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My mother was a smoker and if you had earaches as a kid she used to blow smoke in my ear discount albendazole 400mg without prescription antiviral ointment. She would make bread poultices if you had splinters and mustard plasters when you had colds buy albendazole 400mg antiviral vaccines. Betty also had a story to tell about her mother’s home remedies: My mum always tried to make nutritious meals. We had our vitamins, which I believe in now within common sense, but I have in my cupboard my vitamins. Past occupational experiences were another aspect of personal biography that some informants reinterpreted to mesh with their current participation in alternative therapies. For instance, Lucy and Marie had both worked in the health care system in the past. In their accounts of their use of alternative health care, they reinterpreted these experiences to coincide with their current use of alternative therapies. Marie reinterpreted her duties as a podiatrist’s assistant as a precursor to her present-day engage- ment in training to become a reflexologist: I had worked for a podiatrist when I first got out of high school and part of his treatment was that after he finished with the patient, his digging and cutting and scraping and gouging, the last thing was that I went in for five minutes and I massaged their feet so that they left on a really positive note and I always knew the importance of that. Similarly, in her account, Lucy reinterpreted her experiences working in a hospital as seminal events that inevitably led her to become a user of alternative therapies. In her words, “Well, I had always realized that the medical field can only basically deal with disease. I’ve worked in a 106 | Using Alternative Therapies: A Qualitative Analysis number of hospitals so I was well aware of that. In other words, we engage in “biographical work where old objects must be reconstituted or given new meaning” (Corbin and Strauss 1987:264). That the importance of these past experiences is something that is assigned through retrospective reinterpretation is exemplified in Natalie’s words below. While she believes that her past experiences at work are connected to her present-day use of alternative approaches to healing, her account belies the fact that she has reinterpreted her past occupational experience to explain her current use of alternative therapies. She put it this way: I used to say as I was nursing, ‘There’s gotta be better ways than what the doctor’s ordering here, pushing pills. Even after I gave up nursing and worked in a hospital as a ward clerk, I could see prostate after prostate after prostate coming out and I’m thinking, ‘This has got to be wrong but they’re continuing and they’re still doing it,’ and I think ‘No, there’s got to be another way. Yet when I later asked them what family health care was like when they were children, they began telling me anecdotes about their parents’ use of home remedies. In telling these stories, they connected their parents’ use of home remedies with their own current use of alternative therapies. That these accounts entailed retrospective reinterpretation is evidenced by the fact that the use of home remedies was something these informants’ parents no doubt viewed as conventional rather than alternative, if only because at that time in history Canadian Medicare did not exist. Consequently, most Canadians employed home remedies as a form of self- care before resorting to paying for a physician (Heeney 1995). We used to pay doctors for visits when I was very young until I was in my teens, until we had medical coverage. For example, in looking back and recasting her biography, Nora speculated about a connection between her mother’s use of home remedies and her current participation in alternative health care: I guess I always knew that there were ways to effect better health probably from way, way back in the dark ages when I was a little kid and my mother used to do home remedies. Sore throat, a flannel cloth soaking wet around your neck with a wool sock on that and tied at the back. Things that my godmother had taught me about how to pick the herbs in the forest” (emphasis mine). Brenda and Trudy also reinterpreted memories of their parents’ use of folk and home remedies in light of their contemporary participation in alternative health care. Trudy told me, “My mom’s approach, when I had worms, she ended up [using] onion and garlic. And Brenda said, I think being from Poland my parents were also into home remedies. You know, poultices when I got bitten by a mosquito and herbal teas to this day and camomile. Always my parents, or at least my mother always had a keen interest and some information stayed with me. These accounts can be categorized into three types: the mistaken identity account, the ignorance of others account, and the biographical account. All three of 108 | Using Alternative Therapies: A Qualitative Analysis these types of accounts share some similarities with one or another of the justificatory accounts and/or excuses described by Scott and Lyman (1981) and Sykes and Matza (1957).

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Adult and paediatric manikins are available from several manufacturers worldwide; this chapter concentrates on those generally available in the United Kingdom quality 400 mg albendazole hiv infection cdc. Manikin selection: general principles Training requirements The growing number of different manikins available today can make choosing which manikin to purchase a complex process albendazole 400mg most common hiv infection symptoms. Manikins are vital for learning practical cardiopulmonary resuscitation skills The most important question to ask initially is: which skills need to be acquired? This will obviously depend on the class under instruction; the requirements of a lay class will be quite different from those of professional hospital staff learning advanced life support skills. For large classes it may be better to maximise the practical hands-on exposure by investing in several cheaper With all manikins, realistic appearance, manikins rather than rely on one or two expensive, more accurate anatomical landmarks, and an appropriate response to any attempted complex models. Models vary greatly in sophistication, but most provide some qualitative indication that technique is adequate, such as audible clicks when the depth of chest compression is correct. Some manikins incorporate sensors that recognise the correct hand position and the rescuer’s attempts at shaking, opening the airway, and Resuscitation skills that can be practised palpation of a pulse. The depths of ventilation and chest on manikins compression may also be recorded. An objective assessment of Basic life support performance may be communicated to the student or ● Manual airway control with or without instructor by means of flashing lights, meters, audible signals, simple airway adjuncts or graphical display on a screen. A permanent record may be ● Pulse detection obtained for subsequent study or certification. A score, indicating the number of correct ● Precordial thump manoeuvres, may form the basis of a test of competence. A minimum score of 70% correct ● Defibrillation and cardioversion ● Intravenous and intraosseous access cardiac compressions and ventilations may be taken to (with or withoutadministration of drugs) represent effective life support. This score on a Skillmeter Related skills Resusci Anne manikin is acceptable to the Royal College of ● Management of haemorrhage, fractures, etc. General Practitioners of the United Kingdom as part of the ● Treatment of pneumothorax MRCGP examination. Some care is required, however, and the “skin” should not be permanently marked by lipstick or pens or allowed to become stained with extensive use. Many currently available manikins have replacements available for those components subject to extensive wear and tear. This is particularly true for the face, which bears the brunt of damage and where discoloration or wear will make the manikin aesthetically unattractive. A carrying case (preferably rigid and fitted with castors for heavier manikins) is essential for safe storage and transport. Cross infection and safety To minimise the risk of infection occurring during the conduct of simulated mouth-to-mouth ventilation the numbers of Manikins can be students using each manikin should be kept low and careful used for a attention should be paid to hygiene. Students should be free of variety of communicable infection, particularly of the face, mouth, or training exercises respiratory tract. Faceshields or other barrier devices (see Chapter 18) should be used when appropriate. Manikins should be disinfected during and after each training session according to the manufacturer’s instructions. Preparations incorporating 70% alcohol and chlorhexidine are often used. Hypochlorite solutions containing 500ppm chlorine (prepared by adding 20ml of domestic bleach to 1l of water) are effective but unpleasant to use. They are best reserved for the thorough cleaning of manikins between classes. Moulded hair has now replaced stranded or artificial hair and is much easier to keep clean. Many modern manikins feature a disposable lower airway consisting of plastic lungs and connecting tubes. Expired air passes through a non-return valve in the side of the manikin during expiration. All disposable parts should be replaced in accordance with the manufacturer’s recommendations. Other manikins use a clean mouthpiece and disposable plastic bag insert for each student. Cost Some manikins Cost will depend on the skills to be practised and the number produce printed of manikins required for a class. Sophisticated skills, such as reports on performance monitoring, recording, and reporting facilities, increase cost further.

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Homeopathic remedies are generally made up of “vegetable buy generic albendazole 400 mg hiv infection per country, animal purchase albendazole 400 mg mastercard hiv infection rate spain, or mineral sources” (Craig 1988). These substances are diluted over and over, up to a million trillion trillion times, until imperceptible traces of them remain. The remedy is further “potentized by vigorous shaking at each step of the reduction or dilution” (Craig 1988). HYPNOTHERAPY According to Fulder (1996:xxii), hypnotherapy refers to “the use of hypnotic suggestion” to treat disease and psycho-social problems. IRIDOLOGY Often used by naturopaths, iridology is a diagnostic technique involving exam- ination of the iris, the membrane behind the cornea of the eye (Fulder 1996). MASSAGE According to Vickers (1993:86), massage is “the common root of all touch therapies. MEDITATION In meditation, health is engendered through the use of relaxation tech- niques and focussed breathing which clear the mind and promote both physical and spiritual well-being (Fulder 1996). MIDWIFERY Midwifery involves a holistic and non-invasive approach to childbirth where Appendix: The Therapies | 135 the midwife avoids the use of medical technology and does not “disempower the parents... According to Laura, “I wanted to deliver my baby and feel like I was in control of what was happening. Sickness is conceived of as a signal from the body that the person is in a “healing crisis” and therapy focuses on “stimulating the individuals’ vital healing force” (Clarke 1996:352). Naturopaths stress “natural, drugless healing” (Northcott 1994:494) and make use of a number of different therapies, including homeopathic remedies, nutrition, herbal remedies, massage, yoga, and lifestyle modification. PSYCHIC HEALING Psychic healing is a metaphysical form of therapy that incorporates clairvoyant diagnosis and the treatment of ill health through “the channelling of ‘psychic energy’... REFLEXOLOGY Foot reflexology is a system of diagnosis and healing that “recognizes the feet to be important indicators of the health/disease of the entire body” (Dychtwald 1986:60). For example, Hanna told me that Reflexology’s probably similar to acupressure where it’s stimulating the reflex pads in the head, hands, and feet that correspond to all the parts of the body. There’s about seventy-two thousand nerve endings in your feet and all the body has to function through those nerves. If an organ is unhealthy, the point on the foot corresponding to it will be “very sensitive to touch” and the organ in question can be healed through manipulation and massage of the relevant pressure point (Dychtwald 136 | Using Alternative Therapies: A Qualitative Analysis 1986:60). For instance, in telling me about foot reflexology, Lorraine describes her experience of a treatment given to her by her cousin. She can work on your feet and honestly she’ll hit spots and oh are they sore! So she’ll work that spot, she’ll work my toes and I’ll feel my sinuses draining. It is described as a “non-invasive drugless hands-off technique to assist you in achieving balance in the body/mind/spirit complex” (Brophy 1995) and “on your journey of physical/mental/emotional healing and spiritual growth” (Price 1997). In passing their hands close to and sometimes touching the body of the client, practitioners can transmit healing energy to the person (Fryns 1995). The practitioner is merely the medium: it is the person who heals himself or herself. According to Marie, reiki is very ancient Tibetan healing and it’s channelling the universal energy through our hands to you. I provide a safe environment full of love and light and a safe neutral place for you to do whatever you need to do [to heal]. THE RESULTS SYSTEM The results system is a program of healing that incorporates elements of therapeutic touch, energy work, nutrition, detoxification therapy, meta- physical healing, and creative visualization as healing techniques. According to Natalie, “The results system is a system to heal your mind, body, and spirit all at once. And within four or five sessions a person can be healed by conversation, and by healing of the hand, and by their belief system. The healing process involves determining if there are blocks impeding the flow of energy within the person. In Natalie’s words: “If the chakras4 are blocked for any reason, due to stress, illness, disease, these have to be opened before you can possibly Appendix: The Therapies | 137 help this person. If the fingers fly open as you pull your client’s fingers apart then you know that chakra needs to be opened. Once you open the chakra, then you come back and touch that part of the chakra with your hand just gently and then do the fingers of the client and see if they’re still open. In Natalie’s words: “Once those are all cleared you can go forth and try to heal this person with your hands.

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Magnetic resonance imaging of the brain reveals reversible purchase 400 mg albendazole with visa hiv infection rates russia, bilateral parieto-occipital white matter increased signal abnormal- ities discount albendazole 400 mg otc hiv infection wbc count, with sparing of the occipital cortex, seen best on T2-weighted or FLAIR images. This syndrome may represent hyperfusion breakdown of the blood–brain barrier. Reversible posterior leukoencephalopathy in leukemia may be triggered by methotrexate, steroids, vincristine, and=or high-dose cytarabine, and in other situa- tions has been associated with hypertension or immunosuppression, triggered by renal failure, cyclosporine, or FK506 (tacrolimus). Neurologic Effects of Cancer 257 Reversal of encephalopathy in the pediatric oncology patient can be challen- ging. First, unexplained encephalopathy in the febrile, immunocompromised patient should always prompt initiation of broad-spectrum antibiotics and acyclovir. For chemotherapy-related alterations producing severe or life-threatening encephalopa- thy, or any other profound neurologic insults, discontinuation of the offending agent is usually the wisest choice. Methylene blue has been reported as an antidote for ifos- famide encephalopathy. Acute dysfunction from elevated methotrexate levels can be treated with increasing leucovorin, although whether this affects long-term sequelae is debatable. For children with leukoencephalopathy or cognitive decline, supportive treatment with stimulants such as methylphenidate may prove helpful. INCREASED INTRACRANIAL PRESSURE Elevated intracranial pressure (ICP) can be heralded by a change in mental status, lethargy, headache, or vomiting. Increased ICP can arise from the structural lesions mentioned above, as well as hydrocephalus, meningitis, and pseudotumor cerebri. The retinoids cis-retinoic acid and fenretinide, used in neuroblastoma, and all-trans retinoic acid, utilized in acute promyelocytic leukemia, can cause pseudotumor. The clinician should maintain an orderly approach to the urgent and emergent treatment of increased ICP (Table 4). SEIZURES Seizures in children with cancer may arise from primary brain tumors or metastatic disease, leukemic meningitis, stroke, CNS infection, metabolic abnormalities, or treatment sequelae. Intrathecal methotrexate can cause seizures 7–10 days after administration, while high-dose intravenous methotrexate can lead to seizures more acutely. Standard neu- rologic management of status epilepticus and seizures, described elsewhere in this book, should be followed. For the child undergoing chemotherapy, special consid- eration should be given to the choice of antiepileptic agent. Recent data have shown marked reduction in bioavailability of chemotherapy metabolized by the cytochrome P450 mono-oxygenase system, when patients concurrently receive the enzyme- inducing anticonvulsants phenytoin, phenobarbital, or carbamazepine. For these children, if chronic anticonvulsant therapy is warranted, selection of a non-enzyme-inducing agent, such as gabapentin, levetiracetam, lamotrigine, or topiramate, is preferable to avoid this complication. Furthermore, carbamazepine and valproic acid are avoided owing to their potential bone marrow myelosuppression. MYELOPATHY The neurologist should always think beyond cerebral processes and consider myelo- pathy to explain motor loss, sensory deficit with a dermatomal level, or autonomic (i. Spinal irradiation, months to years after its administration, can lead to myelopathy, often symmetric. Intrathecal agents, 258 Fisher Neurologic Effects of Cancer 259 260 Fisher Table 3 Differential Diagnosis for Stroke in the Child with Cancer Acute promyelocytic leukemia Chemotherapeutics BCNU (carmustine) intra-arterial Cisplatin intra-arterial l-Asparaginase Hyperleukocytosis, in leukemia Intratumoral hemorrhage—high-grade astrocytoma, medulloblastoma Methotrexate-associated stroke-like events days to a week plus after intravenous high dose Neuroblastoma metastatic to the dura or torcula Platelet-resistant thrombocytopenia such as cytarabine, methotrexate, and thiotepa, can cause acute to subacute spine necrosis, specifically when these drugs distribute unevenly in the subarachnoid space because of blockage from tumor. Nuclear medicine studies with technetium or indium can often demonstrate blockage in the presence of leptomengineal disease, even when spine MRI appears to show patent spaces. SPINAL CORD COMPRESSION The most alarming cause of myelopathy in the oncology patient is compression of the spinal cord by tumor. Tumor most often infiltrates through intervertebral foramina, unlike in adults where vertebral body involvement is more often found. Epidural tumor spread through the foramina is seen most frequently with Ewing sarcoma, neuroblastoma, osteosar- coma, rhabdomyosarcoma, Hodgkin disease, and non-Hodgkin lymphoma. Spinal subarach- noid tumor can develop with leukemia and ‘‘drop metastases’’ from the primary brain tumors medulloblastoma, embryonal tumors, ependymoma, and astrocytoma. In addition to the signs of myelopathy already described, these patients com- monly have exquisite back pain and localized tenderness to percussion over the spine.

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Diamond films can now be patterned to geometries suitable for all but the most demanding devices purchase 400mg albendazole overnight delivery hiv/aids infection rates (recent statistics). The final buy albendazole 400mg low price hiv aids infection rates in kenya, and probably the most difficult problem to solve in order to be able to create diamond devices, is that of doping – changing the conductivity of the diamond reliably and reproducibly by incorporation of suitable impurity atoms. Unfortunately, most electronic devices require two different types of impurities to be present, ones that lead to an excess of positive charge, and ones that lead to an excess of negative charge. Creating excess positive charge (p-type doping) is relatively straightforward, since addition of a small amount of a boron-containing gas such as diborane to the CVD process gas mixture is all that is required to incorporate boron into the structure. However, the close packing and rigidity of the diamond struc- ture make incorporation of atoms larger than carbon very difficult. This means that impurities (such as phosphorus or arsenic) which are routinely used to create excess negative charge (n-type doping) in other semiconduc- tor materials like silicon, cannot easily be used for diamond. The develop- ment of a successful n-type doping process has taken a considerable time, and only very recently have a few reports appeared from Japan claiming success in this area using sulphur as the necessary impurity. Despite these difficulties, diamond-based devices are gradually beginning to appear, and it may become the material of choice for electronic applications involving high power and/or high temperature. The electronic prop- erties of diamond are such that when a negative voltage is applied across it in vacuum, electrons are ejected from its surface. This process is also common in most metals, except that in metals the electrons have to over- come an energy barrier, or work function, to escape from the surface. In diamond this barrier has been measured and found to be very small, maybe even negative, and this has given rise to the term ‘negative electron affinity’. In practice, this means that devices based on the electron emis- sion properties of diamond could consume very low power levels and hence be extremely efficient. The electrons emitted from the surface are acceler- ated using a positive grid, and strike a phosphor screen, causing light to be emitted. Each emitting diamond crystal, or group of crystals, would form a ‘pixel’ on a flat panel display screen. Unlike their major competitors (liquid crystal displays), diamond cold cathode field emission displays would have high brightness, have a large viewing angle, and be insensitive to temperature variations. Also, because of their relative simplicity, it is possible that diamond emitting displays could be scaled up to large areas that would be impossible with liquid crystals – maybe even metres square! Conducting diamond electrodes, made by adding boron to CVD diamond films, are very inert compared to other electrode materials (such as platinum). Such diamond electrodes may find applications in analysis of contaminants, such as nitrates, in water supplies, and even in the removal of those contaminants. If growth rates can be increased to economically viable levels, such diamond fibres may find uses as reinforc- ing agents in advanced composites, allowing stronger, stiffer and lighter load-bearing structures to be manufactured for use in, say, aerospace appli- cations. Hollow diamond fibres and two-dimensional diamond fibre mat- Diamond thin films 93 Figure 5. A diamond-coated tungsten wire that is about the same diameter as a human hair. High performance ultra- violet detectors have already been demonstrated and are now in commercial production. Diamond can be used to detect other high energy particles (such as alpha- and beta-particles and neutrons), and be used as a replacement for silicon in the next generation of particle accelerators. Since diamond has a similar response to damage by X-rays and gamma rays as human tissue, a possible application is in medical applications, as a dosimeter for radiation exposure. Researchers and industry are cur- rently concentrating upon developing methods to scale up the CVD pro- cesses and reduce production costs to the point at which it becomes economically viable to use diamond as the material of choice. With the twenty-first century now upon us, we are still some way from diamond becoming the engineer’s dream of being ‘the ultimate engineering mater- ial’. However, some applications are already in the marketplace, such as diamond heat spreaders, windows and cutting tools. In the next few years we can expect to see diamond films appearing in many more applications, especially in electronics. Perhaps the most likely ‘killer applications’ which will firmly establish diamond as a twenty-first century material will be in the area of specialised flat panel displays and high temperature elec- tronics, for which the total available market in the year 2000 has been esti- mated at US$435 million and US$16 billion, respectively. In some ways this may be a shame, since familiarity with diamond as just another com- monplace material may remove some of the glamour and mystique sur- rounding the world’s most sought-after gemstone.

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