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Modifying the report gastritis diet ìîé cheap prilosec 20 mg mastercard, the patient record or the records (waveform data): any time a software operator changes anything on any of these three records the “Reanalyze” button must be pressed before those changes or additions will be stored or appear on those records gastritis cancer purchase prilosec discount. New event group Creates a new event group in the event tree panel of the event list gastritis diet ìàéë discount prilosec 20mg with amex. A dialog box appears for naming the event group and assigning the event types to gastritis diet fruit purchase prilosec canada the event group. Edit event group Opens a dialog box for a selected event group to allocate event types. Signal window Opens the dialog box to customize the signal window in the settings signal view. Time ranges for the signal view, the channels to be displayed, and events as required for individual device types may be set separately for each window. Using the ApneaLink software application 21 Name Description Report • Change the report view size. The measurement details are displayed in the patient record card and in the report. If a physician has already been entered in the patient record card, the physicians data is displayed. Analysis parameter Analysis parameters are specifications for analysing the settings recording. The default values configuration can be set for the flow or the flow and oximetry channel and the settings recording time. Send Event Log by When an error occurs, the Event log can be sent to ApneaLink Air email support. Program info Displays systems information on the current program version and also ResMed addresses. Recording info Opens a dialog box that contains detailed technical information on a recording and the ApneaLink Air device selected in the database. In the database view you have the following options: • Click once on a file to show related files. Notes: • If you delete a patient‘s data, the associated recordings and reports are also deleted. Using the ApneaLink software application 23 Signal view the signal view shows the recording signals as curves together with the events that have occurred. Click the left mouse button and drag the cursor to either right or left at the end of the event to be inserted. If you insert or edit an event, this results in changes to the report for the recording being analysed. Move the cursor to the beginning or end of an event until the cursor shape changes. Allocating an event type Events are automatically assigned to appropriate event types. You can change this allocation by right-clicking the event to open the context menu for allocation of the event type. Notes: • If an event is deleted inadvertently, restore it using the Undo function in the Edit menu. A dialog box appears to confirm if a new report should be created or the current one amended. Only for recordings with pulse oximetry 26 Notes: • Invalid data can be a result of the incorrect application of the sensors, an inadequate power supply or when a recording is continued within 15 minutes after it has been stopped. Using the ApneaLink software application 27 Displaying event list the event list shows all events for the recording that is currently open. When working with the signal view, the event list helps in analyzing a recording by selecting and displaying specific events quickly. The event list consists of event groups and events that have been analyzed in the recording. To open all events allocated to an event group, click an event group in the Event tree panel. Select the checkbox next to an event to allocate the event type to the new event group. Settings Signal view You can change the default settings for resolution and the channels and events to be displayed separately for the upper and lower window in the signal view. Assign color Opens a color selection and assigns the selected color to the highlighted signal. Define order Moves the selected channel upwards or downwards in the required order. Channel height ratio Displays the selected channel larger than the default size of the other channels displayed, by a given factor. Assign color Opens a color selection and assigns the selected color to the highlighted event. The chronological position and amplitude deflection are displayed in the status line on the lower screen border. Using the ApneaLink software application 31 Analysis parameters Analysis parameters are specifications for analyzing the recording. The default parameters set by ResMed may be applied, or individually modified parameters may be set. To open the settings dialog box for the analysis parameter select Settings in the Tools menu. Using an average of the last five breath cycles (combined inspiratory and expiratory waveforms totaling 10 peaks) the software looks for a reduction of 80% or more from that average to score an apnea event. To end the apnea the average inspiratory/expiratory waveforms must increase within 10 to 80 seconds by 80% (or the user set value) to end the event. If an apnea is overlapped during 80-100% of its time by an interruption of respiratory drive, then the apnea is scored as central. If an apnea is overlapped during 20-60% of its time at the beginning by an interruption of respiratory drive, then the apnea is scored as mixed. If an apnea is not overlapped by an interruption of respiratory drive for up to 20% of its time, then the apnea is scored as obstructive. Minimum apnea duration in seconds Minimum duration of an apnea, during which Default setting: 10 s the airflow amplitude must be below the apnea Range: 1–20 s threshold. Maximum apnea duration in seconds this value indicates the maximum duration for Default setting: 80 s an apnea. Time threshold for central apnea If there is no significant respiratory drive for Default setting: 60% more than the selected value of the time with Range: 50%–80% reduced flow, the event will be classified as central event (eg, >60%). Effort threshold for central apnea If the amplitude of the effort signal is less than Default setting: 8 % the selected value, the criteria for scoring Range 2%–30% central events is met. Time threshold for obstructive apnea If there is no significant respiratory drive for Default setting: 20% less than the selected value of the time with Range: 0%–49% reduced flow, the event will be classified as obstructive event (eg, <20%). The following schematic figures are examples for the different apnea classes: Note: Apnea differentiation only is available if the effort signal has been recorded. If none or insufficient effort information is available ApneaLink Air scores corresponding apneas as unclassified apneas. ApneaLink Air may identify a hypopnea in the recording according to one of the following criteria: • If no oximetry data is available, or is missing for a significant portion of the recording, hypopneas are scored when there is a reduction in airflow of 50% that lasts longer than 10 seconds (classic ApneaLink Air definition). The desaturation has to start at the latest 10 seconds after the hypopnea finished. As the scoring criteria may vary depending on the signal quality of the individual recording, the criteria used is documented in the ApneaLink Air report. The following table explains the hypopnea settings in the analysis parameter dialog box: Hypopnea threshold in percent the hypopnea threshold is reached when the airflow Standard: 50% (classic definition); amplitude falls to the currently set value or below. Range: 1–20 s Maximum hypopnea duration in this value indicates the maximum duration for a seconds hypopnea. Range: 1–120 s Maximum respiratory mean time this value specifies the maximum permissible when linking apneas/hypopneas: mean time between an apnea/hypopnea and the Default setting: 1 s apnea/hypopnea that follows it. If the mean time is shorter than the defined value, the events are combined and allocated to the event period with the longer duration, provided that the maximum set period is not exceeded.

Monitoring and evaluation It is important to digestive gastritis through diet prilosec 20 mg overnight delivery think about the impact that will be achieved with a programme gastritis peptic ulcers symptoms buy prilosec master card. In general viral gastritis symptoms discount prilosec 40mg on-line, there is very little evidence that menstrual health interventions have an impact on health outcomes such as infections gastritis translation order discount prilosec on line. There are oth er outcomes that can be taken into account when implementing menstrual health programmes. Discussion about appropriate indicators are still ongoing and has mostly focused on menstrual hygiene management related outcomes instead of broader menstrual health outcomes. A lot of focus has also gone into school drop-out rates, where a lot of the available evidence is qualitative. It is important to take into account that there are multiple factors that contrib ute to girls’ drop-out from school. In Simavi’s Ritu programme we work closely with the Erasmus University, Maastricht University and Johns Hopkins University on a Randomized Controlled Trial amongst 4000 girls that are involved in the programme. Note for Facilitators this manual provides information and guidance on a wide selection of topics that are relevant for menstruators, stakeholders, implementers and facilitators. As an implementer or facilitator it is important to have comprehensive knowledge of menstrual health. Ideally, menstrual health programmes cover a comprehensive package of information as well, to ensure menstruators un derstand all aspects of it. However, depending on the allocated time for training or education, a selection of topics can be made. The Training Sessions of this manual consist of different chapters that discuss elements of the overall topic of the session. Chapters consist of a combination of the following elements: back ground information for the facilitator and key messages, illustrations, tables, activities, and ques tions and answers that can be used to inform the participants. It is advised to make use of the activities suggested in the manual or similar interactive facilitation methods instead of just shar ing facts and information. The training sessions of this manual are designed to be used by a variety of facilitators as well as for a variety of target groups. Most of the sessions are developed for a non or semi-literate audience to ensure as many people as possible are able to actively participate. Depending on the level of knowledge, the target group and the specifc goal of the training, the facilitator can combine different modules. When working with specifc target groups, it might be needed to adjust messaging and delivery methods. For example, when working with women and girls living with a disability, it might be necessary to involve their family or caretaker as they might need their support to manage their menstrual health. For a successful training on a sensitive topic like menstruation, it is important to be well prepared as facilitator. We therefore recommend studying Simavi’s Facilitation Manual and using the tools and guidelines presented in there to carefully plan and prepare your training. Howev er, starting the conversation is the best way to bring menstruation out of the taboo sphere. On an average, a woman spends seven years of her life menstruating, making menstruation a natural and essential part of the reproductive cycle. In addition, women experience other forms of vaginal bleeding and at the end of the reproductive cycle they experience menopause. It is an essential human right to have the ability to manage menstrual health and other forms of vaginal bleeding with adequate knowl edge, safety, and dignity and without stigma. However, many women, girls and other menstruators in low-resource settings are not well prepared when menstruation begins and lack knowledge of other forms of bleeding. As menstruation is a taboo in almost all cultures around the world, it is not openly discussed and therefore women and girls are not well informed about menstruation. Activity: Break the Silence Time: 30 Minutes Materials: Paper sheets and markers Sit in a circle. This can be an experience, a thought or a question – both negative and positive statements are allowed. Then ask each of the participants to show their sheet and ex plain their statement. Key message Menstruation is normal Menstruation is a normal and healthy part of the female reproductive system. It is important to openly talk about menstruation, to ensure that women and girls have suffcient knowledge and feel comfortable to ask questions. Video: Kids talk periods this is a nice video where small children talk about periods. It might be a nice way to ‘break the ice’ for people to feel more comfortable talking about menstruation. Almost al ways, there are social norms or unwritten rules and practices about manag ing menstruation and other types of vaginal bleeding, and interacting with menstruating women and girls. In addition to social norms, there are also religious practices related to menstruation. Although some of these myths and norms are helpful, many restrict women and girls’ levels of par ticipation in society. Sexual reproduction often being a sensitive topic, leads to further shame and embarrassment about menstruation, with negative implications for women and girls. For example, male shop owners may decide not to stock menstrual products or hide them from view, and girls might not be confdent asking for them; mothers may be too embarrassed to talk to their daughters because of the connec tion with sex and reproduction; and teachers may not be allowed to teach the biological facts. Other types of vaginal bleeding tend to be even more surrounded by stigma and shame, similar to the fact that there are other people that menstruate. When talking about menstrual health of women and girls this can be an opening to discuss other menstruators and other episodes of vaginal bleeding. Once people understand that men struation is a natural and healthy process, they will be more open to talk about the topic and can even start challenging restrictions that women face during their menstruation. Key message ‘Myths, norms and practices’ Menstruation is a natural part of a woman’s or girl’s reproductive system. The menstrual blood, or any other blood coming from the vagina, is not impure and menstruating women, girls and menstruators do not pose any health or fertility risks for others. It is important that they take extra care of themselves during menstruation; they should eat well, maintain hygiene, sleep more, and move and rest as needed. This will help facilitators to add to the input of participants during the trainings that they give. When the facts are unknown to the trainer, make sure to park the myth and consult colleagues or the internet for the fact. Split the group up in smaller groups and have each group write down myths and practices sur rounding menstruation that they know of. When the participants fnd it diffcult to come up with myths or practices, you can give some examples to help them get started. Then, for each myth, discuss with the group if they think the myth is true or false. If they don’t know the fact, explain it to them following the list below or the facts that you looked up. Changing myths and practices doesn’t happen overnight, so it might be helpful to come back to this session later in the training. Women should only bleed once A proportion of women and girls will experience some form a month. Women are likely to experience episodes of bleeding for 4–6 weeks after a miscarriage and 4weeks postpartum. Taking a bath/shower/washing Girls should always maintain good hygiene throughout the body during menstruation their menstruation. However, the practice of ‘douching’ (forcing water inside the vagina in order to clean it) can make pelvic infections more likely. Losing blood after meno makes a woman or girl menstru pause is not infuenced by product disposal methods. Burning or burying used menstru Burning or burying of used menstrual products are safe and al materials leads to infertility. To keep the environment clean, used menstrual products are best disposed of in a rubbish bin whenever possible.

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B 40-815 e 12/01 2-21 Start-Up Carl Zeiss Attaching epi-fluorescence illuminator Axiostar plus 2 gastritis back pain prilosec 40mg discount. Filter stop carrier 1 (designated with one dot) has three positions (a follicular gastritis definition discount 10mg prilosec free shipping, b gastritis diet 411 order prilosec 40mg with amex, c) for filters with a 25 mm diameter gastritis vitamins order prilosec 40mg visa. B 40-815 e 12/01 2-25 Start-Up Carl Zeiss Attaching epi-fluorescence illuminator Axiostar plus • Hold the new burner on the labeled metal base and place it in the heat sink so that the reflective portion of the burner points the heat sink must be parallel to the lamp base. If To aling, press spring handle and turn heat sink both sides are reflective, make sure that the with burner in the lamp frame. If there is a sideways reflective melting position on • Replace lamp housing and tighten clamping the burner, it must point to the side in screws (2-23/1). If the image of the light arc and the mirror image are superimposed, the burner will have a greater thermal load. The light arc of the burner 1 Axial burner adjustment (lighter) and its mirror image (somewhat 2 Height adjustment for burner darker) can be seen the filter stop carrier 2 3 Side adjustment for burner 4 Knob for collector adjustment window (2-24/6). B 40-815 e 12/01 2-27 Start-Up Carl Zeiss Attaching epi-fluorescence illuminator Axiostar plus 2. Removing the reflector carriage: • Push the reflector carriage lever (2-25/5) to the left or middle position. Removing a P&C reflector module: • Slightly tip the module and disengage first from the top spring clamps (2-26/1) and then from the bottom spring clamps (2-26/2) to remove completely. If the reflector carriage is not locked correctly, • Push the reflector carriage lever to the left the imaging quality will be affected negatively. B 40-815 e 12/01 2-29 Start-Up Carl Zeiss Attaching epi-fluorescence illuminator Axiostar plus 2. Filter sets or completely equipped P&C reflector modules can be ordered from Carl Zeiss. The arrow indicates the installation direction for the filter into the reflector module and should point in (see arrow in Fig. To minimize image shift during multiple fluorescence procedures, the emission filter can have an additional marking showing the position of the wedge angle. The marking should be aligned to the orientation groove (2-27/4) when inserting an emission filter in the reflector module. This guarantees that the wedge angle of the emission filter has the same defined position in the reflector modules used. This compensates for or minimizes the already slight image shift when Zeiss filter sets are used between modules. To replace a color splitter: • Remove P&C reflector module from reflector revolver. Make sure that the side catch of the spring frame engages in the correct portion of the bottom module half. The reflective (layered) side of the color splitter has an angled edge or corner (Fig. The illumination need not be adjusted even when the lamp is 1 On/off switch with integrated control lamp exchanged by the customer. B 40-815 e 12/01 3-3 Operation Carl Zeiss Transmitted-light brightfield Axiostar plus 3. In order to obtain optimum resolution with full – If a slider for phase contrast is available with illumination of the field, the condenser, the the 0. Requirement: – As described in section 2, the microscope is ready for operation and switched on according to section 3. If the microscope is equipped with a mechanical stage 75 x 30 R (stage drive on the right side), then the condenser drive will be attached on the left in the factory. In most applications, this setting of the aperture 1 Focusing drive diaphragm provides optimum contrast at 2 Luminous field diaphragm almost full resolution and therefore the best 3 Lever for aperture diaphragm setting compromise for the human eye. For objectives < 4x, the swivel wide-angle unit must be moved into the light path (see section 2. B 40-815 e 12/01 3-5 Operation Carl Zeiss Transmitted-light phase contrast Axiostar plus 3. The phase contrast technique uses the optical modulators "phase stop and phase ring" and the interference procedures during the formation of the intermediate image to change the small phase differences in intensity and color differences which are visible to the human eye. Therefore, clean the front lens of the objective used, the visible condenser surfaces, the upper cover slip surface and the lower carrier plate surface of the specimen with particular care and carefully remove grease. If a phase stop position (or darkfield position) is set on the turret condenser, a green dot 1 Turret disk appears in the window of the aperture 2 Window for turret disk position diaphragm indicating that the stop must be 3 Aperture diaphragm lever opened completely (green dot on the aperture 4 Window for aperture diaphragm marking diaphragm and in the window (3-6/4) are in the 5 Adjusting screws for phase stops same row. Ph 2, or set the relevant position on the turret disk (3-6/2) of the Abbe condenser with 5-position turret. For this, remove one eyepiece and replace it with the diopter (3-5/11) or a auxiliary telescope (3-5/3). Focus on the phase ring by pulling out or pushing in the 3-5/1) of the auxiliary Fig. Complete phase contrast is only achieved if the bright phase stop (in the condenser) and the • Then replace the diopter or the auxiliary dark phase ring (in the objective) are exactly telescope with the eyepiece. B 40-815 e 12/01 3-7 Operation Carl Zeiss Transmitted-light darkfield Axiostar plus 3. The – When using the Abbe condenser with situation changes significantly if such specimens 5-position turret, set the darkfield position are viewed in transmitted-light darkfield. Only the diffracted and scattered light components which are so important for image – For further details, please see the following production reach the objective, while the table: directly reflecting light bundles are guided past the objective. Condenser with slider for contrasting techniques Suitable objectives Slider for darkfield 0. For darkfield setting, it is also possible to use the slider for phase contrast 3 and the following objectives instead of the slider for darkfield 0. Chapter 2 offers an overview 5 Centering screws for condenser of applicable types and recommended N osepiece 7 Binocular tube objectives. Open the luminous field • If necessary, swivel open the wide-angle diaphragm just above the viewing field unit, colored disk carrier, polarizer or edge. Darkfield specimens require a considerably • Place darkfield condenser carrier in higher level of cleanliness than specimens for condenser carrier and center approximately other methods; fingerprints, dirt and dust in so that when the condenser carrier moves particular brighten the background. There will be an increasing or decreasing light ring above or below the focus level of the luminous field diaphragm (circular “breathing” of the luminous field diaphragm depiction). The luminous field diaphragm appears only as a • Place darkfield condenser carrier in circle segment on the edge of the viewing field condenser carrier and center approximately due to the high magnification of the immersion so that when the condenser carrier moves oil objective. As a result, focusing and centering the condenser moves into the gap of the of the luminous field diaphragm must be mechanical stage without making contact. Then step diaphragm, the contrast can be further by step swivel in the next largest dry optimized by turning the adjustment of the objectives and focus the specimens with the iris diaphragm. Darkfield specimens require a considerably • Place one drop of immersion oil on the higher level of cleanliness than specimens for specimen location, swivel in immersion oil other methods; fingerprints, dirt and dust in objective and focus specimen. B 40-815 e 12/01 3-11 Operation Carl Zeiss Transmitted-light polarization Axiostar plus 3. The transmitted-light polarization technique is Depending on the level of birefringence, used with specimens that change the thickness and orientation of the object, polarization state of light. These interference colors can be of 1 or viewed between crossed polarizers (polarizer higher order. Analysis: • If the crystal needles oriented parallel to the gamma direction of the lambda plate are yellow, and the crystal needles lying at a right angle to the gamma direction are blue, the crystals are monosodium urate crystals (gout). This analysis is also possible using a polarizer with cemented lambda plate which can be placed on the luminous-field diaphragm. B 40-815 e 12/01 3-13 Operation Carl Zeiss Setting epi-fluorescence Axiostar plus 3. The filtered short wave excitation beam is reflected by a the mercury vapor short-arc lamp must be dichromatic beam splitter and focused on the adjusted with the adjustment guide before specimen via the objective. If absorbs the short-wave beam and emits a long necessary, you must readjust the setting wave fluorescence beam (Stoke’s Law), which is depending on the amount of use. Before starting: – the microscope is ready for use as outlined the excitation and blocking filters must be in section 2. You can get an overview of filter sets and fluorochromes available from Zeiss at: • Search for the specimen location to be observed in the transmitted light.

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