Join Our Mailing List

What We Do
Preventive Program
Adult Education and Literacy
Youth Program
Legal Services Program
Health Program
Anti-Violence Program
Khalil Gibran International Academy
I Need To Be Heard!

Program Contact Information

Danny Salim
Anti-Violence Program Manager
(718) 250 - 5122

Levitra Super Active

However buy levitra super active 40 mg with amex, most data would support the use of such instruments in older adults with and without cognitive impairment (Corran et al. Some older persons will suffer from multiple comorbid medical illnesses, physical impairments in vision or hearing, severe cognitive impairment, or difficulties with verbal communication skills, all of which may complicate routine psychometric pain assessment. Behavioral–observational meas- ures of pain can bypass many of these difficulties and have been examined for use in frail older populations (e. Interrater reliability and concurrent va- lidity appear to be adequate in older nursing home residents, including those with mild to moderate cognitive impairment (Kovach, Griffie, Matson, & Muchka, 1999; Simons & Malabar, 1995; Weiner et al. However, the level of agreement between resident and staff perceptions of pain as indexed by behavioral markers has been shown to be relatively poor (kappa. A related ap- proach involves measurement of discrete facial expressions as nonverbal indicators of pain (Craig, Prkachin, & Grunau, 2001). A characteristic pain face has been noted (including lowered eyebrows, raised cheeks, closed eyes, parting or tightening of lips), and despite some individual differences, this expression is instantly recognizable by other third-party observers. The complexity and speed of facial gestures can lead to errors of judgment, but a facial action coding system (Ekman & Friesen, 1969) has been devel- oped to systematically analyze facial expressions from videotaped record- ings. When using this technique in frail older adults, interrater reliability has been shown to be excellent and there is good validity evidence (Hadji- stavropoulos et al. It is noted, however, that self-report measures of pain and nonverbal indices do not always correspond (e. Nonetheless, these findings are encouraging and may offer another method of pain measurement that is sensitive to differences in functional capacity and can capitalize on the available communication repertoire of persons at the end stage of the life span. The final class of measures involves third-party proxy ratings of pain by medical staff, carers, or others who know the individual well. Given that pain is a latent and subjective experience, which is really only accessible to the individual who is suffering, this method cannot be recommended for routine pain assessment.

best 40mg levitra super active

If not identified clinically at the time of examination buy levitra super active 40 mg free shipping, pectus excavatum can be suspected radiographically if the anterior ribs are seen sloping steeply on the postero-anterior projection of the chest. Pneumothorax Pneumothorax is defined as air within the pleural space7 that results in total or partial collapse of the lung. It may occur spontaneously, particularly in tall, thin, male adolescents, or as a result of trauma, medical intervention or as a conse- quence of another respiratory condition (e. Patients with a pneumothorax will present clinically with chest pain, dyspnoea and cyanosis. Plain film radiography of the chest will display increased radio- opacification of the deflated lung, evidence of the lung edge medial to the wall of the thorax and increased radiolucency lateral to the lung. Treatment is typi- cally by insertion of a chest drain to remove the air from the pleural space and allow the lung to re-inflate. A small pneumothorax will generally resolve without medical intervention. The puncture wound acts like a valve allowing air into the pleural cavity on inspiration but closing to prevent air escaping on expiration thereby resulting in increasing pressure within the pleural cavity and compression of the lung and mediastinum. This condition requires immediate surgical intervention and diagnosis is based upon clinical examination. Post-interventional plain film radiography of the chest may be required to assess lung re-expansion. Pneumomediastinum Pneumomediastinum is the presence of air within the mediastinum (Fig. The most common cause of pneumomediastinum in children is asthma and results from alveolar rupture (see Chapter 6). Pleural effusion Pleural effusion is defined as fluid within the pleural cavity and generally occurs as a reaction to another pathological condition (e. It may be identified on an erect chest radiograph (postero-anterior or lateral) as blunting of the costophrenic angles (Fig. The altered translucency of the lung, which occurs as a result of imaging a pleural effusion in the supine position, may be subtle and therefore, if a pleural effusion The chest and upper respiratory tract 43 Fig. Cystic fibrosis Cystic fibrosis is the most common, lethal, genetic disease affecting Caucasians and is reported to be present in 1:2500 live births in the UK2.

buy levitra super active 20mg online

Other complications of the transposition of the tu- berosity include recurrent lateral dislocations cheap 40 mg levitra super active otc, overcor- ⊡ Fig. Schematic view of the Roux-Hauser operation: The distal rections with medial dislocations and a low patella attachment of the patellar ligament is chiseled out with a block of (patella baja) as a result of scarring of the patellar tendon bone and fixed with a screw in a more medial (and possibly distal). Unless a pro- riceps muscle is detached from the femur and transposed nounced patella alta is present, the operation should be medially (⊡ Fig. Ideally, the Elmslie for congenital and habitual dislocations, and occasionally method should be used in which only the proximal part also for neuromuscular dislocations of the patella. We of the tuberosity is transposed, while the distal part is left recently followed up 7 patients with 9 congenital disloca- in place. Before surgery, an exten- Corrections involving the proximal extensor mechanism sion deficit of 20–50° had been present in all knees. At the The following procedures can be performed on the proxi- latest follow-up, 6 knees could be fully extended, while the mal extensor mechanism: other 3 showed a deficit of 10–20°. If indicated, therefore, ▬ Insall procedure for distalization of the vastus media- quadriceps transfer is a useful procedure. Two options for correcting the patellofemoral groove were recently proposed: The Insall procedure for distalization of the vastus medialis Elevation of the lateral femoral condyle by osteotomy attachment on the patella is indicated if the inser- according to W. This situation is Deepening of the intercondylar sulcus (trochleaplasty) usually linked with a patella alta. In this operation the by retrograde reaming of the patellofemoral groove. Postoperatively, the extended leg is yet be assessed with any great accuracy, we have had good immobilized in a removable splint for 4 weeks. The to allow the newly inserted tendon to integrate with the subchondral bone has to be resected carefully, leaving an bone, flexion must not exceed 30° during this period. It is a techni- our experience, this operation, if appropriately indicated, cally difficult but rewarding operation.


The Arab-American Family Support Center is a 501(c)3 non-profit, non-sectarian organization that provides culturally and linguistically sensitive services to immigrant communities throughout New York City.  © 2017 All Rights Reserved.

AAFSC Brooklyn
150 Court Street, 3rd Flr
Brooklyn, NY 11201
T: 718 - 643 - 8000
F: 718 - 797 - 0410
E: info@aafscny.org
AAFSC Queens
37-10 30th Street, 2nd Fl.

Queens, NY 11101
T: 718 - 937 - 8000
F: 347 - 808 - 8778
AAFSC @ the Family Justice Centers
FJC Bronx (718) 508-1220
FJC Brooklyn (718) 250 - 5035
FJC Manhattan (212) 602-2800
FJC Queens (718) 575 - 4500
FJC Staten Island (718) 697 - 4300