Y. Roland. Eastern Mennonite University.

There can be hun- to produce capsules when inside the human host generic ranitidine 150mg mastercard gastritis not going away, as a defense dreds of fimbriae scattered all over the bacterial surface buy discount ranitidine 150 mg line gastritis diet untuk. An example is Neiserria gonorrheae, the agent of gonor- gular, flagellum). Strains of the bacteria that produce fimbriae are more from a bacterium. They are long, up to ten times the length of virulent than strains that do not manufacture the appendage. Each flagellum is composed of a spiral arrange- Not unexpectedly, such pili are a target of vaccine develop- ment of a protein (flagellin). The second type of pili is called conjugation pili, sex end removed from the cell. These are relatively long and only a few are face hooks into the membrane(s), where they are held by two present on a bacterium. The basal bodies act as bush- and serve as a portal for the movement of genetic material ings, allowing flagellar tube to turn clockwise and counter- (specifically the circularly organized material called a plas- clockwise. By spinning around from this membrane anchor, mid) from one bacterium to the other. The genetic spread of flagella act as propellers to move a bacterium forward, or in a antibiotic resistance occurs using pili. These runs and tumbles enable a bac- See also Anti-adhesion methods; Bacteria and bacterial infec- terium to move toward an attractant or away from a repellant. The tactic process is highly orchestrated, with sensory BACTERIAL ARTIFICIAL CHROMOSOME proteins detecting the signal molecule and conveying the sig- nal into flagellar action. In contrast, an Olympic Bacterial artificial chromosomes (BACs) involve a cloning sprinter can propel himself at just over five body lengths per system that is derived from a particular plasmid found in the second. Depending upon the type of bacteria, flagella are char- bacterium Escherichia coli. The use of the BAC allows large acteristically arranged singly at only one end of the cell pieces of deoxyribonucleic acid (DNA) from bacterial or non- (monotrichous), singly at both ends of the cell (amphitrich- bacterial sources to be expressed in Escherichia coli. Repeated ous), in a tuft at one or a few sites (lophotrichous), or all over expression of the foreign DNA produces many copies in the the bacterial surface (peritrichous). BACs proved useful in the sequencing BACTERIAL FOSSILIZATION • see FOSSILIZATION of the human genome. OF BACTERIA The BAC is based on a plasmid in Escherichia coli that is termed the F (for fertility) plasmid. The F plasmid (or F fac- tor) contains information that makes possible the process called BACTERIAL GENETICS • see MICROBIAL GENETICS conjugation. In conjugation, two Escherichia coli bacteria can physically connect and an exchange of DNA can occur. A BAC contains the conjugation promoting genetic infor- BACTERIAL GROWTH AND DIVISION Bacterial growth and division mation as well as stretch of DNA that is destined for incorpora- tion into the bacterium. The sequences are referred to as sequence tag tion on agar in a liquid growth medium, in natural settings, connectors. In the laboratory, where growth conditions of Using a BAC, large stretches of DNA can be incorpo- temperature, light intensity, and nutrients can be made ideal rated into the bacterial genome and subsequently replicated for the bacteria, measurements of the number of living bacte- along with the bacterial DNA. In molecular biology terminol- ria typically reveals four stages, or phases, of growth, with ogy, pieces of DNA that contain hundreds of thousands of respect to time. Initially, the number of bacteria in the popula- nucleotides (the building blocks of DNA) can be inserted into tion is low. Often the bacteria are also adapting to the envi- a bacterium at one time. Depending sections of the foreign DNA, the amount of DNA that can be on the health of the bacteria, the lag phase may be short or analyzed can be very large. The latter occurs if the bacteria are damaged or have just BACs were developed in 1992. The primary reason for this popu- After the lag phase, the numbers of living bacteria rap- larity is the stability of the inserted DNA in the bacterial idly increases. Because the inserted DNA remains in the bacterial the population keeps doubling in number at the same rate. This genome during repeated cycles of replication, the information is called the log or logarithmic phase of culture growth, and is is not lost.

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Principles of adult education Although there seems to be a general acceptance that ● Adult learners are likely to be highly current training approaches are well developed and produce a motivated ● They bring a wealth of experience to build high level of learner interaction cheap ranitidine 300 mg free shipping gastritis gastroenteritis, satisfaction purchase ranitidine 150mg with visa gastritis symptoms upper right quadrant pain, and professional upon development, little formal evaluation of courses has been ● Knowledge presented as relevant to their reported to date. These studies are useful in providing ● Instructors should be aware of the needs information about the syllabus and conduct of training but fail and expectations of the adult learner to indicate the strengths and weaknesses of training classes, and it proves difficult to compare one approach with another. Two important questions about the educational process are: ● How does it enable the acquisition of knowledge and skills and help their retention? Teaching adults ● Treat them as adults The process of learning is largely dependent on the individual ● The “self” should not be under threat and the preferred personal approach of that individual towards ● Ensure active participation and self learning. In order to teach adults in an optimal fashion it is evaluation as part of the process important to ensure that this individuality and preferred learning ● Previous experience should be recognised style is considered and provided for, wherever possible. Yet many courses concentrate on only two of these areas, with the emphasis on knowledge and skills. Failing to acknowledge fully attitude and the building of relationships can have a detrimental effect on the outcome of this style of education. Key areas of the resuscitation curriculum ● Knowledge Retention of resuscitation skills ● Skill ● Attitude This subject is one of the most studied areas of healthcare ● Interpersonal relationships provision and several general principles have been established. Individuals formally tested one year after training often show a level of skill similar to that before training. The degree of skill retention does not correlate with the thoroughness of the initial training. Even when candidates are assessed as being fully competent at the end of a training session the skill decay is still rapid. Neither doctors, nurses, nor the lay public can accurately predict their level of knowledge or skill at basic resuscitation techniques when compared with the results of formal evaluation. Simplification of the training programme and the repetition of teaching and practice are the only techniques that have been shown to maximise recall. Research shows that experience acquired by attending actual cardiac arrests does Adult BLS class not improve theoretical knowledge or skill in performing resuscitation. It has been shown that a health professional’s confidence in performing resuscitation correlates poorly with their competence. Teaching resuscitation skills Resuscitation uses skills that are essentially practical, and Retention of resuscitation skills practical training is necessary to acquire them; the ● Poor retention in healthcare professionals and lay people development of sophisticated training manikins and other evaluated from two weeks to three years after training teaching aids has greatly assisted this process. Repetition of ● Individuals tested one year after training often show skills both theory and practice is an important component of any similar to those before training training programme. The use of visual imagery to integrate skills acquired is ● Simplification of the programme and repetition are the only one that healthcare professionals seem to be comfortable with techniques to have demonstrated recall and it adds a dynamic element. It also allows the candidate to ● Repeated refresher courses have been shown to help apply the abstract components of new knowledge into the real retention of psychomotor skills world of everyday work. Asking candidates to think about ● No evidence to show attendance at a cardiac arrest improves clinical situations they have experienced will help them to retention of knowledge or skills ● Healthcare professionals’ confidence in their resuscitation appreciate their previous knowledge and allow the teacher to skills correlates poorly with their ability base new learning around this. The mastery of skills is concerned with how the candidate interacts with the teaching environment and is shaped by previous knowledge, skill, and attitude. The process of acquiring new skills, and therefore changing behaviour, seems to be dependent on the candidates being able to relate the new learning to their immediate situation. It is this “situation dependency” that enables candidates to organise, process, and apply new learning successfully into their work. Opportunities for candidates to integrate new knowledge, skills, and attitudes into their everyday practice need to be shaped as structured learning opportunities. The four-stage teaching approach This represents a staged approach to teaching a skill that is designed to apply the principles of adult learning to the classroom. The process is about knowledge and skill transference from an expert instructor to that of a novice (a candidate who aspires to be a member of the cardiac arrest team). In the staged approach the responsibility for performing the skill is gradually placed further away from the instructor and closer to the learner. The goal is a change in behaviour, with performance enhanced through regular practice. Group learning 92 Teaching resuscitation This approach places the emphasis on the candidate’s The four-stage teaching approach ability to frame learning around recognisable scenarios and removes the abstract thought necessary to acquire skills in Stage 1: silent demonstration of the skill In this first stage, the instructor demonstrates the skill as isolation.

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While those Why People Turn to Alternative Therapies | 51 who participated in this research did associate disillusionment with allopathic medicine with their initial forays into alternative health care 150 mg ranitidine gastritis diet , none had wholly rejected allopathic medicine in favour alternative therapies buy generic ranitidine 150 mg on line gastritis diet . And as Sharma (1992:77) rightly points out, dissatisfaction with allopathic medicine can not fully explain an individual’s decision to turn to alternative therapies, as discontent with Western medicine is “by no means confined to users of complementary medicine. In this case they found an alternative solution in alternative approaches to health and healing. THE WIDER SOCIO-CULTURAL CONTEXT I have argued that these informants’ initial use of alternative therapies is an instance of problem-solving reflective of generic social processes. But in what social context does this generic process of problem-solving take place? Or more precisely, is the choice of alternative therapy as a solution to problems of ill health reflective of larger socio-cultural change whereby alternative solutions constitute a new option in health-seeking behaviour? In addressing this issue, authors have explained lay participation in alternative therapies by placing it within the context of larger socio-cultural changes in beliefs about health, illness, and the body, which include the following: disillusionment with medical science; lay demands for a larger share of control over health and healing; and a belief in holistic health care, where “health is more than a lack of disease... However, when the frame of analysis is one of the problem-solving actions of individuals, the image which emerges is one of consistency rather than change. To illustrate, the ideological components of the alternative model of health espoused by these people are not new in any objective sense. Culturally speaking, these ideas about health and healing were always there (Archer 1988). For example, elements of these informants’ notion of holism harkens back to Galen and the four humours school (Ziegler 1982). Accordingly, it is not that the elements of the ideology are necessarily new; rather, it is that these beliefs 52 | Using Alternative Therapies: A Qualitative Analysis have now been taken up by these informants in order to articulate a model of health care they perceive as alternative therapy. These ideological components are cultural symbols, ultimately subjective in nature (Cohen 1985:15). Moreover, there has always been a plurality of healing options available to the individual (O’Connor 1995). For instance, in the 1663 volume of the diary of Samuel Pepys, we read of his attempts to solve his health problems by choosing between remedies offered by the apothecaries and those advo- cated by the doctors of physique (Latham and Mathews 1995). Likewise, Connor (1997:59) points out that it was only in the latter part of the nineteenth century that healing options were seen to narrow for Canadians: In addition to those practitioners who would be recognized as physicians by today’s criteria … there existed a smaller group of other medical practitioners... The same phenomenon is evident in the British context, where “the evolving boundaries between orthodox and unorthodox medical knowledge... More to the point, the boundaries that emerged did not eradicate all forms of health care other than allopathic medicine; rather, they remained within the health care system (Bakx 1991), their ideological underpinnings part of the symbolic framework of “ideas which at any given time have holders,” ready to be used by people in their efforts to solve health problems (Archer 1988:xix). Hypothetically, even if non-allopathic approaches to health care had been wiped out during this brief period, the individual always had the option of self-care or the option of doing nothing about his or her health problems. Therefore, the nature of the actions of individuals in choosing this option can not be said to have changed; rather, they were, and remain, attempts at solving problems of ill health. On the other hand, what has changed is that there is now something people call alternative therapy, or complementary health care, or integrative medicine, the symbolic components of which have always been part of the ideology of health care options available to people in solving health problems. Conceptualizing health-seeking behaviour as a Why People Turn to Alternative Therapies | 53 generic process of problem-solving allows us to account for whichever solution, alternative or otherwise, individuals choose. While alternative health and healing ideology was not a significant factor in motivating the people I spoke with to begin using alternative health care, its importance should not be discounted, as these beliefs are some- thing that individuals acquire through their participation in alternative health care and something that holds importance for them in their continued use of alternative therapies. Moreover, these ideologies form their alternative models of health and healing. See also Anyinam (1990); Fulder (1996); Furnham and Smith (1988); Monson (1995); Northcott (1994); and Taylor (1984). See also Coward (1989); Dunfield (1996); Easthope (1993); Furnham and Beard (1995); Furnham and Bhagrath (1993); Murray and Rubel (1992); Northcott (1994); and Vincent and Furnham (1996). See also Anyinam (1990); Dunfield (1996); Furnham and Bhagrath (1993); Northcott (1994); and Vincent and Furnham (1996). It is important to note that no pattern emerged in the analysis between type of therapy used, or length of time using a therapy, and reasons informants gave as to why they first began using alternative forms of health care. See also Coward (1989); Dunfield (1996); Easthope (1993); Furnham and Bhagrath (1993); Murray and Rubel (1992); Northcott (1994); Vincent and Furnham (1996); and Yates et al.

It also acknowledged that medical development had in the past been assisted by concepts and techniques derived from unorthodox sources cheap ranitidine 150mg mastercard symptoms of gastritis in cats, but emphasised that these must be evaluated by ‘systematic buy ranitidine 300 mg on line gastritis prevention, scientific’ methods before they could be incorporated into the mainstream. By the evidence of this report, in the mid-1980s mainstream medicine was confident about the methods and proud of the achievements of medical science and unwilling to make any concessions to unorthodox alternatives, even at the behest of the royal patron of the BMA. In 1993, the BMA published Complementary Medicine: New Approaches to Good Practice, the product of another working party set up in response to the growing popularity of alternative therapies and to indications that medical attitudes to them were softening. A major survey of doctors undertaken by the BMA in 1992 revealed that 29 per cent of respondents believed that acupuncture and osteopathy should be provided in GPs’ surgeries (37 per cent were opposed). Women GPs and those under 45 were more likely to be in favour of alternative approaches. The new report, which made only one passing reference to the 1986 report, adopted a much more conciliatory tone. In place of the previous spirited argument for scientific medicine, the new report offered a pragmatic, defensive, definition of ‘conventional medicine’ as ‘that treatment which is delivered by a registered medical practitioner’ (BMA 1993:7). In a new posture of abject relativism, the BMA now proposed the term ‘non-conventional therapies’ as ‘a general and neutral term within which to explore the diverse nature of different practices’ (BMA 1993:8). Whereas a few years earlier the BMA had been concerned to draw a line of principle between orthodox and alternative therapies, it now sought to make a pragmatic distinction between different forms of non-conventional treatment. Having abandoned a definition of mainstream medical practice in terms of medical science, the BMA now decided that five complementary therapies— acupuncture, chiropractic, herbalism, homeopathy and osteopathy— could be regarded as ‘discrete clinical disciplines’. This arbitrary classification was clearly based on judgements about which therapies were more popular (with patients and doctors) and were 146 THE CRISIS OF MODERN MEDICINE more established in terms of training and procedures of professional regulation. There was no attempt to make any objective claim for the superiority of, say homeopathy and herbalism over rolfing and iridiology. The BMA’s main concern was to foster the profes- sionalisation of the big five complementary therapies and to marginalise the rest. The price paid by the medical profession for this opportunist approach towards alternative therapies was to betray the historic commitment to medical science which had been the foundation of its growing success over two centuries. It is quite understandable that patients who find conventional medicine ineffective and conventional medical practitioners unsympathetic should turn to alternative practitioners. But for orthodox doctors to collaborate with such practitioners implies a capitulation to irrationalism. Nor can the legitimacy of alternative therapeutic systems be enhanced by studies in the form of clinical trials which claim to show their effectiveness. No doubt many patients derive much therapeutic benefit from praying to statues and icons, but this is no reason why these techniques should be incorporated into clinical practice. In his commentary on the nineteenth century triumph of medical science over the antecedents of today’s alternative therapies, Dalrymple observed that the distinctive feature of scientific medicine was its openness to critical evaluation, revision and improvement, features it shared with the wider Enlightenment traditions of reason and progress from which it emerged (Dalrymple 1998:58). By contrast, rival approaches— such as Samuel Hahnemann’s ‘intellectually ridiculous’ homeopathy — offered no comparable method of development, but were presented as ‘complete, fully-formed’ systems. The correspondence between the inquisitive and interventionist outlook of medical science and the dynamic and progressive values of Victorian Britain was the key to the early success of the medical profession. Dumbing down In Tomorrow’s Doctors, the GMC outlined the ‘goals and objectives’ of the new curriculum under the rubric of ‘knowledge, skills and attitudes’ (GMC 1993). Whereas in the past knowledge was crammed for exams, skills were picked up on the job, and attitudes (for better or for worse) unconsciously assimilated, now students were going to be taught formally in all three areas. Knowledge would be reduced to a ‘factual quantum’ defined by a ‘core 147 THE CRISIS OF MODERN MEDICINE curriculum’: this would include the familiar basic medical sciences, but also unfamiliar subjects such as ‘human relationships’ and ‘the importance of communication’. The extensive and detailed attitudinal objectives reflected the values of the culture of therapy and the demands of political correctness (neither previously a major influence on the medical mainstream). Students would be expected to show respect for patients’ diverse identities and rights, they should be able to ‘cope with uncertainty’ and they should display an ‘awareness of personal limitations, a willingness to seek help when necessary and an ability to work effectively as a member of a team’. One of the key concepts of the new curriculum is that of ‘prob- lem-based’ learning: instead of acquiring a grounding in basic medical sciences before encountering sick patients, students begin from a clinical problem presented by a patient and organise their studies around this problem (Lowry 1993:28–32). The idea is that, by being relevant to the resolution of a real clinical problem, their study of anatomy, physiology, biochemistry, etc. The role of the teacher is no longer to transmit knowledge, but to facilitate the process of problem-solving by students, working collectively, in teams. The defect of problem-based learning is that it assumes that defining a clinical problem is a straightforward matter, whereas in practice it is often profoundly difficult. According to Abraham Flexner, whose historic 1910 report promoted the reorganisation of medical education in the USA on the basis of scientific medicine, ‘for the analysis of the simplest situation which the ailing body presents, considerable knowledge is required’ (Flexner 1925:13) Furthermore, for practical treatment ‘still another volume of knowledge and experience is requisite’.

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