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By: Leonard S. Lilly, MD

bulletProfessor of Medicine, Harvard Medical School, Chief, Brigham and Women's/Faulkner Cardiology, Brigham and Women's Hospital, Boston, Massachusetts


To have sign value for a market segment the customer displayed in the report must be seen as a classic example of the segment blood pressure xl cuff purchase 0.25mg lanoxin with mastercard. However pulse pressure heart order 0.25 mg lanoxin otc, a segment archetype need not be an accurate representation of an individual customer blood pressure medication valsartan generic lanoxin 0.25mg on-line. It can also be a composite drawn from attributes of several customers in the study blood pressure medication starting with z buy lanoxin 0.25mg fast delivery. In our segmentto-life research reports we often include mini-biographies or character sketches of individual informants that serve as emblems of different facets of the target segment. Seeking the right metaphor Gozzi (1999) suggests a process of metaphor analysis that we find very useful. It begins with identifying the surface-level metaphors that arise from the text in question, in our case the ethnographic data. For example, a segment of hard-core freeway commuters may emphasize the desire to shut out the outside world, to retreat into their music or books on tape, and to unwind from work stress on the way home. The next step is to tease out the implications of the guiding metaphor and to question the conclusions that flow from it. Which of these tendencies best reflects the preferences of the hard-core commuter segment? If exterior flashiness is a desired attribute, maybe the sanctuary metaphor needs rethinking. Reporting ethnographic research 365 the third step is to suggest alternate metaphors. Schouten and McAlexander, 1995) in that it forces a higher level of scrutiny of our conclusions. What other guiding metaphors might also account for the emerging system of surface metaphors? Finally Gozzi recommends studying the source and usage of the guiding metaphor to better understand its political agenda or position. We should ask ourselves, is the guiding metaphor we have identified for the target segment representative of their moral and emotional reality? However, we also face the difficult task of conveying the essence of complicated consumption experiences to our clients. The segment-to-life report is more than a compendium of our research activities and findings. Ideally it will also help to protect the integrity of the analysis by reducing the chance of its being misinterpreted. The guiding metaphor that frames the report must therefore serve accurately as a signifier of the deeper meaning in the data, and it must also function as a rhetorical device. The verisimilitude of the metaphor rests on the audience accepting the appropriateness of the comparison. If the attributes of a commuter car and the attributes of a sanctuary seem sufficiently comparable, the metaphor works. Well-crafted ethnographic research builds plausible findings on a corpus of data and on carefully developed themes. For this reason the guiding metaphor for a research report should emerge from the data. The data form the foundation of the metaphor and the metaphor helps to carry the meaning intended by the researcher. We believe the process of selecting a guiding metaphor should involve client research liaisons, drawing on their insights and understanding of their organizations. Client liaisons are likely to have a better understanding of the kinds of metaphors or phraseology that have already circulated in their realm. They also will be more sensitive to potential misunderstandings that may arise from cultural differences within the firm. On many occasions we have been dissuaded by client research liaisons from using terms or phrases in our research reports because of a belief that they would spark misconceptions among certain internal audiences and possibly bring about the rejection of our conclusions. Making movies: the segment-to-life research process Our preference for a final report of segment-to-life research takes the form of a documentary-style video accompanied by a multimedia presentation with embedded photographs, video clips, in-depth prose notes and written character sketches of customers that embody important facets of the target segment.

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In the fourth and last section of this thesis heart attack film discount lanoxin 0.25 mg overnight delivery, conclusions drawn from this thesis are summarized (Chapter 8 and 9) blood pressure chart age 65 cheap lanoxin 0.25mg with amex. Infection risk with immunomodulatory and proteasome inhibitor-based therapies across treatment phases for multiple myeloma: A systematic review and metaanalysis arrhythmia vs heart attack lanoxin 0.25 mg low cost. Influenza in immunosuppressed populations: a review of infection frequency heart attack 40 year old male generic 0.25 mg lanoxin fast delivery, morbidity, mortality, and vaccine responses. A Systematic Review and Metaanalysis of Antirheumatic Drugs and Vaccine Immunogenicity in Rheumatoid Arthritis. Tsachouridou O, Skoura L, Zebekakis P, Margariti A, Georgiou A, Daniilidis M, et al. A brief history of the pneumococcus in biomedical research: a panoply of scientific discovery. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Initial and subsequent response to pneumococcal polysaccharide and protein-conjugate vaccines administered sequentially to adults who have recovered from pneumococcal pneumonia. Effect of Immunosuppressive Therapies for the Treatment of Inflammatory Bowel Disease on Response to Routine Vaccinations: A Meta-Analysis. Cost-effectiveness of pneumococcal conjugate vaccination in immunocompromised adults. Travel-associated infection presenting in Europe (2008-12): an analysis of EuroTravNet longitudinal, surveillance data, and evaluation of the effect of the pre-travel consultation. Spectrum of disease and relation to place of exposure among ill returned travelers. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on 25 immunization practices. This, potentially results in unawareness of the importance of vaccination and low vaccination rates. Based on our findings, we recommend pneumococcal vaccination in immunocompromised patients. International guidelines recommend pneumococcal vaccination in these groups, as reviewed by Lopez et al (5). As a result, the relevance of pneumococcal vaccination in immunocompromised patients is often questioned, with physicians hesitant to advise their patients on pneumococcal vaccination (15, 16). Accordingly, worldwide pneumococcal vaccination rates in immunocompromised patients are low (15-20). The data obtained may provide a better rationale for pneumococcal vaccination for subgroups of immunocompromised patients. We excluded duplicates studies; studies written in other languages than English; studies that included isolation of S. Subsequently, one author (MvA) read and analyzed selected studies for eligibility. Citations and reference lists from review articles found in the initial search were checked to ensure that no studies were missed. This Critical Appraisal Tool provides a checklist that covers nine domains: appropriateness of sample frame, recruitment of participants, adequacy of sample size, description of study subjects and setting, coverage of identified samples, valid methods for identification of the condition, a standardized and reliable measurement of the condition, appropriateness of the statistical analysis, and adequacy of the response rate. We used the following formula to calculate the sample size for the incidence rate: Rate/standard error2 (s. Accordingly, studies with a sample size < 5,000 persons lack power to accurately estimate the incidence. The statistical analysis was considered appropriate if the methods section of a study described the calculation of the incidence. Most studies calculated more than one incidence rate for different years, or for different patient 35 categories, i. Therefore, although we excluded duplicate studies, we included some studies in the meta-analysis more than once, albeit with extraction of different data sets. The resulting overlap between 2000 and 2003 is due to publication of data on patients recruited in the period from 1996 to 2003.

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After some extensive brainstorming the research team decided to arteria hyaloidea discount lanoxin 0.25mg with amex produce a theatrical performance arteria dorsalis pedis discount 0.25mg lanoxin overnight delivery. At what the client believed to arteria tibialis posterior buy discount lanoxin 0.25 mg be the conclusion of the formal presentation the research team shared their observation that it would be very valuable if they could hypertension kidney pathology purchase 0.25mg lanoxin overnight delivery, somehow, bring members of the segment to the meeting. In one dramatic production the research team had presented their results orally, visually and kinesthetically, truly bringing the segment to life. While a play with live actors may not always be feasible, as a general premise creative, multimodal reporting offers great value to audiences of ethnographic work. In our work with large, culturally complex client organizations we have discovered several keys to powerful research reporting. The first key is to organize and deliver the main themes of the research in the form of a strong guiding metaphor. The third is to involve the client research liaison as an active partner throughout the research process. We now begin with a discussion of the guiding metaphor and its core usefulness in ethnographic research reporting. Finally, throughout the research process, we emphasize the importance of involving the client research liaison. Making meaning: the hard-working metaphor Metaphors help us to understand unfamiliar things in terms of things that are more familiar (Aristotle, 1954). Metaphors in an ethnographic research report can convey deeper insights and enhanced understanding of the lived experiences of consumers than can mere description. The problem of communicating the findings of segment-to-life research is precisely the one described by Aristotle: making unfamiliar things familiar. One client describes the benefits of metaphor for her advance planning and strategy team: A metaphor is so much easier for people to recall later. It is a common understanding ­ when there is some kind of metaphor ­ people already have some sort of thing to draw reference to. Dennis Stefani of Diagnostic Research similarly states that metaphors `make something very complicated come to life. They now have an easy way to explain to their people what the research is about in a very easy to understand form. Beyond merely shaping our understanding, metaphors can govern our behaviors as individuals and societies. One metaphor demands a cure or the eradication of disease whereas the other argues implicitly for appreciation and the preservation of cultural uniqueness. Semiotics refers to a sign as something that includes both a representation and an object represented. In this case the image of the individual customer (Person X) functions like an icon that evokes or conjures the characteristics of the segment which it represents. Both the video and the multimedia presentation are built around a central guiding metaphor. We may use the same metaphor for both reports, or we may choose different metaphors for each report, depending on the message we desire to communicate with each. We find that this combination of forms and media provides the necessary multi-modality to reach diverse audiences. In the spirit of the foregoing discussion we have chosen to describe the ethnographic process of bringing segments to life in terms of its own guiding metaphor: movie making. The metaphor works whether or not we actually include a documentary-style video as part of the final report product. Pre-production planning: fine-tuning the research objectives Client research liaisons are the executive producers of segment-to-life research. Client involvement starts with the request for proposals and continues throughout the research process. As executive producers they have commissioned the project, they are responsible for the budget and they should be kept informed of progress. If problems arise in any aspect of the project, they should be informed and consulted.

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The use of the pedal blood pressure weight loss discount lanoxin 0.25mg mastercard, of course pulse pressure heart failure buy lanoxin 0.25 mg otc, beautifies the sound and assists the legato in cantabile passages heart attack bpm discount 0.25 mg lanoxin free shipping. Mozart never indicated arteria mesenterica superior 0.25 mg lanoxin with visa, in any of his works for or with piano, the use of a device to raise the dampers. It has been pointed out in recent times that Mozart did write two bars in which it is not possible to hold the notes with the fingers, in which case he seems to be implying the use 278 of a device to raise all the dampers at once. It has also been said, on the other hand, that in Mozart one can use pedal harmonically through chordal passages, arpeggios and even through melodies containing rests. No authoritative answer may ever be found, but it would seem on stylistic grounds that the use of pedal in Mozart on the modern piano should be somewhat sparing and that, in any event, it should not be used to create effects. Haydn (1732-1809) Haydn was born over twenty years before Mozart and outlived him by ten years. As the sound of a harpsichord is quite evanescent, a device for raising the dampers generally was apparently never fitted to harpsichords. When Haydn started using crescendo and diminuendo markings in his keyboard sonatas they were composed with the piano in mind. Haydn generally did not indicate the use of the pedal in his piano sonatas but there is an exception, in his last sonata, H. Apart from this it is possible to use carefully changed pedal in many places in the Haydn sonatas but it would seem that overall he tends to write without a pedalled sonority in mind. There is no mention of pedalling in the first edition of that treatise and, according to Czerny, Clementi was not known for an extreme use of the pedal during his performing career. Clementi did, however, rewrite many of his earlier piano works, inserting pedal markings as well as extending compasses. The markings in that sonata consist mainly of fairly short washes of tonic harmony at the end of each movement. The pedals were invented and in use in England in the 1790s but only made their way across to Europe after 1800. As Beethoven marked the use of the pedal, or its predecessor, about a thousand times throughout his works for or with piano, it is clear that Beethoven took a close interest in pedal sonority. These markings called for the sustaining of a bass note through tonic-dominant effects in the upper register and many instances of pedalling through rests. This is a significant early example of a physiological approach to piano notation and a move towards a modern pedalled sonority for the piano. This indicates the influence on Beethoven of the earlier style of writing for the piano. In particular it seems that the pedal should usually sustain single bass notes marked staccato as it seems these markings are physiological. Liszt certainly thought so in his arrangements of the Fantasy, both for piano solo and for piano and orchestra. The sustaining pedal, also called the damper pedal or, incorrectly, the loud pedal, is usually simply called the pedal since it is the one most frequently used. Use of the pedal assists the pianist to play legato, that is, to play notes in a smooth, connected manner, and enables the pianist to sustain notes that he or she cannot hold with the fingers. Pedalling is one of the techniques a pianist must master since piano music from Chopin on benefits from, and indeed requires, extensive use of the pedal. In contrast, the pedal was used sparingly, if at all, in the early compositions of the classical period. The soft pedal, or una corda pedal, is always placed at the left hand of the other pedal(s). This softens the note and modifies its tone quality but does not change the touch or feel of the action. The soft pedal was invented by Cristofori and thus it appeared on the very earliest pianos. In the eighteenth and early nineteenth centuries the soft pedal was more effective than it is today, because pianos were made with only two strings per note and therefore just one string would be struck. In modern pianos there are three strings per note, except for lower notes which have two and the very lowest which have only one. It operates a mechanism that moves the resting position of the hammers closer to the strings. Since the hammers have less distance to travel this reduces the speed at which they hit the strings and hence the tone volume is somewhat reduced. This, however, does not change the tone quality in the way that the una corda pedal does on a grand piano.

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