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Medium 9781780643960

14: Mycobacterial Infections in Elephants

Edited by H Mukundan, Los Alamos National Laboratory CAB International PDF

14 

Mycobacterial Infections in Elephants

Susan K. Mikota,1* Konstantin P. Lyashchenko,2

Linda Lowenstine,3 Dalen Agnew4 and Joel N. Maslow5

1

Elephant Care International, Howenwald, USA; 2Chembio Diagnostics, Inc.,

Medford, USA; 3University of California, Davis, USA; 4Michigan State University,

East Lansing, USA; 5Morristown Medical Center, Morristown, USA

A Brief History of TB in Elephants

Tuberculosis (TB) is an ancient disease of man and animals, including elephants. TB has also been postulated to have been a factor in the extinction of the mastodon (Mammut americanum) during the late Pleistocene (Rothschild and Laub, 2006), as foot lesions identical to those documented in bison and considered as pathognomonic for TB were found in 59 of 113 (52%) mastodon skeletons examined

(Rothschild and Laub, 2006). A disease in Asian elephants (Elephas maximus) resembling TB was described over 2000 years ago in the ancient

Sanskrit text ‘Hasthyayurveda’ (Iyer, 1937).

Case reports in the 19th century include that of an 18-year-old Asian bull that died of TB at Jardin des Plantes in Paris, recorded in the

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Medium 9781782201632

CHAPTER FIVE The disability transference: transference and countertransference issues

Alan Corbett Karnac Books PDF

CHAPTER FIVE

The disability transference: transference and countertransference issues

T

he narrative of forensic disability psychotherapy is largely constructed in the “here and now” experience of the countertransference relationship. Through an intersubjective exchange of feelings, thoughts, and memories a jointly authored narrative emerges that is guided as much by affect as cognition. The countertransference becomes the repository for those elements of the patient’s unconscious he cannot bear to keep hold of, providing the therapist with projected aspects of the forensic patient’s self and allowing an insight into those aspects of their perversion that can rarely be put into words. Through this process the countertransference becomes an invaluable tool with which the patient’s internal landscape can be mapped and navigated. In this chapter I wish to examine various theoretical concepts relating to transference and countertransference in forensic disability therapy. Through examining some clinical vignettes in which failures to work through problematic transference issues have resulted in breakdowns in therapeutic functioning, I will outline the notion of the disability transference, a way of conceptualising the various countertransference implications of working with patients with disabilities.

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Medium 9781937554873

8 Leadership: A Matter of “Refereed” Experience

Christopher Lance Coleman Sigma Theta Tau International ePub

Franklin Shaffer, EdD, RN, FAAN
CEO, CGFNS International

When we look for good art, we look for a “juried” art show, where a panel of experts chooses only the best art works. When we need access to the most valid research, we look in “refereed” journals only. All this is well and good, but despite the plethora of literature on the subject of leadership, reading the literature will not help you become a leader. Leadership skills can be acquired a number of ways—through mentorships, training programs, on the job experience, and so forth. However, they are not acquired by reading a book! The reason for this is that leadership skills are primarily learned, tried, and tested through experience (Zelinsky, 1991).

Whether they are male or female, many nursing leaders believe that all leaders need the same characteristics; that people excel owing to these characteristics; and that neither intelligence nor “caring” are gender specific. The differences in how individual nurses actualize the nursing role account for varying levels of success. Indeed, this might be so, but gender plays a significant part in who you are and how you actualize your potential. If gender bias exists as an unrecognized, unaddressed component of nursing education programs, the outcomes degrade the profession and limit our ability to recruit and retain a robust workforce (Anthony, 2006).

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Medium 9781782201731

CHAPTER EIGHT Split-brain evidence for two minds

David J. Uings Karnac Books PDF

CHAPTER EIGHT

Split-brain evidence for two minds

I

n Chapter One, I made reference to the operation called a callosotomy, in which the link between the two hemispheres of the brain is severed, in order to treat severe epilepsy. Those who have undergone this operation are known as “split-brain” patients, and they have been extensively studied during the past fifty years.

The methods used for testing split-brain patients31 have become ever more sophisticated over the years (Gazzaniga, Ivry, & Mangun, 2002, p. 408), but the basic idea remains the same: an object is displayed so that it is seen by only one half of the brain. Initially, researchers used a piece of equipment called a tachyscope to show an image for a fraction of a second. The subject was required to focus on a point in space, and the tachyscope was positioned so that the image was seen either to the left or the right of the focal point. Remember that the left hemisphere receives visual data from the right side of each eye and controls the right hand, whereas the right hemisphere receives visual data from the left half of each eye and controls the left hand (Figure 8 overleaf).

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Medium 9781855759688

11. On turbulence

Donald Meltzer Karnac Books ePub

Donald Meltzer

I

f Bion’s Theory of Thinking has some essential truth in it one must expect that new ideas, the ones which have an impact to produce catastrophic change, would appear first in dream form, only later to find some verbal and abstract representation. This is no more than to say that symbolic representations of ideas are most likely to be generated by borrowing formal elements from the outside world to portray internal world phenomena. These formal elements may implicitly include abstractions which lend themselves to analogical use in dream-life. Thus do artists and poets operate to perform their social function of giving communicable form to the new ideas nascent in the culture. To succeed in this function they must disturb us, frame questions in order to set the audience in motion to seek the answers, answers which, of course, mainly take the form of new readiness for new questions.

Psychoanalysis has come some considerable distance in defining the spectrum of emotional nuances which hold the meaning of our mental experiences. It would be a cogent view of our so-called theories that they are merely descriptive devices for outlining the structure of the variety of internal and external experiences which manifest themselves within us as emotion. But I would suggest that one whole area of emotion has as yet found no place in our body of theory because it has been assumed to stand merely in a quantitative relation. I am speaking of passions. If we adopt Bion’s basic formulation of L, H and K, these passions would be “in love”, “in hate” and “in awe”, each with its negative counterpart, “anti-in love”, “anti-in hate” and “anti-in awe”. I think I am correct, certainly with regard to my own ideas, in stating that it has been assumed that passions were merely very intense emotions.

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Medium 9781855750203

3. The process of internal consultation

Robert Bor Karnac Books ePub

There are many approaches that can be used when consulting to professional colleagues. An aim of consultation is to elicit and address different views of problems and to generate a climate in which new ideas, beliefs, alternatives, meanings and behaviours can emerge. There is no research at present which has established the efficacy of any one consultation approach. If the consultation is to be conducted in a professional manner then guide-lines, based oil theory of practice, can be used to focus on the different stages of the process and for conducting the consultation interview. The guidelines have emerged from a theory of the evolution, maintenance and resolution of interpersonal problems. A theory is important because it informs our professional practice. Explanations about what happens in clinical practice (ie why a specific intervention was chosen or why another was ruled out) take place between colleagues and between professionals and their students. In some circumstances, explanations have to be made in a court of law. One cannot not have an explanation for what happens in clinical practice. In this chapter, one approach is described which has been found to be helpful in expanding to requests for consultation. Such guide-lines help to organize ideas about how to best help colleagues by clarifying roles and professional relationships, and identifying what happens in the course of consultation.

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Medium 9780253355270

Conclusion: Postcolonial Ontological Politics

Stacey A. Langwick Indiana University Press ePub

If post-colonialism is the time after colonialism, and colonialism is defined in terms of the binary division between the colonizers and the colonized, why is post-colonial time also a time of “difference”? What sort of “difference” is this and what are its implications for the forms of politics and for subject formation in this late-modern moment?

—Stuart Hall, When Was the Postcolonial?

Traditional medicine is a highly politicized and deeply intimate battle over who and what has the right to exist. As a modern category of knowledge and practice—forged through encounters between traditional healers, scientists (from Tanzania, Britain, China and elsewhere), biomedical practitioners, government bureaucrats, and international development organizations among others—it embodies the frictions central to postcoloniality. It grounds arguments for a history that is not bound by colonial categories of knowledge, in the intimate care of loved ones and the bodies of kin. Close attention to struggles for control over the right to determine what objects are central to life and the relations that sustain them reveals a new story of colonization, post-independence socialism, and its collapse in the face of economic liberalization. Postcolonial healing tells this history as a series of struggles over rights to existence and over the particular forms of materiality that support different claims to existence. In other words, postcolonial healing reveals contemporary struggles not only over material and conceptual resources but also over who gets to determine what is material and what is immaterial, or “merely” conceptual.

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Medium 9781938835155

5 recovery: getting it and keeping it

Karolyn Crowley Sigma Theta Tau International ePub

IN THIS CHAPTER:

Recovery Is a Lifestyle

Denial: The Emperor Has No Clothes

Riding the Wave

Restoration

Disclosure: Who, When, and How Much to Tell

Secrecy, Fear, Shame, and Penance

If you’re feeling stunned, scared, and overwhelmed, you’re on target. To gain a new way of life, you have to dismantle the old one. This chapter emphasizes that recovery is a lifestyle, not a destination. It introduces some useful concepts, tips, and strategies to help you shift into the recovery lifestyle. It also notes some classic pitfalls that you will encounter.

Recovery is a journey. And as with any new journey, it is normal to feel disoriented and out of control—something that many addicts just aren’t comfortable with. Being uncomfortable has to do with trust issues. The only thing you thought you could really trust is that you would find a way to use or drink. Addicts blow their own ethical moral codes. To be out of control is very challenging when you don’t have much faith or trust in how things are going to turn out. A huge part of recovery is discovering how benevolent life becomes when you choose health and well-being.

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Medium 9781855754188

CHAPTER THREE: Amanda, Arnaud, Alice, Sandrine and Emma-somatisations and regressions

Jean Benjamin Stora Karnac Books ePub

“Somatic diseases generally stem from the individual's inadequacies with regard to the living conditions that he encounters”.

Pierre Marty (1990, p. 48)

When we examine somatic patients in a hospital setting at the request of doctors in the department, the conditions are different from those found in psychosomatic psychoanalytic institutions. The psychologist or psychoanalyst who is also a psychosomatician is in a difficult position because he is not conducting a psychiatric examination (with which somatician doctors are familiar) and he has to communicate the essential findings of his examination to doctors in a matter of minutes so as to assist in the patient's care in a way that complements the medicine being given. Beyond the difference in scientific approach, there is also the question of the terms in which the diagnosis is formulated: how are we to communicate the provisional findings of an examination to a doctor who has no knowledge of the psychosomatic and psychoanalytic models that form the point of reference? We can thus recognise the scale of difficulty surrounding the exchange and interaction between the various parties who are addressing problems of illness and health.

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Medium 9781855755161

4 The skin and the levels of symbolisation: from the Ego-skin to the thinking-Ego

Jorge Ulnik Karnac Books ePub

As was pointed out in Chapter 2, Didier Anzieu claims that there is a system of basic traces or representations, the reference of which is tactile, concrete experience. With symbolic development, these representations will be the backdrop against which ulterior operations of thought are inscribed. As these tactile traces are denied and separated, though still maintained, the central idea is that they subsist in parallel with the representations mounted on them, thus configuring different levels of symbolisation. In this way, taking the Ego-skin as a starting point, an Ego capable of thinking and of representing can be formed, an Ego called the thinking-Ego (Anzieu, 1995).

With the understanding that different levels of symbolisation exist, the discussion as to whether a physical disease is from a psychoanalytical viewpoint a phenomenon, a symbol or a symptom could be settled at least in part, because it could be claimed that the disease is a form of symbolisation on a different level to that used in spoken language. In contrast, when the somatic is automatically excluded from the symbolic field, we limit ourselves to saying that where a word, a thought, an affect or a conflict should appear, what does in fact appear is the somatic, and in this case, all things considered, our only theoretical contribution would be establishing a relationship between two things by proposing a simple substitution. Then the theoretical development hides that substitution, seeming to explain in economic terms or by means of formulas and mathemes the way in which the somatic inserts itself into a system, which can be either economic or signifying, and which has been established a priori. In some cases the conclusion is not so different from that of the ordinary observer who, on seeing someone under a lot of stress, says: “Some day or other he will burst”, confirming when he falls ill: “Well, what do you expect, bottling things up for so long? It had to come out one way or another.” Without underestimating folk psychology, we nevertheless get the impression that this kind of interpretation, which is purely economic, is the product of simplification.

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Medium 9781855754188

CHAPTER ONE: Emotions and traumas

Jean Benjamin Stora Karnac Books ePub

The desire to “heal” arose in that distant period of my childhood and in a sense I can say that in so far as possible I help to treat the “mind” of diseased bodies by incorporating in my therapeutic approach a consideration of the status of the illness from which patients are suffering, as well as the nature of the family and professional environment in which they are developing. Rather than taking the place of doctors who treat the body, I am exercising a complementary role that is necessary for returning to a form of mental functioning that is responsive to medical treatment. This consists in an inner mental attitude towards patients and their illnesses.

This attitude differs in certain respects from the perspective adopted by researchers and practitioners in various disciplines who operate within historically determined epistemological constraints and are accustomed to posing problems in a framework with which they are familiar, along the following lines:

•  If the mind is disturbed (a disorder caused by multiple factors), it can generate somatic illnesses and the so-called psychosomatic and/or psychiatric approach is then required;

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Medium 9781855758094

CHAPTER FOUR: Decisions and time

W.M. Bernstein Karnac Books ePub

Brain–mind is a decision-making system. Decisions, by definition, involve choosing between alternatives. Hence, at some level, decision making is always “conflict resolution”. The central importance of conflict in human psychology has been recognized by psychoanalysts since Freud, and by social and neuroscientists (e.g., Deutsch, 1977; Lieberman &Eisenberger, 2004). In this chapter we describe decision making under emergency conditions. In such situations there is not usually conflict about “ends”, that is, the clear goal is to avoid the danger. Emergency decision making involves choosing between “means” or methods of life saving. “What is the best way to avoid the danger?” Since the stakes are high, emergency operations ideally consider alternative interpretations of a dangerous situation; and, alternative predictions about the outcome of different “avoidance strategies”. At the same time, danger induces strong feelings that must be controlled in order to effectively think and act. Recollections of a real emergency decision-making situation are described below.1

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Medium 9780253357090

5 AIDS Policies for Markets and Warriors: Dispossession, Capital, and Pharmaceuticals in Nigeria

Dilger, Hansjörg ePub

Kristin Peterson

Most of the literature on globalization that theorizes flexible capital, flows (media, migration, technology), global cities, cosmopolitanism, and local–global relationships proceeds from an analysis of finance and manufacturing capital.1 Such paradigms account for accumulation, speed, and the migratory patterns of both people and technology via capital circulating among cybernetic and physical spaces. As one imagines the enormity of capital movement, what is said of the spaces and places that are emptied out, from which these voluminous forms of capital are originally extracted? As it is widely recognized that the African continent continues to provide raw material in the form of oil, minerals, and cash crops to the rest of the world in crumbling and non-reproducible ways, can there be an analysis of an emptied-out space as the left-behind effect of such movement? Can there be an accounting of this space that is connected to but defies overlap with other spaces in the transnational realm; an account that, though cannot always imagine how raw material and capital are transformed and consumed beyond its boundaries, is not parochial in the estimation of its own loss?

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Medium 9781855753228

3. Severe Eating Difficulties: Attacks on Life Traumatised Children and Their Families

Emanuela Quagliata Karnac Books ePub

Jeanne Magagna

‘When I’m thin I’ll be happy. I’m fat and therefore unhappy. My body is huge and disgusting. Nobody tries to understand who I really am. They are only interested in how much I weigh and how they can make me fatter.’ These words, spoken by an anorectic girl after the failure of a treatment programme for anorexia, underline the importance of having an assessment process which enables a child to feel that the whole of her being (feelings, physical condition, body sensations, thoughts) is accepted and understood.

UNDERLYING HYPOTHESIS

My hypothesis is that refusal to eat does not simply refer to refusing to open the mouth to take in food. It might simultaneously mean closing the mind to the emotional experience of oneself and others. ‘I won’t eat’ can in fact signify closing the mind in the face of conflicts or withdrawing from the nurturing emotional link with the mother. The anorectic child’s fear of being fat, as well as being linked to the pressure society exercises on women to become thin, also includes the fear of bodily sensations and intense emotions that overwhelm the child to the point of threatening her sense of identity, her perception of the form and size of her body and her own mental health (Palazzoli, M., 1974).

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Medium 9781780644394

27 Technologic Support for Antimicrobial Stewardship

LaPlante. K. CABI PDF

27

Technologic Support for

Antimicrobial Stewardship

Renée-Claude Mercier1* and Carla Walraven2

1

University of New Mexico College of Pharmacy, Albuquerque, New Mexico, US;

University of New Mexico Hospitals Department of Pharmacy Services,

Albuquerque, New Mexico, US

2

Introduction

Over the last 25 years, advances in technology have significantly changed practice within the healthcare setting. From literature searching, e-mail communication, electronic medical records, clinical decision support systems to mobile devices, every component has helped to enhance access to data, and communication with the patient and amongst providers. Technological advances have been of great benefit for most specialties within the hospital, including the antimicrobial stewardship team.

Important aspects of stewardship involve medical chart reviewing and documentation, literature searching, education and communication with healthcare professionals. Technologies that have contributed to facilitating the work of the stewardship team are the focus of this chapter.

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