Assistant Professor, Noorda College of Osteopathic Medicine
In a project focused on out-of-home food consumption among participants aged about 20 symptoms neck pain buy flexeril visa, we first started with annotated photo diaries and focus groups medications requiring prior authorization buy flexeril 15 mg with mastercard. Realizing in the process that the wee hours were crucial food consumption moments symptoms 3dpo cheap flexeril 15 mg fast delivery, we then asked our respondents to create video diaries in the following week treatment for shingles purchase discount flexeril on line. The life events unfolded in the hours bracketed by the focus groups (boy and/or girl friends lost and gained; jobs lost and 434 Handbook of qualitative research methods in marketing gained, the palpable singles scene it at times became) were all data produced, between and among ourselves, clients and participants, all speaking to the symbolic construction of food in real time. This is a pragmatic decision but also not without theoretical grounding (see Arnould and Wallendorf, 1994). We routinely have clients become part of the ethnographic interview, as videographers, notetakers or observers. Thus, for example, the intern who was chastised by us because he floated alone with a camera in spaces beyond the talk of the interview became a source of insight in a study on Mexican American cooking. In this case, wayward behavior became an additional context for crystallizing analytic observations on food. Or we would say that R&D folks look at the world differently, keying into details we might not notice otherwise. In their questioning (and even in what they implicitly prioritize on tape in their role as videographers), we gain an alternative point of view (produced knowledge) that has an impact on what we know, on how we answer the culturally framed questions we started with. In a luxury roadster study in 2003, we neglected to specify that the car be there as a prop and component of the interview. When we arrived, the car was often not present: taken by someone else in the household for some errand, some event, some something. And so the spaces among researchers, clients who attend and respondents become mutually implicated in the research process (see Sunderland et al. A cultural analysis is also a bridge into semiotic analysis in which texts (advertising or websites) are subject to the same kinds of scrutiny as our ethnographic data. In part, a more formal analysis invokes what seem to be inscrutable terminologies from the vantage point of its commissioners (brand managers or researchers, agency account directors or planners) and its merits seem hard to articulate. In semiotic analyses that we do, we focus on the cultural meanings presupposed by the texts that give meaning to the brand or product. Looked at through the range of the category, one is able to talk about symbolic landscapes, where brands fit and where opportunities might exist. Following Saussure (paradigmatic analysis), Peirce (symbols, icons or indexes) or Jakobson (communicative relationships presupposed by the texts), we nonetheless convey our findings as a cultural analysis. What is presupposed by New Zealand and Australian car, beer and convenience food advertising about cultural identity? Importantly, while we can observe metaphors, elucidate nuances of cultural symbols, illustrate key icons and so on, our ability to assess relevance of findings for marketing opportunities is not based on and born of the ads (or other texts), but on knowledge produced through years of studying a specific consumer culture. Can these endeavors pushing into diaries, essays, consumer-created video documentary, bringing in clients as part of the ethnographic endeavor, semiotic analysis of texts produced by the culture be construed as ethnography? Especially in the world of practice, a photo diary or essay, collage, or even a consumer-created video, does not constitute ethnography simply because it occurs outside the focus group room. To paraphrase Geertz (1973), it all depends on the intellectual framing of the task. If we observe store displays and consumers shopping from these displays we have gained an alternative site for the production of meaning. In semiotic analysis when ads under scrutiny do not make sense, when decoding can yield formal observations yet result in little corresponding sense (as occurred in both the analysis of messaging to teens and in trans-Tasman reading of advertisements for meanings of cultural identity), it becomes abundantly clear that ads are a kind of performance, verbal art, privileged from day-to-day discourse (Bauman and Briggs, 1990). Advertisements rely on social knowledge outside their frames to create meaning for a brand within societies, much less beyond them. In this sense, delving into the meaning with informants/participants/consumers of what is observed through formal analysis becomes itself an ethnographic exploration. Advertising thus becomes an additional discourse for situating cultural and ethnographic analysis, allowing scrutiny of symbols, meanings, values or metaphors in play in contemporary culture (cf. The third boundary: reporting If the first boundary we want to cross is the integration of explicit theory into practice, and the second is multisited and multivoiced inquiry in a corporate world of compressed time, the third boundary to be breached is reporting. In a recent presentation to Gatorade, of a multivoiced project (including one anthropologist, one PhD in marketing and several industry-experienced clients) that focused on endurance athletes, the senior manager asked at the end of the presentation (with a tone of praise), `Are all your reports like this? Within the world of practice 436 Handbook of qualitative research methods in marketing our reports do not, often enough, speak in marketing terms. In the case of Gatorade, we recast endurance athletes as a cultural idea, thereby getting beyond an industry descriptor of (and assumptions about) a particular group of people.
After she heard him play the Mendelssohn C minor Trio in 1857 symptoms 0f heart attack order flexeril 15mg, she wrote that `he so rattled it off that I did not know how to control myself and often he so annihilated fiddle and cello that I could hear nothing of them medications like xanax order flexeril 15 mg with amex. Either there is a perfectly wild noise or else a whisper with the soft pedal down symptoms 0f pneumonia order flexeril once a day. To this day I can recall how Rubinstein sat down at the piano his leonine head thrown back slightly treatment breast cancer buy generic flexeril 15mg on-line, and began the five opening measures of the principal theme. The grandeur of style with which Rubinstein presented those five measures, the beauty of tone his softness secured, the art with which he manipulated the pedal, are indescribable. His crescendo had no limits to the growth of the power of its sonority; his diminuendo reached an unbelievable pianissimo, sounding in the most distant corners of a huge hall. He often treated the same program absolutely differently when he played it the second time, but, more astoundingly still, everything came out wonderfully on both occasions. He would remark to his students about `what deep breaths Rubinstein used to take at the beginning of long phrases, and also what repose he had and what dramatic pauses. Rubinstein himself admitted, after a concert in Berlin in 1875, `If I could gather up all the notes that I let fall under the piano, I could give a second concert with them. German piano teacher Ludwig Deppe advised American pianist Amy Fay to watch carefully how Rubinstein struck his chords: `Nothing cramped about him! He spreads his hands as if he were going to take in the universe, and takes them up with the greatest freedom and abandon! Those who valued interpretation as much as, or more than, pure technique found much to praise. Pianist and conductor Hans von Bьlow, who had his pedantic moments himself, nevertheless called Rubinstein `the Michaelangelo of music. The German critic Ludwig Rellstab called him `the Hercules of the piano, the Jupiter Tonans of the instrument. Rubinstein himself told an interviewee, `Strength with lightness, that is one secret of my touch. With him the piano sounded like a whole orchestra, not only as far as the power of sound was concerned but in the variety of timbres. When he wanted to , Rubinstein could play with extreme lightness, grace and delicacy, although he rarely displayed that side of 351 his nature. He had learned quickly that audiences came to hear him thunder so he accommodated them. During this tour, Rubinstein received more press attention than any other figure until the appearance of Paderewski a generation later. Rubinstein was a man with an extremely robust constitution and apparently he never tired He had a colossal repertoire and an equally colossal memory until he turned fifty, when he began to have memory lapses and had to play from the printed score. Paderewski heard Rubinstein towards the end of his career, remembering great moments alternating with memory slips and chaos. Rubinstein was most famous for his series of historical recitals seven consecutive concerts covering the history of piano music. Rubinstein played this series of historical recitals in Russia and throughout Eastern Europe. In Moscow he gave this series on consecutive Tuesday evenings in the Hall of the Nobility, repeating each concert the following morning in the German Club free of charge for the benefit of the students. Rubinstein concluded his American tour with this series, playing the seven recitals over a nine day period in New York in May 1873. Forty-four years later he told his biographer Oscar von Riesemann, `[His playing] gripped my whole imagination and had a marked influence on my ambition as a pianist. One listened entranced, and could have heard the passage over and over again, so unique was the beauty of the tone. He himself very happily expressed his ideas on the subject when he said, "The pedal is the soul of the piano. He chose to exercise his compositional talents within the German styles and Mendelssohn and Schumann were his greatest influence. It was felt that his establishment of a Conservatory in St Petersburg would damage Russian musical traditions. Over recent years, his work has been performed a little more often both in Russia and abroad and has met with a positive reception.
Regarding rabies medicine for diarrhea purchase flexeril with amex, immunoglobulins are routinely required as post-exposure treatment medications bad for kidneys purchase flexeril 15mg otc, despite adequate pre-exposure vaccinations (14 medicine to increase appetite purchase flexeril 15 mg visa, 15) treatment coordinator discount flexeril 15mg fast delivery. Visits for a different travel episode were handled as separate inclusions because travel destination, travel duration, vaccination indication, and medication use may differ at different time points; whereas repeated visits in preparation for a single travel episode counted as single inclusion. Secondary outcomes were P/E for malaria chemoprophylaxis; ratio of antibody titre assessments and total number of patients with an indication for this assessment (A/I); ratio of prescription of standby antibiotics and total number of patients with an indication for this prescription (P/I). Primary immune disease Vaccination in specific cases not useful Double doses of hepB vaccine ContraStandbyindication live antibiotics attenuated indicated vaccines Titre assessment indicated Yes t. No Legend Yes: contra-indication for live attenuated vaccines; standby-antibiotics and titer assessment indicated No: live attenuated vaccines can be administered safely; standby-antibiotics and titer assessment not indicated Contra-indication for live attenuated vaccines; standby-antibiotics and titer assessment indicated to be considered (t. For M1 areas, malaria chemoprophylaxis is routinely recommended; whereas for 135 M2 areas, this depends on itineraries to endemic regions within these countries and on seasonal transmission risk (8). Geographical destination We grouped travel destinations into geographical regions as defined by the United Nations Geoscheme (20). Categories of underlying disease Because the indication for vaccination, titre assessment and prescription of standby antibiotics may differ per underlying disease or medication use, we categorised our study population in 14 different groups (Table 1) (Box 1). We compared patient categories 136 with all other participants; male to female, and younger and older adults to other participants. We used the Chi-square test for categorical, and the T-test for continuous normally distributed variables to compare baseline characteristics. We used the MannWhitney U test for not normally distributed continuous variables and the Chi-square test for significant differences in P/E; P/I; A/I. We excluded 557 patients, of which 401 visited for other reasons than pre-travel care. We categorised patients according the immunocompromised or chronic condition leading to specific pre-travel recommendations (Table 1). Travel duration and destination Mean travel duration among all participants was 34. Although overall P/E rates for these vaccinations were high, coverage was lower in certain subgroups. In those groups, hepA and hepB antibody titres were assessed at least once before travelling in 58. They were often referred to our centre for this vaccination specifically, explaining the lower P/E rates for the other vaccinations. However, the low hep B P/E (certain groups) and A/I stipulate the question whether physicians should be more pro-active and move towards a lowthreshold approach regarding this, and antibody titre assessments to demonstrate protection (28). However, since current studies showed travel related antibiotic use to be a risk factor for acquisition of antibiotic resistant enterobacteriaceae, more evidence is needed to establish the role of standby antibiotics in the prevention of severe complications of infection (29). Strengths and limitations A strength of this study is that, to the best of our knowledge, this is the largest study in this field up to now. However, to improve pretravel care, uniform international pre-travel guidelines are highly needed, in the first place based on expert opinion, because the evidence base is often lacking. Hepatitis A vaccine for immunosuppressed patients with rheumatoid arthritis: a prospective, open-label, multi-centre study. Rapid decline of antibodies after hepatitis A immunization in liver and renal transplant recipients. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices. Canada communicable disease report = Releve des maladies transmissibles au Canada. Enquiries to the United Kingdom National Travel Advice Line by healthcare professionals regarding immunocompromised travellers. Pre-travel advice to the most immunocompromised; Trying to guide where evidence is scarce. Therefore, they are advised to attend specialised pre-travel clinics for advice on vaccination, malaria chemoprophylaxis and on demand antibiotics. Telephone interviews were conducted 2-4 weeks post-travelling, applying a structured questionnaire. Reversely, 6/30 (20%) did not use on demand antibiotics while actually indicated according to this protocol. As a consequence, these patients feel healthier and more often travel to high-risk destinations (either defined as a destination with an increased risk of exposure to endemic infectious diseases (1) or as a destination where hepatitis A and typhoid fever vaccinations are recommended (2). Due to their often complex medical situation, pre-travel advice in specialised pre-travel clinics is recommended (2-5), but there are apparent obstacles to achieve optimal coverage.
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