Professor of Pharmacology and Physiology, Departments of Cellular & Molecular Pharmacology and Physiology
University of California, San Francisco
https://neurograd.ucsf.edu/people/roger-nicoll-md
Before any dental treatment is started androgen hormone function effective 10mg uroxatral, previous or predisposing factors should be considered mens health 032013 buy discount uroxatral on-line. The parents were instructed to place a quarter pea sized portion of a remineralising paste (HealOzone toothpaste androgen hormone of pregnancy cheap 10mg uroxatral, KaVo) directly into the treated cavities 2 to 4 times a day man health forum uroxatral 10mg for sale. At a 6-week review prostate revive best buy for uroxatral, all lesions were hard man health supplement uroxatral 10mg without a prescription, shiny prostate cancer mayo clinic cheap 10 mg uroxatral visa, and showed no classical signs of decay activity prostate cancer xenograft mouse model buy uroxatral with a mastercard. Clinical Management of Deciduous Caries using Ozone H 191 this grouping can be used to determine the most ap 2. Monitoring of the caries risk ide includes the enhancement of the remineralis should be routinely recorded to fine tune treatment and ation processes, by shifting the remineralisation/de support offered. If existing lesions have not progressed mineralisation rate equation toward remineralisation and new lesions are not detected, caries activity has de (Anderson, Bales and Omnell, 1993). Increased numbers of new lesions or changes leads to an increased resistance of the tooth structure in the oral environment. Fluoride is added to drinking Restorative materials, per se, will not prevent or elimin water (Balakrishnan, Simmonds and Tagg, 2000) in ate disease. Water fluoridation has been shown to microflora is controlled, all restorations are at the risk reduce caries by up to 50% in the primary dentition. This leads this is the same for the permanent dentition (Rugg to cyclical replacement dental therapy. Drinking water fluoridation is very effec be broken, the profession must first acknowledge the tive when considered in terms of cost and frequency of primacy of prevention (Mount and Ngo, 2000). In order to use fluoride to its greatest potential, it should be available Prevention methods: both systemically during tooth development, and topi 1. Dietary counselling: the process of tailoring rec cally and daily at low concentration after eruption. Fluorosis (brown/white discolorations and mottling Dietary analysis (a three-day record of all food/bev of teeth due to fluoride excess) can be a common aes erage intake) is followed by targeted dietary advice thetic problem (Balakrishnan, Simmonds and Tagg, (Harris and Harris, 1998). Young children tend to swallow half of the ians, carers and children can be advised to: toothpaste they use and the attractive taste may lead to overdosage. The systemic uptake during tooth develop O Reduce the amount and frequency of refined ment puts them at risk of fluorosis. For this reason it is sugar snacking and consumption particularly be essential that children under 6 years should use a small tween meals and at bedtime (Harris and Harris, pea-sized blob of low-fluoride paste with adult super 1998). The use of non-acidogenic sweetener duction of approximal, facial and lingual caries. But such as xylitol, sorbitol, saccharin and aspartame its effects are less on the rate of occlusal pit and fissure in a wide variety of products including sweets, caries. These pits and grooves are impossible to thor candies, chewing gum, oral hygiene products and oughly debride with a manual toothbrush and during pharmaceutical products has been shown to re normal routine oral hygiene. The fissure sealant can duce the incidence of dental caries (Balakrishnan, prevent caries in these locations. A fissure sealant is Simmonds and Tagg, 2000): usually an unfilled resin, placed in the pits and fissures O Avoid using of bottles and feeder cups for con of teeth. This would pro the development of the acid niche environment and long the time tooth surfaces are exposed to su hence caries (Murray and Nunn, 1993). If a night bottle is given it should contain primary posterior teeth have not normally been re only water (Harris and Harris, 1998). These situations are ap O To avoid the creation of an anxious, dental phobic plicable, if there is no permanent successor and the (Harris and Harris, 1998). O Children and young people with physical disabil Restoration of primary teeth is significantly different ities and limitations of manual dexterity. Primary teeth have a O Children with learning disabilities who cannot limited lifespan, children exhibit variable levels of coop cooperate for fissure sealants to be applied. Cavities tend to be O Disabled individuals whose general health would wider and shallower than in permanent teeth (Fleming be jeopardized by either development of oral dis et al, 2001). Provided such as cardiac problems, immunosuppression, that primary teeth exfoliate, the need for restoration bleeding disorders, blood dyscrasias, metabolic longevity is less in primary dentition than in permanent and endocrine problems. In comparison to permanent teeth, primary teeth: the rational for resin-bonded pit and fissure sealants O Are smaller and more bulbous (Harris and Harris, for primary molars is the same as for sealing perma 1998). Before sealant placement it should be O Have broad flat proximal contact areas (Stoner, confirmed, both clinically and radiographically, that 1967; Tinanoff and Douglass, 2001). The mesio-buccal pulp Other preventive methods include antimicrobial horn, particularly of the primary lower first molars, is agents, caries vaccine and laser treatment. Usually there is less than 2 mm of tooth structure between the pulp and external surface (Stoner, 1967; Tinanoff and Treatment of caries in deciduous teeth Douglass, 2001). O Have different fissure morphology (Tinanoff and Retention of the primary dentition is important, as their Douglass, 2001). Restorative dental materials in this would make his individual more at risk to caries. Restorative therapy only O Space maintenance for the permanent dentition, and becomes necessary when there is preventative failure. This Restorative therapy in primary teeth is essential where aim can be achieved by early diagnosis of caries, be there is a need to restore tooth integrity to prevent space fore marginal ridge breakdown and space loss so that loss or disease progression into dental pulp. However, the teeth can be restored to their original mesiodistal restorative therapy is a nonreversible procedure that dimension (Harris and Harris, 1998). Clinical Management of Deciduous Caries using Ozone H 193 Restorative materials for primary teeth include: teeth (Fleming et al, 2001). Amalgam: amalgam is banned in some countries for these dissolve when oral fluids activate the acidic ma restorative care for children. The ability to leach fluoride helps to prevent a relatively weak material, has poor resistance to wear recurrent caries in the interproximal region it may compared to a resin-bonded composite and can be reduce the risk of caries starting in the opposing sur difficult to light-cure (Christensen, 2001). Composite Resins: the potential advantage of seconds of light cure, a coefficient of thermal expan resin-based composite is their ability to bond to sion similar to tooth structure, and a greater fracture etched enamel. Most import the classic Black-design is not required (Kilpatrick, antly, it releases fluoride ions to the adjacent tooth 1993). These materials can be used in situations where materials is highly technique sensitive and their cor light-cure is difficult, such as a large restoration or the rect placement requires excellent moisture control wrap-around restoration. Composites have little or no caries best restorative material when treating caries-active pa preventive properties (Christensen, 2001). Marginal leakage ultimately leads to re these products have similar properties to conven storative failure. All the above factors are considered tional glass ionomers but with enhanced strength. They are set by a typical acid-base reac most promising and very popular restorative materials tion and do not require light curing. These materials are suitable to finish and clinicians reported that these restora for restoration of load bearing restorations in primary tions served for several years (Christensen, 2001). A reduction in anxiety has also been noted in with these restorative materials the accompanying carers or relatives. Lasers (Holmes J, 2003) showed that non canitated occlusal fis are outside the scope of this book, although laser and sure caries can be managed successfully using ozone in O3 therapies could be combined into an effective treat this double blind, controlled, randomised clinical trial. This study examined primary occlusal fissure carious lesions over a 12-month period in 76 patients of 2 to 12 year old children, in a general dental practice. Pa conducted by Baysan, Whiley and Lynch (2000) study tients were recalled at 12 months and clinically re-as ing the effect of O3 on micro-organism associated with sessed. The results of this study showed a 98% reversal in primary root carious lesions showed that O3 application the O3 treated group. The control carious lesions, which for a period of 10 seconds was capable of reducing the had not received any O3 treatment, did not significantly numbers of S. The conclusion of this study glass beads and this treatment was an effective, quick, was that O3 may be considered to be an effective alterna conservative and simple. The safety of the HealOzone tive to conventional drilling and fillingfor non vavitated system has been extensively reported. All age lesions of varying clinical severity scores in primary groups in this study benefited from the treatment. Why O3 is useful in treating the child 21 child patients with 74 non-cavitated occlusal carious patient lesions were recruited. The study concluded that O3 treatment resulted in the O Date of examination least anxiety compared to other routine dental treat O Description of lesion site. Air abrasion was used to remove the unsupported enamel All subjects received preventive advice and were given over the lesion. Soft dentinal caries was removed to standard tooth brushes and toothpaste at each recall. After 3 with O3 for 10 seconds at each of the recall visits at 3, months, the glass ionomer was carefully removed, the 6 and 9 months. At re es increased in both groups, and this was greater in the call, some members of the group treated with tra untreated group. Group 1, O3 treated teeth may have in ditional dentistry had post-operative complications. At 3 months all O3-treated the Group 1 values decreased, whilst those for Group 2, dentine caries was hard and required no additional re the untreated control lesions, increased. The conclusion in this study was that air abra scores reflect remineralisation after ozone treatment. Analysis of the clinical severity index showed an improvement in the treated Treatment of deep deciduous caries with the Atraumatic group, as shown by lower scores. Beside this severe category, (judged to have an almost cariously ex proven efficacy of O3 treatment, the non-invasive pro posed pulp) compared to conventional treatment. Optibond Solo Plus and Point 4 (KerrHawe) composite 196 H Clinical Management of Deciduous Caries using Ozone resin. Up to 1 mm of seems to be well accepted by children and by parents softened carious dentine was left overlying the pulpal and decreases anxiety in children. After 18 months 30% of the conventionally results after 2 years show this to be also very useful in our treated teeth had symptoms suggesting pulpal necrosis daily practice whilst caring for our patients. Treating caries in anxious children with ozone: parentsattitudes after the first session Conclusions Treating anxious children remains a challenge in paedi atric dentistry. Sometimes the only options are the In stark contrast to traditional dental care, these studies treatment with sedatives or in general anaesthesia which into O3 treatment show pleasant dental care can take includes high cost, certain risks and a child that will place. Dahnhardt et al (2003) reported on treat in soft carious lesions is possible, when treatment ther ing caries in anxious children with Ozone and assessed apies. These treatment regimes com was to evaluate parentsattitudes towards the treatment pliment each other, and the data suggest that conven of caries with ozone (Heal Ozone Unit, KaVo) in tional treatment protocols will lead to greater tissue de anxious children. Deeper and more plication), the father and/or mother was questioned extensive caries may need a combined approach of tra about their attitudes toward the ozone treatment. All parents answered the questionnaire but most children were accompanied by their mothers only O O3 treatment is less time-consuming than conven (90%). All of them were happy that they O3 treatment and 2 minutes for restorative place started the ozone treatment. In total, about 5 minutes at the most, of the parents would recommend the ozone treatment compared much longer times for traditional dental to family or friends and would agree to have an ozone therapy. Clinical Management of Deciduous Caries using Ozone H 197 Ozone treatment with the HealOzone device has been plans can be printed and discussed with each patient. These this preventative approach integrated with ozone treat dental practices have reported less anxiety, less trauma, ment has an exciting potential. Incorporation of fluoride into Root caries is a major reason for tooth loss and is a composite resin materials also failed to show any benefi problem, which increases with age. The resulting, tooth cial effect in reducing demineralisation of root carious loss can diminish function and contribute to loss of lesions when compared to glass ionomer cements self-esteem in elderly populations. This leads to more (Dijkman et al, 1994; Takahashi et al, 1993; Torii et al, complex restorative challenges for dentists since the res 2001; Vermeersch et al, 2001). Placement of whilst the maintenance of pulpal integrity through the a restoration may result in the tooth being subjected use of biologically acceptable dressings to the pulp-den to a repeat restoration cycle where the restoration may tine reduces the depth of lesions but do not provide the ultimately fail, to be replaced by progressively larger res aesthetic, physical and mechanical qualities required for torations (Elderton, 1996). Whilst all these materials lationships with weight changes during fluoride release have their merits, they also have limitations in the res and uptake. Five specimens for each ChemFil Superior, toration of carious lesions in conservative dentistry. However, amalgam cannot be used specimen weight and fluoride release were monitored in areas where aesthetics are of prime importance (Se for 12 weeks. These authors reported that there was a signifi posites are now being used as either amalgam substi cant weight loss for all glass ionomer cements following tutes or amalgam alternatives. When lesions become inactive, the blood, above a certain threshold it becomes very i. It should also be noted that arrested lesions ozone is short and this oxidant rapidly converts into remained unchanged during several years of observation oxygen via endothermic reaction. Among ozone the best management strategy for root caries still biological effects (Belianin and Shemelev, 1994; Bocci, needs to be developed. The possibility of preventing 1997 and 1999; Viebahn, 1999), the improvement of and controlling root caries for all populations world oxygen metabolism, increasing cell energy, the immun wide is a strong incentive. However, compared to en omodulator property and the enhancement of the anti amel caries, there has been relatively limited research oxidant defence system are some of the beneficial effects available into pharmaceutical management of root of ozone in medical use. The use of ozone therapy on caries, and many of these studies have also been carried age-related degenerative retinal maculopathy demon out in vitro. As an alternative management strategy for strated a decrease in lipid peroxidation but an increase root caries, ozone can be considered. Ozone has strong in superoxide dismutase and an enzyme scavenger of oxidisation power and has been used as deodorisation, anion superoxide. This powerful oxidant minimise the damage produced by lipid peroxidation is also effective for the inactivation of micro-organisms. In addition, ozonised the use of ozone in medicine blood was shown to have a protective effect on isch aemia-reperfusion injury in different organs such as Ozone has been used in several medical applications liver, kidney and brain. These authors also stated that lactate produc 1993; Romero Valdes et al, 1993; Rodriqueuz et al, tion was inhibited and survival time was significantly 1997; Dolphin and Walker, 1979; Gloor and Lip increased. Unfortunately, there are very few studies on the effect of ozone application in patients (n68) with reti use of ozone for dental purposes. The numbers of micro-organisms that have ozone by rectal administration (dose10 mg) for 15 been found in water samples collected from dental units sessions. These authors reported a significant improve may exceed current limits for water quality and are per ment in 88. The microbial effect of ozone on dental treatment units Recently, Zamora et al (2001) also reported the use of lasted longer when compared to the conventional ozone (200 ug/250 gb. In their study, groups in vivo and in vitro (Putnins et al, 2001; Lee et al, 2001; pretreated with ozone and antibiotics in combination Filippi et al, 1991; Filippi, 1995 and 1997). Filippi, showed a significant increase of survival of rats in com 1997 tested the effect of ozone on Pseudomonas aerugi parison with the groups treated only with antibiotics. These results show clearly that ozone treatment (10 mg ozone/ml water), there were no ozone was useful in the inflammatory response. Furthermore, there pretreatment in combination to antibiotics was capable was no evidence of air pollution related to the use of of reducing the mortality. Between the second and 7th post O3 is also utilised externally in the form of ozonylat operative day, there were no further effects observed re ed olive or sunflower oils. However, the author stated that the ef ment with ozone appears to be safe, therapeutically fect observed in the first 48 hours, modified the final beneficial, and cost-effective. Ozonised sunflower oil wound closure thereby under the influence of ozone, (Oleozon) has shown antimicrobial effects against virus,more wounds were closed after seven days and cell pro bacteria and fungi (Sechi et al, 2001). These authors stated that substance produced by the reaction of ozone with un the use of ozone is completely safe as ozone dissipates saturated fatty acids present in sunflower oil, this reac very quickly in water. The preventive and therapeutic effects of ozone in However, medically relevant properties of ozonated medicine have been well established (Baysan et al, water in oral surgery still remain to be proved. Antimicrobial Effects of Ozone on Caries H 201 A denture cleaner using ozone bubbles (Ozone con concentration of 2,100 ppm10%. The vacuum pump centration approximately 10 ppm) was considered as pulls air at 615 cc/min through the generator to supply clinically appropriate in view of its strong disinfecting ozone to the lesion and purges the system of ozone after and deodorising power, and high biological safety (Fil ozone treatment. The effectiveness of this cleaner against (diameters ranging between 5 and 8 mm), attached to Candida albicans was investigated and levels of this mi the handpiece, is provided for receiving the gas and ex crobe were found to decrease to about 1/10 of their posing a selected area of the tooth to the gas. The system then draws a liquid reductant those caused by acid-electrolyzed water and one of the through the sealing cup to further neutralise residual commercial denture cleaners. The reductant mainly contained deionized However, there has been no study concerning the water, sodium benzoate, methylparaben, sodium fluor clinical evaluation of ozone on its therapeutic benefits ide, xylitol and citric acid. These cation for a period of 10 s was also capable of reducing teeth were randomly divided into two groups to test the the numbers of Streptococcus mutans and S. Plaque was the authors believe that the use of ozone in dentistry removed using a hand-held standard fine nylon fibre is conservative and harmless. This proposed ozone de sterile toothbrush with water as a lubricant within 15 livery system has been investigated in in vitro and in min of extraction. Recent clinical studies, which were also ile cotton wool rolls and a dental three-in-one air sy conducted by Baysan and Lynch have demonstrated the ringe. Half of a lesion was removed using a sterile exca effect of ozone on the microbial flora and clinical sever vator. Following sampling, a reductant from the ozone ity of primary root caries by the ozone delivery system delivery system was only applied to the samples for a (Suzuki et al, 1999). The excavator blade gated the safety and efficacy of the use of ozone for the was used to traverse the lesion in line with the long management of root caries in a longitudinal study.
The distinction androgen hormone imbalance buy uroxatral 10mg without a prescription, while useful and important mens health 082012 purchase discount uroxatral, is ofen difcult in practice to apply to individuals prostate juicing ruined milk order uroxatral 10 mg with mastercard, especially when dealing with historical fgures androgen hormone optimization order uroxatral amex. See Carol Padden and Tom Humphries prostate cancer 411 buy 10 mg uroxatral amex, Deaf in America: Voices from a Culture (Cambridge prostate cancer journal purchase uroxatral once a day, Mass prostate cancer 2016 cheap uroxatral 10 mg visa. In intercourse with his fellows he promptly acquires the supposedly difcult art of depicting and expressing all his thoughts prostate cancer yahoo answers buy uroxatral online pills. We express ourselves on all subjects with as much order, precision, and rapidity as if we enjoyed the faculty of speech and hearing. The best account of the contemporary American Deaf community can be found in Padden and Humphries, Deaf in America. For anyone wishing to understand the world of deaf people, this small but rich and insightful book is a fne place to start. For a concise history of the formation of the deaf community in nineteenth-century United States, see John Vickrey Van Cleve and Barry Crouch, A Place of Teir Own: Creating the Deaf Community in America (Washington, D. Tese latter are not true languages but manual codes invented for educational use to represent English manually. Manualists in the nineteenth century at diferent times used both, and oralists opposed both. A Memoir of Deafness (New York, 1990), 259; Kisor was orally educated, never learned sign language, and has been very successful communicating orally all his life. Richard Winefeld, Never the Twain Shall Meet: Bell, Gallaudet, and the Communications Debate (Washington, D. Instruction in oral communication is still given in all educational programs for deaf and hearing-impaired children. But American Sign Language was commonly used in the nineteenth century, while today some form of signed English delivered simultaneously with speech is most common. The integration of deaf pupils into the public schools, with the use of interpreters, is now the norm. The arguments today are not for the most part between oralists and manualists but between the advocates of signed English and American Sign Language, and between mainstreaming and separate residential schooling. The emphasis on the heart rather than the intellect was of course a commonplace of Second great Awakening Evangelicalism. Reason and knowledge were not, however, seen as opposed to religion, and were also highly valued; see Jean V. Although he married a deaf woman, used sign language, and was an ardent supported of the establishment of Gallaudet College, he claimed to prefer the company of hearing people and expressed contempt for deaf people and sign language. While he did not speak or lip-read, he became one of the small minority of deaf adults who supported the oralist movement. See also, Alexander Graham Bell,Proceedings of the Twelfh Convention of American Instructors of the Deaf (New York, 1890), 181. Gordon,TeDiference Between the Two Systems of Teaching Deaf-Mute Children the English Language: Extracts from a Letter to a Parent Requesting Information Relative to the Prevailing Methods of Teaching Language to Deaf-Mutes in America (Washington, D. Alexander Graham Bell, Memoir Upon the Formation of a Deaf Variety of the Human Race (Washington, D. Bruce, Bell: Alexander Graham Bell and the Conquest of Solitude 48 Douglas Baynton (Ithaca, N. The equation of equality with sameness was a staple of Progressive reform thought; see Lissak, Pluralism and Progressives, 153. Fishman, Language Loyalty in the United States: The Maintenance and Perpetuation of Non-English Mother Tongues by American Ethnic and Religious Groups (The Hague, 1966). George Lakof, Women, Fire, and Dangerous Tings: What Categories Reveal about the Mind (Chicago, 1987), xiv. Schein, At Home Among Strang ers: Exploring the Deaf Community in the United States (Washington, D. In the frst fve years of Gallaudet College (1869 to 1874), a liberal arts college exclusively for deaf students, 75 percent of its graduates became teachers at schools for the deaf. Since the 1920s they had been accustomed to looking at images of men who marked physically the masculine exuberance and patriotic spirit embodied in icons of Americans commercial production. For Evans, such icons of American labor were fundamental to the health of the postwar economy, since they promoted the strength and vitality of the American workingman. The text that accompanied the Fortune photo-essay (which may have been written by Evans himself) observed: The American worker. His hat is sometimes a hat and sometimes he has moulded it into a sort of defant signature. It is this diversity, perhaps, which makes him, in the mass, the most resourceful and versatile body of labor in the world. If the war proved anything, it demonstrated that American labor can learn new operations with extraordinary rapidity and speed ily carry them to the highest pitch of productive efciency. Here are none of those worn, lusterless, desolated faces we have seen so frequently in recent photographs of the exhausted masses of Europe. Most of these men on these pages would seem to have a solid degree of self-possession. By the grace of providence and the eforts of millions including themselves, they are citizens of a victorious and powerful nation, and they appear to have preserved a sense of themselves as individuals. Many older cities in the Northeast and Midwest 49 50 David Serlin relied almost exclusively on steel, coal, iron, lumber, and oil as well as the nexus of related industries including railroads, automobile and appliance manufacturing, production of chemicals and plastics, and shipping and storage technologies. In this industrial milieu, the image of the blue-collar man still carried substantial power as a dignifed symbol for corporate strength. The image of the city as a hive of gleaming ofce towers housing white-collar corporate capital was still only a dream of urban planners, economic theorists, and real estate moguls that would not be realized in cities like Detroit until the 1970s. One could trace these icons of the masculine work ethic to images by Progressive Era photographers like Lewis Hine or, somewhat later, works by muralists and photographers who created public art for the Works Progress Administration during the 1930s. Film representations of ruggedly masculine American men like James Cagney and Clark Gable were enjoyed by Depression audiences who found admiring such handsome fgures a convenient escape from the economic deprivation of the era. During the work shortages of the Depression, conservative critics had sounded a note of fear over the perceived erosion of masculinity among American men. Teir worst fears were realized in the early 1940s when the mobilization of hundreds of thousands of women in the labor force, combined with the prolonged absence of men from traditional positions of family and community authority, began to give a new shape to civilian domestic culture. Many were displeased by new confgurations of family and marriage, not to mention the new sexual divisions of labor on the home front. One could argue that afer the attack on Pearl Harbor in December 1941, and the war that followed it, the bodies of American men were marked simultaneously by their solidity and their fragility, the dual norms of American heterosexual masculinity. One of the foremost concerns of the era was what efect trauma and disability would have on veteransself-worth, especially in a competitive economy defned by able-bodied men. How did normative models of masculinity afect disabled veterans who had to compete against the reputation and image of the able-bodied American workingman I read the stories of veterans and their prostheses as neglected components of the historical reconstruction of gender roles and heterosexual male archetypes in the Other Arms Race 51 early Cold War culture. Like artifcial body parts created for victims of war and industrial accidents afer the Civil War and World War I, prosthetics developed during the 1940s and 1950s were linked explicitly to the fragile politics of labor, employment, and self-worth for disabled veterans. The advent of new materials science and new bioengineering principles during the war and the application of these materials and principles to new prosthetic devices helped transform prosthetics into its own biomedi cal subdiscipline. By the mid-1950s the development of new materials and technologies for prostheses had become the consummate marriage of industrial engineering and domestic engineering. By the late 1940s and early 1950s, however, prosthetic devices were constructed from a variety of new materials such as acrylic, polyurethane, and stainless steel. Furthermore, by the late 1950s and early 1960s, new biomechanical principles and cybernetic control systems had begun to be applied to the operation of artifcial arms and legs. Because of these myriad changes, prosthetics themselves were entirely reimagined by the designers and engineers who made them as well as by the veteran and civilian amputees who wore them. As a result, the prosthesis is regularly abstracted as a postmodern tool or artifact, a symbol that reductively dematerializes the human body. They also fail to give agency to the people who use prosthetic technology every day without glamour or fanfare. Far from transforming them into supermen or cyborgs, prostheses provided veteran amputees with the material means through which individuals on both sides of the therapeutic divide imagined and negotiated what it meant to look and behave like a so-called normal, able-bodied workingman. For engineers and prosthetists, artifcial parts were biomedical tools that could be used to rehabilitate bodies and social identities. For doctors and patients, prosthetics were powerful anthropomorphic tools that refected contemporary fantasies about ability and employment, heterosexual masculinity, and American citizenship. Physicians, therapists, psychologists, and ordinary citizens alike ofen regarded veterans as men whose recent amputations were physical proof of emas culation or general incompetence, or else a kind of monstrous defamiliarization of the normal male body. Social policy advocates recommended that families and therapists apply positive psychological approaches to rehabilitating amputees. This seemed to be a more familiar strategy than empowering the disabled themselves.
He had gone there with Yossarian and Dunbar after the two had come unexpectedly to his tent in the clearing in the woods to ask him to join them mens health xtreme nitro buy uroxatral now. Intimidated as he was by Colonel Cathcart prostate infection treatment buy generic uroxatral 10 mg online, he nevertheless found it easier to brave his displeasure than to decline the thoughtful invitation of his two new friends prostate cancer janssen discount 10 mg uroxatral mastercard, whom he had met on one of his hospital visits just a few weeks before and who had worked so effectively to insulate him against the myriad social vicissitudes involved in his official duty to live on closest terms of familiarity with more than nine hundred unfamiliar officers and enlisted men who thought him an odd duck prostate quadrants purchase uroxatral 10 mg on line. With a pensive expression on his oblong androgen hormone 24 buy cheap uroxatral 10mg on-line, rather pale face androgen hormone tablets generic 10mg uroxatral with amex, he allowed his gaze to settle on several of the high bushels filled with red plum tomatoes that stood in rows against each of the walls prostate cancer 40 year old uroxatral 10mg overnight delivery. He hated the chaplain venomously for being a chaplain and making a coarse blunder out of an observation that in any other circumstances mens health february 2014 cost of uroxatral, he knew, would have been considered witty and urbane. He tried miserably to recall some means of extricating them both from their devastating embarrassment. He recalled instead that the chaplain was only a captain, and he straightened at once with a shocked and outraged gasp. His cheeks grew tight with fury at the thought that he had just been duped into humiliation by a man who was almost the same age as he was and still only a captain, and he swung upon the chaplain avengingly with a look of such murderous antagonism that the chaplain began to tremble. The colonel punished him sadistically with a long, glowering, malignant, hateful, silent stare. We were speaking about conducting religious services in the briefing room before each mission. The men are already doing enough bitching about the missions I send them on without our rubbing it in with any sermons about God or death or Paradise. General Peckem feels it makes a much nicer aerial photograph when the bombs explode close together. I just assumed you would want the enlisted men to be present, since they would be going along on the same mission. His spirits drooped suddenly a moment later, and he ran his hand nervously over his short, black, graying curls. The colonel stopped in his tracks again and eyed the chaplain sharply to make certain he was not being ridiculed. There was something funny about the chaplain, and the colonel soon detected what it was. The chaplain was standing stiffly at attention, for the colonel had forgotten to put him at ease. Let him stay that way, the colonel decided vindictively, just to show him who was boss and to safeguard himself against any loss of dignity that might devolve from his acknowledging the omission. Colonel Cathcart was drawn hypnotically toward the window with a massive, dull stare of moody introspection. He looked downward in mournful gloom at the skeet-shooting range he had ordered built for the officers on his headquarters staff, and he recalled the mortifying afternoon General Dreedle had tongue-lashed him ruthlessly in front of Colonel Korn and Major Danby and ordered him to throw open the range to all the enlisted men and officers on combat duty. The skeet-shooting range had been a real black eye for him, Colonel Cathcart was forced to conclude. Colonel Cathcart was helpless to assess exactly how much ground he had gained or lost with his goddam skeet-shooting range and wished that Colonel Korn were in his office right then to evaluate the entire episode for him still one more time and assuage his fears. Colonel Cathcart took the cigarette holder out of his mouth, stood it on end inside the pocket of his shirt, and began gnawing on the fingernails of both hands grievously. Everybody was against him, and he was sick to his soul that Colonel Korn was not with him in this moment of crisis to help him decide what to do about the prayer meetings. Once it was gone, he was glad to be rid of it, for he had been troubled from the start by the danger of instituting the plan without first checking it out with Colonel Korn. He had a much higher opinion of himself now that his idea was abandoned, for he had made a very wise decision, he felt, and, most important, he had made this wise decision without consulting Colonel Korn. The colonel kept him squirming a long time with a fixed, uninterested look devoid of all emotion. He had intended to take a much stronger stand with Colonel Cathcart on the matter of the sixty missions, to speak out with courage, logic and eloquence on a subject about which he had begun to feel very deeply. Instead he had failed miserably, had choked up once again in the face of opposition from a stronger personality. The chaplain was even more frightened of Colonel Korn than he was of Colonel Cathcart. The swarthy, middle-aged lieutenant colonel with the rimless, icy glasses and faceted, bald, domelike pate that he was always touching sensitively with the tips of his splayed fingers disliked the chaplain and was impolite to him frequently. He kept the chaplain in a constant state of terror with his curt, derisive tongue and his knowing, cynical eyes that the chaplain was never brave enough to meet for more than an accidental second. Colonel Korn was an untidy disdainful man with an oily skin and deep, hard lines running almost straight down from his nose between his crepuscular jowls and his square, clefted chin. His face was dour, and he glanced at the chaplain without recognition as the two drew close on the staircase and prepared to pass. Colonel Korn was proceeding up the stairs without slackening his pace, and the chaplain resisted the temptation to remind him again that he was not a Catholic but an Anabaptist, and that it was therefore neither necessary nor correct to address him as Father. Colonel Korn halted without warning when he was almost by and came whirling back down upon the chaplain with a glare of infuriated suspicion. The chaplain looked down his arm with surprise at the plum tomato Colonel Cathcart had invited him to take. He smiled without warmth, jabbing the crumpled folds of his shirt back down inside his trousers with his thumbs. It was almost lunchtime, and the earliest arrivals were drifting into the headquarters mess halls, the enlisted men and officers separating into different dining halls on facing sides of the archaic rotunda. The chaplain was the only officer attached to Group Headquarters who did not reside in the moldering red-stone Group Headquarters building itself or in any of the smaller satellite structures that rose about the grounds in disjuncted relationship. He was not able to gauge the effect of the mild pills he took occasionally to help him sleep and felt guilty about it for days afterward. The only one who lived with the chaplain in his clearing in the woods was Corporal Whitcomb, his assistant. He was openly rude and contemptuous to the chaplain once he discovered that the chaplain would let him get away with it. The borders of the two tents in the clearing stood no more than four or five feet apart. Another good reason was the fact that having the chaplain around Headquarters all the time made the other officers uncomfortable. It was one thing to maintain liaison with the Lord, and they were all in favor of that; it was something else, though, to have Him hanging around twenty-four hours a day. All in all, as Colonel Korn described it to Major Danby, the jittery and goggle-eyed group operations officer, the chaplain had it pretty soft; he had little more to do than listen to the troubles of others, bury the dead, visit the bedridden and conduct religious services. And there were not so many dead for him to bury any more, Colonel Korn pointed out, since opposition from German fighter planes had virtually ceased and since close to ninety per cent of what fatalities there still were, he estimated, perished behind the enemy lines or disappeared inside the clouds, where the chaplain had nothing to do with disposing of the remains. The religious services were certainly no great strain, either, since they were conducted only once a week at the Group Headquarters building and were attended by very few of the men. Both he and Corporal Whitcomb had been provided with every convenience so that neither might ever plead discomfort as a basis for seeking permission to return to the Headquarters building. Back home in Wisconsin the chaplain had been very fond of gardening, and his heart welled with a glorious impression of fertility and fruition each time he contemplated the low, prickly boughs of the stunted trees and the waist-high weeds and thickets by which he was almost walled in. The chaplain relished the privacy and isolation of his verdant surroundings and the reverie and meditation that living there fostered. Fewer people came to him with their troubles than formerly, and he allowed himself a measure of gratitude for that too. What displeased Corporal Whitcomb most about the chaplain, apart from the fact that the chaplain believed in God, was his lack of initiative and aggressiveness. Corporal Whitcomb regarded the low attendance at religious services as a sad reflection of his own status. His mind germinated feverishly with challenging new ideas for sparking the great spiritual revival of which he dreamed himself the architect box lunches, church socials, form letters to the families of men killed and injured in combat, censorship, Bingo. It was people like the chaplain, he concluded, who were responsible for giving religion such a bad name and making pariahs out of them both. Unlike the chaplain, Corporal Whitcomb detested the seclusion of the clearing in the woods. One of the first things he intended to do after he deposed the chaplain was move back into the Group Headquarters building, where he could be right in the thick of things. When the chaplain drove back into the clearing after leaving Colonel Korn, Corporal Whitcomb was outside in the muggy haze talking in conspiratorial tones to a strange chubby man in a maroon corduroy bathrobe and gray flannel pajamas. The chaplain could not believe that Corporal Whitcomb was offended again and had really walked out. He just wanted to discuss the possibility of saying prayers in the briefing room before each mission. He gazed down remorsefully and saw that the orderly forced upon him by Colonel Korn to keep his tent clean and attend to his belongings had neglected to shine his shoes again. He listened like an unwilling eavesdropper to the muffled, indistinguishable drone of the lowered voices outside. As he sat inertly at the rickety bridge table that served as a desk, his lips were closed, his eyes were blank, and his face, with its pale ochre hue and ancient, confined clusters of minute acne pits, had the color and texture of an uncracked almond shell. In some way he was unable to fathom, he was convinced he had done him some unforgivable wrong. He had intended for some weeks to have a heart-to-heart talk with Corporal Whitcomb in order to find out what was bothering him, but was already ashamed of what he might find out. For a few precarious seconds, the chaplain tingled with a weird, occult sensation of having experienced the identical situation before in some prior time or existence. He endeavored to trap and nourish the impression in order to predict, and perhaps even control, what incident would occur next, but the afatus melted away unproductively, as he had known beforehand it would. The subtle, recurring confusion between illusion and reality that was characteristic of paramnesia fascinated the chaplain, and he knew a number of things about it. He knew, for example, that it was called paramnesia, and he was interested as well in such corollary optical phenomena as *jamais vu*, never seen, and *presque vu*, almost seen. There were terrifying, sudden moments when objects, concepts and even people that the chaplain had lived with almost all his life inexplicably took on an unfamiliar and irregular aspect that he had never seen before and which made them totally strange: *jamais vu*. And there were other moments when he almost saw absolute truth in brilliant flashes of clarity that almost came to him: *presque vu*. It was not *jamais vu*, since the apparition was not of someone, or something, familiar appearing to him in an unfamiliar guise. He wanted desperately to confide in Yossarian, but each time he thought about the occurrence he decided not to think about it any further, although now that he did think about it he could not be sure that he ever really *had* thought about it. He came away from the center pole and shook his finger at the chaplain for emphasis. Every time he tries to report you to his superiors, somebody up at the hospital censors out the details. The only one who might complain in a case of forgery is the person whose name you forged, and I looked out for your interests by picking a dead man. He sat mutely in a ponderous, stultifying melancholy, waiting expectantly for Corporal Whitcomb to walk back in. He decided to pass up lunch for a Milky Way and a Baby Ruth from his foot locker and a few swallows of luke-warm water from his canteen. He felt himself surrounded by dense, overwhelming fogs of possibilities in which he could perceive no glimmer of light. He dreaded what Colonel Cathcart would think when the news that he was suspected of being Washington Irving was brought to him, then fell to fretting over what Colonel Cathcart was already thinking about him for even having broached the subject of sixty missions. As soon as the latch of the door had clicked shut, the whole humiliating recollection of the naked man in formation came cascading down upon him in a mortifying, choking flood of stinging details. There was a sinister and unlikely coincidence exposed that was too diabolical in implication to be anything less than the most hideous of omens. The name of the man who had stood naked in ranks that day to receive his Distinguished Flying Cross from General Dreedle had also been *Yossarian! He climbed to his feet with an air of intolerable woe and began moving about his office. The naked man in formation, he conceded cheerlessly, had been a real black eye for him. So had the tampering with the bomb line before the mission to Bologna and the seven-day delay in destroying the bridge at Ferrara, even though destroying the bridge at Ferrara finally, he remembered with glee, had been a real feather in his cap, although losing a plane there the second time around, he recalled in dejection, had been another black eye, even though he had won another real feather in his cap by getting a medal approved for the bombardier who had gotten him the real black eye in the first place by going around over the target twice. A moment ago there had been no Yossarians in his life; now they were multiplying like hobgoblins. Yossarian was not a common name; perhaps there were not really three Yossarians but only two Yossarians, or maybe even only one Yossarian *but that really *made no difference! Intuition warned him that he was drawing close to some immense and inscrutable cosmic climax, and his broad, meaty, towering frame tingled from head to toe at the thought that Yossarian, whoever he would eventually turn out to be, was destined to serve as his nemesis. Colonel Cathcart was not superstitious, but he did believe in omens, and he sat right back down behind his desk and made a cryptic notation on his memorandum pad to look into the whole suspicious business of the Yossarians right away. He wrote his reminder to himself in a heavy and decisive hand, amplifying it sharply with a series of coded punctuation marks and underlining the whole message twice, so that it read: Yossarian! The colonel sat back when he had finished and was extremely pleased with himself for the prompt action he had just taken to meet this sinister crisis. It was like *seditious* and *insidious* too, and like *socialist, suspicious, fascist* and *Communist*. It was not at all like such clean, crisp, honest, American names as Cathcart, Peckem and Dreedle. Almost unconsciously, he picked up a plum tomato from the top of one of the bushels and took a voracious bite. He made a wry face at once and threw the rest of the plum tomato into his waste-basket. The colonel did not like plum tomatoes, not even when they were his own, and these were not even his own. Colonel Cathcart often wondered if what they were doing with the plum tomatoes was legal, but Colonel Korn said it was, and he tried not to brood about it too often. He had no way of knowing whether or not the house in the hills was legal, either, since Colonel Korn had made all the arrangements. Colonel Cathcart did not know if he owned the house or rented it, from whom he had acquired it or how much, if anything, it was costing. Colonel Korn was the lawyer, and if Colonel Korn assured him that fraud, extortion, currency manipulation, embezzlement, income tax evasion and black-market speculations were legal, Colonel Cathcart was in no position to disagree with him. All Colonel Cathcart knew about his house in the hills was that he had such a house and hated it. He was never so bored as when spending there the two or three days every other week necessary to sustain the illusion that his damp and drafty stone farmhouse in the hills was a golden palace of carnal delights. No such private nights of ecstasy or hushed-up drinking and sex orgies ever occurred. They might have occurred if either General Dreedle or General Peckem had once evinced an interest in taking part in orgies with him, but neither ever did, and the colonel was certainly not going to waste his time and energy making love to beautiful women unless there was something in it for him. The colonel dreaded his dank lonely nights at his farmhouse and the dull, uneventful days. However, as Colonel Korn kept reminding him, there was not much glamour in having a farmhouse in the hills if he never used it. He carried a shotgun in his jeep and spent the monotonous hours there shooting it at birds and at the plum tomatoes that did grow there in untended rows and were too much trouble to harvest. Among those officers of inferior rank toward whom Colonel Cathcart still deemed it prudent to show respect, he included Major de Coverley, even though he did not want to and was not sure he even had to . Major de Coverley was as great a mystery to him as he was to Major Major and to everyone else who ever took notice of him. Colonel Cathcart had no idea whether to look up or look down in his attitude toward Major de Coverley. Major de Coverley was only a major, even though he was ages older than Colonel Cathcart; at the same time, so many other people treated Major de Coverley with such profound and fearful veneration that Colonel Cathcart had a hunch they might know something. Major de Coverley was an ominous, incomprehensible presence who kept him constantly on edge and of whom even Colonel Korn tended to be wary. Colonel Cathcart knew that Major de Coverley was away and he rejoiced in his absence until it occurred to him that Major de Coverley might be away somewhere conspiring against him, and then he wished that Major de Coverley were back in his squadron where he belonged so that he could be watched. He sat down behind his desk again and resolved to embark upon a mature and systematic evaluation of the entire military situation. With the businesslike air of a man who knows how to get things done, he found a large white pad, drew a straight line down the middle and crossed it near the top, dividing the page into two blank columns of equal width. He rose to his feet in terror, feeling sticky and fat, and rushed to the open window to gulp in fresh air. His gaze fell on the skeet-range, and he reeled away with a sharp cry of distress, his wild and feverish eyes scanning the walls of his office frantically as though they were swarming with Yossarians. The only colonel he trusted was Colonel Moodus, and even he had an in with his father-in-law. Colonel Cathcart liked Big Chief White Halfoat because Big Chief White Halfoat kept punching that lousy Colonel Moodus in the nose every time he got drunk and Colonel Moodus was around. He wished that Big Chief White Halfoat would begin punching Colonel Korn in his fat face, too. Someone at Twenty-seventh Air Force Headquarters had it in for him and sent back every report he wrote with a blistering rebuke, and Colonel Korn had bribed a clever mail clerk there named Wintergreen to try to find out who it was. Maybe sixty missions were too many for the men to fly, Colonel Cathcart reasoned, if Yossarian objected to flying them, but he then remembered that forcing his men to fly more missions than everyone else was the most tangible achievement he had going for him. As Colonel Korn often remarked, the war was crawling with group commanders who were merely doing their duty, and it required just some sort of dramatic gesture like making his group fly more combat missions than any other bomber group to spotlight his unique qualities of leadership. Certainly he would be much better off under somebody suave like General Peckem than he was under somebody boorish and insensitive like General Dreedle, because General Peckem had the discernment, the intelligence and the Ivy League background to appreciate and enjoy him at his full value, although General Peckem had never given the slightest indication that he appreciated or enjoyed him at all. Colonel Cathcart felt perceptive enough to realize that visible signals of recognition were never necessary between sophisticated, self-assured people like himself and General Peckem who could warm to each other from a distance with innate mutual understanding. Wintergreen, who also wanted to be a general and who always distorted, destroyed, rejected or misdirected any correspondence by, for or about Colonel Cathcart that might do him credit. For another, there already was a general, General Dreedle who knew that General Peckem was after his job but did not know how to stop him. General Dreedle, the wing commander, was a blunt, chunky, barrel-chested man in his early fifties. His nose was squat and red, and he had lumpy white, bunched-up eyelids circling his small gray eyes like haloes of bacon fat. He had a nurse and a son-in-law, and he was prone to long, ponderous silences when he had not been drinking too much.
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Venom-spitting, lizardlike monster having the head and wings of a rooster and the body of a snake and allegedly fatal breath and glance Big Foot. Mischievous, brownielike goblin or spirit, especially one haunting a particular place Bogeyman (boogyman). Evil being who kidnaps little children who leave home without permission Borrowers, The. Faceless gray-cloaked Azkaban prison guard able to sense any happy thought and suck the life from it or from his victims with a kiss in a Harry Potter novel by J. Brownie who guards hidden treasure; mindless old man, goblin, or house-elf, such as the who appears in a Harry Potter novel Dragon. Waterspout, usually in the form of a grotesque figure or fan tastic creature Ghost. Spirit of a dead person who appears to living people as a pale, shadowy form Ghoul. Evil spirit that robs graves and feeds on the flesh of the dead in Muslim folklore Gnome. 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Animals he captured from Geryon, the 3-headed monster considered the strongest creature on earth 11) Apples (or golden apples). Fruit of the Hesperides he stole from a tree guarded by the daughters of Hesperus 12) Cerberus. Central character of the Iliad, the greatest Greek warrior in the Trojan War, who was initially kept back by his mother because she knew he was fated to die in the war Adonis. Handsome young man with whom both Aphrodite and Persephone, the goddess of the underworld, fell in love Aeneas. Trojan who fled the burning city of Troy and became the founder of the Roman race Agamemnon. Mortal Lydian woman, proud of her weaving ability, who challenged Athena to a weaving contest and after winning was changed by Athena into a spider so that she could spend the rest of her life weaving Atlas.
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