By A. Tippler. Pennsylvania State University at Harrisburg. 2018.
Many drugs and agrochemicals can exist as two forms which are mirror images of one another safe atarax 25mg, only one of which is useful order atarax 10mg mastercard, the other being useless or even dan- gerous discount 25 mg atarax free shipping. As an example of mesoporous materials containing chiral metal-centred catalysts generic 10 mg atarax fast delivery, the group of Daniel Brunel in Montpellier has published work on transformations using zinc species. Selectivity to the desired form was good, approaching that achievable with conventional systems. Further reﬁnement of these systems will lead to improvements in the design of the catalytic site, and its surrounds, and the prospects for this area of catalysis are exciting. One of the strongest current trends in the industry is towards green chemistry, which will involve redisign of many of these processes for the preparation of this bewildering array of products. Much success has already been achieved, and many major products are now pro- duced using green technologies. Much remains to be done, however, and several approaches are currently being investigated. One of the most excit- ing is the development of new materials which can function as catalysts, and whose structures can be ﬁne tuned for the application in mind. The rate of the advances made in the last eight years of the twentieth century has been remarkable, and further advances will allow these fascinating materials to contribute greatly to the quality of life for everyone in the twenty-ﬁrst century. Further Chemistry on the inside 73 work will reveal advanced catalytic systems, possibly containing more than one type of active site, and the control over pore dimensions will allow an ever-increasing level of control over selectivity towards the desired product. The ability to incorporate polarity-modifying groups will also play a major role in transport processes, of great importance in both catalysis and membrane processes. Many other opportunities exist due to the enormous ﬂexibility of the preparative method, and the ability to incorporate many different species. Very recently, a great deal of work has been published concerning methods of producing these materials with speciﬁc physical forms, such as spheres, discs and ﬁbres. Such possibilities will pave the way to new application areas such as molecular wires, where the silica ﬁbre acts as an insulator, and the inside of the pore is ﬁlled with a metal or indeed a conducting polymer, such that nanoscale wires and electronic devices can be fabri- cated. Initial work on the production of highly porous electrodes has already been successfully carried out, and the extension to uni-directional bundles of wires will no doubt soon follow. The ability to produce threads, discs and spheres of deﬁned size and structure will be of great importance when the very promising initial results from catalytic studies are applied on a larger scale. Processes using heterogeneous catalysts require the ability to control particle size and shape in order to ensure good mixing of all the reaction components, and separations after reaction. A further application of this technology will certainly be the fabrica- tion of membranes of these materials. Membrane reactors have shown great utility in many systems, where one component of a reaction mixture can be separated by permeation through a membrane, thus driving a reac- tion forwards, by continuous separation. Looking further ahead, the pores in these materials could be consid- ered as analogous to ion channels in cell walls. The encapsulation of the enzyme inside the cell could then possibly be used to protect the enzyme from harsh conditions outside the cell, while allowing reaction components to diffuse in, react, and diffuse out again. Already, some effort is being expended on silica/biological composites, with signiﬁcant advances being made. MACQUARRIE discovery of the MTSs in 1992, such major advances will no doubt become reality in the early years of the twenty-ﬁrst century. May School of Chemistry, University of Bristol, Bristol BS81TS, UK Diamond has some of the most extreme physical properties of any material, yet its practical use in science or engineering has been limited due its scarcity and expense. With the recent development of techniques for depositing thin ﬁlms of diamond on a variety of substrate materials, we now have the ability to exploit these superlative properties in many new and exciting applications. In this paper, we shall explain the basic science and technology underlying the chemical vapour deposition of diamond thin ﬁlms, and show how this is leading to the development of diamond as a twenty-ﬁrst century engineering material. They were prized for their scarcity for centuries, and still remain a symbol of wealth and prestige to this day. Diamonds were ﬁrst mined in India over 4000 years ago, but the modern diamond era only began in 1866, when huge diamond deposits were discovered in Kimberley, South Africa, creating a huge rush of European prospectors. The wealth this created helped to underwrite the British Empire, and changed the fates of many African countries. Apart from their appeal as gemstones, diamonds possess a remarkable 75 76 P.
Balance in the self includes the sub-concept of being grounded or centred atarax 25 mg low cost. The concepts of balance in the body and balance in the self are inextricably connected to the category of control buy cheap atarax 25 mg on-line, which is itself composed of two distinct concepts: taking control and self-control atarax 25mg line, where taking control includes the sub-concepts of Image not available Introduction | 9 control of one’s healing process and taking responsibility for one’s health generic 10mg atarax visa. Finally, the concept of self-control is comprised of such sub-concepts as control over one’s behaviour and lifestyle choices, and control over one’s thought processes and emotional reactions. THE STRUCTURE OF THE BOOK In chapter one I begin the story of the experiences of these informants by addressing the questions of how we should conceptualize alternative health care and just who we should consider a user of alternative therapies. In it I argue for a subjectivist understanding of alternative approaches to health and healing, as well as against the notion that the individual who participates in alternative forms of healing is a particular type of person. Using demographic information collected from the people who took part in this study and comparing it with what is known in general about the users of alternative therapies in Canada, the United States (US), and the United Kingdom (UK), I demonstrate that people who use these therapies are no different from individuals engaged in any other form of health- seeking behaviour. In the next two chapters I consider how and why people participate in alternative approaches to health and healing. Through analysis of the networks of alternative therapy use negotiated by these informants, I present a new conceptual model of the health care system informed by their experiences. Rather than conceptualizing alternative therapies as isolated, this model situates alternative forms of healing within every sector of the health care system. In chapter three I examine the debates surrounding what is said to motivate the individual to seek out alternative modes of health and healing. I demonstrate how it is more fruitful to understand individuals’ use of alternative therapies as a generic social process of problem-solving than it is to focus on particular ideological motivating factors. Chapters four and five are the lynchpins of this book, as they contain the alternative models of health and healing espoused by the people who par- ticipated in this research. The centrality of these models to understanding the experiences of individuals who participate in alternative therapies lies in the link they provide between adoption of alternative health belief sys- tems and the impact of these alternative health and healing ideologies on an individual’s sense of self. In chapter four I describe these informants’ model of alternative healing and discuss how they give meaning to it by 10 | Using Alternative Therapies: A Qualitative Analysis contrasting it with what they see as the negative standard of biomedicine. In chapter five I turn to an analysis of their model of alternative health. This model gives voice to the lay perspective, in contrast to existing models of alternative health which rely on physician and alternative practitioner beliefs. I extend my analysis of the potential implications for the individual of participation in alternative health care in chapter six by addressing the hitherto underdeveloped analysis of the relationship between alternative therapy use and the self. I discuss how some of the people who spoke with me used the ideology contained within this model of health to construct a healthy sense of self. In chapter seven I address the less positive impact of alternative healing ideology on identity through analysis of how these people manage the stigma associated with their participation in alternative therapies. My conclusion provides a summary of the major findings of this research, a discussion of the implications of these findings for health policy, and suggestions for future research in the growing field of the sociology of alternative forms of health and healing. I have also included an appendix of brief descriptions of the alternative therapies mentioned in this book. It is important to note that I provide these sketches solely for the benefit of those readers who may be unfamiliar with particular alternative healing techniques; in no way do I mean these descriptions to be read as definitive. Hence I have chosen the descriptions randomly from a selection of scholarly literature, popular sources, advertising pamphlets, and—in keeping with my focus on the user of alternative therapies—quotations from informant interviews. The interviews took place between 1993 and 1996 and the transcription was conducted between 1993 and 1998. The number of informants who participate in grounded theory research is in one sense irrelevant, as the unit of analysis in these cases is the concept rather than the individual (Corbin and Strauss 1990). All informants were asked to give their written consent prior to the interviews. They were informed of the purpose of the research, assured that their participation in the study was voluntary, told that they had the right to end the interview at any time and that they were not required to answer any questions they did not wish to. They were also made aware that if they decided to withdraw from the project at any time, their tapes and tran- scripts would be destroyed. Participants were offered an opportunity to review their transcripts and those sections of the analysis containing portions of their interviews.
I have a belief that there are people out there who have a higher power than ours buy cheap atarax 25 mg online. Some of these informants saw a relationship between their spirituality and their use of alternative health care generic 10 mg atarax with visa. For example cheap atarax 10 mg line, Jane told me: “I’m into a lot of other things like spirituality that’s not mainstream minded 25 mg atarax with amex, so this [alternative therapy] is just part and parcel of the package. Sharma (1992:45) makes the same point more generally, concluding that “using ‘alternative’ medicine... There was little if any variation by sex, age, ethnic category, or SES—neither in terms of accessing alternative therapies, of beliefs about alternative approaches to health and healing, nor of the impact participation What Are Alternative Therapies and Who Uses Them? Rather, the user of alternative therapies is no different from any other person engaged in health-seeking behaviour, and arguments that those who participate in alternative forms of health care are particular types of people remain unconvincing. Portions of this chapter were originally published in the journal Complementary Therapies in Medicine (2001), 9:105–110. See also de Bruyn (2001); Glik (1988); Murray and Shepherd (1993); Sharma (1992); Vincent and Furnham (1996); and Wellman (1995). This sub-sample consisted of two hundred and eight respondents who used alternative therapies in the six months prior to the survey, who did not discuss their alternative therapy use with their doctors, and who responded to the question: “If you were to tell your doctor about using these alternative health services (not including chiropractor) do you think your doctor would say that they would...? It is a matter of considerable debate whether this is due to a greater incidence of morbidity among women than among men, or to the more frequent medicalization of women’s bodies and lives (Miller and Findlay 1994). CHAPTER TWO How People Use Alternative Therapies While the user of alternative therapies is no different from any other health seeker, the way in which those who spoke with me experience using alternative therapies is a distinct process dependent on developing ever- expanding alternative health care networks composed of alternative therapies and the people who use them (de Bruyn 2001). Creating these networks is rarely accomplished in a systematic fashion; rather, it is a matter of one thing leading to another (Glik 1988; Sharma 1990). For example, Pam told me, “I picked up a couple of books and sort of one thing has led to another. From reading one book I get reference to another book”; and Natalie said, “Well I started off with positive thinking books, from there I went to tapes on healing and then I started taking courses on therapeutic touch and went from therapeutic touch to the results system. For example, Greg just happened to run into his brother-in-law, who is a naturopath: I caught some kind of stomach bug or whatever, and I’m staggering back across the street with a little prescription from my doctor and I happened to walk past my brother-in-law, and he could see that I was pretty wobbly, and he looked at the prescription and he figured the whole idea was just to shut the whole body down. She’s the one that said she was going to a healer in Quebec and she said: ‘You’ve gotta go. According to Lorraine, One girlfriend said: ‘This doctor’s speaking on natural medicine, would you like to go? Then her name [came] up again about three times and I thought, well destiny is telling me go to this doctor and finally I got to go to her. I do believe that it’s part of your predestined path to get into this kind of thing. In like manner, Trudy associated these encounters with the inscrutable workings of the universe: I also believe, and have experienced, that usually whatever it is you’re looking for, the people and the circumstances sort of fall into place, even if you don’t know what it is. You just have to do your part and the uni- verse takes care of the rest. No matter how they make sense of these key encounters, one thing lead- ing to another results in the development of ever-expanding networks of users and sources of alternative health care. In Laura’s words: I work part-time for a little store and a customer came in who I know and she was lamenting that her one son had just been diagnosed as having this wheat allergy and she said: ‘And he’s got a birthday party on Saturday and I don’t know what to do. Neighbour down the road was at work and somebody was lamenting her daughter is wheat sensitive now and this woman phoned me clear out of the blue. I think I’ve talked to maybe four people who have just called because somebody has been talking about a friend of a friend and so we’ve been networking. These alternative health care networks were conceptualized in a variety of different ways by the people who spoke with me. For example, Natalie con- ceptualized this web of people as a grapevine: “I went to a healing circle. They’d hear about it through the grapevine, just people in conversation. Someone will overhear a conversation and say: ‘My husband’s got cancer’ and someone will say: ‘Oh I know a healing group. She told me: “Guest speakers would come and lecture on all of these different topics so there- fore you meet this person, this person, this person, ‘Well I’m interested in this,’ ‘Well go and see this person.
Feel for surgical emphysema purchase atarax 25mg amex, which is often associated with rib fractures discount 10mg atarax otc, a pneumothorax order atarax 25mg visa, flail segment purchase 25 mg atarax with visa, or upper airway disruption. Five main life-threatening thoracic conditions that must be identified and treated immediately are: Sizing of the “Stifneck” collar ● Tension pneumothorax ● Haemothorax If all the following criteria are met, cervical spine ● Flail chest stabilisation is unnecessary: ● Cardiac tamponade ● No neck pain ● No distracting injury ● Open chest wound. Asymmetric chest wall excursion, 66 Resuscitation of the patient with major trauma contralateral tracheal deviation, absent breath sounds, and hyperresonance to percussion all indicate a significant tension pneumothorax. Initial treatment by needle decompression aims to relieve pressure quickly before insertion of a definitive chest drain. Needle decompression is performed by inserting a l4G cannula through the second intercostal space (immediately above the top of the third rib) in the midclavicular line. Haemothorax is suggested by absent breath sounds and Bilateral needle decompression (note that the left-sided needle has become stony dullness to percussion. The presence of air dislodged) (haemopneumothorax) may mask dullness to percussion, particularly in a supine patient. Cardiac tamponade is diagnosed by the Flail chest occurs when multiple rib fractures result in a free classic Beck’s triad: segment of chest wall that moves paradoxically with respiration. Heart sounds are often quiet in hypovolaemic patients and central venous pressure may not be raised if the patient is hypovolaemic. Pericardiocentesis is performed by insertion of a needle 1-2cm inferior to the left xiphochondral junction with a wide bore cannula aimed laterally and posteriorly at 45 towards the tip of the left scapula. Connecting an electrocardiogram (ECG) to the needle and observing for injury potential as the needle penetrates the myocardium has traditionally been advocated as a means of confirming anatomical location. Nowadays, many accident and emergency departments have access to portable ultrasound, which provides better visualisation. Open chest wounds require covering with a three-sided dressing (to prevent formation of a tension pneumothorax) or an Asherman seal together with early insertion of a chest drain. Blunt trauma is associated with pulmonary contusion, which may not be apparent on early chest x ray examination but can result in significantly impaired gas exchange. Circulation Asherman seal Hypovolaemic shock is a state in which oxygen delivery to the tissues fails to match oxygen demand. It rapidly leads to tissue hypoxia, anaerobic metabolism, cellular injury, and irreversible damage to vital organs. Although external Classification of hypovolaemic shock and changes in haemorrhage is obvious, occult bleeding into body cavities is physiological variables common and the chest, abdomen, and pelvis must be examined carefully in hypovolaemic patients. Isolated head Class I Class II Class III Class IV injuries rarely cause hypotension (although blood loss from Blood loss scalp lacerations can be significant). Assessment of the circulatory system pressure Very low begins with a clinical examination of the pulse, blood pressure, Systolic Normal Normal Decreased Barely capillary refill time, pallor, peripheral circulation, and level of Diastolic Normal Decreased Decreased recordable consciousness. Most physiological variables in adults change Pulse Normal 100-120 120 (thready) 120 (very little until more than 30% blood volume has been lost; children (beats/min) thready) compensate even more effectively. Any patient who is hypotensive through blood loss has, therefore, lost a significant Capillary Normal Slow Slow Undetectable volume and further loss may result in haemodynamic collapse. This technique tends to overestimate blood pressure; ● Tension pneumothorax the radial pulse may still be palpable at pressures ● Acidosis considerably lower than a systolic of 80mmHg. Blood tests are of little use in the initial assessment of haemorrhage because the haematocrit is unchanged immediately after an acute bleed. Management of haemorrhage External bleeding can often be controlled by firm compression and elevation. Compression of a major vessel (for example, femoral artery) may be more effective than compression over the wound itself. Intravenous access Two large-bore intravenous cannulae (14G ) should be inserted. These can be used to draw blood samples for cross-match, full blood count, urea, and electrolytes. Central venous access allows measurement of central venous pressure as a means of judging the adequacy of volume expansion. It should only be undertaken by an experienced physician because the procedure may be difficult in a hypovolaemic patient.