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By Y. Arokkh. Prescott College.

Within this sphere one would find individuals who identify themselves as healers or practitioners but who are not regulated by legislation or who do not operate under the auspices of socially legitimated generic zenegra 100 mg amex erectile dysfunction exercises wiki, professional associations. For instance, individuals who practice reiki out of their homes or a physician who uses alternative therapies not officially sanc- tioned by professional bodies such as the Canadian Medical Association. In the regulated sector I include health care practitioners governed by legislation and/or regulated by professional associations. Here we find chiropractors, naturopaths, and midwives in addition to allopathic health care professionals. The other substantial change I make to Chrisman and Kleinman’s (1983) model is to encircle the three spheres of the health care system by a boun- dary. This perimeter is represented by a dotted line to indicate that access to any form of health care can be more or less limited in any given place, at How People Use Alternative Therapies | 41 any given time, to any given person; for instance, someone who can not find a family doctor, or who is on a waiting list for specialty medical serv- ices such as MRIs, or who would like to use acupuncture to cope with chronic pain but is unable to locate a practitioner. In sum, accessing alternative therapies means finding a point of entrée into the alternative healing networks within the larger health care system. Once entrée is achieved, using alternative therapies is a matter of negotiating an infinite number and variety of alternative health care networks. For the people who participated in this research, negotiating these networks was experienced as a long, incremental process. I had read things about the use of Chinese herbal medicine also in the past few years in connection with the chronic fatigue syndrome. I had a friend in the training who was very involved in that, so I learned a little bit about it in a very superficial way. Not personally too interested at the time, but it’s sort of filed away there. I decided that I would investigate; I guess it was through a friend of mine partly, even though I’d done reading, like I said earlier. She had highly recommended this person, a doctor from China, that this doctor had been helpful for a friend of hers who had problems with these things; so I decided to go. Most conceptualized this ongoing process as a search or journey: “I would say that was the beginning of a sort of over-all healing journey that I’ve been on” (Scott). What distinguishes this long, incremental process from general health-seeking behaviour, and makes it truly alternative for these informants, is that in par- ticipating in alternative health care, in interaction with alternative practitioners and other lay users of alternative therapies, these people began to espouse alternative ideologies of health and healing. Those who had consulted an alternative practitioner in the six months prior to the survey. CHAPTER THREE Why People Turn to Alternative Therapies The majority of researchers investigating why people seek out alternative approaches to health and healing have been concerned with discovering the motivating factors for individuals’ use of alternative health care. Some authors argue that participation in alternative therapies represents an over- all disenchantment with biomedicine (Furnham and Kirkcaldy 1996). These contrasting views have been conceptualized as the push/pull debate by Furnham and Smith (1988), among others (Vincent and Furnham 1996; Kelner and Wellman 1997; Sharma 1990). The question becomes: Are people pushed away from allopathic medicine and, as a consequence, pushed towards alternative therapies, or are they pulled towards alternative health care and, consequently, pulled away from allopathic medicine? However, the explanations for why people turn to alternative health care subsumed within the push/pull debate are problematic for a number of reasons, not the least of which is that what are commonly reported in the literature as motivating factors in people’s use of these therapies did not figure prominently amongst the people who participated in this research. In general, the people who spoke with me did not turn to alternative therapies for ideological reasons; they were neither seeking a holistic approach to health and health care, nor seeking control over matters of Why People Turn to Alternative Therapies | 43 health and healing. Nor does dissatisfaction with allopathic medicine alone sufficiently explain why these people first engaged in alternative approaches to health and healing. Rather, in participating in alternative therapies, they were actively seeking relief from problems for which they found little or no redress in other quarters. However, the people who took part in this research rarely identified ideological issues as reasons for their decisions to first seek out alternatives. While these informants made reference throughout their interviews to a variety of ideological components of the alternative model of health and healing they espouse, including a belief in the value of a holistic approach to health care or therapies that allow them to take control of health and healing, these beliefs were almost never voiced in conjunction with the accounts they gave of why they first turned to alternative therapies. Furthermore, while dissatisfaction with allopathic medicine was mentioned by informants as concomitant with their initial participation in alternative forms of health care, it proves problematic to attempt to explain an individual’s use of these therapies solely through a dissatisfaction with allopathic medicine. Control That alternative therapies allow individuals a greater degree of control over their health and health care is often specified as a motivating factor in people’s participation in these therapies (Furnham and Beard 1995). For example, in talking about her encounters with her naturopath, Grace said, “She encouraged me to take control.

Although serum antibodies to many peripheral nerve antigens have been found in GBS cheap zenegra 100 mg fast delivery erectile dysfunction water pump, their role in the pathogenesis of the disease remains unclear. Therapy Mortality rates from GBS have fallen dramatically in recent decades mainly because of improvements in nursing and critical care measures. Any child suspected of hav- ing GBS should be hospitalized until the maximum degree of clinical disability is 170 Sumner established. In the early stages of the disease, respiratory status should be monitored carefully with frequent measurement of vital capacity. Endotrachial intubation and mechanical ventilation should be initiated early, when proper intensive care specia- lists can be assembled in a careful and controlled manner, rather than waiting for a respiratory crisis. Generally, any sign of compromised airway during the progressive 3 phase of GBS, or vital capacity below 15 cm =kg, is an indication for intubation. In older, larger children preventive measures for deep venous thrombosis and pulmon- ary embolus should include use of leg stockings (TEDS) and subcutaneous heparin. It is essential to monitor patients for autonomic nervous system dysfunction such as blood pressure fluctuations, cardiac arrythmias, gastrointestinal pseudoobstruction, and urinary retention. Physical therapy with passive range of motion exercises should be started immediately to avoid con- tractures. Pain is common in children with GBS, and should be aggressively treated, sometimes with opiates. In profoundly weak children who are unable to communi- cate, sinus tachycardia and other features of sympathetic activation may represent primary autonomic involvement, pain, or both. In several large clinical trials in adults, plasma exchange and intravenous immunoglobulin (IVIg) have each been shown to be equally effective in reducing the time to recovery in patients with GBS, if initiated within the first two weeks (Table 3). Observational studies suggest similar benefit in children, although the potential for complications due to plasma exchange increases with smaller body size. On balance, these therapies are recommended only for the minority of children who manifest more severe forms GBS: those that have lost the ability to ambulate or have bulbar weakness causing dysphagia or aspiration. Because of the difficulty with vas- cular access and potential problems with fluid shifts given smaller blood volume, of the two therapies, treatment with IVIg has become the accepted therapy for GBS in children. The recommended schedule is 2 g=kg of body weight divided into five con- secutive daily doses of 400 mg=kg each. Side effects are generally minor, but severe side effects can include chemical meningitis, acute tubular necrosis, and renal failure (particularly in patients with pre-existing renal disease), thomboembolic events, and rarely anaphylaxis. Table 3 Treatment Options for GBS Therapy Regimen Side effects Plasma exchange Remove 200–250 mL=kg Catheter placement may cause of plasma over 7–10 days pneumothorax, bleeding, deep vein thrombosis, pulmonary emboli, or sepsis. Blood removal may cause hypotension, anemia, thrombocytopenia, or electrolyte derangements Intravenous 0. In centers with appropriate experience, this may be safely done in children who weigh more than 10 kg. The usual protocol, derived from experience with adults, involves exchanges on the 1st, 3rd, 5th, and 7th days targeting a total exchange volume of 250 mL=kg. Problems with plasma exchange include difficulty with placement and maintenance of central lines and hypotension during exchanges. If patients experience a relapse within approximately 10 days of the first treatment, retreatment with the same initial agent at half the dose is recommended. Prognosis Overall prognosis in GBS is good with approximately 90–95% of affected children making a complete functional recovery within 6–12 months. Those who do not recover completely are often ambulating independently with only minor neurologic residua. Since the advent of modern critical care, mortality from GBS in children is rare. CHRONIC INFLAMMATORY DEMYELINATING POLYRADICULOPATHY (CIDP) CIDP is a form of inflammatory motor and sensory neuropathy that evolves over a protracted time of more than 4–8 weeks. CIDP is less common than GBS and occurs less frequently in children than in adults. Nonetheless, CIDP represents approxi- mately 10% of all chronic childhood neuropathies. Diagnosis=Clinical Features The classic symptoms and signs of CIDP include largely symmetric weakness in proximal and distal limb muscles, reduced or absent tendon reflexes, and, sometimes, sensory deficits and paresthesias. Most often children present with abnormal gait and frequent falls secondary to weakness of the legs. CIDP may manifest with a chronic progressive, monophasic, or relapsing–remitting clinical course.

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The future will thus witness a flurry of activity directed at understanding the role of quantum mechanics and protein motion in enzyme action 100 mg zenegra erectile dysfunction pills amazon. Goodman Department of Chemistry, Cambridge University, Lensfield Road, Cambridge CB21EW, UK Making molecules has been important to human society from prehistoric times. The extraction of tin and lead from their ores has been possible for thousands of years. In the past century, carbon-containing molecules have become increasingly important for the development of new sub- stances, including plastics, other new materials and health products. Organic chemistry was originally the study of compounds connected with life, but, more than a century and a half ago, Wöhler showed it was pos- sible to make an organic compound (urea, which may be extracted from urine) from inorganic (that is, not living) compounds. What had seemed a precise distinction between living and non-living compounds became hazy. The subject may now be defined as the study of molecules which contain carbon atoms, although the precise boundaries of the area are not clear, as the overlaps with biology, with materials science, with inorganic chemistry, and with physics can all be debated and boundaries drawn and re-drawn. However, it is clear that understanding of organic chemistry advanced tremendously in the closing century of the second millennium Increasing knowledge of the properties of molecules has made it pos- sible to synthesise very complicated compounds. Organic synthesis is engineering on an atomic scale, and requires delicate operations to be per- formed on objects which are too small to see. It also requires techniques of mass production, because single molecules are usually not useful by them- selves. A car factory may produce tens of thousands of cars each year, but 43 44 J. GOODMAN this is very small scale compared to the job of a synthetic chemist. A pint of beer contains approximately 1025 (ten million million million million) molecules. If you were to pour a pint of beer into the sea, wait for the waves to mix it well all around the world, and then take a pint of sea water from any part of any ocean, that pint would probably contain a thousand mole- cules from the original pint. A successful synthesis of a new molecule would not make hundreds or thousands of copies of the molecules, but mil- lions of millions of millions. In order to make a complex molecule, it is necessary to have methods which join simpler molecules together, and also techniques to make small changes to different bits of the molecule, once the framework has been con- structed. There is an enormous variety of reagents which can be used to transform one arrangement of atoms into another. The line drawings at the top show the same molecules as the ball and stick representations below. In the lower version, hydrogen atoms are white, carbon atoms are dark grey, and oxygen atoms are speckled. In the more concise representation at the top, hydrogen atoms attached to carbon are omitted, and the carbon–oxygen double bond in the ketone is drawn with a double line. The lower diagram shows the two hydrogens which must be removed to turn the alcohol into the ketone. One of these is on the oxygen, and the other on the central carbon atom. Many reagents are available which will transform an alcohol into a ketone, removing these two hydrogens and turning the carbon–oxygen single bond into a double bond. It is a problem if the same transformation is used to make a more complicated molecule, such as PM-toxin (Figure 3. This molecule, which is produced by the fungal pathogen Phyllosticta maydis, has been the cause of major epidemics of leaf blight disease in the United States. The top representation is much more concise, but does not give information about the shape of the molecule. The lower illustration shows how the atoms are arranged in space as well as how they are connected to each other. This molecule has four alcohol groups (an oxygen joined to a carbon atom and a hydrogen atom by single bonds). Changing one of these to a ketone (an oxygen joined to a carbon by a double bond) without affecting the others will be difficult, as all the reagents which can do this are likely to act on the whole molecule, not just on a specific part of it. A synthesis could not finish by oxidising just some of the alcohols to ketones, because the reagent would not know which alcohols should be oxidised and which should not. How is it possible to selectively make ketones in the presence of alcohols? More generally, how can a trans- formation be made to act on only a part of a molecule?

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After World War II zenegra 100 mg sale erectile dysfunction pills cape town, Laurie Macdonald contin- ued his orthopedic practice with a special interest in pediatrics. He was an honorary orthopedic William Laurence MACDONALD surgeon to Sydney Hospital, the Royal North Shore Hospital and the Royal Alexandra Hospital 1900–1986 for Children. His early training at Oswestry, in pre-antibiotic days, gave him a conservative The Australian Orthopedic Association lost one of approach to most surgical problems. When the its principal founders during the year that it was British volume of The Journal of Bone and Joint preparing to celebrate its Golden Jubilee. In 1936, Surgery was established in 1948, Macdonald was Laurence Macdonald returned to Australia after 8 appointed, with A. Meehan, as one of the first years’ postgraduate study in orthopedics in the Australian representatives on the editorial board. United Kingdom and, with his colleague Alex He was later made an honorary fellow of the Hamilton, persuaded the more senior orthopedic British Orthopedic Association. He was president surgeons in Sydney to form a new association of the Australian Orthopedic Association in 1959 based on the British Orthopedic Association. Vance tralasian College of Surgeons and served on the was elected president, A. Macdonald editorial secre- Like his friend and colleague John Colquhoun tary. Macdonald and Hamilton continued to in Melbourne, Laurie retained pride in his play a dominant role in the new association Scottish ancestry and they shared a lifelong and both survived all their other foundation enjoyment in playing golf. In 1928 he went to able to be present at the celebration of the Jubilee Liverpool on the advice of E. Vance, and of the Association that had played such an impor- obtained the degree MCh(Orth) and also the tant part in his life. He was survived by his wife, Fellowship of the Royal College of Surgeons of two daughters and four grandchildren. During his course at Liverpool he was invited by Sir Robert Jones to fill a vacancy as medical officer at the Shropshire Orthopedic Hos- pital. Macdonald accepted on the condition that he would stay for only 3 months. In fact he stayed for 5 years and for the last 3 years was resident surgical officer there. This was at a time when Australians filled the majority of the posts at 208 Who’s Who in Orthopedics the moment when Lister began tentatively to apply carbolic acid to compound fracture wounds, so that Macewen witnessed in Glasgow Royal Infirmary the birth of an antiseptic system that revolutionized surgery. For 4 years he watched its unfolding, part of which time he was Lister’s dresser. Macewen graduated as Bachelor of Medicine and Master of Surgery in 1869, just after Lister had left Glasgow to succeed Syme as Regius Pro- fessor of Surgery at Edinburgh. After qualifying, he served as house surgeon and house physician before becoming for a short period superintend- ent of Glasgow Fever Hospital at Belvedere, an appointment notable for Macewen’s introduction of intubation of the larynx through the mouth instead of by tracheotomy or laryngotomy—a procedure that aroused interest at home and Sir William MACEWEN abroad whereby he anticipated O’Dwyer’s tubes. In 1871 he was appointed district medical officer, 1848–1924 a post that enabled him to gain experience in prac- tical surgery at the parish hospital in Parliamen- Sir William Macewen was one of the most versa- tary Road. He watched the dawn of surgeon to the Central Police Division of antisepsis, grasped its implications and eagerly Glasgow, an office offering him rich experience played a leading part in the romantic expansion in emergency surgery and enabling him to con- of surgery that followed. Many of his widespread tribute many original papers to medical journals, contributions were of fundamental importance. Macewen had “Woodend” on the Port Bannatyne side of Skeoch noticed that the pupil of the eye in such a state Wood, Isle of Bute. He was youngest of the 12 remained contracted as long as the individual was children of John and Janet (née Stevenson) undisturbed, but under mechanical stimulus such Macewen. His father was a marine trader doing as passive movement of a limb, insufficient to business in sailing ships plying from Rothesay, arouse from somnolence, the pupil dilated only to but family fortune ebbed and flowed like the tide. This At one time he was master of the “Breadalbane,” sign is sometimes referred to as a “Macewen a yacht that ferried Free Church Ministers to and pupil. He proceeded to the degree of Doctor of Med- The boy, brought up in a seafaring atmosphere, icine in 1872 and the following year was elected felt the call of the sea all his life, returning to it to the important office of dispensary surgeon to whenever he could conveniently flee the city. Macewen was now well set William attended the Collegiate School, Garnett for a surgical career. He was a big, bright and lively boy, dis- tice at 73 Bath Street, in the center of Glasgow.

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