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plumber, painter, electrician, or other tradesperson for major or minor maintenance Being available twenty-four hours a day to respond to emergencies You can promote your business by preparing a simple brochure describing what you do and leaving copies with local doctors, senior citizen centers, day-care centers, social workers, hospital discharge administrators, councils on the aging, and home health agencies. You might also try to obtain publicity in your local newspaper by writing a press release about your new business and the need for elder care in the community. You will probably have to experiment with your fee schedule. Either work out a retainer fee for providing services needed on a regular basis (such as checking daily, cooking, cleaning, shopping) or charge on an hourly or per-visit basis. For more information about this profession, you might investigate the National Association of Professional Geriatric Care Managers. It was founded in 1983 and had more than fourteen hundred members by 2002. These range from corporations to small home-based businesses whose clients are relatives who live some distance from the elder needing care. Most home-care businesses are owned and operated by nurses, social workers, or individuals who have adapted their knowledge and experience to providing a service they believe seniors in the community need.

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It is evident that these spinoreticulothalamic pathways continue to evoke the psychic experience of pain even SPINAL CORD when the direct spinothalamic pathways have been interrupted However, it is the direct spinothalamic pathway, which projects to the ventroposterolateral Spinothalamic tract (VPL) nucleus of the thalamus and thence to discrete areas of the sensory cortex, that subserves the sensory- Figure 8-2 The main somatosensory pathways The spinothalamic tract (pain, thermal discriminative aspects of pain, ie, the processes that sense) and the posterior column lemniscal system (touch, pressure, joint position) are underlie the localization, quality, and possibly the in- shown Offshoots from the ascending anterolateral fasciculus (spinothalamic tract) to nuclei tensity of the noxious stimulus Also, the pathways in the medulla, pons, and mesencephalon and nuclear terminations of the tract are indicated.

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for visceral pain from the esophagus, stomach, small The cortical representation of sensation is shown grossly; it is shown more explicitly in Fig bowel, and proximal colon are carried largely in the 9-4 and discussed in Chap 9 vagus nerve and terminate in the nucleus of the solitary tract (nucleus tractus solitarius, NTS) before projecting to the ments below the lesion as noted earlier After a variable period of thalamus, as described below Other abdominal viscera still activate time, pain sensibility usually returns, probably being conducted by the NTS when the vagus is severed in animals, probably passing pathways that lie outside the anterolateral quadrants of the spinal through the splanchnic plexus cord and which gradually increase their capacity to conduct pain It should be emphasized that the foregoing data concerning impulses.

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One of these is a longitudinal polysynaptic bundle of the cells of termination of cutaneous nociceptive stimuli and the small myelinated bers in the center of the dorsal horn (the dorsal cells of origin of ascending spinal afferent pathways have all been intracornual tract); another consists of axons of lamina I cells that obtained from studies in animals (including monkeys) In humans, travel in the dorsal part of the lateral funiculus the cells of origin of the long (direct) spinothalamic tract bers have not been fully identi ed Information about this pathway in Thalamic Terminus of Pain Fibers humans has been derived from the study of postmortem material and from the examination of patients subjected to anterolateral corThe direct spinothalamic bers separate into two bundles as they dotomy for intractable pain What can be stated of clinical releapproach the thalamus.

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