Sunday, December 30, 2007
Family Cruises Guide
Family cruises are the ideal solution when you're in need of a stress-free family vacation that's fun for everyone. No need to worry about traffic jams, valet parking or keeping the kids entertained. You can just relax in the comfort of your plush onboard surroundings, and let the kids explore a mind-blowing array of cruise entertainment or you can join in the activities too!
Throughout the year there is no shortage of cruise ships catering for families leaving ports all around North America. Family cruises to Disney are popular as are themed family cruises during spring break and summer vacation time. Destinations such as Bermuda, the Caribbean and the Bahamas are all within easy reach of east coast ports. On the west side, Mexico, Canada and Alaska are equally accessible too for family cruises.
Further afield, family cruises along the Amazon or fly-cruises around Europe offer great value for your dollar. Besides the wealth of onboard entertainment for all the family to enjoy, what child would not be impressed by a close encounter with pink dolphins on the Amazon, or the sight of gladiators re-enacting Roman times in an Italian amphitheater? There's no end of fun to be had, and all at a price that is affordable, especially when compared to land-based vacations of a similar standard!
Family cruises for kids
Kids of all ages can expect a dazzling array of entertainment to greet them on family cruises. For younger children games rooms and video rooms showing cartoons are available on many cruise ships that cater for families. There are video games, sports activities, dancing classes and organized activities under the direction of the ship's crew for older children to delight in. Some cruise liners even have 'kids-only' swimming pools.
Family cruises for parents
For parents everything from golf to poolside massages are available on family cruises. Kids can be left in the capable hands of the cruise liner's staff leaving you free to enjoy some 'you' time. Most cruise boats offer a babysitting service. So, why not take advantage of it and steal an evening walk under the stars together or share a romantic meal at the ship's restaurant? You might just find that it is the most enjoyable and relaxing vacation you've been on in years!
Jonathan Medcalfe writes about all types of cruise vacations including bahamas cruises, alaska cruises luxury cruises and much more. If you want more information about interesting cruises, visit his site here: http://www.fgcruise.com.Visioneer Cardreader 100 Sheetfed Scanner Usb
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Saturday, December 29, 2007
Politically Incorrect Weight Loss Tips
Politically Incorrect Weight Loss Tips
Excerpts from tips that San Antonio chiropractor and chiropractor San Marcos acupuncturist Dr. Jeffrey S. Reynolds gives to his patients on losing weight.
1. Cut Out Sodas! Let's review some the basic ingredients of sodas: BONE DEMINERALIZER (carbonated water), SUGAR, SPEED (caffeine). Sodas are now the #1 cause of osteoporosis. People do not realize the amount of calories and carbohydrates in sodas. You might as well eat a piece of cake every time you drink a soda because you're getting the same amount of empty calories. It has been shown that if you drink 1 cola a day, you will gain 10 POUNDS in one year. DRINK MORE WATER!
2. Reduce Caffeine Intake! The problem with caffeine is that it is an energy substitute. Instead of your body using its own resources for energy, like fat, your body uses caffeine first. You body is set up to make the least amount of effort, so why should it burn fat when you give it free energy in caffeine. DRINK MORE WATER!
3. Reduce carbohydrate intake! When you break down a carbohydrate it becomes a simple sugar for energy. If you eat more carbohydrates than your body needs, then your body stores it as fat. The problem with low fat foods is they increase the sugar amount so that it will still taste good. REDUCE THE AMOUNT OF BREAD, TORTILLAS, CHIPS, POTATOES, SPAGHETTI, AND WHITE RICE IN YOUR DIET.
4. Stop Going To Buffets! Usually your determination not to overeat is overridden by the desire to get your money's worth. Temptation can be very difficult to deal with, so the less you have the better. Treat yourself to a better quality meal with smaller portions. Next time you are at the buffet just look around and see who's eating there. It's mostly fat people! EAT SMALLER PORTIONS!
5. Start Walking! One of the easiest ways to exercise is walk 30 minutes every morning. If you walk before you have your breakfast, your body will burn more fat. Walk 15 minutes in one direction away from your house and then turn around and walk home. There are TREMENDOUS benefits to exercise. WALK DAILY!
6. Stop eating at least 3 Hours Before You Go To Bed. This is a major key to the weight loss products that you drink at night before you go to sleep. When sleeping, your body wants to rest and repair, not digest. Plus, you are not active, so you not burning many calories.
7. Change Your Life! Basically what you are going to have to do is break old habits and create new ones. Being thin is a way of life!
To get a copy of the entire article contact Dr. Reynolds at http://www.reynoldschiropractic.com
San Antonio chiropractor and chiropractor San Marcos acupuncturist Dr. Jeffrey S. Reynolds of Reynolds Chiropractic Acupuncture Clinic is a leading expert on chiropractic care San Antonio and has been practising as chiropractor San MarcosCanon Elura 70 Minidv Camcorder W 18x Optical Zoom
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Friday, December 28, 2007
Central American Midwives - A True Labour of Love
There is no doubt that midwives worldwide are very special people. They possess a unique ability to care for women and newborns and it takes a distinctive set of skills to qualify for the job. More than 60% of the worlds babies are helped into the world with the hands of a midwife or traditional birth attendant. In Central America, midwives are generally referred to as traditional midwives.
Central American traditional midwives are usually well known and respected in their community. Many traditional midwives say they felt a calling to be a midwife and learned their skills through apprenticeship and experience rather than formal training.
But Central American midwives have a tougher job on their hands than their counterparts in wealthier countries. In countries such as Guatemala, Honduras, Costa Rica, Nicaragua and El Salvador midwives can often be found working under appalling conditions, depending on how unstable their countrys health system is, and the majority of these women do not get paid for their hard work.
PAHO (Pan American Health Organization) estimates that there are about 22,000 maternal deaths per year in Latin America and the Caribbean with an aggregate ratio of 190 deaths per 100,000 births. PAHO also estimates that under-reporting in many regions can be as high as 70%.
In Central America, traditional midwives attend most of the deliveries where the maternal mortality is the highest due to poverty. The contribution of traditional midwives to the health of nations has been undervalued by governments and insufficient resources have been allocated to providing midwives with the equipment, training and medicines that they need to carry out their job safely and effectively.
In April 2004, a group of midwives from these five countries took a ground-breaking step by coming together in Costa Rica to share their experiences as midwives in their respective countries. Their tales reflect their love and devotion to their work, and their ongoing commitment to the many women they have helped through childbirth.
They tell their stories of how unjust their health systems are and share harrowing accounts of health care systems which fail its people.
Central American Midwives, the charitable organization that funded this assembly, produced a DVD depicting these womens stories. In the documentary, one of the Nicaraguan midwives, Doa Alicia, compares the care the traditional midwives give to the impersonal care of the local hospital; The midwife offers love and trust and confidence and she doesnt do it mechanically like the nurses and doctors. However, I dont mean to offend these health care workers, who do the best job they can. For example, a woman goes to have her baby in a hospital. In the room she will find a nurse, a person who cleans and another woman in the next bed to her. The doctor arrives and says "lets see lady, open your legs", and the woman feels ashamed. On the other hand if a midwife attends this woman in the privacy of her own home, the woman experiences trust.
Doa Alicia went on to say that she didnt want to offend the doctors because they do offer good care when they are needed. But that they do not possess the kindness of a midwife, and often lack the patience the midwife has.
Josefa Mira, a midwife from El Salvador, explained that the midwives are constantly monitoring the progress of the labour and when a complication presents itself they organize immediate transfer to a hospital. And we dont only care for women of the community during pregnancy and birth, she said. We also look after the general health of women and their families, domestic violence and all the illnesses that are common in our communities.
However, lack of transport is a major problem in most areas and women in high-risk conditions often cannot be moved to a hospital for medical help due to this dilemma. The same problem exists if there are not enough basic medicines to treat disease in pregnancy.
The Central American Midwives plea is to be recognized and accepted for the value of their knowledge, to work as a team with health care services, to be adequately trained and equipped, and rightfully compensated. This issue needs to be recognised as an important, pressing matter.
Let us help those who bear the hands that hold our future generations. Let us help the Central American Midwife Crisis.
Guatemalan midwife Mara Cecilia says; What I would like most for our country Guatemala is health for everyone, that having a baby would become safer, that we would have safe and healthy childbirth, and that society would give importance to mothers and the work of mothers. When we are expecting our babies we should feel cared for and receive love. And the other thing I wish for is that one day midwives would really be part of the health care system and have a salary that we can enjoy.
To order your copy of this inspirational, educational DVD or for more information on Central American Midwives, contact http://central-american-midwives.org
Catherine Cunningham is a copywriter based in Costa Rica. She works full time for a web design company and writes articles and site content for clients. You can contact her on catherine@unidad22.comMature Porn Photos Online Merchandise
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Wednesday, December 26, 2007
Introduction To Alternative Treatments For Depression
There are a number of treatments available to sufferers of depression who are looking for more help than using antidepressants alone in fighting depression. Treatments ranging from herbs and acupuncture to guided imagery are all finding their place in an ever modernising approach to treating depression. Although this field of medicine is vast, it is worth looking at treatments that are becoming increasingly popular with those looking to help them deal with their depression.
There are a number of herbal treatments available all claiming to relieve the symptoms of depression. Very few of them however do as most are unstudied or have had limited studies into their effectiveness.
Those herbs that are effective are just a few that have undergone multiple clinical trials whose outcome provides clinic proof backed by research. It is important to note that these herbs have proven to be effective only when taking the correct dosage of the herb and in a quality equal or greater to that used in the studies. There is conclusive proof that pharmaceutical-grade St John's Wort is very effective in relieving the symptoms of depression. Studies have found that high quality St John's Wort is just as effective as popular anti-depressive drugs such as Prozac, Zoloft and Paxil. It also causes less side-effects than the anti-depressive drugs. Studies have thus indicated that high quality St John's Wort is the most effect herbal treatment available for depression.
Ginkgo Biloba is considered to be the oldest living tree species in existence. Ginkgo Biloba is affective in increasing blood flow throughout the body. This includes the brain where it helps increase memory function. Memory impairment is one of the symptoms of depression and very prevalent in a major depressive episode.
Meditation is the art of breathing. Maintaining a steady breath while sitting relaxes the body and mind. You cultivate mindfulness by concentrating on the present moment and what it brings to you. Some say it is about clearing the mind of clutter, but that is not the sole purpose of meditation. Daily practice will promote relaxation not just during sitting but throughout the day.
Reflexology is the practice of applying pressure to various parts of the hands and feet such that it will stimulate the body to heal itself. These various points are said to represent various parts of the human body, and by applying pressure to them, they induce healing in that particular part of the body.
The ancient Chinese practice of acupuncture involves 'puncturing' the patients skin with very fine needles into carefully positioned points on the human body. Acupuncture stimulates the release of chemicals that alleviate the sensation of pain. It also corrects imbalances by stimulating the body functions to fight illnesses and conditions such as depression.
Massage is the art of using touch to promote relaxation concentrating on the link between mind and body. When the body is relaxed this is believed to promote relaxation and calmness in the mind. This will lead to lowering symptoms of depression. There are a number of massage therapies available such as shiatsu, Swedish and spinal release therapy.
Guided Imagery uses powerful mental image techniques to promote harmony between the mind and body. The patient is encouraged to see peaceful mental images that create calm within the mind of the patient. This is taught as a coping skill that can be used to fight unhealthy negative emotions such as anger, as well as helping relieving pain, stress and depression. It can also help relieve insomnia which is a symptom of depression and anxiety.
Physical exercise produces endorphins which cause a natural 'high' felt by the person. Exercise is known to relax the body and mind along with relieving stress and depression.
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Tuesday, December 25, 2007
Big No-No's In Your Relationship with A Woman, Which She Secretly Wish You Knew!
There are things that women want men to know but do not tell them. This is going to mean the difference between a good relationship and a bad one. If men could only know about these things that are big no-nos and knew what women wanted, they would be able to have happier relationships with the woman in their life.
1) Giving Respect is as Important as Getting It
One thing is respect. Women want to have respect. When it comes to respecting women, some men are not so good at it. This may end up resulting in them losing out in the relationship. It is important to show respect to a woman that you are involved with or any woman for that matter. Give them an opportunity to see that you can be a good guy and that you can respect what they believe and let them have their own feelings about things.
Respect is going to be shown through actions. You can do nice things for a woman like opening up the door, giving up your seat or talking to her differently with passion and concern. It is not acceptable to just fake some charm on a first date. You need to be real and up front about how you are going to be in the relationship on a day-to-day basis.
2) Being Kind to the World
Being kind is another secret that most men do not know that women want. Women want their man to be kind to everyone. They want them to nice to everyone that they meet to some degree.
Treating others nicely will mean that they are kind and are going to give the same type of treatment that they deserve and expect from everyone else. Kindness can go a long way to a women's heart and it should be something that men think about.
3) Having Accountability for Actions
Women want men to have accountability. They wan to make sure that men are going to take the responsibility for the things that they have done. This can mean anything from the smallest problem to bigger life changing events that happen in their life. Women want to make sure that they are with a man that is going to be a stand-up guy and do what they are supposed to do.
4) Loving Family
One no no that women hate is a man that does not love her family. Women want to have a man that is going to love their family and take on the pressures of family life in a good way.
This means their parents, brothers, sisters and children all the same. They need to know that they can rely on their husbands or boyfriends to do what is needed of them. Most women need someone that they can trust and whom they know is going to be there for them when they are most in need.
5) Being Safe and Secure
Women want to also feel safe with their men. They want to know that they have nothing to worry about and that they are in good hands when they are with them. Having the feeling of security is going to mean all the difference when a woman is with their man. They want to be secure not only with their man but they also want to know that their man is going to be there to protect them when they need it the most.
Women need to make sure that their man is taking their relationship seriously. They want to know that their man is going to be there for them no matter what and they want to make sure that they are for real in the partnership.
Try not to joke around all the time and laugh about things in the relationship as this is going to insult some women and make them feel low. Women want their men to be committed and serious about what is going on in the relationship just as they do.
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Monday, December 24, 2007
Nipple-Areola Complex Sensitivity after Primary Breast Augmentation
Background:
The body of literature documenting normative breast sensation and postoperative changes in sensation after reduction mammaplasty has grown considerably over the last several years. Despite this, only two studies have ever been published on the subject of postaugmentation mammaplasty sensory outcomes. The purpose of this study was to precisely measure sensory thresholds at the nipple-areola complex in women who have undergone augmentation mammaplasty by either the inframammary or periareolar approach.
Methods:
Twenty women underwent primary augmentation mammaplasty by either the periareolar or inframammary approach at an average follow-up of 1.12 years. Sensory testing was performed using the Pressure-Specified Sensory Device by comparing moving and static sensory thresholds at the upper and lower areola and nipple. Nine women served as size-matched, nonoperated controls in the study.
Results:
Primary augmentation mammaplasty was found to have a statistically significant negative effect on sensory outcomes when nonoperated controls were compared with women who had undergone augmentation mammaplasty via either the periareolar or inframammary approach. No differences in sensory outcomes were found between the two approaches used. Implant volume was found to be highly predictive of sensory outcomes, with an inverse relationship between implant size and the degree of sensitivity within the nipple-areola complex.
Conclusions:
Plastic surgeons should feel comfortable counseling patients that augmentation mammaplasty by either the inframammary or periareolar approach results in no discernible differences in sensory outcomes. Furthermore, women who choose very large implants relative to their breast skin envelopes should be warned about potential adverse sensory sequelae within the nippleareola complex. (Plast. Reconstr. Surg. 117: 1694, 2006.)
The body of literature documenting normative breast sensation and postoperative changes in sensation has grown considerably over the last several years. This is especially true in women following reduction mammaplasty. In addition to anatomic studies that have outlined the innervation of the nipple-areola complex, precise sensory measurements have been performed on patients who have undergone reduction mammaplasty by several different techniques, including the inferior pedicle, medial pedicle, and breast amputation--free nipple graft approaches.16 Despite the expanding knowledge base on this subject, only one study has been published since 1976 on the comparably larger subset of patients who have undergone augmentation mammaplasty.7 As previous studies have demonstrated, women with macromastia are considerably less sensate in the region of the nipple-areola complex than age-matched controls with small to normal-sized breasts.6,8,9 The causal relationship of this finding has been speculative and is thought to be related to nerve traction injury and decreased innervation density in patients with gigantomastia. Although evidence is anecdotal, women with macromastia who present for reduction mammaplasty are primarily motivated by chronic symptoms of pain and discomfort, the inability to engage in vigorous physical activity, and intertriginous infections. Concerns regarding sensory outcomes are usually secondary and frequently inconsequential, since preoperative sensation is diminished. In contrast, women who present for augmentation mammaplasty are highly sensate in the region of the nipple-areola complex, and in the course of the preoperative consultation there are frequently questions about postoperative sensory outcomes. In women with micromastia, sensation of the nipple-areola complex is often of paramount importance and, in some women, an important source of stimulation during intimacy. Until now, informed consent regarding this issue has been achieved by the operative plastic surgeon by suggesting that sensory loss is a potential outcome, but that sensory outcomes are uncertain and variable. It is also the practice of some plastic surgeons to discourage the periareolar approach of implant placement in women who voice concerns about the loss of sensitivity, because of the risk of transection of nerve fibers leading directly to the nipple-areola complex. Although other techniques of performing augmentation mammaplasty, such as the transumbilical and the endoscopically assisted transaxillary techniques, have gained popularity over the last several years, the vast majority of breast augmentations today are performed via either the inframammary approach or the periareolar approach. Unlike the two previous studies on the subject of sensory changes associated with augmentation mammaplasty,7,10 we utilized the Pressure- Specified Sensory Device (Sensory Management Services, Baltimore, Md.). Previous studies have employed modalities such as light touch, pain perception to electrical currents, vibratory stimulus, and Semmes-Weinstein nylon monofilaments. Relative to the technologically advanced sensory testing modalities available today, the techniques used in the two previous studies on this subject are considered unreliable and inaccurate.11 Thus, the purpose of this study was to quantify the sensation of the nipple-areola complex following breast augmentation using the Pressure-Specified Sensory Device and to compare the inframammary and periareolar approaches with respect to sensory outcomes.
PATIENTS AND METHODS
A total of 29 women were included in this study; nine of them were nonoperative controls (group 1), 13 had undergone breast augmentation through an inframammary approach (group 2), and seven had undergone augmentation via a periareolar approach (group 3). All women agreed to a 1-hour sensory examination that was performed in the presence of a female chaperone. No financial or other compensation was provided for enrollment in the study. The breast sensory testing protocol was accepted by our institutional review board, and all study subjects gave informed consent for sensory testing to be performed. No woman enrolled in this study reported a history of diabetes mellitus, thyroid disorders, collagen vascular disease, alcoholism, pernicious anemia, known neurological impairment, or history of previous breast surgery. Sensory evaluation was performed in all 29 women (58 breasts) by one examiner using the sensory device. Women were seated in a reclining chair with one breast exposed for testing and the other draped with a sheet. Women were asked to close their eyes so that the computer screen or the breast being tested could not be seen. A button linked to the computer was placed in the hand opposite to the breast being tested and the women were instructed to press the button to indicate perception of the test stimulus. The nipple and upper and lower halves of the areola were selected as testing sites. At each test site, five readings were recorded. The highest and lowest values were discarded to eliminate outliers, and the mean of the remaining three was reported as the pressure threshold in grams per square millimeter. One-point static and moving pressure perception threshold was measured within a continuous range of 0.1 g/mm2 to 100 g/mm2. Data were entered into an Excel spreadsheet (Microsoft Corp., Redmond, Wash.). Statistical analyses were performed to compare the one-point moving and static sensibility measurements among groups 1, 2, and 3 using the Mann-Whitney nonparametric test between each group. Data for each of a subjects breasts were averaged for each woman, since the left and right sides are highly correlated.
Group 1: Normative Controls
Nine women served as nonoperative controls. The average age of the participants was 28 years (range, 19 to 38 years; SD, 6 years). Breast size among participants ranged from 34A to 36C. A total of 18 breasts were tested and the results were averaged. Data on these patients have previously been published.6
Group 2: Inframammary Approach and Group 3: Periareolar Approach
A total of 20 women underwent augmentation mammaplasty by either the inframammary incisional approach (13 patients; 26 breasts) or the periareolar incisional approach (seven patients; 14 breasts). In study participants in whom the periareolar approach was utilized, the incision was designed from the 4 oclock to the 8 oclock position at the inferior border of the areola. Implants in both groups were placed in either the subglandular or submuscular plane. Study group participants were not further subdivided according to the plane of implant insertion, because study cells would suffer from small sample size and inadequacy for statistical analysis. Preoperative breast sizes ranged from 32B to 36C among study participants. The average duration between surgery and sensory evaluation was 1.12 years (range, 102 to 1512 days). The average age of participants at the time of testing was 33 years (range, 20 to 47 years; SD, 7 years). There were no significant differences in age at time of testing or in the interval between surgery and testing between the groups of women who underwent augmentation mammaplasty by either approach. The average implant size used was 375 cc (range, 340 to 475 cc) in the periareolar incisional approach group and 428 cc (range, 315 to 700 cc) in the inframammary incisional approach group; this was not statistically different (p _ 0.05).
RESULTS
Cutaneous pressure threshold values for the nipple-areola complex were determined for study participants in all groups (Tables 1 and 2). There were no statistically significant differences (p _ 0.20) in values between the upper and lower halves of the areola for each group for one-point moving and static tests; therefore, values for the upper and lower halves of the areola were pooled. Sensory measurements for both nipple-areola complexes of each participant were averaged for each participant (left and right nipple-areola complex), and the nonparametric Mann-Whitney test for two independent groups was performed (Tables 1 and 2). No statistically significant differences were found between women who underwent augmentation mammaplasty by the inframammary approach and those who had the periareolar approach (p _ 0.51 for each test, nonparametric Mann-Whitney test) (Table 1). Groups 2 and 3 were therefore pooled and compared as a single group (n _ 20) to normative controls (group 1, n _ 9) (Table 2). Significant differences were found, with p_0.03 for each test. Mean cutaneous sensory thresholds were nearly 10 times greater in women who underwent augmentation mammaplasty by any approach compared with unoperated controls with breast cup sizes ranging from 34A to 36C. Groups 2 and 3 were pooled and then subgrouped into two categories by length of time from the date of surgery to testing. Six study participants were found to have a follow-up time of between 3 and 6 months. Fourteen study participants had a follow-up time of between 6 months and 4.1 years. No statistically significant differences were found, with p _ 0.50 for each test (nonparametric Mann-Whitney test). In comparing sensory threshold variations by age at surgery, incision type, and preoperative cup size, a regression analysis was performed and in each case was found to have a p value greater than 0.05. Once each of the nonsignificant variables was dropped from the statistical model, regression analysis revealed that 50 percent of the variation in sensation was found to be attributable to implant volume (p _ 0.02).
DISCUSSION
The postoperative sensation of the nipple-areola complex after operative procedures on the breast is being investigated with increasing frequency. Despite an increasing body of knowledge on this subject following reduction mammaplasty, there is a paucity of information about sensation after augmentation mammaplasty. No studies, before this one, have compared sensory outcomes utilizing different incisional approaches or sensory outcomes based on differences in implant volume. Although there are a variety of ways to assess sensation, computer-assisted quantitative neurosensory testing represents a significant advance in our ability to perform continuous measurements. The Pressure-Specified Sensory Device is a computer- assisted instrument that uses a hemispheric probe attached to a force transducer to make continuous measurements of cutaneous pressure possible. It allows for one-point static (Merkel cellneurite complexes, Ruffini complexes), one-point moving (Pacinian and Meissner corpuscles), and moving and static two-point (innervation density) discrimination.12 Unlike nylon monofilaments, which provide only an estimate of the logarithmic range of cutaneous pressure thresholds that cannot be intuitively assessed without advanced statistical transformations, the Pressure-Specified Sensory Device provides continuous measurements of cutaneous pressure, making such statistical analyses and comparisons possible. Normative data for breast sensibility of the nipple-areola complex obtained using the device have been previously published.6 This study represents the first quantitative sensibility analysis that compares postoperative sensation of the nipple-areola complex after augmentation mammaplasty via the inframammary and periareolar approaches. Precise anatomic studies have previously elucidated the dual innervation of the nipple-areola complex medially and laterally from cutaneous branches of the third through sixth intercostal nerves.13,14 It has always been a theoretical risk that transareolar techniques of augmentation mammaplasty place the sensory outcome of the nipple-areola complex at risk, because of the direct disruption of nerve fibers traversing the inferior pole of the areola. This study has demonstrated that there is no statistically significant difference in sensory outcomes when augmentation mammaplasty is performed via the periareolar or inframammary incisional approach. In the design of this study, women were not subdivided based on plane of dissection (submuscular versus subglandular pocket position). This was because the number of women within each subgroup was not large enough for a statistically valid comparison. The neural anatomy of the nipple-areola complex has been well described, so there is no reason to suspect that implant position, either above or below the pectoralis muscle, would affect sensory outcomes.13,14 Our study design was also limited by the lack of preoperative and postoperative sensibility data on the same patients. A preoperative study, in which study participants serve as their own preoperative controls, is planned. Since the first published report on sensory outcomes after augmentation mammaplasty, a great deal has been learned. This study disputes the conclusions of the 1976 landmark article by Courtiss and Goldwyn10 that demonstrated a return to normal nipple-areola complex sensation by 6 months after augmentation mammaplasty. Utilizing a far more sensitive testing apparatus than crude touch and pinprick, this study has demonstrated a nearly 10- fold decrease in sensory thresholds after primary augmentation mammaplasty. It was interesting to find that there was no progressive diminution of sensory loss when study participants with an interval of between 3 and 6 months from surgery to testing were compared with participants with a follow-up of 6 months to 4.1 years. One might have expected to find some amelioration of sensory loss with time as the skin envelope of the breast stretches to accommodate the implant, but no discernible differences were recognized. This suggests that sensory impairments found at 3 to 6 months are not likely to improve with time. The relationship between implant volume and sensory outcome was another primary focus of this study. There was demonstrated to be a strong inverse relationship between implant volume and sensory outcomes. Although this relationship was found to be linear, implant sizes from 315 to 475 cc were found to have the least variability with respect to sensibility outcome. Sensibility outcomes were most variable with implant sizes greater than 475 cc. The relationship found between implant volume and sensory outcome is perhaps best explained by the same forces that act on large pendulous breasts in cases of gigantomastia. In an earlier study, it was demonstrated that control women with relative micromastia (34A to 36C cup size) were far more sensate than control women with gigantomastia (36DD to 46EE cup size).6 It was purported that volumetric differences in the breast were likely related to sensory outcomes because of nerve traction and innervation density, both of which are highly predictive of sensitivity. There are additional factors to consider, however, with respect to skin tension and the size of the skin envelope relative to the size of the implant. It would be expected that a large implant in a breast with a substantial skin envelope would create less tension than a large implant in a breast with a smaller and tighter skin envelope, which would consequently cause more nerve traction. In the vast majority of women who choose to undergo breast augmentation, there is an improvement in overall body image.7 Despite the fact that significant statistical differences have been found between women who have undergone augmentation mammaplasty and those who have not, it is not clear whether there is any clinical significance to these findings. Erogenous sensation is a cortical transfer function and is not necessarily correlated to sensory thresholds. The provision of this information regarding sensory outcomes to our patients is only one facet of the informed consent process that patients should undergo before having augmentation mammaplasty. Plastic surgeons should feel comfortable counseling patients that augmentation mammaplasty by either the inframammary or periareolar approach results in no discernable differences in sensory outcomes. Furthermore, women who choose very large implants relative to their breast skin envelopes should be warned about potential adverse sensory sequelae within the nippleareola complex.
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Saturday, December 22, 2007
Meet the 21st Century Single Mom
The 21st Century Single Mom is not perfect. However, she has mastered the technique of sharing her emotions in healthy ways. She is an encourager to her children by allowing them to observe and learn how to do the same. She supports her children in their lives, but, most importantly she has a life of her own.
One of the biggest mistakes single Moms make is not forgiving themselves for the inherent struggles of single parenting and making their children the center and focus of their lives. It is unhealthy for the children and the parent.
The 21st Century Single Mom follows her words with consistent actions. She commands respect by giving respect. She is firm and holds her children accountable for their actions. She inspires them because she is inspired by life and the growth she sees in her children. She doles out more and more challenging responsibilities so her children can grow to become healthy adults. She is confident and honest, letting her children see the rewards from adopting this character.
Here are five actions you can take today for a more invigorating lifestyle that leaves time for you to enjoy life with your children and have hope for their future on the road to becoming an adult.
1. Allow your children to share with you whats on their mind. Become involved in the things they enjoy doing. Ask questions about the things that interest them.
2. Teach your children to tap you gently on the shoulder while you are engaged in conversation with others, should they have a desire to interrupt with a question or concern. This teaches patience without a sense of urgency at all times.
3. Play games with them whenever possible. Through role playing important lessons can be taught in a fun atmosphere.
4. Join the child on their level. Lower yourself physically to a childs level by sitting or bending down. Imagine how intimidating it would be if everyone in your world were taller or larger than you.
5. Always take time to interact with your children. Sacrifice the time, even if there is a room filled with adults. You would be amazed how much you enjoy their innocence and unpretentiousness.
Whether youve become a single mom by choice or due to circumstances, realize there will be moments when your whole world is upside down. But you always have a choice. Go ahead and cry for a minute. Then figure out how this setback can be turned into an opportunity.
If you want to inspire your children to greatness, you must dare to be great yourself. If you want them to develop the skills to enjoy lives full of fun, joy, accomplishment, with an ability to overcome lifes challenges that present opportunities and rewards, then you must make your own life an example.
Joel Williams is a single parent and author of several books for single mothers from a dads perspective. His special report "Take Charge of Your Life in 7 Days" is available for free at http://singlemomachievers.com. You'll find tips, articles and resources for single moms and single parent.Hot Blonde Girls Having Sex Screensavers
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