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But the lexis of the Germanic languages has been enriched with extensive loanwords from Latin order vardenafil 20mg line erectile dysfunction causes psychological, with an admixture from Greek generic 20 mg vardenafil amex erectile dysfunction uti, either directly transmitted or through the influence of French and English (Hawkins 1990: 75, Finegan 1990: 81, Kooij 1990: 140), thus creating a fairly remarkable split in the vocabulary of these languages between popular and learned words. Compared to Italian, the two Germanic languages clearly exploit their double-layered terminology: in German, for instance, almost every term of Latin or Greek origin has a synonym of vernacular origin (Puato 2011: 119), which is often built by substituting the erudite roots, prefixes and/or suffixes with their ‘inherited’ counterparts. In communicating with patients, the use of these ‘doublets’ can enhance comprehension and have an educational effect: “Die Arterien (Schlagadern) und Venen (Bluta- dern) […]”, “Faszien (Bindegewebshüllen)”, “Urethra (Harnröhre)” are just a few examples from the analyzed websites. The following sentence, for instance, avoids Urethra altogether and uses only Harnröhre: “Häufig kann das Prob- Gender Dysphoria 177 lem mit einem durch die Harnröhre geführten endoskopischen Eingriff beseitigt werden”. The following excerpt from a patient brochure on laparoscopic surgery contains very short sentences with simple syntax, word repetitions and explanations of terms in plain lan- guage. See for instance the explanation of the term hormones in this excerpt: (8) Behandeling met geslachtshormonen Hormonen zijn stoffen die op een bepaalde plaats in het lichaam worden gemaakt (de hormoonklier), aan het bloed worden afgegeven en elders in het lichaam hun effect uitoefenen. Zij worden zo genoemd, omdat zij in de geslachtsorganen worden gemaakt en verantwoordelijk zijn voor de ontwikkeling van het lichaam in mannelijke of vrouwelijke richting. Through one of these small incisions a laparoscope is introduced into the abdomen: this is a long, thin tube enabling the doctor to look into the abdomen. Hormones are substances produced in a particular place in the body (hormone gland), they are released into the blood and have an effect elsewhere in the 178 Mariella Magris / Dolores Ross There are only one Italian and one German website providing glossaries of key terms. These glossaries, however, do not cover all specialized terms contained in the texts, they force the reader to interrupt the reading process and definitely do not represent a reader- friendly alternative to lexical clarity of texts. We think that greater attention should be paid to terminological issues, as the terminology of this specific domain includes many neologisms and – as already seen – controversial terms. We have the impression that the authors of the site have made special efforts to guarantee proper communication, as this subject touches on quite delicate questions. The Italian texts are quite impersonal: they never directly address potential readers and refer to them in the third person as persona, soggetto and the like. In Germany and the Netherlands, no court judgment is needed: in Germany two psychological assessments are required, while in the Netherlands the decision is taken by the gender team, which includes physicians from different specialities as well as a psychiatrist. The absence of similar passages in the Dutch and German texts, therefore, might be due not only to differences in communicative style, but also (and perhaps more prominently) to the legal context of the surgical intervention. The next Italian example, on the contrary, is not related to any national specificity, as it points to the side effects, stressing that they can be minor, but also very serious and even life-threatening. Of course, it is fundamental to inform the reader about risks and compli- cations, but not necessarily in such a way as to discourage potential patients.

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In the late 19 century best 10mg vardenafil erectile dysfunction injection therapy, medically-based addiction treatment mostly involved trying to cure individuals of their addiction order vardenafil 10 mg otc erectile dysfunction treatments vacuum, often with the use 138 of other addictive substances. By 1910, private sanitariums in the United States offered specialized treatment for addicted individuals--but only for those who could afford the expense. Similar to today, many of the “treatment experts” opening facilities were savvy businessmen or enterprising physicians, including Harvey Kellogg (later of cereal fame) and Dr. Between 1892 and 139 1893, almost 15,000 people with addiction were treated at the famous, yet controversial Keeley Institutes. Keeley’s treatment for addiction involved bichloride of gold remedies, a substance purportedly containing gold that would cure addiction involving alcohol and opioids. Keeley in 1900, the popularity and ultimately, the existence of 140 his institutes waned. Although Keeley’s treatments were later discredited, his position that addiction was decidedly a disease rather than a religious or moral failing was ahead of its time. His use of “shot treatments” or hypodermic treatments that induced vomiting was a precursor to later aversion therapies and his introduction of clubs for addicted individuals to receive social support to maintain sobriety was a precursor to the mutual support programs that remain prominent today. His focus on helping people 141 quit smoking in the 1920s was prescient in its characterization of nicotine as a harmful and addicting drug. Addiction treatment tactics that are based more on the personal charisma of the founders, catchy phrases and simplistic approaches than on the science of what works in addiction continue to proliferate and show no sign of waning. A simple Google search produces an abundance of “rehabilitation” approaches and facilities with slogans such as: Learn how to heal 142 the underlying causes of dependency--and be free of addiction forever! A recent study examining treatments that a panel * of experts believes qualifies as quackery in addiction treatment found such treatments as electrical stimulation of the head, past-life therapy, electric shock therapy, psychedelic medication and neuro-linguistic programming to be “certainly 143 discredited. In the late 1930s and early 1940s, many hospitals would not admit patients for the treatment of addiction involving alcohol, 144 so lay approaches became an important option.

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The What makes the scientific method unique is that experimenter must record the raw data prior to any it does not accept an explanation as valid until it analysis and document any protocol deviations order vardenafil 20mg on-line erectile dysfunction caused by supplements, has been validated through testing discount vardenafil 20 mg mastercard latest advances in erectile dysfunction treatment. A random phenom- mental finding inconsistent with a theory suggests enon is one where the outcome cannot be predicted that a theory should be revised or rejected. Experimental outcomes contradicting the an identical effect in the same patient under identi- theoretical predictions would lead to a reassess- cal conditions on separate occasions. That In other words, a scientific theory is always tenta- is, one can assign numerical values describing the tive and entirely dependent on experimental likelihood, or probability, of the possible outcomes. Similarly, an True state Decision isolated successful drug treatment outcome does Accept hypothesis Reject hypothesis not prove that the drug is efficacious. This substitution raises a host of conceptual then the smaller the probability that the observed issues beyond the scope of this discussion, except to difference is random, the higher the probability say that this approach has its opponents and is not that rejecting the hypothesis of no efficacy is cor- accepted by all statisticians. Let us illustrate the statistical method with an The key difference between the statistical example: method and the scientific method is that statistic- A pharmaceutical company has developed an ally, no matter how unlikely a result may be, it is antihypertensive drug that is theorized to lower not impossible. Thus, the simple experiment described Seemingly, therefore, whether a drug is efficacious above cannot be used to disprove the hypothesis or not is a dichotomy. Since blood pressure is naturally variable, drug in lowering diastolic blood pressure, then how do we know whether the difference in blood lack of efficacy corresponds to E ˆ 0. Positive effi- pressure before and after treatment is due to the cacy corresponds to E > 0, which contains a con- drug or to the natural randomness of blood pres- tinuum of possibilities depending on the strength of sure? Thus, the hypothesis of no efficacy is variability of diastolic blood pressure; and (b) de- very specific in terms of the size of the effect and termine whether the change in blood pressure is is called a simple hypothesis, while a hypothesis likely to result from natural variability. In drug testing, is measured in all subjects before treatment and the statistical experiment is designed to reject the at some time point when the drug effect should null hypothesisÐthe hypothesis that there is no be measurable if the drug is efficacious. Because rejection of due to the drug and to measure their magnitude, the null hypothesis enables one to make the scien- and to determine adverse effects related to the tific claim that the study was performed to prove, drug. When the result of a test is declared significant, giving a particular drug at a particular dose) causes the only error that could occur is type I error.