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Trauma: the seductive hypothesis.

Abstract

In much of contemporary culture, "trauma" signifies not so much terrible experience as a particular context for understanding and responding to a terrible experience. In therapy, in the media, and in international interventions, the traumatized are seen not simply as people who suffer and so are deserving of concern and aid; they are seen also as people who suffer for us, who are given special dispensation. They are treated with awe if they tell a certain kind of trauma story, and are ignored or vilified if they tell another. Trauma has become not simply a story of pain and its treatment, but a host of sub-stories involving the commodification of altruism, the justification of violence and revenge, the entry point into "true experience," and the place where voyeurism and witnessing intersect. Trauma is today the stuff not only of suffering but of fantasy. Historically, trauma theory and treatment have shown a tension, exemplified in the writings of Freud and Janet, between those who view trauma as formative and those who view it as exceptional. The latter view, that trauma confers exceptional status deserving of special privilege, has gained ground in recent years and has helped to shape the way charitable dollars are distributed, how the traumatized are presented in the media, how governments justify and carry out international responses to trauma, and how therapists attend to their traumatized patients. This response to trauma reflects an underlying, unarticulated belief system derived from narcissism; indeed, trauma has increasingly become the venue, in society and in treatment, where narcissism is permitted to prevail.

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BibTeXRIS

Steven Reisner. 2003. Trauma: the seductive hypothesis.. https://doi.org/10.1177/00030651030510021701

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Individual and collective doses from cosmic radiation in Ireland.

This paper assesses the individual and collective doses in Ireland due to cosmic radiation. Information on the exposure to cosmic radiation at ground level is reviewed and published data on the frequency of routes flown by Irish residents is used to calculate the dose due to air travel. Occupational exposure of aircrew is also evaluated. Experimental data on cosmic radiation exposure at ground level is in good agreement with international estimates and the average individual dose is calculated as 300 microSv annually. Published data on international air travel by Irish residents shows a 50% increase in the number of flights taken between 2001 and 2005. This increase is primarily on short-haul flights to Europe, but there have been significant percentage increases in all long-haul flights, with the exception of flights to Africa. The additional per capita dose due to air travel is estimated to be 45 muSv, of which 51% is accumulated on European routes and 34% on routes to the United States. Exposure of aircrew to cosmic radiation is now controlled by legislation and all airlines holding an Air Operator's Certificate issued by the Irish Aviation Authority are required to report annually the doses received by their employees in the previous year. There has been a 75% increase in the number of aircrew receiving doses >1 mSv since 2002. In 2004 and 2005 the average individual doses received by Irish aircrew were 1.8 and 2.0, mSv, respectively. The corresponding per caput dose for the entire population is <3 muSv. While this is low compared with the per caput doses from other sources of cosmic radiation, aircrew exposure represents a higher collective dose than any other identified group of exposed workers in Ireland.

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[Intraosseous puncture in preclinical emergency medicine. Ten years experience in air rescue service].

INTRODUCTION: The intraosseous puncture (IO) is a fast and safe alternative to the puncture of peripheral veins in emergency situations in children < or =6 years of age. The purpose of this paper is to summarize 10 years of experience on the prehospital use of the IO method by the Helicopter Emergency Medical Service (HEMS) "Christoph 22", Ulm. MATERIALS AND METHODS: This was a retrospective study from 1 January 1996 to 31 December 2005. RESULTS: Out of a total of 9,549 missions, the proportion of children was 11.1%. In 27 children (4.2% of the children < or =6 years of age) an IO puncture was performed. Patients of the IO group were younger (1.0 vs. 3.7 years of age; p<0.001) and showed a higher degree of injury severity (NACA 6 vs. 4; p<0.001) compared to the total children group. In all children of the IO group (100%), the intraosseous puncture was the method of first choice to obtain access to the vascular system by the HEMS team. In 96.4% of these cases (26/27), the first IO puncture attempt was successful - in one child, a second puncture attempt was necessary. A standardized puncture technique was performed using the proximal tibia. The time required for successful placement of the IO infusion line was 60 s or less in all cases. In 37% of the cases (10/27) the IO infusion line was used for induction of general anaesthesia; dosage and onset of administered drugs were described as being equivalent to a peripheral infusion line. In all cases, the IO needle was replaced in-hospital within 2 h by a central or peripheral iv line. No complications were observed. CONCLUSIONS: The IO infusion technique is a simple, fast and safe alternative method for emergency access to the vascular system in children < or =6 years of age in the prehospital setting.

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