpretation representing a perspective, not absolute truth (Denzin, 1994; Hirschman and Holbrook, 1992; Patton, 1990). Though these debates often focus on method of data collection, they can also focus on how research questions are framed and how data are subsequently repre sented (Joy, 1991; Stern, 1998a). Three brief examples emphasize how perspective inu ences framing and data interpretation. Disease versus health model in psychology In the last decade, a movement within the American Psychological Association has attempted to shift the focus from a disease model (psychology focused on what is wrong with people) to a health model (helping people develop what is right with them) (Ruark, 1999). Mainstream psychology for years examined constructs like anxiety, fear and selshness. That is, positive psychologists suggest the qualities posed and addressed by disease model researchers are negatively framed and thus biased. In contrast, the social model focuses on the limitations in society that restrict participation of people with disabilities. The social model views disability as socially constructed, resulting in part from a failure to provide appropriate services to meet adequately the needs of people with disabilities (Oliver, 1996). Social model researchers see the medical model as inherently biased in not recognizing that factors external to the individual can contribute to the isolation of people with disabilities. In both instances, researchers base their charge of bias on the way research questions are framed. Kaufman-Scarborough and Baker (2005) argue that both models are inherently biased, and develop an alternative consumer response model (adapted from Baker, Stephens and Hill, 2001), which takes both the characteristics of the individual and the environment into account. Cognitive processing may focus either on gure or on ground: salient focal objects or the eld where the objects occur. Several studies have found that East Asians tend to attend more to the eld than European Americans, who are more likely to attend to a salient target object (Ishii, Reyes and Kitayama, 2003; Ji, Peng and Nisbett, 2000; Kitayama et al. For example, when observing another person making a statement, North Americans automatically attend to the content of that statement. In contrast, Asians focus more on contextual factors, such as the tone of voice in which the statement was made (Ishii et al. In some Asian cultures, those with physical disabilities may be virtually shunned. Attending to only the focal aspects of a situation is a bias, but so too is attending to only the contextual aspects of a situation. That is, both perspectives are inherently biased and the perspective used aects the conclusions drawn. Researchers are usually trained in or drift toward a perspective, such as one of those in the examples above. These perspectives are used to frame and interpret the data with which the researcher is working. Debates over the contrasting perspectives illustrate how research communities negotiate bias inherent in any perspective. Bias in research on consumer vulnerability Research seeks to classify, represent and evaluate social events and phenomena. In the process, some representations or perspectives are more dominant than others. Researchers could easily get grants to pursue mental illness and the frenzy ensued for 50 years, until researchers, including Csikszentmihalyi and Seligman, looked critically at the way this perspective (bias) was aecting their eld. For instance, in the 1970s, customer satisfaction came to the forefront, Ralph Nader and other consumer activists exposed the failings of business and, in an eort to be useful and relevant to public policies, consumer researchers responded by examining the social con sequences of marketing in a variety of contexts from within a variety of populations. His book stated three basic hypotheses: the problems disadvantaged consumers face are (1) largely attributable to their personal characteristics, (2) attributable to market structure and (3) attributable to unscrupulous business prac tices. This perspective has been dominant in social marketing for many years, and often consumer disadvantage and con sumer vulnerability have been treated as synonymous. Hill and Stamey (1990) helped to dispel the myth that the homeless are responsible for their existence, explored how structural and societal problems contributed to their exist ence and painted a picture of consumers as active agents in meeting their own needs. Consumer research, using qualitative methods conducted among the homeless (Hill, 1991; Hill and Stamey, 1990) and immigrant consumers (Penaloza, 1994), research on feminist thought (Bristor and Fischer, 1993; Hirschman, 1993) and other qualitative research that also explored the life worlds of consumers in underrepresented groups as they live it has served as a catalyst for many researchers interested in social issues and the social consequences of marketing. This lack of consensus is most likely because researchers with dierent perspectives and dierent biases have been engaged in the dialogue. Because of the lack of clarity, consumer vulnerability has been treated as a status, not a state (Baker et al. Consumer researchers and social marketers have primarily dened who is vulnerable, implying that some categories of people, because of their mem bership in a dened class, are always vulnerable (ibid. Creating harm All people eventually experience vulnerability when they face the death of a loved one (Gentry et al. Vulnerable means liable to be injured or victimized, incompetent, incapable and weak. Much of the harm created has come from eorts to classify, sort and represent con sumers into social categories. In striving for relevance and usefulness, tidy categories that represent market segments have been formed. All in all, the process of market segmenta tion may be one of the most benecial strategic tools that the marketing eld oers. However, because of the way the information can be and has been interpreted, harm has come from the process of segmenting consumers according to demographic characteristics (race, age, gender, income). Demographic char acteristics describe who engages in a behavior; they do not explain why they engage in a 326 Handbook of qualitative research methods in marketing behavior. For example, when we take a complex phenomenon such as vulnerability and boil it down to a single dimension. Avoiding harm Researchers (including ourselves) who have engaged in research which they thought would be labeled as investigating consumer vulnerability often express surprise when they do not nd any vulnerability, or nd that vulnerability is not associated with the expected vari ables. When researchers are engaged enough to get past prior beliefs and preconceptions, they exhibit experiential knowing (Reason, 1994) and they are able to avoid doing harm. Experiential knowing requires that researchers be able to understand and articulate the point of view of those who live the behavior (ibid. People dene themselves using their own variables of identication, not those ascribed to them (Baker, 2006; McCracken, 1986; Schouten and McAlexander, 1995). For example, Baker (2006) shows how, when consumers shop, they try on and arm their identities by employing the characteristics they use in their own self-denition processes. However, when symbolic elements in the shopping environment indicate they should use alternative personal characteristics for self-denition, they feel unnatural and not normal.

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