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By Q. Kelvin. Hamline University. 2018.

However tegretol 100mg without a prescription, it is always idiopathic 100mg tegretol overnight delivery, axial tonic seizures are rare or absent buy tegretol 400mg on line, onset is younger than in LGS (typically between 18 months and 4 years) order 200mg tegretol otc, EEG demonstrates photosensitivity, and there is a strong genetic predisposition. Prognosis for seizure control and devel- opmental outcome is more benign than in LGS. Similarly, an entity named atypical benign partial epilepsy of childhood occurs in children between 2 and 6 years, with prominent nocturnal partial seizures, myoclonic, and atonic seizures without tonic seizures. Electroencephalogram is remarkable for diffuse slow spike and wave in sleep and 3-Hz spike wave in the waking record. Seizures remit in late childhood in most patients and developmental regression is limited. Other seizure types that may be mistaken for LGS include frontal lobe epilepsy and multifocal epilepsy with rapid propagation. TREATMENT The therapy of LGS is disappointing, complicated by the variety of seizure types and the occasional worsening of seizure control and cognitive functioning with polyphar- macotherapy. Carbamazepine and phenytoin may exacerbate atypical absence and atonic seizures. Until the introduction of the more recent antiepileptic drugs (AEDs), valproic acid was regarded as the mainstay of treatment of LGS. Valproic acid is still often regarded as a drug of choice because of its broad spectrum of activity; however, seizure control is achieved in only 10–30% of patients. In a double-blind placebo- controlled study, lamotrigine resulted in a decrease in seizure frequency of > 50% in 33% of patients vs. Multiple other studies suggest similar efficacy in children with refractory epilepsy, especially for drop seizures. The risk of 82 Vanderver and Gaillard rash, especially in interaction with valproic acid, a frequently used anticonvulsant in this population, warrants careful titration as doses are increased. Early reports on the use of felbamate in LGS suggested a response with seizure reduction of >50% in 50% of children with LGS. Also, more recent studies in which a subgroup of patients had the diagnosis of LGS, suggest that felbamate continues to be efficacious in 41% of children with refractory epilepsy after 3 years of follow-up. There is also some suggestion that add-on felbamate therapy may decrease the seizure frequency by increasing levels of valproic acid. Although felbamate and lamotrigine are both efficacious, especially for injury causing drop attacks, both are associated with serious idiosyncratic or hypersensitivity reactions leading to interest in newer anticonvulsants. Topiramate has a broad spectrum of action and few therapy-limiting adverse events. An initial double-blind randomized study revealed a decrease in seizure frequency of >50% in 33% of children with target doses of approximately 6mg=kg=day vs. A follow-up open label study after adjustment of mean anticonvulsant doses to 10 mg=kg=day demonstrated a reduction in seizures of! Another multicenter study found seizure reduction of >50% in 40% of patients with a mean dose of 4. A more recent open, multicen- ter study, however, recorded a response rate as defined above of only 25%, although this is discrepant with other reports of topiramate efficacy as add-on therapy in LGS. These three anticonvulsant agents have been shown to decrease seizure fre- quency including drop attacks by about half in as much as one-half of children when used as adjunctive agents. Because seizures remain intractable, other options are often considered. A small sub- group of patients with LGS in a study of zonisamide as an adjunctive agent in pedia- tric epilepsy had a ‘‘response’’ of 25–50%, although effectiveness is not clearly defined. Levetiracetam is also used, although there is limited data regarding efficacy. Benzodiazepines, especially clobazam and nitrazepam, are used with some suc- cess. A small study recently suggested that nitrazepam may be at least as efficacious as other anticonvulsant drugs, decreasing seizure frequency by $50% in more than 60% of patients. Use of these drugs is limited by the development of tolerance and physiologic dependence.

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What is central to both types of identity-change experienced by the people who spoke with me is the ideology contained within the alternative model of health and healing buy 400 mg tegretol with visa. This ideology is both the motivator for taking on the identity of an alternative healer and the mechanism through which they construct a healthy sense of self buy tegretol 400 mg without a prescription. Notwithstanding the fact that these informants experienced positive changes to self through adoption of alternative ideologies of health and 94 | Using Alternative Therapies: A Qualitative Analysis healing discount tegretol 100mg on-line, participation in these forms of health care can also have a negative impact on identity buy discount tegretol 400 mg on line. More precisely, a consequence of participation in alternative therapies is that people are often stigmatized for their use of what have been labelled “deviant systems of medicine” (Saks 1995:119). Therefore, while using alternative therapies can allow the individual to change their self-perceptions and transform their identities for the better, these benefits to self can come at the price of acquiring a deviant identity. My intent here is not an in-depth examination of the components of the alternative healer identity. Rather, I am concerned with what motivates these informants to begin, continue, or complete the process of adopting a healer identity. Interested readers should see Boon (1998); Cant and Calnan (1991); and Lowenberg (1992) for analyses of alter- native practitioner identity. Glik’s (1990) characterization of the changes to self experienced by her informants as imagined is problematic. As Thomas and Thomas (1970:154) made plain, “If [people] define situations as real they are real in their consequences. While Lindsey (1996:466) does not identify the source of the beliefs that allowed her informants to find “health within illness” as alternative healing ideology, much of the data she presents in illustrating how her informants describe health are analogous to many of the components which make up the alternative model of health espoused by the people who spoke with me. For example, one woman who took part in her research defined health as “being in control of myself and making my own decisions” (Lindsey 1996:468). CHAPTER SEVEN Using Alternative Therapies: A Deviant Identity The use of alternative therapies as deviant behaviour is neglected as an area of research, despite the fact that people who use so-called unortho- dox therapies have consistently been ridiculed (Johnson 1999; Leech 1999; Miller et al. For example, Hare (1993:40) equates a patient’s disclosure of her use of acupuncture to her doctor with the Catholic confessional, and the use of alternative therapies with a sin that must be absolved: “She is confessing to her physician who absolves her, even confessing his own foray into the domain of the ‘other. My focus here is on the means used by informants to reduce the stigma associated with their participation in alternative approaches to health and healing. In addition to describing the use of perennial methods of coping with stigma, such as managing disclosure and using humour (Davis 1961; Goffman 1963), I analyse informants’ use of accounts as a technique of stigma management (Scott and Lyman 1981). In particular, I reflect on their use of retrospective reinterpretation of biography employed in their accounts of their participation in alternative therapies. One’s self-defined biography is neither static nor fixed; rather, as Goffman (1963:62) points out, a salient feature of biographies is that they “are very subject to retrospective construction. As we remember the past, we reconstruct it in accordance with our present ideas of what is important and what is not. In Scott and Lyman’s (1981:357) words: “Every account is a manifestation of the under- lying negotiation of identities,” and is no less so in negotiating deviant identities (emphasis theirs). According to Scott and Lyman (1981:343–344), “An account is a linguistic device employed whenever an action is sub- jected to valuative inquiry.... A statement made by a social actor to explain unanticipated or untoward behavior. These categories differ in that justifications are accounts in which the actor “accepts responsibility for the act... For Scott and Lyman (1981:348) the crucial distinction between excuses and justifications is that in the former case the individual accepts that the behaviour in question is wrong, while in the latter case he or she “asserts its positive value in the face of a claim to the contrary. Self-fulfillment accounts justify behaviour through the rationale that the act is not wrong if it corresponds with the actor’s notion of what is necessary to his or her self-fulfillment, whereas “The sad tale is a selected (often distorted) arrangement of facts that highlight an extremely dismal past, and thus explain the individual’s present state” (Scott and Lyman 1981:349). Below, Using Alternative Therapies: A Deviant Identity | 97 I critically apply Scott and Lyman’s (1981) notions of justifications and excuses, as well as Sykes and Matza’s (1957) techniques of neutralization, in analysing informants’ accounts of their experiences with alternative therapies. Further, I argue that the concept of retrospective reinterpretation of biographies can also be used to shed new light on how people who use alternative therapies reduce the stigma associated with their participation in alternative forms of health care. ALTERNATIVE THERAPY USE AS DEVIANT BEHAVIOUR The language used in the literature to describe alternative therapies has been and remains largely derogatory and pejorative. For example, consistently and over time, alternative therapies have been styled unconventional, nonconventional, unorthodox (Dunfield 1996); unscientific and unproven (Feigen and Tiver 1986); “fuzzy stuff” (Monson 1995:170); or “deviant forms of health service” (Cassee 1970:391).

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Clinical experience indicates that many infants and young children with acute or static conditions improve with prompt initiation of appropriate interventions and time discount tegretol 100mg without prescription, and thereby purchase tegretol 200mg, lessen or elim- inate the need for tube feedings order tegretol 200 mg. Caregivers should be reassured that although many families struggle with initial decisions about whether to place GTs trusted 400mg tegretol, following GT placement, 90% of caregivers report that tube feedings have improved the quality of life for their children and the family. SUMMARY Oropharyngeal dysphagia is common in children with neurologic diseases. The underlying condition determines the nature and extent of the swallowing dysfunc- tion, and governs the prognosis for recovery. Early detection of the problem and prompt initiation of appropriate interventions are necessary for improving outcomes for these children and their caregivers. Swallowing disorders in severe brain injury: risk factors affecting return to oral intake. Sanders KD, Cox K, Cannon R, Blanchard D, Pitcher J, Papathakis P, Varella L, Maughan R. Diagnosis and treat- ment of feeding disorders in children with developmental disabilities. Living with cerebral palsy and tube feeding: a popula- tion-based follow-up study. Migraine is a common childhood disorder characterized by recurrent headaches. Most children with migraine are symptom free between episodic headache attacks. Headache frequency and severity increase over time for a subset of pediatric migra- neurs. Chronic migraine headache, transformed migraine, chronic nonprogressive headache, and chronic daily headache probably represent a spectrum of migraine headache syndromes. As headaches increase in severity and=or frequency, patients and their families are likely to experience significant disability. The burden of chronic migraine not only includes severe head pain but also missed school and extracurri- cular activities, academic underachievement, depressed mood, and anxiety. This chapter will focus on therapeutic approaches to chronic headache syndromes; acute therapies are covered. The goal of preventative treatment should be to decrease significantly the frequency and severity of migraine headache, improve quality of life, and increase the effectiveness of abortive therapy. There is no fixed number of headaches per month that requires prophylaxis. Pharmacologic therapy is usually started when headache begins to interfere with a patient’s activities, or when abortive therapy becomes less effective because of overuse (Table 1). Physicians should help patients develop realistic expectations about the limits of treatment for this chronic disorder. Responsibility for headache control should be shared among patient, family, and physician. Patients and physicians often find that a headache diary recording both frequency and severity of attacks as well as possible trigger factors is useful in monitoring the efficacy of treatment. Table 1 When to Consider Preventative Medication Recurrent headaches that interfere significantly with daily activities Ineffectiveness or contraindications to abortive medication Analgesic overuse Very frequent headaches Patient preference Headaches with significant neurologic threat (i. Caffeine, chocolate, mono- sodium glutamate, processed and smoked meat and fish, nuts, vinegar and red wine, citrus fruits, cheeses (especially aged), and aspartame tend to precipitate headache in susceptible individuals. Foods like hotdogs, some corn and potato chips, pizza, soda, and peanut butter must be included on any list for children. Skipping meals, espe- cially during the school day, can lead to headache. Dehydration, especially in the summer and during sports, is an under recognized trigger in many children.

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Antibiotics are natural or synthetic compounds that kill bacte- All the assessments of antibiotic effectiveness need to ria tegretol 200 mg low price. There are a myriad of different antibiotics that act on dif- be done in a controlled manner purchase tegretol 400mg with visa. This necessitates the use of ferent structural or biochemical components of bacteria quality 400 mg tegretol. The concentration the 1930s generic tegretol 100mg without a prescription, there were few effective ways of combating bacte- of the bacteria used is also important. Illnesses such as pneumonia, tuberculosis, and “dilute” out the antibiotic, producing a false indication of typhoid fever were virtually untreatable, and minor bacterial 24 WORLD OF MICROBIOLOGY AND IMMUNOLOGY Antibody-antigen, biochemical and molecular reactions infections could blossom into life-threatening maladies. In the decades following the discovery of penicillin, many naturally occurring antibiotics were discovered and still more were syn- thesized towards specific targets on or in bacteria. Antibiotics are manufactured by bacteria and various eukaryotic organisms, such as plants, usually to protect the organism from attack by other bacteria. The discovery of these compounds involves screening samples against bacteria for an inhibition in growth of the bacteria. In commercial settings, such screening has been automated so that thousands of sam- ples can be processed each day. Antibiotics can also be manu- factured by tailoring a compound to hone in on a selected target. The advent of molecular sequencing technology and three-dimensional image reconstruction has made the design of antibiotics easier. Penicillin is one of the antibiotics in a class known as beta-lactam antibiotics. This class is named for the ring struc- Antibiotic resistance, a problem that develops when ture that forms part of the antibiotic molecule. If an antibiotic is used antibiotics include the tetracyclines, aminoglycosides, properly to treat an infection, then all the infectious bacteria rifamycins, quinolones, and sulphonamides. The action of should be killed directly, or weakened such that the host’s these antibiotics is varied. However, the use of too low otics exert their effect by disrupting the manufacture of pepti- a concentration of an antibiotic or stopping antibiotic therapy doglycan, which is main stress-bearing network in the before the prescribed time period can leave surviving bacteria bacterial cell wall. These surviving bacteria have demonstrated the construction of the subunits of the peptidoglycan or by pre- resistance. If the resistance is governed by a genetic alteration, venting their incorporation into the existing network. In the genetic change may be passed on to subsequent genera- another example, amonglycoside antibiotics can bind to a sub- tions of bacterial. For example, many strains of the bacterium unit of the ribosome, which blocks the manufacture of protein, that causes tuberculosis are now also resistant to one or more or can reduce the ability of molecules to move across the cell of the antibiotics routinely used to control the lung infection. As a final example, the As a second example, some strains of Staphylococcus aureus quinolone antibiotics disrupt the function of an enzyme that that can cause boils, pneumonia, or bloodstream infections, uncoils the double helix of deoxyribonucleic acid, which is are resistant to almost all antibiotics, making those conditions vital if the DNA is to be replicated. Ominously, a strain of Staphylococcus Besides being varied in their targets for antibacterial (which so far has been rarely encountered) is resistant to all activity, different antibiotics can also vary in the range of known antibiotics. They are lethal against only a few See also Bacteria and bacterial infection; Bacterial genetics; types (or genera) of bacteria. Other antibiotics are active Escherichia coli; Rare genotype advantage against many bacteria whose construction can be very differ- ent. Such antibiotics are described as having a broad-spec- trum of activity. ANTIBIOTICS, HISTORY OF DEVELOP- In the decades following the discovery of penicillin, a MENT • see HISTORY OF THE DEVELOPMENT OF ANTIBIOTICS myriad of different antibiotics proved to be phenomenally effective in controlling infectious bacteria. Antibiotics quickly became (and to a large extent remain) a vital tool in the physician’s arsenal against many bacterial infections. ANTIBODY-ANTIGEN, BIOCHEMICAL AND Indeed, by the 1970s the success of antibiotics led to the gen- MOLECULAR REACTIONS Antibody-antigen, biochemical, and molecular reactions erally held view that bacterial infectious diseases would soon be eliminated. However, the subsequent acquisition of resist- Antibodies are produced by the immune system in response to ance to many antibiotics by bacteria has proved to be very antigens (material perceived as foreign.

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These bacteria take in carbon dioxide and ual to maintain his/her blood in the event of a future mishap cheap 400mg tegretol fast delivery. Some scientists assert that these unique bacteria with blood screening technologies there are still several hun- should be classified in their own new taxonomic kingdom discount tegretol 100 mg line. From an immunological viewpoint discount 200mg tegretol visa, See also Bacterial kingdoms; Biogeochemical cycles; another reason for autologous banking is that autologous Extremophiles blood will be immunologically identical to the blood present at the time of return transfusion tegretol 400mg for sale. This eliminates the possibil- ity of an immune reaction to blood that is antigenically differ- AVERY, OSWALD THEODORE (1877-1955) Avery, Oswald Theodore ent from the individual’s own blood. Canadian-born American immunologist The autologous blood collected from the umbilical cord is a source of stem cells. Stem cells are cells that have not yet Oswald Avery was one of the founding fathers of immuno- undergone differentiation into the myriad of cell types that chemistry (the study of the chemical aspects of immunology) exist in the body (e. His studies of the Pneumococcus virus (causing acute under appropriate conditions, stem cells can be encouraged to pneumonia) led to further classification of the virus into many differentiate into whatever target cell is desired. Although this distinct types and the eventual identification of the chemical reality has not yet been fully realized, the potential of stem differences among various pneumococci viral strains. His cell technology as a therapy for various diseases has been work on capsular polysaccharides and their role in determin- demonstrated. These studies also contributed to The differences in blood cells between individuals due to the the development of therapeutic sera used to treat the pneumo- so-called major histocompatibility antigen is not as pronounced nia virus. Thus, umbilical cord blood cells and tissue ogy was the identification of complex carbohydrates as can be used for donation and transplantation. In addition, cord playing an important role in many immunological processes. See also Antibody and antigen; Histocompatibility; Immunity, This discovery forced geneticists of that time to reevaluate cell mediated their emphasis on the protein as the major means of transmit- ting hereditary information. This new focus on DNA led to James Watson and Francis Crick’s model of DNA in 1952 and Autotrophic bacteriaAUTOTROPHIC BACTERIA an eventual revolution in understanding the mechanisms of heredity at the molecular level. Avery was born Halifax, Nova Scotia, to Joseph Francis Autotrophic organisms take inorganic substances into their and Elizabeth Crowdy Avery. His father was a native of bodies and transform them into organic nourishment. England and a clergyman in the Baptist church, with which Autotrophs are essential to all life because they are the pri- Avery was to maintain a lifelong affiliation. There are two family immigrated to the United States and settled in New categories of autotrophs, distinguished by the energy each York City, where Avery was to spend nearly sixty-one years of uses to synthesize food. A private man, he guarded his personal life, even from chemoautotrophs use chemical energy. Both types 2 and 3 pneumococci contain edge of matters outside of the laboratory have no bearing on nitrogen-free carbohydrates as their soluble substances, but the understanding of a scientist’s accomplishments. As a the carbohydrates in type 2 are made up mainly of glucose and result, Avery, who never married, managed to keep his own those of type 3 are composed of aldobionic acid units. He then went into the clinical practice of general surgery In addition to clarifying and systemizing efforts in bac- for three years, soon turned to research, then became associate teriology and immunology, Avery’s work laid the foundation director of the bacteriology division at the Hoagland for modern immunological investigations in the area of anti- Laboratory in Brooklyn. Although his time at the laboratory gens (parts of proteins and carbohydrates) as essential molec- enabled him to study species of bacteria and their relationship ular markers that stimulate and, in large part, determine the to infectious diseases, and was a precursor to his interest in success of immunological responses. Avery and his colleagues immunology, much of his work was spent carrying out what he had found that specific anti-infection antibodies worked by considered to be routine investigations. Eventually Rufus Cole, neutralizing the bacterial capsular polysaccharide’s ability to director of the Rockefeller Institute hospital, became interfere with phagocytosis (the production of immune cells acquainted with Avery’s research, which included work of gen- that recognize and attack foreign material). Eventually eral bacteriological interest, such as determining the optimum Avery’s discoveries led scientists to develop immunizations and limiting hydrogen-ion concentration for Pneumococcus that worked by preventing an antigenic response from the cap- growth, developing a simple and rapid method for differentiat- sular material. Avery also oversaw studies that showed similar ing human and bovine Streptococcus hemolyticus, and study- immunological responses in Klebsiella pneumonia and ing bacterial nutrition. These studies resulted in highly spe- capabilities, Cole asked Avery to join the institute hospital in cific diagnostic tests and preparation of immunizing antigens 1913, where Avery spent the remainder of his career. The culmination of Avery’s work in this At the institute Avery teamed up with A. Raymond area was a paper he coauthored with Colin Munro MacLeod Dochez in the study of the pneumococci (pneumonia) viruses, and Maclyn McCarty in 1944 entitled “Studies on the Chemical an area that was to take up a large part of his research efforts Nature of the Substance Inducing Transformation of over the next several decades.

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