Touch Your Research Articles

Technology Focus: Wellbore Tubulars (June 2017)

Technology Focus This month, I would like to bring out some thoughts on the advancements that have been made in the tubular area, an important and complex system that has a very, very small diameter/length aspect ratio and a high slenderness ratio, making it a thin wall. Sometimes, while flying at an altitude of 35,000 ft, I think of a drillstring and the fact that, if I could hold it from the plane, it would be touching the ground. Amazingly, we are trying to predict the health of this long string in a constrained wellbore with a few sensors at the bottom. It is like saying I will touch your toe with a few instruments and then predict the health of your whole body. The greatest challenge is being able to bring together all aspects of tubulars to advance in lockstep with one another. We have advanced tremendously not only in the modeling but also in materials and manufacturing technologies. Tubular manufacturing, recommended practices for material strength, and wear are important for drillstring integrity. We have seen in recent years many technological advancements in tubular-manufacturing technology. Tubulars also have become part of the data-transmission network and slowly will converge with the data-handling and data-transmission systems. Common thoughts for drilling engineers—when it comes to planning and drilling—often focus on torque and drag, which concern tubulars. Even though we have advanced in the prediction of torque, drag, and hookload estimation, challenges remain concerning drillstring integrity, such as prediction of tool failures, buckling, and string stability. Can we couple fewer casings? Various underlying arguments could be made to answer this question. In the world of exponential technologies, there are many opportunities where we are breaking the status quo to reduce nonproductive time by providing shorter connection times. One of the emerging technologies is brazing of the connection, leading the way to coupling fewer casing runs, which can be automated very well in the future with an autowelding tong on the rig floor instead of casing tongs as the casings are run into the hole. I have selected papers that present a balanced perspective on the advancement of tubulars technology. Also, I would like to encourage attendance at the tubular session in the upcoming SPE Annual Technical Conference and Exhibition in San Antonio. Recommended additional reading at OnePetro: www.onepetro.org. SPE 180437 Structural-Casing/Soil Interaction Effects on Wellhead Motion by Udaya B. Sathuvalli, Blade Energy, et al.

Reclaiming Proportionality (Society for Applied Philosophy Annual Lecture 2016)

Reclaiming Proportionality (Society for Applied Philosophy Annual Lecture 2016)

Moving to different streams of healing praxis: A reformed missionary approach of healing in the African context

There are different streams of healing praxis in Africa today, namely African traditional healing, biomedical healing and spiritual healing (which includes the more recent �touch your TV screen� healing method) among others. These streams offer contemporary African people diverse alternatives with regard to healing. As much as the hegemony of Western biomedicine, as endorsed by missionaries in the past, can no longer serve as a norm in the area of healing, we can also not use the African traditional healing methods and or any other alternative presented to Africa without discernment. This suggests therefore that Reformed mission ecclesiology and missionary practitioners should critically engage the African context, worldview and culture on the matter of healing. It should also engage other forms of spiritual healing methods on offer in the African soil.Intradisciplinary and/or interdisciplinary implications: The use of an indigenous knowledge system when coming to healing in the African context, alongside Western biomedicine and other forms of spiritual healing practices, provides African people with diverse alternatives. It also poses a missiological question regarding the acceptability of such a practice within the framework of the Reformed Missionary Paradigm.Keywords: healing; praxis; Reformed; Missionary; Africa

Design and Manufacture of an Energy-saving LED Lantern with Paper-cut Figure Projection Function

This work designed and manufactured an energy-saving LED lantern adorned with a revolving circle of paper characters, showing the shadow-show function. It used the high-cooling performance LED lamp to light. A small motor was also installed in the lantern to rotate paper characters. Under the light of LED, the rotating paper characters in the lantern would play a shadow show. Many shadows of well-known characters ran on the skin surface of the lantern, being like to tell a story and having lots of fun. For example, “The Magical Monkey King” is the classic Chinese adventure tale. It is one of the favorites in our growing collection of Asian children's books. One can think about that it will touch your mind and return you back to the childhood when such shadows of well-known characters run on the skin surface of the lantern. Besides, it used a special assembly of aluminum-alloy pin-fin heat sinks to be the cooling device of LED lamp within the lantern. The configuration of the cooling device was a vertical hollow square cylinder. Many circular pin fins extended inwardly from the internal surfaces of the vertical cylinder. The LEDs were installed onto the external surfaces of the vertical cylinder. Therefore, the chimney effect of the free convection heat transfer would be formed. A series of experimental tests demonstrated that such cooling design enhanced the total heat-transfer capacity remarkably.

The Author to the Dead, and: Luam & the Flies, and: Luam Mending Clothes, and: Luam to the Dead

The Author to the Dead, and: Luam & the Flies, and: Luam Mending Clothes, and: Luam to the Dead Aracelis Girmay (bio) Beloveds, beneath the surfaceof your last place, the tiny, oblivious fishes form wreaths above the sea grasses& their long reach— Some mornings, in my own city far away,I run to greet “you” come to me as sea, & carry myself out into your long, dark time like a child meetingits older cousins. I touch your teeth & give you the single word of my body. I am a woman again, at the side of Aboy Haile’s bed. Aboy who is 96.He is brushing my acacia hair. He is holding my arm. He says, moving his hand to mean “all around us,”that this is my home. He means Adi Sogdo, but he also means the world.Though I think, in “America,” that I am There &he is Here, that we are different, or far, really, we are each other. My bones areyour bones, he says. His teeth are my teeth [End Page 17] & my smiling is his smiling.He holds my arm tight, until it is a stone, a bone. He smoothes my hairwith force. I am a horse. The long, dark skin of the water,the talk, talking Aboy of the water, the brushing back, brushing back my acacia hair,washing my face. When we are done I cross the sea back into air& return to the traffic of the streets I know. I am marked by the dead, your sea-lettersof salt & weeping. Now I am ready to lay my self downon the earth, to listen to the instructions for how to talk of love & land, to singof home in the horrible years, & to fill my language, like the stars do,with the light, anyway, of a future tense. [End Page 18] luam & the flies umbertide, asmera, new york, october, 2013 It was the end of the world.The world was ending. I sat in my house with the flies. Thoughthe night was dense, was long, we tried to wait for light, to last.But the wind at the doors. & darkness knuckled, flashed its teeth.Outside, the other houses, outside, the solitaryfield, tall singularity of the mama tree. What wasstrong was razed, what was alone. I thought we would, plural, survive.But I saw the deaths of flies. I watched them clean their wings &faces, then die in the night, watching quietly out &,looking, facing it. Morning I saw them at the windowsas though remembering the green, last world. Their legs curled inthe syllable of struggle, [End Page 19] or sleep. I counted six aweswho died in the night, whose sounds died in degrees. Trying to learn,I picked them gently up by their wings & studied, then placedthe six onto one, white plate: six corpses or comas, sixI tried to see but took to the window & poured them outfor the dirt & rosemary. If I were moored to place, ifI had believed that this would always be my home, if Iwere to be lucky. One day their descendants would be mine,would handle my death, too, with their small legs, yellow mouths &wound-hungers. Powerless to brush them from my teeth & eyes,I’d be bright finally with their taking, a city ofeggs, a harvest, an “&”; the emerald signage of bodies.I would be a kind of port or harbor—Finally, themagain. [End Page 20] luam mending clothes umbertide, italy The life of my thread,as I pull it through the clothes I mend,is long. The life of the cypress rows& the roof of the housein a time of peacein a country that bledours dry for its peaceis also so long. But the life of my fliesat the windows, in the yard,covering the fruit,bringing messages, always,of the dead, their livesare not long. Every secondthey acquaint me & acquaint me withthe littleness of their deaths,the ticking we are, each, built with. It is true. For now, I live& must love everyone. Second I Borrow,Breath I...

Kiss, and: Time for an Unfamiliar Animal, and: At Noon, Sex Is Green, and: Room Full of a Host of Butterflies, and: Ladyhawk

Kiss, and: Time for an Unfamiliar Animal, and: At Noon, Sex Is Green, and: Room Full of a Host of Butterflies, and: Ladyhawk Five Poems by Gang Jeong Translated by Brother Anthony (bio) and Chung Eun-Gwi (bio) Kiss Closing the door, you kiss me. The door is narrow but the world inside the door is wide. Entering your door, I touch your heart, and the world my tongue touches bears pictures meandering like the traces of a snake. While I muse on the next shape of humanity, rain gradually mixes blue and yellow. The scene with trees opening hidden eyes is a moment when a fairy tale I read long ago becomes real. The future does not come by a shifting of time, it is a temporary conclusion by an extinction of time, so inside your door, I compose a prophecy of the end everyone experiences. From my tongue, you try to absorb the laws of music and poetry. By you, I try to establish a prototype of beautiful breasts and a type of psychological incest. Therefore, this kiss is a contact in high-level play and strict secrecy unrelated to drug addiction. Your door is opened by my kiss and is eternally closed by my kiss. I am your last man. But for you I am the first man. Inside your door, finality is connected to the experience of extreme near-death. On your projecting teeth foregrounding an aesthetics of bloodsucking, a poetic line, “the taste of a closing coffin-lid,” had been written then erased. As I slightly draw back my tongue, an unhappy family history is drawn on it. [End Page 303] Time for an Unfamiliar Animal Discerning things by smell is not only a skill of four-legged animals.Your erased smell oozes from the last breath of leaves fallen in various directions.I interpret this very familiar trace of fecesas yet another prospect regarding humans.The reason why human beings do not stop lovingis because of a stubborn nostalgia for an already atrophied sense. Maybe it’s because of a desire to erase people already erased from memorythat zoos and amusement parks are so crowded on holidays.Every day my body takes a restI never fail to have pain in my heart. If I listen to music while reading the silent nap of an animal whose end I do not know,the chronicles of extinct species spread in the air like museum art booksand parting is, therefore, the day I eat some meat.Biting into the flesh of things said to be inferior to human beings,striving to liberate my humanness,because someone’s heart, still alive in my body, playing the coquette artisticallywants to touch something outside my body. I look into the mirror after eating meat,covet the eyeballs of the mournful carnivore in the mirrorand masturbate as if turning off the last switch of earth’s destruction. [End Page 304] At that moment, inside my head is the gathering place of the theories of modern physicsthat I had grasped too poetically.As hours and seconds cross boundaries freely, the narrow bathroombecomes the battlefields of the far-off Tang and Sung dynastieswhere tens of thousands of dead men and horses attract flocks of crows. After I have brought up the last drop, perhaps I can go beyond human passion.There is someone pathetically looking at this stupid concentration,trying to deconstruct the curvature of high-tech construction.Putting on another expression in an attempt to quickly conceal my flurried mind,wrinkling my nose in a grin, my body suddenly becomes another animal’s flesh,the prim eyes of the cat in the bedroomthat unfailingly flees my touch on days when I give off a meaty smell.Now I realize,it’s because the more we spend time rubbing skins, the more you become me and I become the wind, invisible to any one, anywhere. [End Page 305] At Noon, Sex Is Green The woman who had been lying stretched out at full length slowly raised herself.Her shadow dropped lower and added to...

The experience of ‘home’ in dementia care

You awaken in the early hours of the morning with a feeling of disorientation and strangeness. Shifting in your covers, you realise that the room that surrounds you is not your bedroom at home, but rather a communal dormitory with other sleeping bodies in beds mere feet from you. You are confused and frightened; moving to step a foot out of bed, an ear-piercing alarm suddenly shrieks through your head. The bodies around you stir awake, and turn towards you with irritation, telling you to ‘stop it’, to ‘shut it off’. Another body opens the door of the room and bundles you back into bed. The alarm stops. After a while, confused, afraid, and inexplicably drowsy, you fall asleep again. Wandering the hallways of this building later that day, you struggle to remember how you got here. Who are these other people? No-one will answer your questions. You touch your ...

Design and Manufacture of an Energy-saving LED Lantern with Paper-cut Figure Projection Function

This work designed and manufactured an energy-saving LED lantern adorned with a revolving circle of paper characters, showing the shadow-show function. It used the high-cooling performance LED lamp to light. A small motor was also installed in the lantern to rotate paper characters. Under the light of LED, the rotating paper characters in the lantern would play a shadow show. Many shadows of well-known characters ran on the skin surface of the lantern, being like to tell a story and having lots of fun. For example, “The Magical Monkey King” is the classic Chinese adventure tale. It is one of the favorites in our growing collection of Asian children's books. One can think about that it will touch your mind and return you back to the childhood when such shadows of well-known characters run on the skin surface of the lantern. Besides, it used a special assembly of aluminum-alloy pin-fin heat sinks to be the cooling device of LED lamp within the lantern. The configuration of the cooling device was a vertical hollow square cylinder. Many circular pin fins extended inwardly from the internal surfaces of the vertical cylinder. The LEDs were installed onto the external surfaces of the vertical cylinder. Therefore, the chimney effect of the free convection heat transfer would be formed. A series of experimental tests demonstrated that such cooling design enhanced the total heat-transfer capacity remarkably.

Strap

Strap Theodore Worozbyt (bio) I touch your suit strap and burgundy flows through my hands. We swim in the dark, we walk closely nearly floating, I hang from the board and buoy you tangled into my thighs. Kisses mix with light, our tongues barely touching barely talking slightly opening the waves the taste of chlorine round our lips, the tennis court light shifting on the water moving along our backs between your belly and me and down. The lights rise and fall and it doesn't feel like water anymore and I lift you like a clock made of feathers into my chest. [End Page 51] Theodore Worozbyt Theodore Worozbyt's work has appeared or is forthcoming in Antioch Review, Best American Poetry, Crazyhorse, The Iowa Review, The Mississippi Review 30 Year Anthology, New England Review, Poesie, Poetry, Sentence, Shenandoah, The Southern Review, TriQuarterly Online and Quarterly West. He has published two books of poetry, The Dauber Wings (Dream Horse Press, 2006) and Letters of Transit, which won the 2007 Juniper Prize (The University of Massachusetts Press, 2008). Copyright © 2013 University of Wisconsin Board of Regents

Make Eye Contact, Sit Down, and Touch Your Patient

Make Eye Contact, Sit Down, and Touch Your Patient

P5.25 A new standard arm position for ulnar nerve conduction study. Proposing “Touch Your Mastoid” position

P5.25 A new standard arm position for ulnar nerve conduction study. Proposing “Touch Your Mastoid” position

Touching My Left Elbow: The Anatomical Structure of the Body Affects the Illusion of Self-Touch

A self-touch paradigm is used to create the illusion that one is touching one's own left elbow when one is actually touching the examiner's arm. Our new self-touch illusion is sensitive to the anatomical structure of the body: you can touch your left elbow with your right index finger but not with your left index finger. Illusion onset was faster and illusion ratings were higher when participants administered touch using the plausible right index finger compared with the implausible left index finger.

What You Can Endure

What You Can Endure Melinda Moustakis (bio) In my deep swimming dreams, my mother tells me I can't come home. Not for the things I have done, but for the things I haven't. There's a story she tells about my grandfather, Fox, leaving her at a hunting stand miles away from the homestead, alone, in the dark, when she was eight. No lantern or light in late September. "Colleen, you're the oldest," he says. "Find your way." She has a rifle. Behind every tree, another tree, another shadow, or a bear. The woods so thick. No stars to follow. "If anyone tells you to cut your hair," she says, "it means they destroy beautiful things." Her father cut her hair. For years. Hacked above the shoulders with the bluntness of practicality. His jagged cuts marked his return from Korea, from working on the slope in Prudhoe Bay. She never wore her hair short when she had a choice. She let it grow down her back, black and straight or in a braid. She makes me feel the top point of her skull where there is a dent the size of a poker chip. "You have it too. Your brother doesn't. I have this mark and you have this mark and we were once whales." When I dream about my mother, there are whales. She says she didn't love me when I was born, it took time. She needed to know I would live, survive, prove to her I was strong enough. I was four years old before she knew. She had fallen asleep on the couch after putting me down for a nap. I crawled out of the bed and found her only tube of red lipstick and painted my naked body, a toddling flame, and rolled across her white rabbit fur rug, over and over again, rolled across the walls, her bed sheets. "A little warrior," she says. "A goddamn mess of a comet." "God is more of a whale than a man," she says. Here, the blood washes up on the shore and melts the ice. My bare feet are tinged with red. The cold snow. The blood warm and pooling from the whale's belly. They have stripped the skin and a layer of fat with chain saws. A whale out of the ocean is a mountain, a horizon, a different bend of sky. "Did you wash your hair?" she says. "It's as slick as cod-liver oil." Which is the worst [End Page 108] thing. A spoonful she had to choke down either before or after a dinner of rabbit stew or moose chili. Once, she found a bottle of her father's cod-liver capsules hidden in a cabinet. Fox's secret stash for himself. "He didn't want to down a spoonful of the godawful-tasting stuff. But he made us kids do it." "I washed my hair," I say. "I don't believe you," she says. But she braids it anyway. Her braids are never straight or neat—they are frayed and wild and I don't dare undo them. We are crossing Chinitna Bay on a fishing boat. My cousins and I huddle in the cabin and wait for the coast guard to pass. We have too many people on the boat. Then there is shouting, "Come up, come up." A whale. We scramble to the deck. A humpback shoots out of the water, twisting in the air, white fins raised to the sky, and back down slamming into the water. My uncles are hollering and spilling their beer on the crowd of us. Another whale breaches, leaps up from under the boat, belly an arm's length from the rail. We all shrink back, me holding on to the hood of my mother's jacket. But she has a hand out, reaching and then brushing the white belly of the falling whale, the splash soaking her. My uncles net the floating bottles they threw overboard in their celebration. "Touch your eye," she tells me. "That's what it feels like." There is a story about how I was almost never to be. My mother...

In Rhythm: A Response to Jean-Luc Nancy

In Rhythm: A Response to Jean-Luc Nancy Geoffrey Bennington (bio) So: Being is always being-in-contact. Contact presupposes a prior separation, and neither precedes nor overcomes it. Contact is never established or given as presence, it is (only) the rhythm or vibration of its own touching and separating, its own touching (even poignant) separation. Separation has a certain priority in this story. Not: Being first, then relation. Nor: Subject first, then contact. The subject is “subject to the outside,” as you say, always already. Which means that the touch (without which the alterity of the other would not impinge at all) is already withdrawing in its very touch, vibrating away again and becoming, intrinsically, a trace of itself, a trace of touch. Once touch becomes trace in this way, and once touch is given a certain priority over the other senses (which are themselves differential vibrations of the rhythm or vibration you here choose to call “touch,”) then phenomenology, ontology, “metaphysics of presence” are themselves touched, moved, upset, shaken up. Touch, presented the way you present it as becoming-trace, is already a conceptual insurrection in philosophy, however accommodating you also seem to want to be toward Descartes, Kant, Fichte, Husserl or Heidegger. (Descartes’s “Je suis” may, as you say, not exactly “contravene” the necessity that being be intrinsically relational, but it is nonetheless all shaken up by that discovery—and the same with all the rest, except perhaps Heidegger.) This can go different ways, depending on the conceptual register chosen: towards a kind of erotology of touch, for example, centered on the human body, which seems to have its attractions for you. But it can also move away from that center, let’s say in two different directions. First, zooming in to a kind of hyper-micrology, it can rub up against something more cosmo-ontological, as it were, not so human, where rhythm and vibration would take us back towards the ruthmos of the ancient materialists, or (perhaps more promisingly) forward to the most modern so-called string theory, which suggests that differential vibration of one-dimensional “strings” subtends the atomic and the subatomic, all “particles” and “matter” resolving into a kind of pure rhythm without presence or substance. Moving this way, your logic of relation-as-rhythm-as-trace might put you in touch with theoretical physicists. Moving in another direction, this time more logico-semantic, we might find ourselves looking at a kind of differential-relational view of language and conceptuality that has been making its way since Saussure, as famously radicalized by Derrida, “difference-without-positive-terms” [End Page 18] becoming (one aspect at least of) différance. Linguistic or conceptual terms also—so it seems—obey the logic of touch and trace; they mean only in their erasure and withdrawal, their rhythm again, this time in a kind of sub-semantic writing rather than in sub-particle physics (but the ancient materialists loved using the analogy of the letters of the alphabet for their never-observed “atoms”). How to decide which way to go? Is going physics an option that is fundamentally different from going language? Your own version of touch (your own rhythm), however corporeal in its declarations, seems (as quite often in your work) moved in the first instance (at least in the ordo exponendi) by an encounter with language, a touch of words, here primarily the German terms that give you your title (the ordo inveniendi, on the other hand, seems to begin in the womb, maybe a different story altogether). I want to say that it must follow from the thought of différance (which I think I take in a more strictly Derridean sense than you tend to, as more than an explication of the Heideggerian ontico-ontological difference) that there is no essential difference between these two “ways,” that they are themselves differentiations of the same as non-identical.1 But this would mean that the apparent (touching, affectively powerful) priority of touch in your description is strategic (or perhaps playful) rather than foundational, and that your choice of, say, “rhythm” to help say what you are saying is marked by a kind of necessary...

Hug or Ugh?

When stepped into Fawn's examination room, she was bouncing on the edge of her chair, feet drumming against the scuffed tiles, more like an impatient schoolgirl than a woman in her late fifties. had been forewarned. had hurled insults at the EMTs when they first rolled her into the emergency department and informed the triage nurse of her well-known heroin and cocaine habit. Found nodding off outside the police station, she had woken up only after receiving Narcan, an opioid antagonist. Now, her sun-roughened face reflected an unsettling mosaic of emotions. extended my hand and introduced myself. Yes, doctor. popped upright, grabbed my hand, and without letting go--before could even say another word--asked me for a hug. hug? said. Yes, sir, she said, boldly locking my gaze with her bloodshot eyes. ranted on about living in shelters, and how, sure, she'd made mistakes in her life, but don't believe that EMT bullshit about her using heroin; maybe a little crack, but she's no addict, and she had nobody in the world to prove them wrong. Just a she begged. My emergency medicine training and over fifteen years of practice had primed my mind and body to respond swiftly to a wide variety of urgent situations. But now my muscles tensed with a new critical challenge. The weight of each second counted against me as took in her dirty nails, ill-fitting clothes, and dark jigsaw teeth; as inhaled her strange aroma of old sweat, recent cigarettes, and greasy food. registered the loneliness trembling in her face. opened my arms. We hugged. To be completely honest, she hugged me. pressed her head against my chest. My heavy white cotton coat felt flimsy and porous between us. OK, said, gently coaxing her away. But she wouldn't release me. Only with forceful encouragement did she return to her seat. What's going on? asked. Words exploded from her tiny mouth, a landmine of thoughts: bogus arrests, undeserved jail time, bad marriages, field hockey and soccer stardom back in high school, ungrateful children, hospitalizations for bipolar, no sleep for five days straight--no, six. disengaged from the scene as she spoke, watched myself listening to her. still felt the force of her body against mine. Later, informed the senior emergency medicine resident who had first evaluated Fawn about her request for a hug. The resident chuckled. She asked me for a hug, too. Oh, said, my pride leaking by the second. What did you do? scoffed, as if the answer was obvious. I told her there were professional boundaries. Sure, said. That was a nice way of wording it. kicked myself for not thinking of that myself. But Fawn made an explicit request. realize I'm not obligated to comply with patients' wishes if they aren't medically indicated. A hug, however, isn't unwarranted gallbladder surgery or needless antibiotics. A hug isn't medical treatment. But from inside that moment, refusing a hug seemed inconceivable, even dangerous. confessed to a few residents what I'd done, certain there was something admirable in the act. They squirmed as if I'd just eaten food off the hospital floor. Don't touch your wife when you get home, said one nurse listening in. Shower and boil your clothes very first thing, said someone else. These young doctors and seasoned nurses were superb clinicians, kind and sensitive individuals, yet my hug was greeted with disbelief, even horror. wear regular street clothes when working in the emergency department, not scrubs. This commingling of my personal and professional life might have intensified the implications of my possible transgression. …

When Species Meet

Get ready for some indigestion. When Species Meet might make you queasy about what is on your plate, or what it means to touch your dog, or what is in your head after “becoming-animal” with Deleuze and Guattari. It would not give you easy answers or universal principles for digesting the complexities of interactions between species, but this brilliant new work by Donna Haraway should convince you that indigestion can actually be “nourishing,” necessary, even crucial, when chewing on possibilities for “becoming with” other species (300–01). Haraway's new book brings her cyborg sensibility once again to constructions of “the human” and “the animal.” In particularly impressive ways (that might also frustrate some readers), Haraway refuses to consider inter-species interactions apart from their situated contexts, including histories of both human and non-human suffering. For example, Haraway explores northern gray wolves imported from North America to South Africa for the purpose of breeding hybrid attack dogs under apartheid and asks how we should respond to the homeless offspring of these animals now. Other case studies explore animal testing, pet cloning, genetic biodiversity projects, dogs used to reform prisoners, cameras mounted on marine species, avian flu trajectories, and feral cat protection. Haraway's project is to focus our attention on all these actual animals in order to “respond”—rather than just “react,” in Derrida's terms—to some of them.

Conventional wisdoms? Er, no

John Kenneth Galbraith, the Canadian economist, invented the phrase “the conventional wisdom” (CW), pseudofacts that everyone knew to be true, were hardly ever questioned but which, when challenged were often not evidence based. Medical textbooks are full of such CWs. Differentiating between sharp and blunt appreciation? Simple. The CW is to ask the patient “Is this sharp or blunt?” when administering a sharp or blunt stimulus. Er, no. Differentiation can be quite difficult. Have you tried it on your own feet? A more useful question is to ask, when alternating a sharp and blunt stimulus, “Is there any difference between these?” The CW when testing for cerebellar intention tremor in the arms is to use the finger to nose test. Er, no. Cerebellar intention tremors get worse as the target is approached and this may cause an affected patient to jab their face. Ask the patient to touch your variably positioned fingertip with their fingertip.

Here and now: Healthcare???s top 10 IT breakthroughs

How many “techno-trends” touch your daily practice? Get the news on the latest IT developments and see if your facility is on the cutting edge.

Push

Push Nancy Kern (bio) At first, don't tell a soul, keep it secret. Go somewhere and tell yourself, if you must tell anyone at all. Whisper it into your mirror. Scream it into your pillow. Just make sure that your sister isn't peeling potatoes in the kitchen, or that her husband isn't downstairs in the basement, playing cards with Mindaugas the plummer. When you take a bath, think of that poster of Ophelia you saw in your ESL class. Pretend there are leaves floating around you, let your hair skim the water's surface. Listen to the rhythm of the droplets from the spigot. Take one finger and run it along your body from top to bottom: skin, nails, teeth, hair. You feel it in your breasts the most. They are tingling and hot and heavy in the water. The rest of you feels unchanged, and yet, it is inside of you, the life. Sing lullabies in your native tongue, hope that no one hears. When you turn out the light at night think about how it feels in the dark. Surround yourself with pillows: the fluffy ones that you brought from home that have lots of give. Curl up under the blankets into a ball, knees to chest, and listen to the rumble of the buses on the avenue. Count the seconds. Count the months, forward and backward. Turn from one side to the other. Whatever you do, don't lie on your stomach, and don't lie on your back. In the morning, you will call your mother in Kaunas. It will be noon on her end and she will answer the phone with a huff, breathless from washing the floor on her hands and knees. She will be listening to the Pope's weekly radio address and thinking of you. Don't be afraid of her anger, it won't last, for you will be giving her an American grandchild. She will tell you, in an authoritative voice, to avoid loud music and nylon hose. And to stop eating fish. And to stop riding in your boyfriend's jeep. And to never, never hold your hands above your head or pick up a cat. Wait to cut your hair. On stormy days, you will need to pin a set [End Page 120] of keys at your waist, and if you ever crave something, you shouldn't touch your face before you get what you crave. Every morning don't forget to drink a teaspoon of vinegar and honey. And don't get too angry, or too sad. She will tell you all of this in English, and you will respond taip, taip like you always do. When you hang up the phone with her you will bend down to put on your sneakers and you will feel a surge of heat within you. You are queasy with knowledge and life. Before work, you walk to Walgreen's and buy a pair of rubber gloves and a mask. You plan to wear them that day, except when Patti, the woman you work for, walks through the room. Then you will quickly turn away and throw the gloves and mask into the soap-water in the bucket next to you. You always clean the house top to bottom, starting with the upstairs bathroom first. Today, when you carry your supplies up the stairs you go slowly, because when you move too fast the muscles inside your abdomen curl up and cramp. The floorboards in this house creak when you walk down the hall. Wood expands in the humidity, you know this from your father, who had been a builder before independence and before rheumatism turned his hands into useless claws. You think of him now as you walk along these noisy floors, carrying your vacuum, your pail and sponges in one hand and your mop in the other. You remember him how he was when you were a child, when he used to come home from work and kiss your mother the way lovers did in the movies. You and your sister would stand in the doorframe and pretend like you had hand-held movie cameras...

Local anaesthetic failure in joint hypermobility syndrome

When taking biopsies to assess skin strength in Ehlers–Danlos syndrome type III (EDS–III), a Danish group noticed that the patients experienced much pain despite conventional local anaesthesia.1 When asked, all these patients reported previous experience of partial or complete failure of local anaesthesia in dental or obstetric procedures—for which reason some had been dismissed as hysterics. Pursuing this finding, Arendt-Nielsen et al.2 compared the effects of local anaesthesia in 8 patients with EDS–III and 8 controls. Although the patients did gain analgesia from intradermal lidocaine the duration of effect was much shorter than in controls. EDS–III (now known as EDS–hypermobility type) is regarded by many authorities as identical to joint hypermobility syndrome (JHS).3,4 We wish to draw attention to the possibility of resistance to local anaesthesia in individuals with this common and under-diagnosed condition. Box 2 Five-part questionnaire for identifying hypermobility (Ref. 7) Answers in the affirmative to 2 or more questions suggest hypermobility with sensitivity 80–85% and specificity 80–90% Can you now (or could you ever) place your hands flat on the floor without bending your knees? Can you now (or could you ever) bend your thumb to touch your forearm? As a child did you amuse your friends by contorting your body into strange shapes OR could you do the splits? As a child or teenager did your shoulder or kneecap dislocate on more than one occasion? Do you consider yourself double-jointed? Box 3 Brighton criteria for joint hypermobility syndrome (JHS) (Ref. 8) JHS is diagnosed in the presence of two major criteria, or one major and two minor criteria, or four minor criteria. Two minor criteria will suffice where there is an unequivocally affected first-degree relative. Major Beighton score of 4 out of 9, or more (either currently or historically) Arthralgia for longer than 3 months in four or more joints Minor A Beighton score of 1, 2 or 3 out of 9 (0, 1, 2 or 3 if aged 50+) Arthralgia in 1–3 joints, or back pain or spondylosis, spondylolysis/spondylolisthesis Dislocation in more than one joint, or in one joint on more than one occasion Three or more soft tissue lesions (e.g. epicondylitis, tenosynovitis or bursitis) Marfanoid habitus (tall, slim, arm span >height, arachnodactyly) Skin striae, hyperextensibility, thin skin or abnormal scarring Eye signs: drooping eyelids, or myopia, or anti-mongoloid slant Varicose veins, or hernia, or uterine/rectal prolapse Many normal people have hypermobile joints and medical diagnosis of the medical syndrome requires symptoms—which can include chronic pain, impairment of proprioception, and temporomandibular joint dysfunction (a manifestation of which dentists may be unaware).5 JHS is overrepresented in general rheumatology clinic populations and in our experience (RG and AJH)6 many of these patients report failure of local anaesthetics. This matter was addressed briefly in a paper published in 2003.7 A questionnaire was completed by 172 female Caucasian JHS patients, 53 non-hypermobile age-matched controls, and 28 individuals who showed evidence of hypermobility with insufficient features to qualify for JHS (HM-sine-JHS) as defined by the Brighton criteria.8 We asked ‘If you have ever had a local anaesthetic injection (dentist/minor surgery/epidural), did you think that it was as effective as it should have been?’. 58% of JHS patients, 21% of controls and 14% of the HM-sine-JHS group answered in the negative. For JHS versus controls the odds ratio was a highly significant 2.85. Although the question was simplistic, non-exploratory, and reliant on recall and selfperception, the difference between JHS and controls was striking. Neither group had knowledge of any study hypothesis. At the time there was nothing of this nature documented in patient information sheets or published research. We suspect that in many people JHS goes unrecognized. So, how can a busy clinician, mindful of possible resistance to local anaesthesia, make the diagnosis? There are two easy methods for identifying hypermobility—carry out a Beighton score9 (Box 1); or ask the patient to answer a five-part screening questionnaire7 (Box 2). The phenotype is shown in Box 3. Box 1 The nine-point Beighton hypermobility score (Ref. 9) One point may be gained for each side for manoeuvres 1–4 so that the hypermobility score will have a maximum of nine points if all are positive. A score of ≥4/9 indicates widespread ... Although the pathophysiology of this phenomenon remains unresolved, an important clue that a patient is at risk of local anaesthetic failure might be in front of our eyes.