More information at http://www.vohrawoundcare.com/education Vohra Wound Physicians: Healing Wounds, Saving Lives Understand Wound Care: Wound Measurement Demonstration Summary- This is a demonstration of a wound care physician exhibiting the correct measurement of a wound. Japa Volchok, DO explains how to accurately and consistently measure wounds. Volchok discusses the importance of proper measurement and documentation in the wound healing process. This demonstration is performed by a trained wound care physician for educational purposes only and should not be tried at home. Understand Wound Care: Wound Measurement Demonstration Commentary: Japa Volchok, DO In this demonstration we will be exhibiting the correct measurement of a wound. For wound measurement you will want to have a disposable paper or similar measuring device as well as a cotton-tipped applicator. The measuring device is either a paper or plastic disposable measuring tape. It is generally marked in centimeter markings with sub-markings in millimeters. A cotton-tipped applicator is useful for measuring depth and checking for any undermining. This model demonstrates a wound. By convention, the superior aspect of the wound would also usually coincide with the head. The inferior aspect would be the foot. We measure length from a head to foot direction. Width is measured from left to right or right to left. Depth is measured at the maximum location of depth in the wound. The left to right or right to left convention does not matter in terms of the documentation. It is important however, that length and width are correctly measured and documented. As the convention from head to feet for length and left to right for width are important in being able to reproduce measurements between measurers. In this particular instance, we would start off by measuring the wound in the length dimension. Where there is the maximum length of this wound of approximately 5.7 centimeters. The width would then be measured at its maximum point of width which is 2.5 centimeters. The depth we then would determine by probing the wound with our cotton-tipped applicator using the cotton end. We would probe all areas of the wound to determine where the most depth was located. It appears to be approximately in the middle of the wound. We would then slide our finger down the cotton-tipped applicator to where it is flush with the intact skin. Pinch the applicator at that point and withdraw from the wound. This can then be laid over your measuring device and the depth determined. In this particular instance, it appears to be 1.8 or 1.9 centimeters. Once the length, width and depth of the wound have been measured, it is important to then record any evidence of undermining and what the dimensions of that undermining are. In determining undermining, gently probe the wound with your cotton-tipped applicator circumferentially around the wound. You can see that over on this side of the wound we are starting to see some undermining. It appears at this location, the cotton-tipped applicator slips deeper under the wound then it does at any other point. This would be the maximum area of undermining. As you can see, by convention, the superior aspect of the wound or the head aspect of the wound would be 12 o'clock. If we then progress clockwise around a clock face, the area of maximum undermining is approximately 10 o'clock. Similar to how we measured the depth of the wound, you would want to slide your finger down the cotton-tipped applicator. Pinch it with your nail. Then, bring it up to your measuring device. In this particular instance, it appears that the undermining is approximately 1.7 centimeters. As you will recall from the last image, the undermining is located at 10 o'clock. This will be recorded as 1.7 centimeters of undermining at 10 o'clock. For more information visit http://www.woundphysicians.com or http://www.understandwoundcare.com
Views: 168901 Vohra Wound Care
Surgical Suturing Techniques Video As a method for closing cutaneous wounds, the technique of suturing is thousands of years old. Although suture materials and aspects of the technique have changed, the primary goals remain the same: Closing dead space Supporting and strengthening wounds until healing increases their tensile strength Approximating skin edges for an aesthetically pleasing and functional result Minimizing the risks of bleeding and infection The postoperative appearance of a beautifully designed closure or flap can be compromised if an incorrect suture technique is chosen or if the execution is poor. Conversely, meticulous suturing technique cannot fully compensate for improper surgical technique. Poor incision placement with respect to relaxed skin tension lines, excessive removal of tissue, or inadequate undermining may limit the surgeon’s options in wound closure and suture placement. Gentle handling of the tissue is also important to optimize wound healing. The choice of suture technique depends on the following: Type and anatomic location of the wound Thickness of the skin Degree of tension Desired cosmetic result Proper placement of sutures enhances the precise approximation of the wound edges, which helps minimize and redistribute skin tension. Wound eversion is essential to maximize the likelihood of good epidermal approximation. Eversion is desirable to minimize the risk of scar depression secondary to tissue contraction during healing. Usually, inversion is not desirable, and it probably does not decrease the risk of hypertrophic scarring in an individual with a propensity for hypertrophic scars. The elimination of dead space, the restoration of natural anatomic contours, and the minimization of suture marks are also important to optimize the cosmetic and functional results. In this article, the techniques of suture placement for various types of stitch are described, the rationale for choosing one suture technique over another is reviewed, and the advantages and disadvantages of each suture technique are discussed. Frequently, more than one suture technique is needed for optimal closure of a wound. After reading this article, the reader should have an understanding of how and why particular sutures are chosen and an appreciation of the basic methods of placing each type of suture.
Views: 1906 Think Bright
As a method for closing cutaneous wounds, the technique of suturing is thousands of years old. Although suture materials and aspects of the technique have changed, the primary goals remain the same: Closing dead space Supporting and strengthening wounds until healing increases their tensile strength Approximating skin edges for an aesthetically pleasing and functional result Minimizing the risks of bleeding and infection The postoperative appearance of a beautifully designed closure or flap can be compromised if an incorrect suture technique is chosen or if the execution is poor. Conversely, meticulous suturing technique cannot fully compensate for improper surgical technique. Poor incision placement with respect to relaxed skin tension lines, excessive removal of tissue, or inadequate undermining may limit the surgeon’s options in wound closure and suture placement. Gentle handling of the tissue is also important to optimize wound healing. The choice of suture technique depends on the following: Type and anatomic location of the wound Thickness of the skin Degree of tension Desired cosmetic result Proper placement of sutures enhances the precise approximation of the wound edges, which helps minimize and redistribute skin tension. Wound eversion is essential to maximize the likelihood of good epidermal approximation. Eversion is desirable to minimize the risk of scar depression secondary to tissue contraction during healing. Usually, inversion is not desirable, and it probably does not decrease the risk of hypertrophic scarring in an individual with a propensity for hypertrophic scars. The elimination of dead space, the restoration of natural anatomic contours, and the minimization of suture marks are also important to optimize the cosmetic and functional results. In this article, the techniques of suture placement for various types of stitch are described, the rationale for choosing one suture technique over another is reviewed, and the advantages and disadvantages of each suture technique are discussed. Frequently, more than one suture technique is needed for optimal closure of a wound. After reading this article, the reader should have an understanding of how and why particular sutures are chosen and an appreciation of the basic methods of placing each type of suture.[
Views: 2748 pghelper. org
The defect left in the patient's nose from the original Mohs surgery excision made in Part 1 is now repaired by Dr. Michael Trauner. This is the final part of the Mohs procedure to treat basal cell carcinoma. Be sure to see Parts 1 and 2 of Mohs surgery on nose: https://www.youtube.com/watch?v=LO_O9uF-AaU https://www.youtube.com/watch?v=6y5-qEHPJQM WE NEED AN ADDITIONAL PHYSICIAN ASSISTANT OR NURSE PRACTIONER FULL OR PART TIME, LICENSED IN CALIFORNIA. EMAIL YOUR RESUME TO [email protected] Click to follow me on Vid.me: https://vid.me/AuburnMedicalGroup Thank you to our patrons on Patreon at the $5 level and higher: BooBoo Kitty Lindsay Graff LeeAnn Vaughan Learn how to contribute and get rewards through Patreon: https://www.patreon.com/doctorvaughan New videos are posted on Friday. This video is not intended to diagnose or treat any condition. It is for educational purposes only. It is not a substitute for evaluation by your own doctor. Be sure to subscribe to the Auburn Medical Group YouTube Channel: http://www.youtube.com/c/auburnmedicalgroup?sub_confirmation=1 You can follow Dr. Mark Vaughan on Twitter and Instagram: @doctorvaughan. You can find the Auburn Medical Group on Facebook: https://www.facebook.com/Auburn-Medical-Group-Inc-102055798325/?fref=ts Please comment and ask questions. Share with your friends who would be interested in seeing this video. To help with correcting transcriptions/captions in any language go to: http://www.youtube.com/timedtext_cs_panel?tab=2&c=UCOShHskqTZNneTshYWV14wQ Go to http://www.auburnmedicalgroup.com to learn about primary medical care in Auburn, California. Mailing address: Auburn Medical Group YouTube Channel 3280 Professional Drive Auburn, CA 95602 All patients on our videos give written consent to post videos on YouTube of their office visit and for discussion of their medical condition voluntarily and without coercion. Music Credit: "Locally Sourced" by Jason Farnham (Royalty Free Music on YouTube).
Views: 5665 Auburn Medical Group
Scenes of Clerical Life by George ELIOT Scenes of Clerical Life, which appeared in book form in 1858 (after serial publication in the previous year), was the first published fiction by George Eliot, the pen name for Mary Anne Evans. It consists of three novellas based on the lives of country clergymen and their communities. These characters interest Eliot not for their theology — she had abandoned conventional Christian belief — but for their humanity. In these stories, we find the earliest signs of the narrative voice, the humanism, and the realism that would make George Eliot one of the greatest novelists of the 1800s. (Introduction by Bruce Pirie) Genre(s): General Fiction- Our Custom URL : https://www.youtube.com/c/AudiobookAudiobooks Subscribe To Our Channel: https://www.youtube.com/c/AudiobookAudiobooks?sub_confirmation=1 ----------------------------------------------------------------------------------------------------- Audio Book Audiobooks All Rights Reserved. This is a Librivox recording. All Librivox recordings are in the public domain. For more information or to volunteer visit librivox.org.
Views: 719 Audio book Audiobooks
The Lane Fleming collection of early pistols and revolvers was one of the best in the country. When Fleming was found dead on the floor of his locked gunroom, a Confederate-made Colt-type percussion .36 revolver in his hand, the coroner's verdict was "death by accident." But Gladys Fleming had her doubts. Enough at any rate to engage Colonel Jefferson Davis Rand—better known just as Jeff—private detective and a pistol-collector himself, to catalogue, appraise, and negotiate the sale of her late husband's collection. There were a number of people who had wanted the collection. The question was: had anyone wanted it badly enough to kill Fleming? And if so, how had he done it? Here is a mystery, told against the fascinating background of old guns and gun-collecting, which is rapid-fire without being hysterical, exciting without losing its contact with reason, and which introduces a personable and intelligent new private detective. It is a story that will keep your nerves on a hair trigger even if you don't know the difference between a cased pair of Paterson .34's and a Texas .40 with a ramming-lever. Intro - 00:00 Chapter 1 - 1:17 Chapter 2 - 16:15 Chapter 3 - 33:30 Chapter 4 - 49:34 Chapter 5 - 1:01:44 Chapter 6 - 1:20:09 Chapter 7 - 1:34:34 Chapter 8 - 1:52:22 Chapter 9 - 2:02:33 Chapter 10 - 2:32:51 Chapter 11 - 3:03:28 Chapter 12 - 3:24:13 Chapter 13 - 3:42:23 Chapter 14 - 4:00:16 Chapter 15 - 4:21:57 Chapter 16 - 4:40:03 Chapter 17 - 4:57:04 Chapter 18 - 5:21:42 Chapter 19 - 5:31:51 Chapter 20 - 5:56:35 Chapter 21 - 6:16:23
Views: 2292 Audiobooks Unleashed
Para ver versão em português: https://youtu.be/07j8BBpj3Ao (**English translation is a new translation, not simultaneous translation from the event.) Dilma Rousseff is an economist and politician who was the 36th President of Brazil from 2011 until 2016. She is the first woman to have held the Brazilian presidency. Previously she served as the Minister of Energy and then as Chief of Staff to President Luiz Inácio Lula da Silva, who held office from 2003-2010. Born in Belo Horizonte, Minas Gerais, she joined the underground movement against the Brazilian military dictatorship in 1965 as a high school student and participated in two resistance organizations until she was arrested in early 1970. Brutally tortured for ten days, she served a three-year term for violating the National Security Act. Released in 1972, she moved to Porto Alegre, in southern Brazil, to be near her husband who was still serving time for his oppositional activities. In Porto Alegre, she was involved in the founding of the Brazilian Democratic Labor Party and served as the Secretary of Energy for the state of Rio Grande do Sul under two administrations. In 2000, she joined the Workers’ Party. After the former trade-union leader Luiz Inácio Lula da Silva was elected President in 2002, Rousseff joined his cabinet as Ministry of Energy. Her “Light for Everyone” campaign expanded rural electrification to millions of households in the countryside. In 2005, she was appointed the President’s Chief of Staff and served in that role until being nominated as the Workers’ Party presidential candidate in 2010. She defeated her main rival, José Serra of the Brazilian Social Democracy Party, 56% to 44% in a second round run-off election. In 2014, she received 54 million votes against Brazilian Social Democracy Party candidate Aécio Neves winning the election by a closer 51% to 49% margin. During her second term in office she was faced many challenges in her initiatives to reorganize the Brazilian economy. In 2016 she was impeached by the National Congress for allegedly breaking a budgetary law, removed from the presidency, and replaced by Vice President Michel Temer in that office. Dilma Rousseff retains her political rights and is actively participating in debates about Brazil, both nationally and internationally. She currently lives in Porto Alegre in southern Brazil.
This is an audio version of the Wikipedia Article: Indira Gandhi 00:02:37 1 Early life and career 00:07:36 2 First term as Prime Minister between 1966 and 1977 00:08:16 2.1 First year 00:08:46 2.2 1967–1971 00:10:48 2.3 1971–1977 00:13:00 2.3.1 Verdict on electoral malpractice 00:15:34 2.3.2 State of Emergency (1975–1977) 00:16:16 2.3.3 Rule by decree 00:17:38 2.3.4 Rise of Sanjay 00:18:29 3 1977 election and opposition years 00:20:29 3.1 In opposition and return to power 00:23:01 4 1980 elections and third term 00:24:09 4.1 Operation Blue Star 00:26:57 4.2 Assassination 00:29:49 5 Foreign relations 00:30:05 5.1 South Asia 00:35:02 5.2 Middle East 00:38:14 5.3 Asia-Pacific 00:39:38 5.4 Africa 00:42:20 5.5 The Commonwealth 00:43:09 5.6 The Non-aligned Movement 00:44:00 5.7 Western Europe 00:44:32 5.8 Soviet Union 00:45:49 5.9 United States 00:46:50 6 Economic policy 00:50:54 6.1 Green Revolution and the Fourth Five-Year Plan 00:55:24 6.2 State of Emergency and the Fifth Five-Year Plan 00:56:58 6.3 Operation Forward and the Sixth Five-Year Plan 00:58:32 6.4 Inflation and unemployment 01:00:19 7 Domestic policy 01:00:28 7.1 Nationalisation 01:03:04 7.2 Administration 01:04:50 7.3 Social reform 01:08:04 7.4 Language policy 01:09:06 7.5 National security 01:11:04 7.6 Nuclear Program of India 01:12:58 8 Family, personal life and outlook 01:14:32 9 Views on women 01:19:38 10 Awards 01:20:10 11 Legacy 01:22:09 12 Posthumous honours 01:23:17 13 See also Listening is a more natural way of learning, when compared to reading. Written language only began at around 3200 BC, but spoken language has existed long ago. Learning by listening is a great way to: - increases imagination and understanding - improves your listening skills - improves your own spoken accent - learn while on the move - reduce eye strain Now learn the vast amount of general knowledge available on Wikipedia through audio (audio article). You could even learn subconsciously by playing the audio while you are sleeping! If you are planning to listen a lot, you could try using a bone conduction headphone, or a standard speaker instead of an earphone. You can find other Wikipedia audio articles too at: https://www.youtube.com/channel/UCuKfABj2eGyjH3ntPxp4YeQ You can upload your own Wikipedia articles through: https://github.com/nodef/wikipedia-tts "The only true wisdom is in knowing you know nothing." - Socrates SUMMARY ======= Indira Priyadarshini Gandhi (Hindustani: [ˈɪnːdɪrə ˈɡaːndʱi] (listen); née Nehru; November 19, 1917 – October 31, 1984), was an Indian politician, stateswoman and a central figure of the Indian National Congress. She was the first and, to date, the only female Prime Minister of India. Indira Gandhi was the daughter of Jawaharlal Nehru, the first prime minister of India. Despite her surname Gandhi, she is not related to the family of Mahatma Gandhi; Gandhi is a common surname in Gujarat. She served as Prime Minister from January 1966 to March 1977 and again from January 1980 until her assassination in October 1984, making her the second longest-serving Indian Prime Minister after her father.Gandhi served as her father's personal assistant and hostess during his tenure as Prime Minister between 1947 and 1964. She was elected President of the Indian National Congress in 1959. Upon her father's death in 1964 she was appointed as a member of the Rajya Sabha (upper house) and became a member of Lal Bahadur Shastri's cabinet as Minister of Information and Broadcasting. In the Congress Party's parliamentary leadership election held in early 1966 (upon the death of Shastri), she defeated her rival Morarji Desai, to become leader, and thus succeeded Shastri as Prime Minister of India. As Prime Minister, Gandhi was known for her political intransigency and unprecedented centralisation of power. She went to war with Pakistan in support of the independence movement and war of independence in East Pakistan, which resulted in an Indian victory and the creation of Bangladesh, as well as increasing India's influence to the point where it became the regional hegemon of South Asia. Citing fissiparous tendencies and in response to a call for revolution, Gandhi instituted a state of emergency from 1975 to 1977 where basic civil liberties were suspended and the press was censored. Widespread atrocities were carried out during the emergency. In 1980, she returned to power after free and fair elections. After Operation Blue Star, she was assassinated by her own bodyguards and Sikh nationalists on 31 October 1984. The assassins, Beant Singh and Satwant Singh, were both shot by other security guards. Satwant Singh recovered from his injuries and was executed after being convicted of murder. In 1999, Indira Gandhi was named "Woman of the Millennium" in an online poll organised by the BBC.
Views: 124 Subhajit Sahu
My advice is this: Settle! That's right. Don't worry about passion or intense connection. Don't nix a guy based on his annoying habit of yelling "Bravo!" in movie theaters. Overlook his halitosis or abysmal sense of aesthetics. Because if you want to have the infrastructure in place to have a family, settling is the way to go. Based on my observations, in fact, settling will probably make you happier in the long run, since many of those who marry with great expectations become more disillusioned with each passing year. (It's hard to maintain that level of zing when the conversation morphs into discussions about who's changing the diapers or balancing the checkbook.) Obviously, I wasn't always an advocate of settling. In fact, it took not settling to make me realize that settling is the better option, and even though settling is a rampant phenomenon, talking about it in a positive light makes people profoundly uncomfortable. Whenever I make the case for settling, people look at me with creased brows of disapproval or frowns of disappointment, the way a child might look at an older sibling who just informed her that Jerry's Kids aren't going to walk, even if you send them money. It's not only politically incorrect to get behind settling, it's downright un-American. Our culture tells us to keep our eyes on the prize (while our mothers, who know better, tell us not to be so picky), and the theme of holding out for true love (whatever that is—look at the divorce rate) permeates our collective mentality. Even situation comedies, starting in the 1970s with The Mary Tyler Moore Show and going all the way to Friends, feature endearing single women in the dating trenches, and there's supposed to be something romantic and even heroic about their search for true love. Of course, the crucial difference is that, whereas the earlier series begins after Mary has been jilted by her fiancé, the more modern-day Friends opens as Rachel Green leaves her nice-guy orthodontist fiancé at the altar simply because she isn't feeling it. But either way, in episode after episode, as both women continue to be unlucky in love, settling starts to look pretty darn appealing. Mary is supposed to be contentedly independent and fulfilled by her newsroom family, but in fact her life seems lonely. Are we to assume that at the end of the series, Mary, by then in her late 30s, found her soul mate after the lights in the newsroom went out and her work family was disbanded? If her experience was anything like mine or that of my single friends, it's unlikely. And while Rachel and her supposed soul mate, Ross, finally get together (for the umpteenth time) in the finale of Friends, do we feel confident that she'll be happier with Ross than she would have been had she settled down with Barry, the orthodontist, 10 years earlier? She and Ross have passion but have never had long-term stability, and the fireworks she experiences with him but not with Barry might actually turn out to be a liability, given how many times their relationship has already gone up in flames. It's equally questionable whether Sex and the City's Carrie Bradshaw, who cheated on her kindhearted and generous boyfriend, Aidan, only to end up with the more exciting but self-absorbed Mr. Big, will be better off in the framework of marriage and family. (Some time after the breakup, when Carrie ran into Aidan on the street, he was carrying his infant in a Baby Björn. Can anyone imagine Mr. Big walking around with a Björn?)
Views: 208459 Shari Wing