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It also becomes attached to the skin order 20 mg apcalis sx with amex erectile dysfunction interesting facts, hair and eyes buy cheap apcalis sx on line erectile dysfunction neurological causes. Pollen allergy occurs where individuals react allergically to certain proteins found in some pollen types cheap 20mg apcalis sx with mastercard erectile dysfunction treatment time. Pollen allergies are usually treated either conservatively or with a variety of prescription medicines, depending on the severity of symptoms. Your veterinarian will need to conduct a thorough physical exam of your cat in order to accurately diagnose pollen allergies. Common signs that may indicate your cat is suffering from pollen allergies may include: Each case of pollen allergies will be unique and symptoms will vary in severity. Symptoms of Pollen Allergies in Cats. Some doctors use homeopathy or acupuncture to reduce hay fever symptoms. The treatment has been proven effective specifically for grass pollen allergies. Young people who do not react to many different allergens have the best chances of success. Immunotherapy for hay fever can be an option for patients with symptoms that are severe and have persisted for over two years. The goal of SIT is to allow the immune system to become used to the allergy-triggering pollen over time. One form of therapy that treats the cause of hay fever is allergen specific immunotherapy (SIT). Corticosteroid nasal sprays have an anti-inflammatory effect and can relieve symptoms such as runny or congested nose. The most important measure in treating an allergy is to avoid the allergen. Rhinitis caused by bacteria or viruses can also be mistaken for hay fever at first. As a first step in diagnosing hay fever, the doctor asks the patient about his or her symptoms. Birch pollen allergy is especially common. Trees: The pollen of early flowering species such as birch, hazel, alder and ash are particularly allergenic. In some people, it takes only a few pollen grains to trigger a severe allergic reaction. Around 12 million people in Germany suffer from hay fever (14.8 per cent). During pollen season, many people cannot work to their full capacity; they sleep poorly and are exhausted. Sneezing, runny nose and itchy eyes are not the only symptoms that patients suffer from. In this context, it would not make sense to refer to early summer hay fever (which it was originally called because it was assumed to be linked to hay and grass). If the climate is mild, the last grass or weed pollens can still be airborne in November, while the first hazel pollens appear as early as December. Hay fever can also cause shortness of breath, as mucus builds up in the lungs and the airway muscles flex, known as bronchospasm. Watery, itchy and red eyes are the norm for pollen allergy sufferers. Another cause: times of high stress often coincide with the different allergy seasons - and the convergence of the two would make anyone grouchy. Usually, an oral allergy medicine will control the allergic symptoms of the eye. If the nose is also itchy and runny, your child probably has hay fever. Pet allergens are in the air. Most eye allergies continue through the pollen season. Most allergens float in the air. An allergic reaction of the eyes, usually from pollen. You can buy a pollen filter for the air vents in your car, which will need to be changed every time the car is serviced. Avoid cutting grass, playing or walking in grassy areas and camping - particularly in the early morning, evening and at night, when the pollen count is at its highest. Keep pets out of the house during the hay fever season. However, reducing your exposure to the substances that trigger your hay fever should ease your symptoms. Hay fever can lead to a middle ear infection if the Eustachian tube (the thin tube that runs from the middle ear to the back of the nose) becomes blocked by a build-up of mucus. The swelling of the nasal passages that occurs in hay fever can prevent mucus from draining out of the sinuses. Infection of the sinuses (small, air-filled cavities behind your cheekbones and forehead) is a complication of hay fever. Unfortunately, the peak of the grass pollen season coincides with the annual GCSE examinations. In one study, a third of adults with hay fever reported that their symptoms had a considerable negative impact on their work, home and social life. They may cause dryness and irritation in your nasal passage, and can make the symptoms of congestion worse (this is known as rebound congestion or rhinitis medicamentosa). Hay fever can cause a blocked nose. Corticosteroids can reduce the inflammation and prevent the symptoms of hay fever. When pollen triggers your allergic reaction, the inside of your nose becomes inflamed. If you have hay fever, your body produces this antibody when it comes into contact with pollen. During a skin prick test, an immunologist will place the pollen allergen on your arm and prick the surface of your skin with a needle. However, the pollen count season can sometimes begin as early as January or end in November. Different trees and plants produce their pollen at different times of the year.

And as we age apcalis sx 20 mg visa erectile dysfunction commercial bob, he added generic apcalis sx 20mg fast delivery erectile dysfunction raleigh nc, we also tend to write off our ailments — runny noses (a side effect of some medications) best apcalis sx 20 mg bradford erectile dysfunction diabetes service, asthmalike symptoms (which may be caused by heart conditions) or sneezing (which occurs naturally as our nasal passageways dry up) — as caused by pollen in the air. By giving corticosteroids, a class of steroid hormones, to mice with hay fever whose symptoms were worst in the morning and early evening, they were able to "reset the nasal circadian clock," bringing a better understanding of how these symptoms change throughout the day, and what effect external factors may have. If you have hay fever, it allows pollens and other allergens in and will likely make symptoms worse. The big one: hay fever is classified as seasonal, so it only shows its symptoms strongly in periods when the allergens are thickly present, as in the spring when all that lovely blossom is sending its pollen everywhere. When hay fever is worse at night, hay fever symptoms like: sneezing, runny noses and sore eyes that normally come into effect during daylight, may peak during the night. To get the count, airborne pollen deposits are measured in the morning mechanically by devices in tall buildings, with the higher number of grains associated with the a high amount of symptoms in people who are allergic,” she said. Allergic rhinitis occurs when allergens in the air are breathed by a patient that is allergic to them, irritating and inflaming the nasal passages. The vast majority of people with animal dander allergy are able to avoid uncomfortable allergic symptoms simply by avoiding the animal sources of their allergens. Keeping your windows open at night during seasons of high outdoor pollen and mold count may worsen your allergy symptoms or asthma because these high-concentration outdoor allergens are allowed into your house to settle. Although many substances in dust can trigger allergic symptoms, the most important indoor allergens are dust mites, pet dander, cockroaches, and molds. Although many allergens in your environment can trigger allergic symptoms, house dust is the main culprit in indoor allergies. Viral sore throats are often accompanied by other cold symptoms that may include a runny nose, cough, red or watery eyes, and sneezing. Other cold symptoms such as a runny nose and congestion may follow the sore throat. The most common symptom of a nut allergy is raised red bumps of skin ( hives ) and other allergic symptoms such as runny nose, cramps, nausea or vomiting. If you suffer from hay fever (allergic rhinitis) caused by pollen, your mouth or throat may become itchy after eating an apple or celery. Cold symptoms of congestion, runny nose and sore throat resolve in a week or two. In turn, mucus production results in common allergic symptoms like watery eyes and a runny nose. But if your child starts accumulating other symptoms, like a fever, sore throat, runny nose, malaise, vomiting and diarrhea, then he or she may indeed be sick with the flu. Allergies may lead to the formation of too much mucus which can make the nose run or drip down the back of the throat, leading to "post-nasal drip." It can lead to cough, sore throats, and a husky voice. Just a sore throat without cough/cold symptoms like a runny nose or congestion. If your sinusitis is caused by a prior allergic rhinitis, it is important to avoid what has caused your allergy symptoms. People may feel sinus pain for a "few days", but these common cold symptoms this can often be relieved by a decongestant. Decongestants: May be helpful in a pill form, or as a nasal spray (topical), to relieve a "blockage", or common cold symptoms of a runny nose. Smoking will further irritate the mucus membranes in your sinuses, and nose, accentuating yoru common cold symptoms. If you have pain in your joints, muscles, or throat caused by common cold symptoms, you may take acetaminophen (Tylenol() up to 4000 mg per day (two extra-strength tablets every 6 hours). Treatment of rhinitis due to allergies may include removing what has caused the allergic reaction (allergen), and controlling the symptoms. Overuse of certain types of nasal sprays to clear your nasal passages, such as Afrin, can cause a "rebound" effect, with worsening common cold symptoms of congestion, and runny nose. Or as a nasal spray (topical), to relieve a feeling of "blockage"; or common cold symptoms of a runny nose. Oftentimes, postnasal drip is caused by allergies in the environment (allergic rhinitis). If a sore throat is a symptom of hay fever or another allergy, your doctor can help you figure out how to avoid the things that trigger your allergies. Sore throat is often caused by a runny nose dripping down the back of your throat (also known as post-nasal drip) and nasal congestion leading to snoring, mouth breathing and a dry throat. One of the most common characteristics of chronic rhinitis is post-nasal drip, which is mucus accumulation in the back of the nose and throat that drips downward from the back of the nose. Pollinosan Hayfever Tablets - these are made from seven tropical herbs and address a whole range of allergic rhinitis symptoms such as sneezing and congestion which often accompany a sore throat. When the immune system over-reacts to things like pollen and dust mites it results in allergic rhinitis and various symptoms like congestion and sneezing However, accompanying these things is often the problem of a sore throat as well. It is a very serious disorder of the back of the throat near the windpipe The most common cause of epiglottitis is an infection by the bacteria, H influenza The condition may present all of a sudden with high fever, severe sore throat, difficult and painful swallowing , drooling saliva, hoarse voice, difficulty breathing and malaise. Many individuals have allergies to pet dander , dust, mites , pollen and molds that can trigger an allergic reaction which present with runny nose , red eyes, congested nose and throat irritation. If your post-nasal drip is due to allergic rhinitis and the allergen cannot easily be avoided or if the allergy symptoms are particularly severe and persistent, immunotherapy treatment might be recommended. Sinusitis also commonly causes post-nasal drip and/or a runny nose (or blocked nose), as well as facial pain/pressure, cough and a loss of smell. Common symptoms and signs of allergies that accompany allergy sore throat include: The result of this response is classic cold symptoms, including sore throat, cough, fever and nasal congestion. Less commonly, the cause of an infection is bacterial , and this is called strep throat It requires a trip to your doctor for an antibiotic, since if left untreated it can spread and lead to serious complications like rheumatic fever, scarlet fever, and kidney inflammation. Post-nasal drip, scratchy throat, headache, and congestion are common symptoms of both colds and allergies. Question: I have always had normal nasal (rhinitis) symptoms, but this year I have also developed asthma and food allergies. Pointing sprays the wrong way: Nasal steroids are one of the most effective treatments we have for seasonal allergy symptoms, but many people stop using these sprays when they get nosebleeds. A better understanding of medication utilisation during pregnancy could help improve the safe and effective treatment of pregnant women (Wyszynski and Shields 2016 Wyszynski DF, Shields KE. 2016. Studies suggest that as many as 10-30% of pregnant women with known allergies will experience increasing allergy symptoms during their pregnancy (Incaudo 2004 Incaudo GA. 2004. It has been estimated that approximately 20-30% of women of childbearing age suffer from allergic conditions, such as rhinitis, asthma, allergic conjunctivitis, acute urticaria, anaphylaxis, and food and drug allergies. 6. Schatz M, Zeiger RS, Harden K, Hoffman CC, Chilingar L, Petitti D. The safety of asthma and allergy medications during pregnancy. Since 1979, a standard five-letter nomenclature developed by the U.S. Food and Drug Administration (FDA) has been used to assign a pregnancy risk category to prescription and OTC medications ( Table 2 ). 2 In response to ongoing criticism of the confusing and simplistic nature of this system, in 2011, the FDA proposed a new rule for labeling that aims to provide more detailed safety data about use in pregnancy and in turn improve clinical decision making.

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The leg is Examination of the back should include inspec- elevated slowly to about 70° and then the foot is tion of the lower back to determine if local muscle dorsiflexed (Figure 7-6) buy generic apcalis sx on line erectile dysfunction no xplode. Patients with radicular spasms are present and if the pain increases by body pain describe sciatica pain that radiates below movements such as bending forward or backward apcalis sx 20mg without prescription erectile dysfunction injections videos. The presence of localized pain to a specific radiculopathy may also produce relative numb- tender vertebra should raise concerns of a possible ness in a particular dermatome purchase apcalis sx on line impotence sentence examples, leg paresthesias, localized process such as epidural abscess, vertebral weakness of muscles in the involved myotomes, metastasis, or vertebral fracture. With the onset of acute In the patient with chronic radiculopathy, the radicular pain, the patient may prefer lying supine involved muscles may be hypotonic and with the legs flexed at the knees and hips. There may be weakness of plantar flexion of the big toe and foot, making walking on the toes difficult. After 3 weeks, the radicu- lopathy produces sufficient root compression to Dorsiflexion produce denervation changes in innervated mus- cles that include fibrillations and positive sharp waves. Her- niated disks and whether the herniation impinges on a spinal root or neural foramina can be seen. It is important to note that disk abnormalities are commonly seen on neuroimaging, especially after (b) middle age, and are often incidental and noncon- tributory to the patient’s symptoms. Since anatomy is not function, neuroimaging must always be cor- related with the history and neurologic exam. Principles of Management of Lumbar Disk Herniation and Prognosis Back pain is usually divided into acute (<3 months duration) and chronic (>3 months). It has been estimated that less than 5% of patients will require surgical intervention, L5 radiculopathy is common and usually due to but many patients will progress to chronic back an L4-to-L5 disk protrusion. Paresthesias may be felt in the entire territory pains, (2) activity changes, and (3) alteration in or distal portion. For most patients, acetamino- lateral calf and medial aspect of the dorsum of the phen or nonsteroidal antiinflammatory drugs foot, including the first two toes. Patients rior part of the thigh, posterior calf and heel, and should be encouraged to return quickly to normal lateral foot to the 4th and 5th toes. Paresthesias and activities, but not strenuous activities requiring lift- sensory loss occur mainly in the lateral foot and ing and bending. N Engl J smoking is thought to constrict vascular beds in the Med 2001;344:363–370. Transverse begin with walking short distances and simple back myelitis: Retrospective analysis of 33 cases, with exercises, which slowly progress in duration and differentiation of cases associated with multiple intensity. The prognosis of acute impingement, or cauda equina syndrome (bladder and subacute transverse myelopathy based on or bowel dysfunction, “saddle” numbness in the early signs and symptoms. Patients most (Excellent review of current theories of pathogen- likely to benefit are those with considerable neuro- esis and end-of-life issues. The include the corticospinal tract, conducting motor longitudinal plane is usually divided into the mid- impulses from the cortex to the spinal cord, and long brain, pons, and medulla and the cross-sectional sensory tracts, conducting information from the divisions are usually medial and lateral. In important tracts and cranial nerve nuclei within addition, the brainstem contains the reticular for- this pattern of division. There are many small penetrat- In determining the location of lesions involving ing arterioles that enter the brainstem from these the brainstem, it is useful first to determine major vessels. The arterioles generally supply one whether the lesion is within the brainstem side of the medial brainstem (paramedian arteriole) (intraaxial) or lies outside the brainstem along the or one lateral side (circumferential arteriole). Extraaxial arteries (superior cerebellar artery, anterior inferior lesions initially affect cranial nerves through cerebellar artery, and posterior inferior cerebellar entrapment or compression, with later signs devel- artery) supply the cerebellum with blood and may oping from compressing brainstem structures or have branches also going to the brainstem. A typical with a lower frequency than the same diseases extraaxial lesion would be an untreated acoustic affecting other brain regions. Hemorrhages cerebellar cortex comes from many brainstem involving the brainstem are uncommon. Ischemic nuclei via excitatory mossy fibers that terminate strokes of the brainstem occur as lacunes or occlu- on myriads of granule cells. These granule cell sions of penetrating brainstem arteries and are less neurons then send inhibitory impulses to Purkinje common than cortical or basal ganglia strokes. The inferior olive also sends excitatory input The cerebellum occupies about 10% of the directly to Purkinje cells. Purkinje cells, the only brain volume but contains more neurons than the output of the cerebellar cortex, send inhibitory entire rest of the brain. The cerebellum is divided Cerebellar neurons do not directly produce into the 3 functional divisions of the spinocerebel- motor movements, but act more as a comparator lum, cerebrocerebellum, and flocculonodular lobe that compensates for errors in movement by com- (Figure 8-2). Each division in the cerebellar cortex paring intention with performance and making sub- sends Purkinje cell axons to specific deep cerebel- tle adjustments. As such, patients with cerebellar lar nuclei and has different functions (Table 8-1). Dysfunction of midline cerebellar structures nucleotide disorders; it expresses most of the clini- (vermis of spinocerebellum) produces imbalance cal cerebellar problems. Chapter 19, “Neurologic problems of midline body structures such as gait and Complications of Alcoholism,” discusses alcoholic truncal ataxia, while cerebellar hemisphere dysfunc- cerebellar degeneration. Unlike the cerebral cortex, damage to one cerebellar hemisphere pro- duces ipsilateral but not contralateral dysfunction. Cerebellar Hemisphere Signs are ipsilateral to side of cerebellar lesion and more abnormal with fast limb movements than with slow movements. Often tested by asking patient to pat one palm alternately with the palm and dorsum of the opposite hand as rapidly as possible. Usually tested by asking patient to touch a target and then quickly touch the nose or to lift one heel and place it on the opposite knee and then move the heel down the shin. Flocculonodular Lobe • Nystagmus • Transient vertigo Triggered by head or body movements from abnormal vestibuloocular reflex (reflex maintains eyes steady in space while head moves). Major risk factors include the vertebral artery via small branches that have hypertension, diabetes mellitus, neck trauma, and considerable variability. Major Clinical Features mon and implies ventral medullary corticospinal tract involvement from a large medullary infarc- Of these patients, 3/4 develop acute onset of tion or hemorrhage. The symptoms will vary depending on how medial the infarction extends Major Laboratory Findings and whether the caudal or distal medulla is maxi- mally affected. Dizziness, strates ischemic infarction in the lateral aspect of vertigo, nausea, vomiting, nystagmus, skewed the dorsal medulla. Patients commonly complain of numbness and shooting Patients require hospitalization with attention to pains on the ipsilateral side of the face and loss of their inability to swallow (50% will require an pain and temperature sensation on the contralat- enterofeeding tube for several weeks). If marked eral side of the body caused by damage to the vertigo, nausea, and vomiting are present, vestibu- descending trigeminal nerve and spinothalamic lar sedative drugs may transiently be required. Dysphagia and dysarthria from paralysis of Dysphagia, dysarthria, and vertigo usually the ipsilateral palate, pharynx, and larynx muscles improve over several weeks. Rehabilitation is are due to damage to the nucleus ambiguous of needed to improve balance, coordination, and gait.

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Newly qualified consultants will initially share lists with more experienced colleagues buy apcalis sx uk impotence cure food. B5(L1) Specialist Children’s Surgical Centres and networks must work together to develop and support Immediate national apcalis sx 20mg sale erectile dysfunction images, regional and network collaborative arrangements that facilitate joint operating order apcalis sx with a mastercard erectile dysfunction alcohol, mentorship and centre-to-centre referrals. B7(L1) All children and young people requiring investigation and treatment will receive care from staff Immediate trained in caring for children and young people, including safeguarding standards, in accordance with the requirements of their profession and discipline. Surgery B8(L1) All paediatric cardiac surgical cases must be carried out by a specialist congenital cardiac surgical Immediate team with expertise and experience in paediatric cardiac disease. B9(L1) Consultant congenital surgery cover must be provided by consultant congenital surgeons Rota: 1 in 3 providing 24/7 emergency cover. If this means that the surgeon is on-call for two hospitals, they must be able to reach the patient bedside at either hospital within 30 minutes of receiving the call. B10(L1) Congenital cardiac surgeons must work in teams of at least four surgeons, each of whom must be Teams of at least the primary operator in a minimum of 125 congenital heart operations per year (in adults and/or three immediate, paediatrics), averaged over a three-year period. Section B – Staffing and Skills Implementation Standard Paediatric timetable immediate B11(L1) Perfusion services and staffing must be accredited by The College of Clinical Perfusion Scientists Immediate of Great Britain and Ireland. Cardiology B12(L1) All paediatric congenital cardiology must be carried out by specialist paediatric cardiologists. Immediate B13(L1) Each Specialist Children’s Surgical Centre must be staffed by a minimum of one consultant Within 3 years paediatric cardiologist per half million population served by the network, working flexibly across the network. B14(L1) Each Specialist Children’s Surgical Centre must deliver 24/7 elective and emergency care, Immediate including specialist consultant paediatric cardiology on-call cover for the Specialist Children’s Surgical Centre and to provide advice across the network including requests for transfers. If this means that the cardiologist is on-call for two hospitals, they must be able to reach the patient bedside at either hospital within 30 minutes of receiving the call. B15(L1) Consultant interventional cardiology cover must be provided by consultant interventional paediatric cardiologists providing 24/7 emergency cover. This Within 1 year could include interventional cardiologists based at a Specialist Children’s Surgical Centre or a Specialist Children’s Cardiology Centre. Each Specialist Children’s Surgical Centre must develop out-of-hours arrangements that take into account the requirement for interventionists only to undertake procedures for which they have the 182 Classification: Official Level 1 – Specialist Children’s Surgical Centres. Section B – Staffing and Skills Implementation Standard Paediatric timetable appropriate competence. If this means that the interventionist is on- call for two hospitals, they must be able to reach the patient bedside at either hospital within 30 minutes of receiving the call. B16(L1) Cardiologists employed by the Specialist Children’s Cardiology Centre and trained to the Within 6 months appropriate standards in interventional and diagnostic paediatric cardiology shall be provided with appropriate sessions and support at the Specialist Children’s Surgical Centre to maintain and develop their specialist skills. B17(L1) Cardiologists performing therapeutic catheterisation in children and young people with congenital Immediate heart disease must be the primary operator in a minimum of 50 such procedures per year. The Lead Interventional Cardiologist in a team must be the primary operator in a minimum of 100 such procedures per year, in each case averaged over a three-year period. B18(L1) Each Specialist Children’s Surgical Centre must be staffed by a minimum of one expert Immediate electrophysiologist experienced in paediatric cardiac disease. B19(L1) Paediatric electrophysiology procedures must only be undertaken by an expert electrophysiologist Immediate experienced in the management of paediatric arrhythmias. B20(L1) The catheterisation laboratory must comply with the British Congenital Cardiac Association Immediate standards for catheterisation and have the following staff to operate safely: a. Section B – Staffing and Skills Implementation Standard Paediatric timetable of equipment required in congenital interventional catheterisation; and d. B22(L1) Each Specialist Children’s Surgical Centre will have a continuous, immediate and documented Immediate availability of specialised cardiac paediatric anaesthetists with full training (in accordance with the Royal College of Anaesthetists’ Guidelines and Paediatric Intensive Care Society Standards) and competence in managing paediatric cardiac cases including a specialist paediatric cardiac on-call rota which is separate from the intensive care rota. B23(L1) At each Specialist Children’s Surgical Centre a paediatric cardiologist will act as the lead for Within 6 months Congenital Echocardiography. The lead will have dedicated echocardiography sessions and will have responsibility for training and quality assurance. B24(L1) Each Specialist Surgical Centre will have a team of congenital echocardiography scientists Immediate (technicians), with a designated Congenital Echocardiography Scientist (Technician) Lead who spends at least half the week on congenital echocardiography-related activity. B26(L1) Paediatric Intensive Care Units and High Dependency care will be staffed in accordance with Immediate national standards. Children and young people must be cared for by children’s nurses with appropriate training and competencies in paediatric cardiac critical care. B28(L1) Nursing care must be provided by a team of nursing staff trained in the care of children and young Immediate people who have received cardiac surgery. The paediatric cardiac inpatient nursing team will be led by a senior children’s nurse with specialist knowledge and experience in the care of children and young people and in paediatric cardiology and cardiac surgery. The precise number, above the minimum seven, and location of these nurses will depend on geography, population and the configuration of the network. Networks must demonstrate that the role of each Children’s Cardiac Nurse Specialist meets the minimum requirements of the Royal College of Nursing role description. Psychology B30(L1) Each Specialist Children’s Surgical Centre must employ a minimum of 0. The location and precise number of practitioner psychologists will depend on geography, population and the configuration of the network. The lead psychologist should provide training and mentorship to the other psychologists in the network. Administrative Staffing B31(L1) Each Specialist Children’s Surgical Centre will provide administrative support to ensure availability Immediate of medical records, organise clinics, type letters from clinics, arrange investigations, ensure timely results of the investigations, arrange future follow-ups and respond to parents/carers in a timely fashion. Section B – Staffing and Skills Implementation Standard Paediatric timetable and database submissions in accordance with necessary timescales. Other (See also section D: interdependencies for professions and specialties where dedicated sessions are required. B34(L1) Each Specialist Surgical Centre will have an identified bereavement officer. Section C - Facilities Standard Implementation Paediatric timeline C1(L1) There must be facilities in place to ensure easy and convenient access for parents/carers. C2(L1) All children and young people must be seen and cared for in an age-appropriate environment, Immediate taking into account the particular needs of adolescents and those of children and young people with any learning or physical disability. C3(L1) Children and young people must have access to general resources including toys, books, Immediate magazines, computers, free wifi and other age-appropriate activity coordinated by dedicated play specialist teams. C4(L1) Specialist Children’s Surgical Centres must have a hospital school with teachers. C5(L1) There must be facilities, including access to maternity staff, that allow the mothers of new-born Immediate babies who are admitted as emergencies to stay with their baby for reasons of bonding, establishing breastfeeding and the emotional health of the mother and baby. Section C - Facilities Standard Implementation Paediatric timeline C6(L1) Parents/carers will be provided with accessible information about the service and the hospital, Immediate including information about amenities in the local area, travelling, parking and public transport. C7(L1) If an extended hospital stay is required, any parking charges levied by the hospital or affiliated Immediate private parking providers must be reasonable and affordable. Each hospital must have a documented process for providing support with travel arrangements and costs. C8(L1) There must be dedicated child friendly facilities in which practitioner psychologists, cardiac Immediate physiologists, children’s cardiac nurse specialists and social work staff conduct diagnostic and therapeutic work. C9(L1) Specialist Children’s Surgical Centres should ideally have landing facilities for a helicopter and must Immediate have local arrangements for transferring patients from airfields and helipads.