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For example, people with moderately positive self-views withdraw from spouses who evaluate them in an exceptionally positive manner.Other critics have suggested that when people with negative self-views seek unfavorable evaluations, they do so as a means of avoiding truly negative evaluations or for purposes of self-improvement, with the idea being that this will enable them to obtain positive evaluations down the road. Tests of this idea have failed to support it. For example, just as people with negative self-views choose self-verifying, negative evaluators even when the alternative is being in another experiment, they choose to be in another experiment rather than interact with someone who evaluates them positively. Also, people with negative self-views are most intimate with spouses who evaluate them negatively, despite the fact that these spouses are relatively unlikely to enable them to improve themselves. Finally, in a study of people's thought processes as they chose interaction partners, people with negative self-views indicated that they chose negative evaluators because such partners seemed likely to confirm their self-views (an epistemic consideration) and interact smoothly with them (a pragmatic consideration); self-improvement was rarely mentioned.
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https://en.wikipedia.org/wiki/Self-verification_theory
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A paddock is a small enclosure for horses. In the United Kingdom, this term also applies to a field for a general automobile racing competition, particularly Formula 1.
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https://en.wikipedia.org/wiki/Paddock
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In Canada and the United States of America, a paddock is a small enclosure used to keep horses. In the United Kingdom, this term has a similar meaning, and also applies to a field for a general automobile racing competition, particularly Formula 1. The most common design provides an area for exercise and is often situated near the stables. Larger paddocks may have grass maintained in them, but many are dirt or a similar natural surface.
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https://en.wikipedia.org/wiki/Paddock
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In those cases drainage and a top layer of sand are often used to keep a suitable surface in the paddock.In the American West, such an enclosure is often called a corral, and may be used to contain cattle or horses, occasionally other livestock. The word paddock is also used to describe other small, fenced areas that hold horses, such as a saddling paddock at a racetrack, the area where race horses are saddled before a horse race. Horse breeders may let stallions loose in a paddock or field with mares that they would like the stallion to impregnate.
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https://en.wikipedia.org/wiki/Paddock
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This allows the most natural form of mating to occur and the regularity of mating using this method promotes the chances of a mare becoming pregnant. However, high-value stallions are rarely used for breeding in this manner, as uninterested mares may severely injure them. == References ==
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https://en.wikipedia.org/wiki/Paddock
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Visual ethnography is an approach to ethnography (the study of people and cultures) that uses visual methods such as photography, film and video. There are many methods available to conduct visual ethnography. According to Sarah Pink, visual ethnography is a research methodology that brings “theory and practice of visual approaches to learning and knowing about the world and communicating these to others”. As a methodology, visual ethnography can guide the design of research as well as the methods to choose for data collection. Visual ethnography suggests a negotiation of the participants’ view of reality and a constant questioning on the part of the researcher.
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https://en.wikipedia.org/wiki/Visual_ethnography
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Beginning in the early 1900s, researchers have recognized the importance of visual methods which has largely emerged from anthropology. That is when photography as well as video became ways of recording targeted populations during field work which are called “salvage ethnography” or “salvage anthropology.” Flaherty's Nanook of the North (1922), Margaret Mead's and Gregory Bateson's video and photos of the Balinese, and Evans-Prichard's photographs of the Nuer are examples of this “salvage ethnography (Pink, 2006, cited in van den Scott, 2018). Boas as explained by Pink was an early user of photography who did not trust it and was thought that surface images could be an issue in which might shift the historical understanding of culture. Through the 1900s to 1950s, mainstream anthropology rejected visual methods.
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https://en.wikipedia.org/wiki/Visual_ethnography
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Ethnographic photography was still in use- less for analysis and more for context. Despite the move away from applied anthropology through the 1970s and 1980s, ethnographic filmmaking is still common. Still marginal, Visual methods slowly became a tradition and exploded when reflexive research made a dramatic turn.
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https://en.wikipedia.org/wiki/Visual_ethnography
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Visual methods shaped interdisciplinary interest during the late 1990s and early 2000s. Visual methods became recognized across social sciences as digital technology became available, maintaining their roots in ethnography and anthropology. Sarah Pink claims for an “anthropology of the relationship between the visual and other elements of culture, society, practice and experience and the methodological practice of combining visual and other media in the production and representation of anthropological knowledge”.
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https://en.wikipedia.org/wiki/Visual_ethnography
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Visual ethnography as an aspect of the use of visual data has become increasingly important as a part of the qualitative research toolbox. Qualitative research is an off-shoot of the anthropological practice of ethnography that focuses on the collection and analysis of diverse narrative or textual forms of expression. In describing the importance of visual ethnography in qualitative research, Banks explained that as images are present in society their illustration should be included in the studies of society, and that study of images in the accumulation of data may reveal sociological understanding that may not be accessible.
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https://en.wikipedia.org/wiki/Visual_ethnography
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Images can be the central part of analysis of social-cultural views and perceptions created by researchers, and/or participants. According to Van Maanen in using visual ethnography as a qualitative research methodology, “the researcher studies an entire cultural or social group on its natural setting, closely examining customs and ways of life, with the aim of describing and interpreting cultural patterns of behaviour, values, and practices". == References ==
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https://en.wikipedia.org/wiki/Visual_ethnography
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The Nomina Anatomica Veterinaria (often abbreviated as NAV) is an standardized nomenclature. It is made by World Association of Veterinary Anatomists (WAVA). It is used as the standard reference for anatomical (zootomical) terminology in the field of Veterinary Science regarding domestic mammals (domestic birds are regarded in the Nomina Anatomica Avium). It is based in cats, dogs, pigs, cows, sheep, goats, rabbits and horses, being horses their main subjects.
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https://en.wikipedia.org/wiki/Nomina_Anatomica_Veterinaria
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Veterinary anatomists split at the 5th International Congress of the International Anatomical Nomenclature Committee in Paris in 1955, due disagreements about the Nomina Anatomica. Following professor Clement Bressou in 1957 in Freiburg (Germany), they form the International Committee on Veterinary Anatomical Nomenclature, renamed World Association of Veterinary Anatomists in 1961, and they published the first edition of the Nomina Anatomica Veterinaria (NAV) in 1968. There have been sixth editions of the NAV, last one in 2017. The 4th edition, published in 1994, was the last commercially printed edition, fifth and sixth edition are available in pdf.
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https://en.wikipedia.org/wiki/Nomina_Anatomica_Veterinaria
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Filipino psychology, or Sikolohiyang Pilipino, in Filipino, is defined as the philosophical school and psychology rooted on the experience, ideas, and cultural orientation of the Filipinos. It was formalized in 1975 by the Pambansang Samahan sa Sikolohiyang Pilipino (National Association for Filipino Psychology) under the leadership of Virgilio Enriquez, who is regarded by many as the father of Filipino Psychology. Sikolohiyang Pilipino movement is a movement that created to address the colonial background in psychology in the country.
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https://en.wikipedia.org/wiki/Filipino_psychology
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It focuses on various themes such as identity and national consciousness, social awareness, and involvement, and it uses indigenous psychology to apply to various fields such as religion, mass media, and health. The movement has three main areas of protest. First, it is against a psychology that promotes the colonial mentality, and decolonizes the Filipino mind.
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Second, it is against the imposition of a psychology that is more appropriate to industrialized countries. Finally, the movement is also against the exploitation of the masses through the use of psychology. Sikolohiyang Pilipino is built on the idea that psychological knowledge can be derived from the culture.
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https://en.wikipedia.org/wiki/Filipino_psychology
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It also believes that foreign theories should not be completely abandoned. According to Luis Enriquez, Sikolohiyang Pilipino does not advocate for the removal of foreign ideas from the field of psychology. In 1978, Enriquez proposed two processes that can be used to indigenize knowledge: indigenization from within and indigenization from without.
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https://en.wikipedia.org/wiki/Filipino_psychology
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Indigenization from without involves searching for local equivalents for commonly used psychological concepts. Indigenization from within is a process in which the knowledge and methods related to psychology are derived from the local culture. In the Philippines, Sikolohiyang Pilipino has been working on the concept of cultural revalidation. The process formalizes the knowledge base and the local culture as its source.
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https://en.wikipedia.org/wiki/Filipino_psychology
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Filipino Psychology emerged and grew as part of the nationalist indigenization movement in the Philippines that was formalized in 1975. The roots of Filipino Psychology can be traced back to the introduction of the American education system in the Philippines. Agustin Alonzo was among the first Filipino psychologists to return from their education in America (in 1925) to teach at the College of Education in the University of the Philippines. This team brought with them psychological knowledge rooted in the American tradition of psychology.
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Western psychology is taught in schools as universal and scientific despite being generally considered by some as insensitive and inappropriate to Philippine culture. This hegemony of Western American Psychology is referred to as Colonial Psychology. During the 1960s, many Filipino intellectuals and scholars were already aware of the limitations and incompatibility of Western Psychology; western-oriented approaches in research in particular, had led scholars to paint the Filipino through the "judgmental and impressionistic views of the colonizers."
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It is with the use of American categories and standards that "the native Filipino invariably suffers from the comparison in not too subtle attempts to put forward Western behavior patterns as models for the Filipino." Early efforts to correct the traditional way of teaching and studying psychology in the 1960s include the translation of foreign materials and the use of the Filipino language as a mode of instruction, however, these efforts fail to address the problems brought about by colonial psychology as these efforts were sparse and not collaborated upon by psychologists. It was only in the 1970s that a concerted effort to address colonial psychology in the form of Filipino Psychology took place.
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Filipino Psychology, along with advances in Filipinology and similarly History's Pantayong Pananaw, was led by Virgilio Enriquez, Prospero Covar, and Zeus A. Salazar in the indigenization movement of their respective fields. Enriquez returned from his studies to the Philippines in 1971, and established the Philippine Psychology Research House (now Philippine Psychology Research and Training House, PPRTH). In 1975, the very first annual national conference on Filipino Psychology was held by the Pambansang Samahan sa Sikolohiyang Pilipino (PSSP) marking the formalization of Filipino Psychology.
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https://en.wikipedia.org/wiki/Filipino_psychology
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Filipino Psychology is described as largely postcolonial and as a liberation psychology. There are even some who had even argued that it is a local variant of Critical Psychology since it served as an emancipatory social science since it aims to decolonize academic neocolonialism. Filipino psychology is usually thought of as a branch of Asian psychology, the placement, determined primarily on culture. However, there is an ongoing debate on the make-up of Philippine culture, because this will generally determine whether Philippine Psychology is to be placed under the realms of either Asian psychology or Eastern psychology.
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https://en.wikipedia.org/wiki/Filipino_psychology
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In 1985, historian Zeus A.Salazar identified four different traditions upon which Philippine psychology can be traced: Academic Scientific Psychology or Akademiko-siyentipikal na Sikolohiya: This follows the American-oriented psychological tradition that can be traced back to Wilhelm Wundt in 1876. It was introduced in the Philippines through formal American education system in universities. Academic Philosophic Psychology or Akademiko-pilosopiya na Sikolohiya: This was started by priest-professors at the University of Santo Tomas during the 17th century Spanish era.
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This tradition originally came from the writings of the preachers and monks in philosophy and "pre-scientific" Spanish elites and would later join with the American-oriented scientific psychology. Ethnic Psychology or Taal na Sikolohiya: this is the Philippine indigenous psychology in the sense that this includes the frame of psychological reasoning, enculturation practices, beliefs, and proto-clinical practices that can be culled from language, literature, myths, legends, etc. This also includes psychological systems worked out by Filipinos with Filipino indigenous elements as basis (e.g. Hermano Pule, Rizal, Isabelo de los Reyes, Kalaw, etc.) and Sikolohiya ng mga Pilipino (Psychology of the Filipino) as formulated by Virgilio Enriquez. Psycho-medical Systems or Siko-medikal na mga Sistema: A psychological tradition that is closely related to ethnic psychology.
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The psycho-medical tradition that has religion as the basis and explanation. This includes the faith healing practices of the babaylan and the katalonan. According to Salazar, he believes that "no real healing could take place if there were no common ideology or frame of reference… understood and accepted by both healer and patient."
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Kapwa is the core construct of Filipino Psychology. Kapwa has two categories, Ibang Tao and Hindi Ibang Tao. Ibang Tao ("outsider") There are five interaction levels under this category: Pakikitungo: civility – right behavior meant right demeanor towards authorities (Parents, Elders, etc.). Pakikisalamuha: act of mixing – This is a social value that is primarily communitarian.
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It espouses the ability to adapt. Pakikilahok: act of joining – This translates to participation of the entire community to help a person. Pakikibagay: conformity – This runs into conflict with individuality which many Filipinos in fact willingly throw away in favor of conformity with demands of those who are in charge. Pakikisama: being united with the group. Hindi Ibang Tao ("one-of-us") There are three interaction levels under this category: Pakikipagpalagayang-loob: it is the act of mutual trust Pakikisangkot: act of joining others Pakikipagkaisa: being one with others
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Pakiramdam: Shared inner perceptions. Filipinos use damdam, or the inner perception of others' emotions, as a basic tool to guide their dealings with other people.
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Kagandahang-Loob: Shared humanity. This refers to being able to help other people in dire need due to a perception of being together as a part of one Filipino humanity.
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Hiya: Loosely translated as 'shyness' by most Western psychologists, Hiya is actually 'sense of propriety'. Utang na loob: Norm of reciprocity. Filipinos are expected by their neighbors to return favors—whether these were asked for or not—when it is needed or wanted. Pakikisama and Pakikipagkapwa: Smooth Interpersonal Relationship, or SIR, as coined by Lynch (1961 and 1973). This attitude is primarily guided by conformity with the majority.
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https://en.wikipedia.org/wiki/Filipino_psychology
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Bahala na: it is translated as "determination in the face of uncertainty" and is used as an expression, almost universally, in Filipino culture. American psychologist Bostrom describes that Filipinos engage in the bahala na attitude equivalent to American fatalism and escapism. Contrary to the connotation of passive fatalism and escapism suggested by Bostrom, "bahala na" would be a confrontative attitutde. It is risk-taking in the face of the proverbial cloud of uncertainty, and the possibility of failure.
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It is also about an indication of an acceptance of the nature of things, including the inherent limitations of one's self. Lakas ng loob: This attitude is characterized by being courageous in the midst of problems and uncertainties. Pakikibaka: Literally in English, it means concurrent clashes. It refers to the ability of the Filipino to undertake revolutions and uprisings against a common enemy.
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Karangalan: Loosely translated to dignity, this actually refers to what other people see in a person and how they use that information to make a stand or judge about his/her worth. Puri: the external aspect of dignity. May refer to how other people judge a person of his/her worth. This compels a common Filipino to conform to social norms, regardless how obsolete they are.
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https://en.wikipedia.org/wiki/Filipino_psychology
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Dangal: the internal aspect of dignity. May refer to how a person judges his own worth.
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https://en.wikipedia.org/wiki/Filipino_psychology
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Katarungan: Loosely translated to justice, this actually refers to equity in giving rewards to a person. Kalayaan: Freedom and mobility. Ironically, this may clash with the less important value of pakikisama or pakikibagay (conformity).
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https://en.wikipedia.org/wiki/Filipino_psychology
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Approaches, or lapit, and methods, or pamamaraan, in Filipino Psychology are different from that of Western Psychology. In Filipino Psychology, the subjects, or participants, called kalahok, are considered as equal in status to the researcher. The participants are included in the research as a group, and not as individuals – hence, an umpukan, or natural cluster, is required to serve as the participants, per se. The researcher is introduced to a natural cluster by a tulay (bridge), who is a part of the umpukan and is a well-respected man in the community.
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https://en.wikipedia.org/wiki/Filipino_psychology
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Some of the approaches and methods used in Filipino Psychology are: Pakikipagkuwentuhan: In this method, the researcher engages in a story-telling with an umpukan. The researcher merely serves as the facilitator, while the kalahok or participants are the one who are to talk. The term kwento, from the Spanish word cuento, literally means 'to tell a story'.
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https://en.wikipedia.org/wiki/Filipino_psychology
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Panunuluyan: In this method, the researcher stays in the home of his kalahok or participant while he conducts the research with consent by the host family, whose head serves as the tulay to an umpukan. The term tuloy, which is the root word of the term panunuluyan, literally means 'to go in'. Pagdadalaw-dalaw: In this method, the researcher occasionally visits the house of his host or tulay, as opposed to staying in the house.
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https://en.wikipedia.org/wiki/Filipino_psychology
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The term dalaw literally means 'visit'. Pagtatanung-tanong: In this method, the researcher undergoes a kind of questioning session with his kalahok or participants.
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https://en.wikipedia.org/wiki/Filipino_psychology
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In this method, however, 'lead questions' (those questions which directly refer to the topic being studied) are not supposed to be asked, instead the questions to be asked are supposed to have been derived from the kalahok's answers themselves. The word tanong literally means 'question'. Pakikiramdam: In this approach, the researcher uses entirely his/her own feelings or emotions to justify if his participants or kalahok are ready to be part of his research or not. The term damdam literally means 'inner perception of emotions'.
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https://en.wikipedia.org/wiki/Filipino_psychology
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Filipino psychopathology, or sikopatolohiya in Filipino, from Spanish psicopatologia, is the study of abnormal psychology in the Filipino context. Several mental disorders have been identified that culture-bound syndromes, and can therefore be found only in the Philippines or in other societies with which Filipinos share cultural connections. Examples of such are: Amok: Malayan mood disorder, more aptly called "Austronesian Mood Disorder", in which a person suddenly loses control of himself and goes into a killing frenzy, after which he/she hallucinates and falls into a trance. After he/she wakes up, he has absolutely no memory of the event.
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https://en.wikipedia.org/wiki/Filipino_psychology
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Bangungot: A relatively common occurrence in which a person suddenly loses control of his respiration and digestion, and falls into a coma and ultimately to death. The person is believed to dream of falling into a deep abyss at the onset of his death. This syndrome has been repeatedly linked to Thailand's Brugada syndrome and to the ingestion of rice. However, no such medical ties have been proven.
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https://en.wikipedia.org/wiki/Filipino_psychology
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Filipino psychopathology also refers to the different manifestations of mental disorders in Filipino people. One example of such is the manifestation of depression and schizophrenia in Filipinos, which are, for the most part, less violent.
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https://en.wikipedia.org/wiki/Filipino_psychology
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Pambansang Samahan sa Sikolohiyang Pilipino (National Society for Filipino Psychology) Bukluran sa Sikolohiyang Pilipino (Union of Filipino Psychology) TATSULOK – Alyansa ng mga Mag-aaral sa Sikolohiyang Pilipino (TATSULOK – Alliance of Students of Filipino Psychology)
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https://en.wikipedia.org/wiki/Filipino_psychology
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Alcatraz Morgue is the morgue on Alcatraz Island, off the coast of San Francisco, California, United States. It is located on the northwestern side of the island towards the centre, halfway between the Alcatraz Water Tower and the Dining Hall, below the side of the Recreation Yard.
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https://en.wikipedia.org/wiki/Alcatraz_Morgue
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The morgue was built in 1910 by the U.S. military on a site which was formerly the entrance to a tunnel which was used by soldiers from the 1870s to cross to the opposite side of the island. It is described as "one of the simplest expressions of the mission revival style on Alcatraz."
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https://en.wikipedia.org/wiki/Alcatraz_Morgue
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The morgue was built with three vaults and an examination table, with a steel door and a grated skylight. The double-door is a mint green color and is padlocked. The examination table is now covered with moss and in poor condition.
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The morgue was only documented to have been used once when a deceased prisoner was stored in it overnight, having missed the last boat run to the mainland of the day. The examination table was never used to conduct an autopsy.During its use by the U.S. Army, deceased officers were originally taken to Angel Island and military cemetery on Angel Island, but after its closure in the early 1900s, officers would then be taken to the San Francisco National Cemetery in the Presidio of San Francisco. During Alcatraz's use as a Federal penitentiary from 1934 to 1963, deceased inmates were taken to the San Francisco County Coroner on the mainland.
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https://en.wikipedia.org/wiki/Alcatraz_Morgue
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Intravenous therapy (abbreviated as IV therapy and known informally as the drip) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrients for those who cannot, or will not—due to reduced mental states or otherwise—consume food or water by mouth. It may also be used to administer medications or other medical therapy such as blood products or electrolytes to correct electrolyte imbalances. Attempts at providing intravenous therapy have been recorded as early as the 1400s, but the practice did not become widespread until the 1900s after the development of techniques for safe, effective use.
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The intravenous route is the fastest way to deliver medications and fluid replacement throughout the body as they are introduced directly into the circulatory system and thus quickly distributed. For this reason, the intravenous route of administration is also used for the consumption of some recreational drugs.
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Many therapies are administered as a "bolus" or one-time dose, but they may also be administered as an extended infusion or drip. The act of administering a therapy intravenously, or placing an intravenous line ("IV line") for later use, is a procedure which should only be performed by a skilled professional. The most basic intravenous access consists of a needle piercing the skin and entering a vein which is connected to a syringe or to external tubing.
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This is used to administer the desired therapy. In cases where a patient is likely to receive many such interventions in a short period (with consequent risk of trauma to the vein), normal practice is to insert a cannula which leaves one end in the vein, and subsequent therapies can be administered easily through tubing at the other end. In some cases, multiple medications or therapies are administered through the same IV line.
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IV lines are classified as "central lines" if they end in a large vein close to the heart, or as "peripheral lines" if their output is to a small vein in the periphery, such as the arm. An IV line can be threaded through a peripheral vein to end near the heart, which is termed a "peripherally inserted central catheter" or PICC line. If a person is likely to need long-term intravenous therapy, a medical port may be implanted to enable easier repeated access to the vein without having to pierce the vein repeatedly.
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A catheter can also be inserted into a central vein through the chest, which is known as a tunneled line. The specific type of catheter used and site of insertion are affected by the desired substance to be administered and the health of the veins in the desired site of insertion. Placement of an IV line may cause pain, as it necessarily involves piercing the skin.
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Infections and inflammation (termed phlebitis) are also both common side effects of an IV line. Phlebitis may be more likely if the same vein is used repeatedly for intravenous access, and can eventually develop into a hard cord which is unsuitable for IV access. The unintentional administration of a therapy outside a vein, termed extravasation or infiltration, may cause other side effects.
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Intravenous (IV) access is used to administer medications and fluid replacement which must be distributed throughout the body, especially when rapid distribution is desired. Another use of IV administration is the avoidance of first-pass metabolism in the liver. Substances that may be infused intravenously include volume expanders, blood-based products, blood substitutes, medications and nutrition.
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Fluids may be administered as part of "volume expansion", or fluid replacement, through the intravenous route. Volume expansion consists of the administration of fluid-based solutions or suspensions designed to target specific areas of the body which need more water. There are two main types of volume expander: crystalloids and colloids. Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules.
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Colloids contain larger insoluble molecules, such as gelatin. Blood itself is considered a colloid.The most commonly used crystalloid fluid is normal saline, a solution of sodium chloride at 0.9% concentration, which is isotonic with blood. Lactated Ringer's (also known as Ringer's lactate) and the closely related Ringer's acetate, are mildly hypotonic solutions often used in those who have significant burns.
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Colloids preserve a high colloid osmotic pressure in the blood, while, on the other hand, this parameter is decreased by crystalloids due to hemodilution. Crystalloids generally are much cheaper than colloids.Buffer solutions which are used to correct acidosis or alkalosis are also administered through intravenous access. Lactated Ringer's solution used as a fluid expander or base solution to which medications are added also has some buffering effect. Another solution administered intravenously as a buffering solution is sodium bicarbonate.
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Medications may be mixed into the fluids mentioned above, commonly normal saline, or dextrose solutions. Compared with other routes of administration, such as oral medications, the IV route is the fastest way to deliver fluids and medications throughout the body. For this reason, the IV route is commonly preferred in emergency situations or when a fast onset of action is desirable.
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In extremely high blood pressure (termed a hypertensive emergency), IV antihypertensives may be given to quickly decrease the blood pressure in a controlled manner to prevent organ damage. In atrial fibrillation, IV amiodarone may be administered to attempt to restore normal heart rhythm. IV medications can also be used for chronic health conditions such as cancer, for which chemotherapy drugs are commonly administered intravenously.
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In some cases, such as with vancomycin, a loading or bolus dose of medicine is given before beginning a dosing regimen to more quickly increase the concentration of medication in the blood.The bioavailability of an IV medication is by definition 100%, unlike oral administration where medication may not be fully absorbed, or may be metabolized prior to entering the bloodstream. For some medications, there is virtually zero oral bioavailability. For this reason certain types of medications can only be given intravenously, as there is insufficient uptake by other routes of administration, such is the case of severe dehydration where the patient is required to be treated via IV therapy for a quick recovery.
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The unpredictability of oral bioavailability in different people is also a reason for a medication to be administered IV, as with furosemide. Oral medications also may be less desirable if a person is nauseous or vomiting, or has severe diarrhea, as these may prevent the medicine from being fully absorbed from the gastrointestinal tract. In these cases, a medication may be given IV only until the patient can tolerate an oral form of the medication.
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The switch from IV to oral administration is usually performed as soon as viable, as there is generally cost and time savings over IV administration. Whether a medication can be potentially switched to an oral form is sometimes considered when choosing appropriate antibiotic therapy for use in a hospital setting, as a person is unlikely to be discharged if they still require IV therapy.Some medications, such as aprepitant, are chemically modified to be better suited for IV administration, forming a prodrug such as fosaprepitant. This can be for pharmacokinetic reasons or to delay the effect of the drug until it can be metabolized into the active form.
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A blood product (or blood-based product) is any component of blood which is collected from a donor for use in a blood transfusion. Blood transfusions can be used in massive blood loss due to trauma, or can be used to replace blood lost during surgery. Blood transfusions may also be used to treat a severe anaemia or thrombocytopenia caused by a blood disease. Early blood transfusions consisted of whole blood, but modern medical practice commonly uses only components of the blood, such as packed red blood cells, fresh frozen plasma or cryoprecipitate.
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Parenteral nutrition is the act of providing required nutrients to a person through an intravenous line. This is used in people who are unable to get nutrients normally, by eating and digesting food. A person receiving parenteral nutrition will be given an intravenous solution which may contain salts, dextrose, amino acids, lipids and vitamins. The exact formulation of a parenteral nutrition used will depend on the specific nutritional needs of the person it is being given to. If a person is only receiving nutrition intravenously, it is called total parenteral nutrition (TPN), whereas if a person is only receiving some of their nutrition intravenously it is called partial parenteral nutrition (or supplemental parenteral nutrition).
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Medical imaging relies on being able to clearly distinguish internal parts of the body from each other. One way this is accomplished is through the administration of a contrast agent into a vein. The specific imaging technique being employed will determine the characteristics of an appropriate contrast agent to increase visibility of blood vessels or other features. Common contrast agents are administered into a peripheral vein from which they are distributed throughout the circulation to the imaging site.
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IV rehydration was formerly a common technique for athletes. The World Anti-Doping Agency prohibits intravenous injection of more than 100mL per 12 hours, except under a medical exemption. The United States Anti-Doping Agency notes that, as well as the dangers inherent in IV therapy, "IVs can be used to change blood test results (such as hematocrit where EPO or blood doping is being used), mask urine test results (by dilution) or by administering prohibited substances in a way that will more quickly be cleared from the body in order to beat an anti-doping test". Players suspended after attending "boutique IV clinics" which offer this sort of treatment include footballer Samir Nasri in 2017 and swimmer Ryan Lochte in 2018.
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In the 1960s, John Myers developed the "Myers' cocktail", a non-prescription IV solution of vitamins and minerals marketed as a hangover cure and general wellness remedy. The first "boutique IV" clinic, offering similar treatments, opened in Tokyo in 2008. These clinics, whose target market was described by Elle as "health nuts who moonlight as heavy drinkers", have been publicized in the 2010s by glamorous celebrity customers. Intravenous therapy is also used in people with acute ethanol toxicity to correct electrolyte and vitamin deficiencies which arise from alcohol consumption.
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In some countries, non-prescription intravenous glucose is used to improve a person's energy, but is not a part of routine medical care in countries such as the United States where glucose solutions are prescription drugs. Improperly administered intravenous glucose (called "ringer"), such as that which is administered clandestinely in store-front clinics, poses increased risks due to improper technique and oversight. Intravenous access is also sometimes used outside of a medical setting for the self-administration of recreational drugs, such as heroin and fentanyl, cocaine, methamphetamine, DMT, and others.Intravenous therapy is also used for veterinary patient management.
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Some medications can be administered as a bolus dose, which is called an "IV push". A syringe containing the medication is connected to an access port in the primary tubing and the medication is administered through the port. A bolus may be administered rapidly (with a fast depression of the syringe plunger) or may be administered slowly, over the course of a few minutes. The exact administration technique depends on the medication and other factors.
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In some cases, a bolus of plain IV solution (i.e. without medication added) is administered immediately after the bolus to further force the medicine into the bloodstream. This procedure is termed an "IV flush". Certain medications, such as potassium, are not able to be administered by IV push due to the extremely rapid onset of action and high level of effects.
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An infusion of medication may be used when it is desirable to have a constant blood concentration of a medication over time, such as with some antibiotics including beta-lactams. Continuous infusions, where the next infusion is begun immediately following the completion of the prior, may also be used to limit variation in drug concentration in the blood (i.e. between the peak drug levels and the trough drug levels). They may also be used instead of intermittent bolus injections for the same reason, such as with furosemide.
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Infusions can also be intermittent, in which case the medication is administered over a period of time, then stopped, and this is later repeated. Intermittent infusion may be used when there are concerns about the stability of medicine in solution for long periods of time (as is common with continuous infusions), or to enable the administration of medicines which would be incompatible if administered at the same time in the same IV line, for example vancomycin.Failure to properly calculate and administer an infusion can result in adverse effects, termed infusion reactions. For this reason, many medications have a maximum recommended infusion rate, such as vancomycin and many monoclonal antibodies. These infusion reactions can be severe, such as in the case of vancomycin, where the reaction is termed "red man syndrome".
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Any additional medication to be administered intravenously at the same time as an infusion may be connected to the primary tubing; this is termed a secondary IV, or IV piggyback. This prevents the need for multiple IV access lines on the same person. When administering a secondary IV medication, the primary bag is held lower than the secondary bag so that the secondary medication can flow into the primary tubing, rather than fluid from the primary bag flowing into the secondary tubing. The fluid from the primary bag is needed to help flush any remaining medication from the secondary IV from the tubing.
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If a bolus or secondary infusion is intended for administration in the same line as a primary infusion, the molecular compatibility of the solutions must be considered. Secondary compatibility is generally referred to as "y-site compatibility", named after the shape of the tubing which has a port for bolus administration. Incompatibility of two fluids or medications can arise due to issues of molecular stability, changes in solubility, or degradation of one of the medications.
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The simplest form of intravenous access is by passing a hollow needle through the skin directly into a vein. A syringe can be connected directly to this needle, which allows for a "bolus" dose to be administered. Alternatively, the needle may be placed and then connected to a length of tubing, allowing for an infusion to be administered. : 344–348 The type and location of venous access (i.e. a central line versus peripheral line, and in which vein the line is placed) can be affected by the potential for some medications to cause peripheral vasoconstriction, which limits circulation to peripheral veins.A peripheral cannula is the most common intravenous access method utilized in hospitals, pre-hospital care, and outpatient medicine.
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This may be placed in the arm, commonly either the wrist or the median cubital vein at the elbow. A tourniquet may be used to restrict the venous drainage of the limb and make the vein bulge, making it easier to locate and place a line in a vein. When used, a tourniquet should be removed before injecting medication to prevent extravasation.
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The part of the catheter that remains outside the skin is called the connecting hub; it can be connected to a syringe or an intravenous infusion line, or capped with a heplock or saline lock, a needleless connection filled with a small amount of heparin or saline solution to prevent clotting, between uses of the catheter. Ported cannulae have an injection port on the top that is often used to administer medicine. : 349–354 The thickness and size of needles and catheters can be given in Birmingham gauge or French gauge.
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A Birmingham gauge of 14 is a very large cannula (used in resuscitation settings) and 24-26 is the smallest. The most common sizes are 16-gauge (midsize line used for blood donation and transfusion), 18- and 20-gauge (all-purpose line for infusions and blood draws), and 22-gauge (all-purpose pediatric line).
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12- and 14-gauge peripheral lines are capable of delivering large volumes of fluid very fast, accounting for their popularity in emergency medicine. These lines are frequently called "large bores" or "trauma lines". : 188–191, 349
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A peripheral intravenous line is inserted in peripheral veins, such as the veins in the arms, hands, legs and feet. Medication administered in this way travels through the veins to the heart, from where it is distributed to the rest of the body through the circulatory system. The size of the peripheral vein limits the amount and rate of medication which can be administered safely. A peripheral line consists of a short catheter inserted through the skin into a peripheral vein.
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This is usually in the form of a cannula-over-needle device, in which a flexible plastic cannula comes mounted over a metal trocar. Once the tip of the needle and cannula are placed, the cannula is advanced inside the vein over the trocar to the appropriate position and secured.
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The trocar is then withdrawn and discarded. Blood samples may also be drawn from the line directly after the initial IV cannula insertion. : 344–348
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A central line is an access method in which a catheter empties into a larger, more central vein (a vein within the torso), usually the superior vena cava, inferior vena cava or the right atrium of the heart. There are several types of central IV access, categorized based on the route the catheter takes from the outside of the body to the central vein output. : 17–22
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A peripherally inserted central catheter (also called a PICC line) is a type of central IV access which consists of a cannula inserted through a sheath into a peripheral vein and then carefully fed towards the heart, terminating at the superior vena cava or the right atrium. These lines are usually placed in peripheral veins in the arm, and may be placed using the Seldinger technique under ultrasound guidance. An X-ray is used to verify that the end of the cannula is in the right place if fluoroscopy was not used during the insertion. An EKG can also be used in some cases to determine if the end of the cannula is in the correct location. : Ch.1, 5, 6
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A tunneled line is a type of central access which is inserted under the skin, and then travels a significant distance through surrounding tissue before reaching and penetrating the central vein. Using a tunneled line reduces the risk of infection as compared to other forms of access, as bacteria from the skin surface are not able to travel directly into the vein. These catheters are often made of materials that resist infection and clotting. Types of tunneled central lines include the Hickman line or Broviac catheter. A tunnelled line is an option for long term venous access necessary for hemodialysis in people with poor kidney function.
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An implanted port is a central line that does not have an external connector protruding from the skin for administration of medication. Instead, a port consists of a small reservoir covered with silicone rubber which is implanted under the skin, which then covers the reservoir. Medication is administered by injecting medication through the skin and the silicone port cover into the reservoir.
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When the needle is withdrawn, the reservoir cover reseals itself. A port cover is designed to function for hundreds of needle sticks during its lifetime. Ports may be placed in an arm or in the chest area.
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Equipment used to place and administer an IV line for infusion consists of a bag, usually hanging above the height of the person, and sterile tubing through which the medicine is administered. In a basic "gravity" IV, a bag is simply hung above the height of the person and the solution is pulled via gravity through a tube attached to a needle inserted into a vein. Without extra equipment, it is not possible to precisely control the rate of administration. For this reason, a setup may also incorporate a clamp to regulate flow.
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Some IV lines may be placed with "Y-sites", devices which enable a secondary solution to be administered through the same line (known as piggybacking). Some systems employ a drip chamber, which prevents air from entering the bloodstream (causing an air embolism), and allows visual estimation of flow rate of the solution. : 316–321, 344–348 Alternatively, an infusion pump allows precise control over the flow rate and total amount delivered.
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A pump is programmed based on the number and size of infusions being administered to ensure all medicine is fully administered without allowing the access line to run dry. Pumps are primarily utilized when a constant flow rate is important, or where changes in rate of administration would have consequences. : 316–321, 344–348
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To reduce pain associated with the procedure, medical staff may apply a topical local anaesthetic (such as EMLA or Ametop) to the skin of the chosen venipuncture area about 45 minutes beforehand. : 344–348 If the cannula is not inserted correctly, or the vein is particularly fragile and ruptures, blood may extravasate into the surrounding tissues; this situation is known as a blown vein or "tissuing". Using this cannula to administer medications causes extravasation of the drug, which can lead to edema, causing pain and tissue damage, and even necrosis depending on the medication.
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The person attempting to obtain the access must find a new access site proximal to the "blown" area to prevent extravasation of medications through the damaged vein. For this reason it is advisable to site the first cannula at the most distal appropriate vein. : 355–359
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Placement of an intravenous line inherently causes pain when the skin is broken and is considered medically invasive. For this reason, when other forms of administration may suffice, intravenous therapy is usually not preferred. This includes the treatment of mild or moderate dehydration with oral rehydration therapy which is an option, as opposed to parenteral rehydration through an IV line. Children in emergency departments being treated for dehydration have better outcomes with oral treatment than intravenous therapy due to the pain and complications of an intravenous line.
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Cold spray may decrease the pain of putting in an IV.Certain medications also have specific sensations of pain associated with their administration IV. This includes potassium, which when administered IV can cause a burning or painful sensation.
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The incidence of side effects specific to a medication can be affected by the type of access (peripheral versus central), the rate of administration, or the quantity of drug administered. When medications are administered too rapidly through an IV line, a set of vague symptoms such as redness or rash, fever, and others may occur; this is termed an "infusion reaction" and is prevented by decreasing the rate of administration of the medication. When vancomycin is involved, this is commonly termed "Red Man syndrome" after the rapid flushing which occurs after rapid administration.
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As placement of an intravenous line requires breaking the skin, there is a risk of infection. Skin-dwelling organisms such as coagulase-negative staphylococcus or Candida albicans may enter through the insertion site around the catheter, or bacteria may be accidentally introduced inside the catheter from contaminated equipment. Infection of an IV access site is usually local, causing easily visible swelling, redness, and fever. However, pathogens may also enter the bloodstream, causing sepsis, which can be sudden and life-threatening.
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A central IV line poses a higher risk of sepsis, as it can deliver bacteria directly into the central circulation. A line which has been in place for a longer period of time also increases the risk of infection. : 358, 373 Inflammation of the vein may also occur, called thrombophlebitis or simply phlebitis.
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